The Virginia Tech story is worse than I thought. This was not an Acute Psychotic Episode. Cho was a chronically psychotic man who had telegraphed his profound illness everywhere he went. In the reports, it’s yet to be said that he was evaluated by a professional, though that’s hard to believe. The saddest report was Lucinda Roy’s interview on Good Morning America. She was the Department Chairman who tried to walk him to Student Health, and then actually called the Police. She said that they said their hands were tied because he hadn’t actually made any threats to hurt anyone. That’s absurd and doesn’t sound like the whole story. Assessment of dangerousness in the mentally ill rests on different criteria than simply what the person says. By all reports, Cho didn’t talk to people. How could one rely on what he said? Cho was sick enough to have been taken for a Psychiatric examination.
To wit:
"It was not bad poetry. It was intimidating," poet Nikki Giovanni, one of his professors, told CNN Wednesday.
"I know we’re talking about a youngster, but troubled youngsters get drunk and jump off buildings," she said. "There was something mean about this boy. It was the meanness – I’ve taught troubled youngsters and crazy people – it was the meanness that bothered me. It was a really mean streak."
Giovanni said her students were so unnerved by Cho’s behavior, including taking pictures of them with his cell phone, that some stopped coming to class and she had security check on her room. She eventually had him taken out of her class, saying she would quit if he wasn’t removed.
Lucinda Roy, a co-director of creative writing at Virginia Tech, said she tutored Cho after that.
"He was so distant and so lonely," she told ABC’s "Good Morning America" Wednesday. "It was almost like talking to a hole, as though he wasn’t there most of the time. He wore sunglasses and his hat very low so it was hard to see his face."
Roy also described using a code word with her assistant to call police if she ever felt threatened by Cho, but she said she never used it.
We used to teach about something called "the praecox feeling," named after Kraepelin’s original name for the illness – Dementia Praecox. It’s a powerful feeling one gets around actively Psychotic people. Dr. Roy obviously felt it. Cho’s classmates obviously felt it [not wanting to "set him off" when discussing his plays in class]. While all States are focused on keeping people out of Mental Hospitals, partially for financial reasons and partially for benevolent reasons, I am unaware of any State that would not have procedures in place for evaluation of someone such as Cho given the number of alarms that were being set off.
I was saying that no one was at fault earlier – meaning no one was at fault for Cho’s illness – but I was not right. There were warning signs going off throughout this young man’s life. If it turns out that he really was never evaluated by someone with mental health experience, Virginia and Virginia Tech have a lot of work to do on the procedures for Emergency Psychiatric evaluations. While this is not a time to blame anyone for this tragedy, it is a time to learn as much as possible about what’s wrong that this chronically psychotic person was allowed to roam free on the campus, buy guns, and ultimately kill 32 other people.
Lucinda Roy in the hero in this story. She knew this young man was quite ill and stood on her head to get him helped. The Cook Counselling Center at Virginia Tech has a procedure for such students who won’t visit them voluntarily, but it’s unclear if they ever sought out Cho. Dr. Roy even removed him from the classroom and the environment of other students. Young adulthood is a time when mental illnesses flower into being – eating disorders and Schizophrenia among them. There will be millions of dollars spent and man-hours expended counselling these students now, but the center of the problem remains what to do when a psychotic student is detected. It’s a question that needs to be answered in a definite way. Looking at the Virginia Mental Health web site, there’s a statement about this tragedy and the forces being mobilized to deal with it. But below that, there’s a cheery statment about new community based programs for recovery and transition. A power point presentation shows how effective their programs are in reducing inpatient bed utilization and length of hospitalization. Good for them. But not all psychotic people "recover." The great flaw in our mental health initiatives is in not leaving room for the people who don’t respond to treatment. Such people have no place.
Schizophrenia, madness, psychosis are part of the human condition – always have been. In history, people with madness were removed from society. – often mistreated. And it’s clear that simply removing such people from society doesn’t do much for the afflicted – they deteriorate when warehoused in Institutions. When effective treatments became available, these Institutions were closed. The tragedy was that the services needed to replace these huge State Hospitals have dwindled away. The elements of an effective system include Evaluation facilities, Treatment facilities, and Ongoing Care facilities. In this country, we are deficient in all three areas. In a modern world, we know what to do. What we don’t know how to do is maintain the appropriate systems in the face of inevitable budget cuts.
The legal issues are clear. In this country, one has the right to be free in society with two exceptions, breaking the law and dangerousness due to mental illness. In either case, citizens have the right to due process to protect their rights. Even before Cho’s crime, he appears to have given plenty of signs that he was dangerously ill. If he was evaluated and someone made a mistake, that’s sad but understandable. All of us who have been involved in these systems have made similar mistakes, in both directions. It’s an inexact science and the mistakes are inevitable and hard to live with. But if he was never evaluated at all, that’s a system failure of mammoth proportions. It’s okay to be wrong. It’s not okay not to even have a look…
In 2005, two female students complained separately to the campus police department about contacts Cho was having with them in person and on the telephone, Flinchum said.
"No threat was made," Flinchum said, adding that neither student pressed charges, and one labeled the contact "annoying."
In the first case — in November 2005 — officers referred Cho to the university discipline system. The next month, at the request of the second female student, officers met with Cho to ask him not to contact her again.
Hours later, a friend of Cho’s called campus police to say he seemed suicidal, Flinchum said. Police then contacted Cho again and persuaded him to undergo an outside psychiatric evaluation. Officials said they did not send Cho to the campus counseling center because staff there do not have the authority to involuntarily hospitalize patients.
Cho was admitted to Carilion St. Albans Psychiatric Hospital in nearby Radford, Va., on Dec. 13, 2005. Officials said they believe Cho entered the hospital voluntarily. They would not say how much time he spent there, citing privacy rules.
I feel like saying, "Let them win." It’s too expensive to even fight on this battlefield. We’ll raise money to send women who are pregnant and desire to terminate their pregnancies to another, more sensible country. But I know it wouldn’t matter. They’d just brand such women as criminals. So we have to live with a group that has only one issue or two, [if you throw in Gay Marriage].
