Loughner: Schizophrenia or Terrorist

a Glock 19—a lightweight, $500 semi-automatic commonly carried by law enforcement officials—to kill six people and injure 13 more, including Rep. Gabrielle Giffords. In 2007, Cho Seung-Hui used the same gun, a along with a Walther P22, to kill 32 people at Virginia Tech before committing suicide. And Giffords herself boasted to the New York Times in 2010: "I have a Glock 9 millimeter, and I'm a pretty good shot."

Readers beat me up for jumping to say that James Lee Loughner probably suffers from Schizophrenia, Paranoid Type, hears voices in his head, follows their directives.

I’m urged to read Slate,
Seena Fazel is an Oxford University psychiatrist who has led the most extensive scientific studies to date of the links between violence and two of the most serious psychiatric diagnoses—schizophrenia and bipolar disorder, either of which can lead to delusions, hallucinations, or some other loss of contact with reality. Rather than looking at individual cases, or even single studies, Fazel's team analyzed all the scientific findings they could find. As a result, they can say with confidence that psychiatric diagnoses tell us next to nothing about someone's propensity or motive for violence.
I'm reminded that most people with schizophrenia do not buy guns and do not shoot people. They try to get help.

As advanced as we are, that should be true.  But many of our homeless suffer from severe mental illnesses like schizophrenia and refuse help.  Suspicion of others, negative attribution, is the nature of the disease.  And the onset isn't usually until adulthood, so the premorbid space, when a person is beginning to get sick, is often overlooked as an adjustment disorder or depression, even individuation.

The problem is that the suffering of schizophrenia is incomprehensible to “most.” We're told to avoid people who talk to themselves, and that's probably not bad advice.  It is a very complicated illness, attacks cognition and emotion, feels primarily like anxiety. Behavior seems irrational to others, strange.  Thinking is different, careful, afraid, comes from a dark place.  This is a vulnerable population.

So the complaint is leveled.  How dare a therapist link violence and mental illness?  Such a gross injustice to millions who suffer mental disease.  Never my intention to claim statistical significance in any way.   These are idiosyncratic cases, off the charts, outside the norm.

And the real menace is that Glock 19.

This is not to say  that the individuals who perpetrated mass murders within the past three years in this country were not mentally ill. Two mass murders at large schools, Virginia Tech and Northern Illinois University, young assailants suffering from schizophrenia.  Access to guns.  Jared Lee Loughner seems familiar. Social profile detached, expelled from community college pending mental status exam, a lesson, no doubt, from past school attacks. The sheriff says, 20/20 hindsight, We knew about Jared.

But still, jump to a diagnosis of mental illness when so many other things predict violent crime, and mental illness is usually not one of them?

Diagnosis is what therapists do, sorry. We make initial, provisional diagnoses. We consider context, but at the end of the day, we see the individual and it's our job to assess what hurts. Schizophrenia is an Axis I disorder, which implies the illness isn’t a function of personality development, or behavior. The disease itself hurts.

Social context affects that pain, can even predict the course of an Axis I disorder.   But in the case of schizophrenia, environment doesn't make it so. It is in the genes. Of the contextual variables associated with schizophrenia, the one thing we know is that it gets worse, symptoms “flare up,” when there is anger in the room.We urge families to tone it down.

We also know that the onset of the illness for young men tends to be young-adulthood, when developmental stressors collide with coping skills. Crunch time: What do I do with the rest of my life? I can’t live here forever!  And my skills, my learning even, seems limited. 

More hearsay about the Loughner case:

(a) neither of the two parents socialize with neighbors,
(b) his mother buys two cases of beer, 30 in each case, with the family groceries,
(c) she is the only one in the family holding down a steady job,
(d) neighborhood kids think of father as an angry man who irrationally yells at them
(e) only son Jared is considered odd, has access to the Internet, obsesses about political conspiracies, seems dangerous and disconnected to others, seems to be in his own world, laughs when no one else is laughing. 

We might think Jared is from an alcoholic family, was neglected/abused, perhaps an unfair assumption. We might wonder how anger affected him. And sure, we might diagnose him on the many spectrums of mental and behavioral illness, including autism/asperger’s, and attach various personality disorders, Axis II’s, the personality disorders, considering his odd behavior.   Or bullied, alienated, like millions of others, he found comfort on the Internet and inspiration for assassinations. Unhappy childhood, solace in socio-politics, a decision to end a quiet life of desperation with a bang. Save the world.

Not necessarily schizophrenia. But do we ignore a diagnosis of schizophrenia because it isn’t politically correct? Isn’t it possible that in some cases it can happen that people do hear voices or receive Internet messages that tell them to kill a dozen or so people in a supermarket parking lot?

Group statistics are there to find central tendencies, describe groups of people, averages over thousands. The men who pull triggers on innocent people are hardly average. They are so few and far between that they do not dent central tendencies. We’re grateful for that. Group statistics de-stigmatize. Most people who suffer from mental disorders are not violent. Would that we could say that about the non-clinical population.

These particular cases of mass murder are unique. We wouldn't be very interested in them if they were not. This is why I’m so interested when it happens. It does seem, in these cases of mass murder, that the offenders suffered from Schizophrenia, Paranoid Type.

We're not doing enough to detect and protect the mentally ill.

More salient to the issue is that everyone has access to guns, not only people who have no rational control, whose minds aren’t functioning in our reality, who should be on some medication, in groups, therapy, rehabilitation. Killing is glamorized on television fifty times a day, and in the movies, as are theoretical concepts, ideas about assassination, terrorism, taking justice into one’s own hands.

I used to think

terrorist = suicidal bomber packing nails and bolts on a bus

But why wouldn't terrorists use automatic weapons? We don't label terrorists with mental illness, we call them social activists with an agenda. What is gleaned from Loughner’s indecipherable rambling on the Internet is that he is anti-government, a terrorist, essentially. He has an agenda.  Something out there made sense to him.

Or others found him, perhaps a group sponsored his gun, ala  Lee Harvey Oswald. That's surely what they're saying.

But I'm putting my money, sad to say, on his illness.



I tried to make a comment yesterday - but it was so long winded that Google posted an error. I'll try to be more to my point today. TherapyDoc you hit the nail on the head for me.

I'm a Tucsonan who is very much devastated and a responsible gun owner. I thought it might be interesting to detail what it takes to purchase a gun in Arizona and how it would be easy for someone who has severe undiagnosed (or even diagnosed for that matter) mental illness to obtain a gun.

The only legal barrier to purchasing a gun in Arizona is passing the National Instant Criminal Background Check System (NICS). You fill out the first page and a half of a two page booklet with the usual name, address, social security number type information. You are asked a series of question, for example "Are you a legal citizen?" "Have you been dishonorably discharged from the military" "Have you been convicted of any crimes?" "Have you been diagnosed with a mental illness which would not allow you to own a firearm."

The gun retailer then verifies your information by calling NICS - it takes all of 20 minutes for an answer to come back. The system readily checks residency status and criminal history. Mental illness diagnosis is a bit tougher.

In order for the mental health illness to send up a red flag it has to be 1)properly diagnosed, 2) Diagnosed in one of only 22 states that report this information (statistic as of 2007) and 3) Added to the FBI's "Denied Person's File"

Brings up the sensitive question that even if a person is diagnosed with a severe mental illness and even if the state reports this information – what is the tipping point to say “This person is sane enough to have a gun, but this person is not.” No matter where the criteria is set, there will always be that statistical outlier that no one accounted for…
Mound Builder said…
I find it difficult to be concise on this topic. Though I am not a mental health professional, I've been around some people who were diagnosed with paranoid schizophrenia. Loughner, what it's possible to know of him at this point, reminds me of them, particularly when I read that his behavior had changed a lot in the past year or two and then when I saw his age, 22. I've gathered that is a pretty typical age for schizophrenia to become apparent.

I've wondered if the inclination or lack thereof to violence by someone who has a diagnosis of paranoid schizophrenia can be affected in part by how those within one's family respond and react to it. Though I don't think schizophrenia itself is caused by a difficult home life, I wonder if expressions of anger could exacerbate someone who is becoming unstable; likewise, that watching certain kinds of TV or internet could make things worse.

It's hard to know what someone whose mind is disintegrating will latch onto and become an object of fear. A woman in my neighborhood that I believe probably had schizophrenia seemed to be obsessed with a white cat belonging to a neighbor. She seemed to be certain that the white cat was evil. Another person I knew who was schizophrenic seemed to be very suggestible to certain words, things like 'peanut butter' or 'swiss cheese', these two words not causing violent behavior but seeming to launch him into some sort of pleasant hallucination, judging by his smile and gaze. He also had a tendency when I knew him to drink, smoke pot, take other drugs. I think the intersection of a disintegrating mind, drug use, and access to guns, along with anger in the home or in one's environment via TV, etc. could be a particularly bad combination of things.

I'm curious, TD, why a terrorist wouldn't be considered to be mentally ill. Is it possible that some terrorists suffer from mental illness? Surely, with as many people who've apparently inclined themselves toward terrorist groups, some percentage of them would be mentally ill, just as a matter of statistical likelihood.
I think it important to look at the isolation of his family. With only the feedback of parents one with a possible drinking problem. With the internet as a means of communication. With the internet we seek out like minded thinkers to validate the way we believe.

My uncle was paranoid about the government and at one point thought they were controling the weather. He had a family and friends to keep him from getting to caught up in it. Without that he might have went a little over board. We avoid those with strange ideas or odd behavior and then wonder why they act out. If I had only myself for feedback who knows what might happen.
IMO, the idea of how to label this troubled young man is a moot point. As a society, we have to figure out how best to keep dangerous weapons out of the hands of people who could use them, deliberately OR in a delusional state, to hurt large numbers of innocent people. Whether that means instituting nationwide "sanity licensing" in order to purchase a handgun, or permanently taking the car keys away from Grandpa after he's run into the trash cans too many times, at some point our freedom and safety as a society has to trump the "rights" of "everyone" to pack a firearm or drive a car. What doesn't seem to work well is laws that are lax in one state, strict in another.

I hope people will realize, though, that mental illness is a real problem, and that those who have it and their loved ones need community help and support, long before something like this happens. People don't choose to be mentally ill, and they certainly don't choose to have parents or children who are.
Cheryl said…
I think you might be interested in this as well, which I just came across

Anonymous said…
I love you TD but i was little miffed by the comment that you can't give guns or other sharp objects to those with Schizophenia or that they all uncontrollable and violent due to the disease--that was definetly a wet noodle moment.
Syd said…
I don't know what was wrong or why but obviously something was very wrong with this young man. Only 22 and already so much hate. What happens to someone in 22 years to do something like this?
Pain SUX said…
Well this one was a little tough to for me....my sister is a schizophrenic who unfortunately when she was on her meds thought she was doing good (because she was on her meds and she was) so she'd stop taking her meds!! (HUGE MISTAKE!!) Well, she ended up taking a shop gun and standing a foot away from my paternal grandfather and shooting him in the heart!! She now lives the rest of her life in prison where they make sure she take her meds (I think) but most of my family doesn't talk to me anymore (misplaced anger, I think...as if I had something to do with my sick sister killing my grandpa???) It's sad for everyone's sake...not just mine!!

Wendy said…
Love the new background, can't read a thing on it. Have to print it out to see what it says...
Wendy said…
Everything you said in your post today made so much sense to me. I don't know much about mental illness except what I have experienced. I know I don't have enough energy to put a decent meal together let alone plan an execution. And if I managed to plan anything it would be either everyone or nothing, because the power of concentration is elusive! I have more of a feeling that he had an agenda, a target, and a plan. Part of the plan may have been to appear to be mentally ill for legal reasons. Or maybe the plan of appearing to be mentally ill became real with the execution of the horrendous act he committed... I agree that the key is the Glock 19. You don't buy one of those to go duck hunting with. It's only purpose is to kill, kill many as fast as possible.
Anonymous said…
As the parent of an adolescent with schizophrenia that was diagnosed in childhood and as a physician, i would like to comment that the study alluded to in Slate did not differentiate between idiopathic/genetic schizophrenics and those that are associate with drug induced disease. These patients may be more prone to violence.

Teachers and health care workers have an obligation to identify individuals with potentially serious mental illness and report as they would child abuse, severe infectious diseases, drug use or any other public health problem.

There are a lot of areas of waste in medicine but Mental Health needs to be elevated in funding and public awareness.
Beth said…
I've appreciated your take on this sad and tragic situation. Thanks.
Margo said…
your blog looks pretty today.
Ms. Adventuress said…
And thank you for the Mikvah info...what a sweet thing...I'm going to have to do it. :o)
Ivory said…
I was thumped by your comment, "We're not doing enough to detect and protect the mentally ill."

Also, no one is doing enough to prevent it. I work with people who are the damaged products of illegal drugs, liqueur, and (sadly) poverty. Too many of this people get on public assistance and produce children like rabbits - all of the with mental issues. It is horrendously sad and seems to be a cycle. I'm not saying that someone should prevent babies from surviving, or prevent anyone from procreating, I'm saying we need to find a way to address education and illegal use of drugs and the effects of STDs. I don't know what the answer is, but I think it's all being addressed after the fact - we are trying to fix the symptoms, not the disease.
Anonymous said…
I liked this post. Don't even get me started on the gun issue, but as a mental health professional, this kid shows many signs of paranoid schizophrenia. Reading his history it seems as though his close family and friends and the mental health system failed him. He should have received professional treatment. It takes a lot for someone, however mentally ill, to commit an act such as this, but when you throw cannabis useage into the mix, it becomes a whole new ballgame. I stress though, that schizophrenics are not prone to violence. I encourage anyone who is interested in this issue to look up the associations between psychosis and cannabis, also the 'prodromal' period of psychosis. You will learn a lot. Awareness is the key.
Anonymous said…
I completely agree that the Glock 19 is the real menace. I once saw a Glock 19 walking down a street, and it was harassing some poor woman just out walking her dog. The Glock 19 was clearly in the wrong, but you know how angry Glocks can get, especially Glock 19s.

In fact, I remember that time a Glock 19 was driving an SUV a few years ago and fell asleep at the wheel. That poor family never had a chance. If only someone had stopped that Glock 19, reached out to him, and told him that somebody loved him. Tragic, really.
therapydoc said…
You forgot the Glock Glock joke, Who's there? How could you forget that? Right. Guns don't kill people. People with guns kill people.
Mound Builder said…
The tired argument that 'guns don't kill people, people kill people' seems quite threadbare, worn, and unimaginative. There are any number of ways that we, as humans who try to live together, have laws that reflect a need for collective safety. There are laws about when we'll turn a car over to a child, laws that allow for teens to incrementally increase their access to using a car. We've got laws, too, about not driving while intoxicated. For that matter there are laws as to how old one has to be in order to purchase cigarettes or alcohol. One could say that cars, alcohol, and cigarettes don't kill people but there seems to be some collective recognition that it is in our collective interest to place some restrictions on those things. There are quite a few laws that have to do with the collective safety of the community of which we are a part.