Tuesday, March 05, 2013

Schizophrenia and Mass Killings: The Facts

Paul Steinberg, a psychiatrist in private practice, has in the New York Times given us a compelling picture of what’s wrong with our current treatment of potential mass murderers. According to Steinberg, we are the victims of
too little education about the public health impact of untreated mental illness.
too few psychiatrists to talk about and treat severe mental disorders — even though the medications now available can be remarkably effective.
too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking.
As a result, we neglect the rights of ordinary Americans to be free from being shot.

Steinberg makes these points:
  • The most common source of severe psychosis in young adults is schizophrenia, . . a physiological disorder caused by changes in the prefrontal cortex, an area of the brain that is essential for language, abstract thinking and appropriate social behavior[, a] brain area . . . weakened by stress. . . often . . . in adolescence. 
  • [schizophrenia] may result in auditory hallucinations, as well as disorganized thoughts. When the voices become commands, all bets are off. . . symptoms include . . . distorted thinking. . . a spaceship, or a comic book character — is controlling one’s thoughts and actions. 
  • People with schizophrenia are unaware of how strange their thinking is and do not seek out treatment. 
  • At Virginia Tech, where Seung-Hui Cho killed 32 people in a rampage shooting in 2007, professors knew something was terribly wrong, but he was not hospitalized for long enough to get well. 
  • The parents and community-college classmates of Jared L. Loughner, who killed 6 people and shot and injured 13 others (including a member of Congress) in 2011, did not know where to turn. 
  • what demons tormented Adam Lanza, who slaughtered 26 people at an elementary school in Newtown, Conn. on Dec. 14, are not known, though his acts strongly suggest undiagnosed schizophrenia. 
Steinberg specifically criticizes the so-called Goldwater Rule, an ethical standard of the American Psychiatric Association that prevents psychiatrists from commenting on someone’s mental state if they have not 1) examined the person and 2) received permission to discuss the case. As a result psychiatrists, the ones who know the most about severe mental illness, have been marginalized.

And he reminds us that medication and treatment work. The vast majority of people with schizophrenia, even untreated, are not violent, though they are more likely than others to commit violent crimes.

Steinberg believes we need
criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists to treat the disorder [over] less dangerous conditions.
For an idea of what Steinberg’s recommendations are up against, listen to Abby Rapoport, writing in the progressive American Prospect:
The stereotype that the mentally ill are very violent is simply incorrect. According to the National Institute for Mental Health, people with severe mental illness, like schizophrenia, are up to three times more likely to be violent, but “most people with [severe mental illness] are not violent and most violent acts are not committed by people with [severe mental illness.]” On the whole, those with mental illness are responsible for only 5%  of violent crimes.

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