Fear-Mongering and the Mentally Ill

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Jared Loughner deserves no sympathy. The same cannot be said about the 2.4 million adult schizophrenics in America or the roughly 55 million other adults with mental illness. In the wake of mass killings there is always the danger of a fear-fueled backlash against the innocent—remember the Sikhs attacked after 9/11? Amid generalizations and misstatements of fact, there is now a danger of such a backlash against the 25% of American adults with diagnosable mental illness.

My friend Joe Klein has a column in this week’s magazine in which he asks, “Given the flood tide of massacres perpetrated by crazy people, have we made a grievous error in our policies regarding the confinement of the mentally ill?” Joe says of schizophrenics, “not all of them are violent, but a significant minority of them are.” In fact, according to Jeffrey Swanson of Duke University, who studies violence in the mentally ill, just 7% of schizophrenics commit a violent act, including shoving or pushing, in any given year. By comparison, says Swanson, 10% of males aged 18-24 commit such acts annually. “The best estimate we have (albeit from the 1980s) of the proportion of violence in the United States accounted for by mental illnesses is 3%–5%,” wrote Paul Appelbaum, director of Columbia University’s division of Law, Ethics and Psychiatry.

Joe then suggests that violent schizophrenics are homeless. “Such people,” he says, used to be confined to institutions, but by the 1960s the streets of most of America’s major cities were “teeming” with homeless people, many of them severely mentally ill. “Teeming” is an unattractive choice of words: having reported on discrimination against the Roma (better known as gypsies) in Eastern Europe, it conjures up in my mind the rhetoric of infestation used against ethnic groups there. But in any case, why are we talking about the homeless at all? Loughner wasn’t homeless. Neither was the killer at Virginia Tech. Joe doesn’t cite a single example of a massacre committed by these “teeming” masses of crazy homeless people, let alone enough to support the idea that there is a “flood tide” of them.

It is probably worth noting at this point that no one actually knows if Loughner is schizophrenic. There are lots of reports of drug abuse, which can produce delusions indistinguishable from those generated by schizophrenia, but there is no public psychiatric diagnosis. True, a research psychiatrist named E. Fuller Torrey of the independently-funded Stanley Medical Research Institute performed a Frist-like tele-diagnosis and declared “chances are 99% that he has schizophrenia.” But Torrey is a controversial figure. In a review of Torrey’s book, “The Insanity Offense,” for example, Appelbaum criticized Torrey’s “dubious use of data” and said that in one case he turned a “guess based on inadequate data” into a “’clear’ finding.”

Even if Torrey guessed right–he may well have–and Loughner is schizophrenic, one needs to be careful about the conclusions one draws from the events in Arizona. According to Torrey, who is the most outspoken proponent of the ideas Joe is espousing, deinstitutionalization is responsible for much of the violence among the mentally ill because they can’t always stay on their meds on their own. For a small number of deeply troubled people, that is undoubtedly true, and it is a national shame that our society doesn’t do a better job of protecting itself and helping them. I actually agree that for a small number of very dangerous people who are mentally ill, some form of compelled outpatient treatment or institutionalization is the answer.

But the language one uses matters and fear-mongering can not only harm the innocent, it can be dangerously counterproductive. It could even have played a role in Arizona. If society is going to identify and help those at risk of dangerous, violent schizophrenia, the best place to focus resources and attention is at colleges, which are semi-monitored environments with existing funding streams and (usually) health and mental health infrastructures. It is also where those most likely to begin to show signs of schizophrenia, which declares in the late teens and early 20s, spend their days. But fear-mongering makes the job of getting college kids help harder. Look at Pima Community College, which suspended Loughner rather than engaging him directly with an active, dedicated counselor. Says one professor friend of mine, “stigmatizing the mentally ill and exaggerating the risk of harm only scares faculty away from a difficult but necessary part of the job.”