Propose for a moment you are about to say something that you know people don’t want to hear and will argue with you angrily, saying that your motives are devious and self aggrandizing. They might quote books you’ve already read yourself or mount arguments you’ve heard endlessly before. Perhaps they’ll end up saying that your profession isn’t actually even a profession, but rather chicanery, that you’re on some kind of power trip. Would you say it?
A Rhode Island police sergeant reported Alexis to naval station police last month after the suspect told cops he was “hearing voices” through his hotel room wall and that three people were following him and sending vibrations into his body, according to a police report… According to the document, the officer said he was sent to a local hotel on Aug. 7 to check out a suspicious person report involving Alexis, who told him he was a naval contractor and traveled often. Alexis told the officer that while flying from Virginia to Rhode Island, he got into an argument with someone else at the airport who he believed had sent three people to follow him and keep him awake by talking to him and sending vibrations into his body, the report stated. Alexis also said he thought he heard these three people speaking to him through a wall of his hotel room and through the walls, floors and ceiling of a hotel on the Navy base. Alexis told the officer the trio was using “some sort of microwave machine” to keep him awake.
On Aug. 23, he went to a VA hospital in Providence. Five days later, he went to another one in Washington, seeking a refill of the medication he had been prescribed in Rhode Island, according to the officials, who spoke on the condition of anonymity because the investigation is ongoing. In both cases, doctors sent Alexis home with the medication, identified by law enforcement officials as Trazodone, a generic antidepressant that is widely prescribed for insomnia. The VA doctors told him to follow up with a primary-care doctor. It is unclear whether he did. “Mr. Alexis was alert and oriented, and was asked by VA doctors if he was struggling with anxiety or depression, or had thoughts about harming himself or others, which he denied,” the Department of Veterans Affairs said in a memo sent to Congress on Wednesday.
Are there people around who would’ve suspected what was coming? A better question is are there people around who would’ve seen what was coming as a possibility? The answer to the second question is "yes." The person reporting him at the hotel knew it. The policemen knew it. They called to tell the Naval Yard. The people in the Emergency Room knew enough to ask him if he was thinking about harming someone or himself. Someone who had spent some time in grade would have noted that Aaron was actively afraid of a Pseudocommunity coming after him using Tausk’s Influencing Machine, and that he was acting on those beliefs. He had lost his sense of agency and intentionality [welcome relief…]. They would have surmised that he was having ominous auditory hallucinations from his history. They might have experienced Rümke’s praecox feeling. These are all danger signs so they would have then been in a position of saying something he would likely not want to hear, "We need to put you in the hospital," and possibly gotten the reaction I started with in the first paragraph or something similar – not as a rhetorical discussion about psychiatry vis-à-vis science in general, but because the psychiatrist would quickly have been moved into the Pseudocommunity of a paranoid experience.
In the 1940s, he would have been sent to a State Hospital which he may have never left. In the 1970s, he might have been admitted and heavily medicated but released when no longer psychotic. Nowadays, it’s unclear what would’ve happened had his illness been properly diagnosed. Hopefully he would’ve been hospitalized, but many such patients end up in jail where they are treated. I once heard that America’s largest mental facility is the L.A. County Jail. Unfortunately, in our modern world, there’s not always a clear path for officers, doctors, psychiatrists, other mental health personnel, or ordinary citizens to know what to do. Even worse, the patients undergoing the terrifying experiences don’t know what to do or where to go either. Sometimes they do what Aaron did. Sometimes, they commit suicide. Sometimes they get treated. Many options.
When I arrived to psychiatry in the 1970s, this business of involuntary hospitalization was all new to me – a major unknown. And in training, the first year was spent mainly seeing psychotic people where that came up throughout most days. I didn’t like anything about it. As I’ve said and many critics have said, it didn’t feel like "doctoring." Those were the days when Dr. Szasz was in full form and antipsychiatry was a stated position for many. After a time, I realized that nobody wanted to do it – make an assessment of dangerousness which is an essential part of the decision. And the stakes were pretty high. I finally decided that whether I liked it or not, it was right for psychiatrists to at least make the initial assessments. I was spending every day among psychotic people, or reading about psychotic people. I had patients who had killed people, hurt themselves, been abused by one system or another, been overmedicated, been undermedicated, been misdiagnosed, wrongly hospitalized, wrongly released, etc. If only by experience, I ought to be able to make accurate assessments. And the best teachers weren’t the faculty, they were the staff who had worked in psychiatric facilities forever and had a sixth sense about what to do and when to act. I made my mistakes in all directions. That’s part of the job – it’s so subjective.
I feel sorry for not just Aaron Alexis’ victims. I feel sorry for him too. From his perspective, he was under attack on all fronts and he could find no safety. Unlike Eleanor Longden [voices…], he didn’t understand his torment as split off wounded parts of himself, but rather as an ever-present enemy. I hope that if I had met him along the way, I’d still have my assessment skills and a proper level of suspicion to pick up on his internal state. I hope I would still have the will to tell him what he might not want to hear, and follow the procedure to get him some place safe. I hope that he would’ve been someone who was not overmedicated but rather appropriately medicated and followed by someone who knows the ins and outs of this disease.