ignoring it just doesn’t work…

Posted on Monday 10 January 2011

Jared Loughner became disruptive last summer, and by October he was dismissed from college. He bought his gun at the end of November. On the Internet, he recently posted:
In conclusion, reading the second United States constitution, I can’t trust the current government because of the ratifications: the government is implying mind control and brainwash on the people by controlling grammar. No! I won’t pay debt with a currency that’s not backed by gold and silver! No! I won’t trust in god!
The Internet is covered with speculations about this young man, his politics, what makes him tick. There are diagnoses of Schizophrenia, Manic Depressive Illness, "Evil," and rejoinders not to diagnose him, not to jump to conclusions. However, the hints we have in his writings are too typical to ignore. Take this comment, " No! I won’t pay debt with a currency that’s not backed by gold and silver! No! I won’t trust in god!" While it’s tempting to think he’s speaking ideologically, it could be [and probably is] an example of the extremely literal and concrete thinking of a person in the disorganizing throes of a psychotic decompensation. What’s on the back of our currency? "IN GOD WE TRUST." Our currency is not backed by gold and silver. It says "IN GOD WE TRUST" on the back, and in his illness, he doesn’t trust anything. That kind of literal translation of "back/backed" and the motto "IN GOD WE TRUST" is typical in a psychotic thought disorder.

Were I to have read that last paragraph prior to my experience working in mental hospitals, I would be incredulous that anyone might make such an interpretation, so I’m aware how odd it sounds. I pass it on because it is indicative of the profoundly disabling interior disturbance experienced by someone with such an illness. Even the simplest of meanings gets lost in the chaos.

I can’t decipher "In conclusion, reading the second United States constitution, I can’t trust the current government because of the ratifications." The "second United States constitution" might be comparing the one before his illness and the way he reads it in his illness, but that’s a guess. And the word "ratifications" appears to be a neologism [new word], conflating "ratify" and "ramifications." Both meanings sort of fit ["ratify" the Constitution, "ramifications" as in consequences]. The remainder of the sentence, "the government is implying mind control and brainwash on the people by controlling grammar," is typical of psychotic thought. It is paranoid, and the word "implying" is again an amalgam of "implying" and "applying" with both meanings fitting. "mind control and "brainwash" refer to what are called "ideas of influence" – the feeling that one’s thinking is being controlled from the outside through some mechanism. In this case, he feels the "influence" is being implemented "by controlling grammar." Having lost the ability to understand abstract meanings, the psychotic person searches for meaning in the structure of language, often with bizarre results.

Then I read this:
The federal complaint outlines discoveries from the investigation since the shooting on Saturday. In a search of Mr. Loughner‘s home, authorities found a note in a safe with a handwritten note saying, "I planned ahead," "My assassination," and "Giffords," as well as what appears to be Mr. Loughner’s signature. Investigators also found a note, dated Aug. 30, 2007,  addressed to "Mr. Jared Loughney" from Ms. Giffords’ office thanking him for attending a "Congress in Your Corner" event in Tucson.
What is the significance to this very ill man of a routine thank you letter from Congresswoman Giffords? Why would one keep it in a "safe?" It must have had a very important meaning to him. Another guess  – I wonder if he didn’t interpret the mis-spelling of his name as an encrypted message – some attempt to influence his thoughts "by controlling grammar." The implications of that interpretation are, of course, tragic – that he shot her because he thought she was tormenting him.

Again, I recognize how arbitrary and speculative these readings of this man’s communications might seem. They don’t seem so odd when you’ve heard this kind of thinking repeatedly. It’s just a matter of knowing the rules. In a psychotic deterioration like this, words lose their usual meanings and become objects to be deciphered – often with bizarre results. My reason for writing this is to talk about the second tragedy in this story. The first is obviously the death of six innocent people and the grave circumstances of Congresswoman Giffords. But the second tragedy is the state of our mental health system. As early as this summer, this young man was shouting out ouvertly psychotic things in class. When his Professor asked a simple arithmetic question, he exploded, "’How can you deny math instead of accepting it?‘ Mr. Loughner asked, after blurting out a random number." The Professor and other students were frightened.
“I was getting concerned about the safety of the students and the school,” said Mr. McGahee, who took to glancing out of the corner of his eye when he was writing on the board for fear that Mr. Loughner might do something. “I was afraid he was going to pull out a weapon.”

A student in the class … wrote an e-mail to a friend expressing her concerns. “We do have one student in the class who was disruptive today, I’m not certain yet if he was on drugs [as one person surmised] or disturbed. He scares me a bit,” Ms. Sorenson wrote in an e-mail in June that was forwarded Sunday to The New York Times. “The teacher tried to throw him out and he refused to go, so I talked to the teacher afterward. Hopefully he will be out of class very soon, and not come back with an automatic weapon.”
In the literature, this is called "the praecox feeling" – the uncanny feeling of fear and "craziness" others feel in the presence of actively psychotic people ["praecox" comes for the earlier term for Schizophrenia – Dementia Praecox]. They intuitively knew he was dangerous [both dangerous to others and dangerously ill]. He’s been desparately ill for a long time – at least six months – and everyone around him knew it. He should’ve been hospitalized then, or multiple times in between, yet he was allowed to continue to fall to pieces until he did something horrible that brought him to attention with this senseless tragedy. Even if he had refused treatment and been released, he would’ve been "flagged" and would not have been allowed to buy a gun [the Brady Act].

In the past, this young man would have been hospitalized. In the pre-psychopharmacology era, he may have spent years in a mental hospital until he either recovered or died. Then the antipsychotics came along, and finally such patients could be treated. The expensive mental hospitals were shut down rapidly [too rapidly] and hospitalizations became brief [days rather than years][too brief]. We got so used to psychosis being treatable that we forgot what we had learned in the centuries before – that these patients are desperately ill and can be dangerous when in the throes of a psychotic deterioration. Nowadays, there’s virtually no place to hospitalize them, and the patient rights side of the equation makes it hard to hold them until they [we] are safe. The anti-psychotics do not cure Schizophrenia. They usually control psychotic thinking, but they are no fun to take [side effects] and are often discontinued. Often they can only be used intermittently.

In the 1970s, we passed through a period where the mental health system and the "state of the art" were somewhat in balance. There were hospitals for stabilization and Mental Health Centers to follow these patients [and many definitely need following]. Some patients didn’t respond and did need something like custodial [protective] care. But the coming of Nixon and then Reagan [I’m sorry, but it’s true] defunded all of that. So now, the biggest Mental Hospital in America is the LA County Jail. Most people with psychotic illnesses are able to live in the community. Many live normal-ish lives and do okay. Some live beneath bridges in the world of the homeless. But the system for those who can’t manage is almost non-existent. 

I completely agree with the call not to be too quick to "label" Jared Loughner with a diagnosis, but the evidence here is already overwhelming. And I also ardently hope that this episode leads to a tempering of the outrageous political rhetoric  we’ve had to live with in the recent past. It’s toxic to mentally ill people. It’s toxic to me. But it didn’t cause what happened. There’s another very important point in all of this. Our mental health system is in shambles. Lives were lost here. Six dead. A Congresswoman disabled for life if she even survives. And a very sick man who was possibly treatable is also lost forever – imprisonment, execution, or a life detained as not guilty by reason of insanity. If something good is to come from any of this, it’s a long hard look at our mental health system. We can’t cure this illness, but given the resources, we certainly know some things about how to treat it. Ignoring it just doesn’t work…
  1.  
    January 12, 2011 | 9:37 PM
     

    Wonderful, wonderful post. Bravo.

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