One of the most interesting and sensitive blog commentary that I've read about the tragedy in Arizona has been from bloggers who have had their own struggles with mental health.
Like Dan, I'm not convinced that this incident tells us much about increasing violence in the United States. As Dan says, political violence in the United States is rare and even less a part of our culture than in the past.
Perhaps the real message behind the AZ tragedy is that we need to be better at identifying those with mental illnesses and helping them receive treatment, even as the growing isolation of Americans
Dooce writes,
If any good dialogue comes out of this mess, please let part of it be about mental illness and access to treatment.
Did Loughner have access to mental health care? Did he seek it? Did he even know to seek it? Did anyone who cared about him urge him to get help? If he had wanted help, would he have been able to afford it?
I don't know the answers to any of these questions, but for most people who suffer from a mental illness, the answer to each and every one of them is almost always NO. And the result is all too often a life of debilitating sadness, occasionally suicide, and in this rare instance a mass killing.
Penelope Trunk refers to a suicide letter written by a poor man who was driven mad by his abuse as a child. (The link to this letter has been traded by many of my twitter-types. The chattering class is a small and insular group.) Trunk, like Dooce, has struggled with mental health issues and has been urged to find help through random strangers on the Internet. Like Dooce, she also thinks that the mental health system needs reform.
The mental health system is broken. Few people have enough money to get good mental health care. And few dollars are spent to encourage people to use those expensive benefits. But we can help change that by spreading the word that going to therapy is a hard first-step, but it’s life-saving.
While I am admittedly a neurotic, I'm a happy neurotic. Mental health has never been a concern of mine, so I can't add any personal anecdotes on these matters. However, I've needed support while raising a child with special needs and frequently this support has come from virtual communities. That's why Malcolm Gladwell is dead wrong about the Internet only creating weak ties between individuals. At the same time, there are limits to what a virtual community can do. We need strong ties in the community, as well as real mechanisms to assist these disturbed individuals.
UPDATE: More reactions on Loughner's mental health problems. His poor parents.
Apt. 11d 
I don’t think Loughner would have gone voluntarily for treatment. If anything, he thought of his hallucinations as a special gift.
At the moment, it looks like he had no interactions with the mental health system. I’m currently wondering:
1. Who was Lougher threatening? How long had he been doing it?
2. What did his interactions with law enforcement look like? How long had the police known about Loughner’s threats?
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We have this same discussion every time a mentally ill person lives out his hallucinations/alienation/depression with the benefit of access to high power weapons.
Delusional mentally ill people are delusional. They are unlikely to accept help without being compelled. When they have involved and able family members, sometimes the family members work to compel them to accept treatment (and it’s not easy). Access to care might help in those circumstances.
But, in the other cases, we also start toying with the path that we must have somehow known that this particular delusional mentally ill person was going to be able to cause great chaos and destruction for the rest of us. But, our ability to limit the rights/compel treatment/incarcerate people because of what we fear they might do in the future is very limited (and it should be).
Is it a “threat” to say that you’re going to “reload” or “water the tree of liberty?” None of the interactions with Louhner I’ve heard of in the class room are identifiable threats (calling someone who has had an abortion a terrorist, accusing someone of ignoring math by not admitting that 2+2=7, . . . ). Maybe there are others, but odds are there wasn’t anything actionable.
On the other hand, I do think that stricter regulation of access to weapons would limit the damage that mentally ill people could do.
Suicide, on the other hand, I do think can be addressed by better access to care. One of the interesting things in the quora thread is descriptions of outreach to Asian Americans who are depressed or suicidal.
Homicidal mania, less likely that access to care is going to make the difference. Access to guns? well, I’d like to try that one, especially since it’s a lot cheaper than access to care.
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“Access to guns? well, I’d like to try that one, especially since it’s a lot cheaper than access to care.”
Counts differ, but there are supposed to be something like 200 million privately-owned firearms in the US, or according to Reuters, 90 firearms per 100 residents, although nobody knows for sure. Lots of luck regulating that.
http://www.reuters.com/article/idUSL2834893820070828
I think there is actually political will to do something about involuntary treatment of the severely mentally ill.
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On the last point, see also the article about Mac Tonnies in the NYT Magazine from Sunday. Internet communities are strong and well.
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Well as someone who has a certifiable & certified diagnosis that spooks people but who has never engaged in anything more violent than a few internet flame wars and the odd dish thrown against the wall…it’s a tough one.
I would not want to be forced to seek help. But I don’t have the experience of having been delusional and then have medication help. However I do know that in my particular mental health community over the Internet (which I agree is not that weak of a tie, or at least hasn’t been at critical points for me) more restrictive laws probably would just drive people deeper into hiding their issues and going to greater lengths to avoid situations where they might be evaluated.
I already know people who have suffered terribly physically because they were worried that a doctor might put something in their file, so they have failed to pass on critical information about their health or their ability to manage treatment.
It’s a tough one. I personally wonder if there were more resources and funding for mental health, particularly for young adults when a lot of these things show up, the mental health experts could themselves develop more expertise in how to get people to come in without having to coerce them. But I’m not sure such a system would ever pick up someone like Lougher.
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“I think there is actually political will to do something about involuntary treatment of the severely mentally ill. ”
Ah, but it’s probably unconstitutional, so it doesn’t matter that people are often willing to take the easy fix of limiting the liberty of a subgroup of people who they think won’t include them.
And, for the most severe of mental illnesses, especially the delusional kind, “treatment” is really a euphemism for restraint and incarceration. Treatment protocols are iffy and outcomes are not great.
I’m up for regulating behavior, but not intent or thought or illness. So we’d have to describe what behaviors we think are threatening enough that a person should be restrained. What’s the threshold from those who have the political will to involuntarily “treat” the mentally ill?
Americans love their guns, and the political will to regulate them has been weak. But it’s still worth trying (oops, I was going to say “giving it a shot”, but then thought again about it). And, sincerely, regulation does not have to mean outright bans. It’s true that I dislike guns intensely and don’t understand people’s liking/love/attachment to them, but I feel that way about jet skis, too, and am not working to ban those.
Laws regulating the kind of weapons that can be purchased, requiring training in the use of the weapon, and more through background checks might have been effective in both this and the Virgina tech incidents. They won’t prevent many incidents of gun violence (including suicides, which are correlated with the availability of guns). But they would be a helpful step. Let’s start with the ban on extended clips that languished in the house. If Loughner had had to reload with half the number of shots, maybe Christina Green would be alive.
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“Ah, but it’s probably unconstitutional, so it doesn’t matter that people are often willing to take the easy fix of limiting the liberty of a subgroup of people who they think won’t include them.”
Not me. For the record, I do not want to be a smelly, delusional bag lady who doesn’t know to come in out of the cold. Where do I sign to make that legal?
“I’m up for regulating behavior, but not intent or thought or illness.”
It’s the thoughts that make people dangerous–if you believe that “they” are trying to kill you or control your thoughts, it’s only half a step from that to being a danger to others.
(In my circle of family and friends, there’s a female relative who is a quiet, well-behaved schizophrenic who keeps odd hours, as well as a good friend of my husband who has demons talking to me (not sure if they still do under medication). He’s the sweetest guy, and is compliant with treatment. Lastly, there’s our friend who is bipolar and has been in a slow downward spiral, despite doing medication, therapy, etc. The first two do pretty well on their own, although it wouldn’t surprise me if the bipolar guy eventually wound up in an institution–he lately hasn’t been able to keep a job, and he has been getting into altercations. He doesn’t hallucinate, he just has no judgment at this point.)
“Let’s start with the ban on extended clips that languished in the house.”
It is possible to carry more than one loaded firearm.
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Sorry. “demons talking to HIM” not “me.”
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“It’s the thoughts that make people dangerous”
Could be, but we can’t incarcerate people for their thoughts.
“Not me. For the record, I do not want to be a smelly, delusional bag lady who doesn’t know to come in out of the cold. Where do I sign to make that legal? ”
On a durable power of attorney + some form of living will. You should do it, if you really want to be forcibly removed from the streets in such a case. It would make it is a lot easier for your relatives.
A ban on extended clips would not prevent a person from coming up with new ways kill successfully. But it would potentially decrease the availability of one tool that could be used towards that end (without, hopefully, limiting too many peoples’ ability to gain utility, and whatever joy and happiness that results from that same tool). Say, for example, the trade we make on limiting/regulating the purchase of spray paint and big markers. The threshold for regulation isn’t that it is a panacea that cures all ills, merely that it have a positive effect at the costs imposed. We can draw different lines about how much cost we’re willing to bear and how much positive effect there should be. But, we should be having that discussion, unless we truly do think that even the mentally ill should be allowed to buy whatever guns they want.
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I did a short comment earlier that didn’t appear.
“But, we should be having that discussion, unless we truly do think that even the mentally ill should be allowed to buy whatever guns they want.”
From what I gather from some discussions I’ve seen, it is already the law that if a person has been involuntarily hospitalized for mental illness, they are not eligible to buy a firearm. I’m not sure how well that system works, or whether it applies to private sale, but that’s the law already.
One of the lingering questions about the case is whether Loughner’s previous behavior should have automatically put him on the screening list.
MH, how do involuntary hospitalizations work? I’ve seen mentions of 48-hour and 72-hour involuntary hospitalizations.
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Involuntary commitment laws are different in every state and the procedures variable within a state. You have to be a danger to yourself or others regardless, but the path to getting noticed by someone making that call happens through very different channels depending on education, social class, lawyers on retainer, whether you’re already in voluntary treatment, if you’ve been committed before, and how scary you look to the kinds of people you come into contact with. Generally, the first time through really lowers the threshold for future visits.
On a durable power of attorney + some form of living will.
“Living Will” (as a name) was giving people teh creepies, so they now call it an Advance Directive in most states. There is a specific thing called a Psychiatric Advanced Directive. They are not iron clad and won’t do much unless you have somebody watching for you, but if you have somebody watching, it can be a help.
I should add that late onset (i.e. after 25 or so) of schizophrenia is usually much more mild than early onset.
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“I feel that way about jet skis, too, and am not working to ban those.”
Jet skis don’t kill people, morons on jet skis do.
This horror in AZ came right on the heels of a change in state law here (IA) which allows much greater latitude in the approval of concealed weapons permits. Permit numbers have skyrocketed. Don’t be surprised if the next terrible story happens here. When can we have a reasonable discussion in this country about gun control? Why does anyone, outside of law enforcement or the military, need an automatic weapon of any caliber? I know you’re not using a Glock to go deer hunting.
The NPR interview with the husband of the woman who brought Christina Green to the event was heartbreaking. The whole thing is but what happened to that little girl just tears me up inside.
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Lucy,
Are concealed carry permits that closely associated with mass shootings? I don’t think I’ve ever heard of the two being at all connected. On the other hand, accidents do happen.
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I think, actually, that you don’t need a permit at all to carry a concealed weapon in Arizona.
So have there been any mass homicides using a weapon other than a gun? The Virginia tech killer used the same kind of handgun as the Tucson killer. What did the woman in Alabama use?
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Lucy’s talking about Iowa. I believe AZ permits open carry.
“So have there been any mass homicides using a weapon other than a gun?”
The Jonestown massacre comes to mind, but that was a one-off (mainly poisoning). Explosives are more standard for the truly ambitious, but that’s notoriously subject to user-error. There’s also arson (night clubs are very dangerous due to crowded conditions and lack of exits), and I believe the Soviets were known to sink barges full of unwanted prisoners.
(Dear HSA: I’m totally harmless.)
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Nietzsche has finally turned up in this story, like a bad penny.
“He talked about reading Friedrich Nietzsche’s book “The Will To Power” and embraced ideas about the corrosive, destructive effects of nihilism — a belief in nothing.”
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“Nietzsche has finally turned up in this story, like a bad penny.”
Time to quote Wanda talking to Otto, then. Alternatively, time to mouth piously that Nietzsche doesn’t kill people, people kill people.
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More importantly, regarding concealed carry laws, the prevalence of guns among people in a public place means that the wrong person could easily be shot. Apparently, when Joe Zamudio came running up to the scene, ready to play hero with his concealed gun, he saw someone with a gun and almost shot him. He considers himself lucky he didn’t–because it wasn’t the gunman holding the gun. It was one of the men who had disarmed Loughner.
How can you tell in such a situation?
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How can you tell in such a situation?
If they smile like that guy in the mug shot, you’re safe to shoot.
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bj,
Motor vehicles also offer a lot of possibilities. There have been surprisingly few attempts at indiscriminate vehicular mayhem. The only one I can remember right now is that Chapel Hill student (Mohammed Reza Tahiri-Azar) who rented an SUV and then plowed through a crowd with it. He didn’t manage to kill anybody, but there were six hospitalizations.
Having gone through some options, it does seem that while there are many other choices open to mass murderers, firearms are less intellectually demanding, less subject to embarrassing premature detonation and more portable.
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“How can you tell in such a situation?
If they smile like that guy in the mug shot, you’re safe to shoot.”
I’m not sure if that’s funny as a joke, but I do know that there’s a fair amount of energy being invested in the autism/developmental disability/deaf/etc. community to prevent people from shooting because they think someone looks odd.
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“. . . firearms are less intellectually demanding, less subject to embarrassing premature detonation and more portable. ”
And we’ve started significantly regulating restricting people’s access to some of the other methods (i.e. explosives of various sorts, airplanes and airports, even some poisons).
Cars are still freely available, but, apparently, not as effective at killing people.
In the case of suicide, it’s pretty clear that restricting access to firearms, to high bridges, to simple means of suffocation (i.e. head in the oven) have a direct effect on the number of successful suicides. The psychological theory of suicide is different from paranoid delusions, since delusions are longer term. With suicide, apparently the impulse dissipates, and most people who try to kill themselves, even with lethal means, and fail, don’t try again.
But as with suicide, limiting access to means during paranoid delusions or other impulses towards destruction might give us a bit of extra time, and that time might make the difference.
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“And we’ve started significantly regulating restricting people’s access to some of the other methods (i.e. explosives of various sorts, airplanes and airports, even some poisons).”
Speaking of regulation of dangerous materials, the state of Texas regulates the possession of lab glassware by the general public. If you own it, you need to be registered with the state, and I believe the same goes for “filters” (!!!). It’s a drug war thing, I expect.
http://keyholefull.blogspot.com/2008/12/texas-outlawed-erlenmeyer-flask.html
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I’m not sure if that’s funny as a joke, but I do know that there’s a fair amount of energy being invested in the autism/developmental disability/deaf/etc. community to prevent people from shooting because they think someone looks odd.
Probably not the best joke. However, the efforts to prevent police from shooting when they shouldn’t tend to presume nobody has fired a shot yet. No matter what his diagnosis, if Loughner had a gun in his hand, the clear call would have been to take the shot.
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yes, I agree that having a gun in your hand should change the priors (or the evidence) contributing to the decision. Not sure home much more the countenance of the person should change change the weights, though.
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Speaking of non-firearm mass homicides, there’s also that woman who drowned her five children 8 or 9 years back.
In this particular case, I think that Loughner was confused and disorganized enough that he wouldn’t have been able to pull off the same number of casualties without a firearm, unless he did something simple and impossible to prevent like purposely causing a major freeway accident.
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