Bedlam and Virginia Tech


For four decades I've had a ring side seat overlooking the evolving treatment of mental illness, of my mom and several friends. For most of that time I've felt a kinship with the critics of psychiatry. It is the least successful of all the medical arts.

Yet I've also kept running into dedicated and empathetic doctors, nurses and social workers who clearly had the best interests of their patients and clients in mind. And there has been some modest improvement in the medications available along with a more honest assessment of their limitations.

Eight years ago I forced mom into a psychiatric hospital. After several relatively quiet years her hallucinations had taken over her life again, resulting in an insane diet and extremely high blood pressure. She was well on the way to having a stroke or heart attack. I gave up my libertarian views and petitioned a justice of the peace to become her substitute decision maker.

I don't know whether an involuntary commitment would have prevented Seung-Hui Cho from becoming a mass murderer. Nevertheless when I read Bedlam Revisited, Jonathan Kellerman's essay in today's Wall Street Journal, I found myself nodding in agreement several times:

Diagnosis from afar is the purview of talk-shows hosts and other charlatans, and I will not attempt to detail the psyche of the Virginia Tech slaughterer. But I will hazard that much of what has been reported about his pre-massacre behavior--prolonged periods of asocial mutism and withdrawal, irrational anger and hatred, bizarre writing and speech--is not at odds with the picture of a fulminating, serious mental disease. And his age falls squarely within the most common period when psychosis blossoms.

No one who knew him seems surprised by what he did. On the contrary, dorm chatter characterized him explicitly as a future school-shooter. One of his professors, the poet Nikki Giovanni, saw him as a disruptive bully and kicked him out of her class. Other teachers viewed him as disturbed and referred him for the ubiquitous "counseling"--an outcome that is ambiguous to the point of meaninglessness and akin to "treatment" for a patient with metastasized cancer.

But even that minimal care wasn't given. The shooter didn't want it and no one tried to force him to get it. While it's been reported that he was involuntarily committed to a "Behavioral Health Center" in December 2005, those reports also say he was released the very next morning. Even if the will to segregate an obvious menace had been in place, the legal mechanisms to provide even temporary "warehousing" were absent. The rest is terrible history.

That is not to say that anyone who pens violence-laden poetry or lets slip the occasional hostile remark should be protectively incarcerated. But when the level of threat rises to college freshmen and faculty prophesying accurately, perhaps we should err on the side of public safety rather than protect individual liberty at all costs.

If the Virginia Tech shooter had been locked up for careful observation in a humane mental hospital, the worst-case scenario would've been a minor league civil liberties goof: an unpleasant semester break for an odd and hostile young misanthrope who might've even have learned to be more polite. Yes, it's possible confinement would've been futile or even stoked his rage. But a third outcome is also possible: Simply getting a patient through a crisis point can prevent disaster, as happens with suicidal people restrained from self-destruction who lose their enthusiasm for repeat performances.

At the very least, in a better world, time spent on psychiatric watch could've been used to justify placing the Virginia killer on a no-buy gun list. I'm not naïve enough to believe that illegal firearms aren't within reach for anyone who really wants them, but just as loud dogs deter burglars and crime rates drop during harsh weather, sometimes making life difficult for a would-be criminal is enough.


Read the rest here.

Posted: Mon - April 23, 2007 at 12:37 PM          


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