The Tucson Tragedy and Mental Health: Beware of Simplistic Responses


Too much of the initial response to the terrible tragedy in Tucson calls to mind the kind of reflexive response which health specialists refer to as a spinal reflex arc. The best example is when you touch a hot stove – your arm recoils in a jerky, sudden manner, before you ever consciously feel the pain. This is so because the brain is not involved in the response. The painful stimulus travels from your finger up the sensory nerve to the spinal cord, triggering a motor response back down the motor nerve that pulls the arm back.

No brain required for this response. But we have seen it, unfortunately, many times over the past few days.

The reason for this response style is the demand of the 24-hour news cycle for talking heads, even if the heads may not really know what they are talking about. This cycle is driven by our human need for a definitive answer, even when a definitive answer is hard to find. The best example I have ever seen of this irrational need is “forty two”, which, according to Douglas Adams, in his remarkably sage Hitchhiker's series, is “the answer to the ultimate question of life, the universe and everything.” The problem is – what's the question? And yet, the answer “forty two” sounds so certain that it satisfies us, if we don't spend too much time thinking about it.

Unlike many esteemed (and not so esteemed) mental health professionals, I believe that it is irresponsible and unethical to render a diagnosis on an individual whom I have never seen nor evaluated professionally. It is said that the alleged killer Jared Loughner has “schizophrenia,” and he may well suffer from that or some similar illness.

The little that I have seen of his writings and videos certainly seems bizarre and perhaps frankly delusional. Some of my friends and coworkers have apparently concluded that his psychosis (if he has one) renders the politics behind his actions irrelevant. To take this view to its logical conclusion, if only we had better/more accessible/cheaper mental health care, this tragedy would have been avoided.

Others have concluded that Loughner was a right-wing “wing-nut”, and they see his behavior stemming from any number of politically driven motives. In this explanation, if only our political discourse was more civil and respectful, the tragedy could have been avoided.

Still others view the ease of access to weapons in Arizona as the “lowest common denominator” here. While I personally find this to be among the most reasonable arguments, it is, like all of the other “obvious solutions,” incomplete. Even if Arizona had more restrictive gun laws, we all know that guns are readily available through extra-legal channels, and that had Loughner been suitably motivated, he would have been able to obtain the weapons he needed. However, proponents of this argument assert that with stricter gun laws, the tragedy could have been avoided. As H.L. Mencken once observed, There is always an easy solution to every human problem–neat, plausible, and wrong.”

I have heard and read about individuals who claim that “if only” any one of these solutions were in place, this tragedy never would have occurred. I believe that such “easy solutions” do more to make us feel better than they do to resolving the complexities of human behavior. In my own practice, I have worked with a number of individuals charged with committing crimes on school grounds.

For example, Florence was charged with trespassing on school grounds at the community college where she was taking classes. A 47-year-old returning student, Florence was observed by her classmates spraying an unknown substance on her desk and wiping it off. She also sprayed the floor around her seat. When approached by the instructor and asked to stop, Florence pulled out a small knife from her purse. The campus police were called, and they removed her from the campus. She was subsequently suspended for a semester, after an administrative review. When she later returned, she was charged with trespassing.

In court, Florence appeared odd and disorganized, and appeared to be unable to understand the court proceeding. She was found incompetent to stand trial and committed for treatment. She responded to medication, her thoughts became more organized, and she agreed to follow her outpatient treatment.

Is Florence the next Jared Loughner? She is likely to return to school, as she wants to obtain her degree. Her family is supportive of her continuing treatment, recognizing that she suffers from a mental illness. But will she follow her doctor's recommendations? How can any of us really know?

These sorts of incidents happen all the time, all over the country. For every Jared Loughner, there are literally thousands of others dealing with mental illness, with varying levels of compliance to their treatment plans, who never engage in such extreme violence.

What about politics? From the little I have seen, it appears to me that Jared Loughner built a set of beliefs around his extreme political views. I have had people tell me that if he has schizophrenia, his politics are irrelevant and meaningless. Frankly, I find this to be an extreme example of “all or nothing” thinking.

Any mental health professional has been involved with people who build delusions around aspects of reality in their world. We have all heard of the paranoid delusion that “the CIA is after me” as a motivator for engaging in defensive actions, such as covering windows with heavy material. Well, the CIA really is after some people – this is reality. Whether the CIA is actually after my patient is rather more doubtful, but it is certainly possible, isn't it?

In this case, it appears to me from where I sit that the most likely truth is that Jared Loughner built a complex delusional system around his political views. Does this mean that Sarah Palin or anyone else is personally to blame? Of course not. Does it mean that the nature of our political discourse plays a role in the extreme views that Loughner developed? Perhaps. (That said, anyone interested in extreme political discourse should review some of the political literature of the eighteenth century, both before and after the Revolution–some of which led to a fatal duel between Hamilton and Burr.)

Now, as to guns: it is clear to me that had Loughner not had access to the weaponry he obtained, he would have had a more difficult time perpetrating this tragedy, as he is alleged to have done. But it is simplistic to lay all of this on easy access to guns, without considering the role of the gun owner. The Crime Report has already discussed gun ownership and mental illness, and this will continue to be problematic in a country that so values its liberties. Personally, I believe guns should not be easy to obtain, and it strikes me as problematic that guns are so easy to obtain while mental health care is so hard to obtain, and getting harder.

I am aware that in the past few years, services have been cut around the country–and in Arizona–in the face of our budgetary struggles. I see this every day in my own work, and I have already written about this.

Do I believe mental health care should be more accessible? Yes. Do I believe that it should be easier to force treatment on the unwilling? Now, that's a more complex question that requires the balancing of personal liberty with public safety, isn't it? For those who would like to see this as a psychotically driven act divorced from politics, an argument I have seen primarily from those on the right, how do you answer this question while still arguing for less government intrusion into our lives? If one wants to view this simplistically as all schizophrenia, it logically follows that “we the people” must provide adequate funding for more and better services, something that runs counter to the “cut taxes and make government smaller” platform. Further, those who want to see this as psychotically driven and not as politically motivated should be satisfied with a finding of “not guilty by reason of insanity” (a very unlikely result), rather than of guilt.

This was a terrible tragedy. On that we all agree. While I have seen many reflexive responses, absent among them is a recognition of the following two truths:

First, predicting violence or aggression is very difficult. Psychiatrists and other mental health professionals in many jurisdictions are asked to do just this. While we may have some ability to forecast in the near term, our predictive power over time diminishes rapidly. A proper assessment is complex and time consuming. The best way to understand what we do is to think about our work as more akin to a weather forecast than it is to a true prediction. We are more accurate when considering the likelihood of an event occurring in the near future.

Second, violent events are prevented every single day, many times a day, by our public safety and, yes, our mental health professionals around the country. Each day, in our streets, in our schools and in our emergency rooms, people in crisis are assessed, helped to find safer places, and escorted to treatment settings, and tragedies are avoided. The problem is: how do we prove a negative?

So, for those still reading, here is my conclusion: There is no one single answer to this problem, which is complex and, like most, multi-determined. The genesis of Loughner's alleged actions will be found in politics, in mental illness, and in easy access to guns. All of these issues should be addressed in a logical, thoughtful manner–not by reflex, not without thinking.

What makes us human is our ability to consider passionate issues in a dispassionate manner. We need to respect each other, while still asserting our views and ideas. But at the end of the day, it is our higher level cognition and ability to think things through, and not our reflexive ability to avoid pain, that is likely to lead us to the best possible answer.

Erik Roskes is a forensic psychiatrist and currently the Director of Forensic Services at the Springfield Hospital Center in Maryland. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes' employers or consultees, including the Maryland Department of Health and Mental Hygiene.

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