Opinion: Shooting raises mental health issues

September 21, 2013


— In the liberal remake of “Casablanca,” the police captain comes upon the scene of the shooting and orders his men to “round up the usual weapons.”

It’s always the weapon and never the shooter. Twelve people are murdered in a rampage at the Washington Navy Yard, and before sundown Sen. Dianne Feinstein has called for yet another debate on gun violence. Major opprobrium is heaped on the AR-15, the semiautomatic used in the Newtown massacre.

Turns out no AR-15 was used at the Navy Yard. And the shotgun that was used was obtained legally in Virginia after the buyer, Aaron Alexis, had passed both a state and federal background check.

As was the case in the Tucson shooting — instantly politicized into a gun-control and (fabricated) tea-party-climate-of-violence issue — the origin of this crime lies not in any politically expedient externality but in the nature of the shooter.

On Aug. 7, that same Alexis had called police from a Newport, R.I., Marriott. He was hearing voices. Three people were following him, he told the cops. They were sending microwaves through walls, making his skin vibrate and preventing him from sleeping. He had already twice changed hotels to escape the men, the radiation, the voices.

Delusions, paranoid ideation, auditory (and somatic) hallucinations: the classic symptoms of schizophrenia.

So here is this panic-stricken soul, psychotic and in terrible distress. And what does modern policing do for him? The cops tell him to “stay away from the individuals that are following him.” Then they leave.

But the three “individuals” were imaginary, for God’s sake. This is how a civilized society deals with a man in such a state of terror?

Had this happened 35 years ago in Boston, Alexis would have been brought to me as the psychiatrist on duty at the ER of the Massachusetts General Hospital. Were he as agitated and distressed as in the police report, I probably would have administered an immediate dose of Haldol, the most powerful fast-acting antipsychotic of the time.

This would generally relieve the hallucinations and delusions, a blessing not only in itself, but also for the lucidity it brought on that would allow him to give us important diagnostic details — psychiatric history, family history, social history, medical history, etc. If I thought he could be sufficiently cared for by family or friends to receive regular oral medication, therapy and follow-up, I would have discharged him. Otherwise, I’d have admitted him. And if he refused, I’d have ordered a 14-day involuntary commitment.

Sounds cruel? On the contrary. For many people living on park benches, commitment means a warm bed, shelter and three hot meals a day. For Alexis, it would have meant the beginning of a treatment regimen designed to bring him back to himself before discharging him to a world heretofore madly radioactive.

That’s what a compassionate society does. It would no more abandon this man to fend for himself than it would a man suffering a stroke. And as a side effect, that compassion might even extend to potential victims of his psychosis — in the event, remote but real, that he might someday burst into some place of work and kill 12 innocent people.

Instead, what happened? The Newport police sent their report to the local naval station, where it promptly disappeared into the ether. Alexis subsequently twice visited VA hospital ERs, but without any florid symptoms of psychosis and complaining only of sleeplessness, the diagnosis was missed. (He was given a sleep medication.) He fell back through the cracks.

True, psychiatric care is underfunded and often scarce. But Alexis had full access to the VA system. The problem here was not fiscal but political and, yes, even moral.

I know the civil libertarian arguments. I know that involuntary commitment is outright paternalism. But paternalism is essential for children because they don’t have a fully developed rational will. Do you think Alexis was in command of his will that night in Newport?

We cannot, of course, be cavalier about commitment. We should have layers of review, albeit rapid. But it’s both cruel and reckless to turn loose people as lost and profoundly suffering as Alexis, even apart from any potential dangerousness.

More than half of those you see sleeping on grates have suffered mental illness. It’s a national scandal. It’s time we recalibrated the pendulum that today allows the mentally ill to die with their rights on — and, rarely but unforgivably, take a dozen innocents with them.

— Charles Krauthammer is a columnist for Washington Post Writers Group.


Richard Heckler 4 years, 5 months ago

What is the NRA? The National RightWing Association.

What is the NRA? A political action committee for the Right Wing Party that most likely is making more work for law enforcement. Too damn many politicians see nothing wrong with making military style assault weapons readily available to anyone who can afford to buy them.

A shot gun requires far less accuracy and offers up a spray like pattern depending on the number of lead balls in the shotgun shell.

ikuyasu 4 years, 5 months ago

I don't think he did. Average Americans watch TV for 4 hours a day. They don't have a time to read.

Paul R Getto 4 years, 5 months ago

We cleaned out the mental hospitals to "save" money in the 1980's. Now we are paying the price.

workinghard 4 years, 5 months ago

Finally, a journalist that sees the real problem. Also, state laws regarding the privacy of a person's mental history should not override federal laws. If a person's mental history cannot be accessed by the federal government for background checks and they have been involuntarily committed to a mental institution, how are we suppose to keep guns out of the hands of mentally unstable people?

Liberty275 4 years, 5 months ago

"I know the civil libertarian arguments. I know that involuntary commitment is outright paternalism."

Sorry Charlie. If you think a person is dangerous, you call the police and furnish them with details of your diagnosis. It is not a doctor's job to force any person to do anything or to deprive them of their freedom. Judges make those decisions.

voevoda 4 years, 5 months ago

Yes, we certainly do need better mental health care in this country. (As well as better and more affordable care for physical illnesses.) And we need to have legal and practical means to keep guns out of the hands of persons who are mentally unstable and potentially violent.

Krauthammer has no problem advocating depriving persons who show signs of mental imbalance of their freedom in order to protect them from themselves and forestall injury to others. So shouldn't he be even more willing to endorse restrictions on the sale and transfer of firearms to such persons? That is a much less significant intrusion upon their rights as citizens than committing them to a hospital. Yet Krauthammer did not even mention this as a possible approach to the problem. Why not?

kawrivercrow 4 years, 5 months ago

Regardless of any lost opportunity for psychiatric intervention, there was another glaring red flag that should have kept him from passing a background check for gun ownership; unlawful use of a firearm. He had a documented sentinel event where he fired a gun three times into the tires of a car after having a temper tantrum. That alone should have met exclusion criteria for gun ownership IMHO.

Armstrong 4 years, 5 months ago

Why is it that when an automatic or semi auto is involved it's the guns fault. This time a plain old everyday shotgun was used, but now this tragedy is the shooters fault ?

voevoda 4 years, 5 months ago

That's a red herring of an argument, Armstrong. Guns and unstable persons don't mix, ever, no matter what the weapon. Even a BB gun.

Armstrong 4 years, 5 months ago

I agree with you. I am questioning the medias coverage based on the type of weapon used, kind of a selective outrage.

Linda and Bill Houghton 4 years, 5 months ago

If there were more resrictions on the types of weapons that people could get (and don't need) then the mentally unstable could do a lot less damage with the available weapons.

Armstrong 4 years, 5 months ago

Yeah, it worked really well in this case. Again you can't govern crazy

workinghard 4 years, 5 months ago

You know what I don't understand? We will pay for a homeless shelter, 18 million for a library, 20 million for sports/rec center, and the list goes on and on, BUT we will not pay for a mental health ward at LMH. Very, very sad. But hey, we have art.

IndusRiver 4 years, 5 months ago

But we know that the law is good, if a man uses it lawfully;

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