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.

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