Tucson Terror & The Usual Suspects

The recent horrible violence in Tucson, Arizona is an abomination. It is not excuseable. Yet the mainstream media, talking heads, politicians and all of the usual suspects blame their usual suspects: Glock, Colt, Sig, Smith and Wesson, the NRA and Sarah Palin. And as always they are strident and they are wrong. The old adage holds true; guns don't kill people, people kill people. And the kind of people who commit these atrocities all have a similar history.

So you ask, who are usual suspects? The ACLU, the anti-gun lobbies, elements of the liberal left, the overt and covert anti-psychiatry idiots in our country and large numbers of ill-informed people.

Before I proceed further I will simply state some real parametric data about gun ownership and violence. Everywhere guns have been banned and confiscated horrible violence has and does occur. Be it Nazi Germany, Stalinist Russia, Cambodia, the United Kingdom, Australia, Central America or Chicago, Illinois. The lowest incidence of violent crime occurs in places where private gun ownership is required or permitted: Switzerland, Israel, Florida, New Hampshire and the like. While violence with firearms is loudly trumpeted by the press and their cohorts violence prevented by firearms is rarely mentioned. Certainly there are those rare reports in the press of homeowners and business owners protecting themselves from criminal home invaders and robbers with firearms but these are few and far between the actual number of events that occur. Furthermore there is no data available from the thousands of times per day criminals choose not to commit an assault or a robbery or other vicious crime because they are concerned that they might end up on the wrong side of the gun. Most citizens don't bother to call the police after they have pulled back their jacket or reached into their purse and displayed their legally concealed weapon and a thug or gang banger has hotfooted it in retreat. It's worked for me several times. I only had to call the police once when our car was rammed and forced to the roadside by two drunken construction workers with road rage and crowbars. But enough about this reality. Let's explore the problem.

The social engineering that occurred in this country after World War II and again during the civil rights movement and great Society of the late 60s and throughout the 70s implemented some grandly idealistic and hopeful programs. Unfortunately some did not work yet remain in place. The social welfare model that abolished orphanages and reformatory's in place of foster care, the alphabet soup of children and family services in each state, welfare in general and specifically increased income per child per month for single mothers with no man in the household became the standard. Heterogeneous groupings in schools replaced levels and tracks as did social promotion and the elimination of failure because of the purported impact on the self-esteem of students. State psychiatric hospitals, asylums and sanitariums (many dreadful, some good) were replaced by the community mental health system, patients rights, least restrictive environments, right to refuse treatment, right to refuse medication, right to live on the street indigent and defecate on the sidewalk. Long-term commitment of the “insane”, addicted, or feebleminded was replaced by ultra-short-term emergency commitments in situations of demonstrated imminent risk or very narrowly defined grave disability. Privacy and confidentiality restrictions constrain the ability of psychiatrists, hospitals, schools and therapists to notify authorities of potentially serious individuals and circumstances. While mandatory good-faith reporting of certain abuses and imminent risks are required and appropriate the prognostications of experienced psychiatrists, school counselors and others are in the first case difficult if not impossible to disclose and in the second case lead to no useful interventions.

The federal government as well as many organizations and societies, the preponderance with a liberal bent have declared and acknowledged that the social welfare model, the heterogeneous grouping, the community mental health system and its residua are all failures! But of course as with most government programs they move along with the inexorable inertia and exponentially increased cost and waste. The entrenched unions, bureaucracies, foundations, school boards and naïve altruistic citizens continue to believe that suddenly a new, different and salutary result will suddenly emerge from these profoundly dysfunctional processes. Having served on the boards of directors of several children's services entities I have witnessed the word orphanage grow from a muttered whisper to a strident cry. But, historically and prospectively it is understood that the only viable and effective orphanages cannot be run by the government and have been and would need to be run by religious organizations (Catholic, Jewish, Lutheran…) and even when the discussion evolves to such entities being nonsectarian in administration and philosophy pretzel logic deems this a violation of the separation of church and state doctrine and the conversation sputters to a halt.

I have done many emergency “safety evaluations” for schools after a student has said or done or drawn a picture that has worried someone. The vast preponderance of these students simply were annoyed or angry at a teacher or a bully and presented no risk whatsoever. Some were abused and this was reported. Some were clinically depressed, had undiagnosed medical conditions, undiagnosed ADHD and various other medical matters and treatment recommended but not necessarily implemented by parents. Some families would move or homeschool their children rather than have proper medical and psychiatric care provided. From time to time a truly pathological and dangerous child or adolescent would be seen–and in some cases in my practice a truly pathological and dangerous adult has been seen–but not imminently so. There has been insufficient information to perform a mandated report of a prior act and insufficient information to generate a commitment or trigger a mandated warning of imminent risk. Recommendations for intensive further evaluation and treatment intervention, usually encompassing the family were made. In every case wherein the school required such evaluation and treatment, or suggested that a potential notification of child and family services might ensue the families packed up and moved.

Before anyone comments that this is a “rant” or tries to paint me into a particular political corner let me say the following: I'm an independent with libertarian, conservative and some truly radically liberal opinions. I'm a firm believer in the entire Bill of Rights, not just selected excerpts and passages. And my politics per se have very little bearing on this essay. In psychiatry and psychotherapy we look at patterns and cycles and the tendency of people, groups and systems to repeat themselves whether the results are rewarding or not. The core of neurosis is to continue to do the same thing over and over the same way in the same situation and to be upset, outraged, disappointed and surprised when the same result is achieved.

Obviously the present economy and world tensions do nothing to give one a sense of peace and security. Also the vitriolic and vituperitive political and media rhetoric only drive further polarization, animosity and acrimony. As a citizen and as a psychiatrist I am outraged that this behavior, and the errors of commission and I am frustrated and outraged at the errors of omission.

We do not need restrictions on gun rights, the right to free speech, the right to criticize politicians and normal human beings. Our freedoms are unique in human history and under continuous assault from without as well as from within. Indeed, there is a very obvious pattern seen in the life histories, behavioral patterns, psychopathology and violent acts of the perpetrators of most of the massacres of the past decades. They all had histories. They were all known to the police, the schools, and even to the mental health systems but they were not contained, committed, incarcerated, treated or anything else useful safe and productive. They were ignored in the hope that they would just go away.

Operant conditioning does not work on human beings. It works well with gerbils, cats, dogs and some other mammals but not with human beings. Those human beings who are not constrained by conscience, morality, ethics or shame can only be constrained by the very real threat or actual imposition of sanctions. Stated or implied sanctions. In the twisted minds of these killers they are gratified even when they are ignored because in their own mind they are getting away with it, whatever it is. In the same perverse way that an erotomaniacal delusional stalker is emboldened by being "ignored" by someone who may not even know that the stalker exists until too late these killers become more omnipotent and more dangerous the longer they are permitted to live freely in their perverse, deluded and often drug addled universe.

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I deal with schools, police and social service agencies almost every day. I also deal with victims everyday. They are the ones who have been violated by pathological individuals whose rights have been inviolate. And then, when prosecuted, incarcerated or committed more of the usual suspects scramble forward further concerned about the violator's rights. The conditions in the prison or hospital; enough time on the basketball court, insufficient treatment (!), abuse ad nauseum,

To reflect upon and the many episodes of mass violence over the past few decades, including Jonestown, Fort Hood, the brutal home invasions in Connecticut and New Hampshire over the past couple of years one cannot but see some patterns. The perpetrators all had histories. The perpetrators wandered free until they ran amok. Afterwards amidst the finger-pointing, the politicking and the grief I have yet to see anyone call to question the profound dysfunction in our culture engendered by the over adjustment in our social fabric in the latter part of the last century. Changes must be made in our society's ability to identify, treat or confine individuals with obvious pathology and predictable paths. And no, I do not suggest draconian fascist interventions nor the abolition of patient's rights and privacy. I do suggest that patients rights and privacy must be in balance with the right to freedom, safety, liberty and the pursuit of happiness we are supposed to enjoy.

Please don't be foolish and suggest that episodes of mass violence are more common in the United States than elsewhere because of firearms. They do occur everywhere. But, if you care to examine closely the laws, civil rights, and mental health regulations in the “enlightened European social democracies” you will see that they are dramatically different than ours. Do the homework. I don't want to take up more space with long dissertations about this. In Scandinavian countries serious sex offenders (who by definition are not truly treatable) are surgically or chemically castrated. There aren't a lot of repeat offenders. But these cultures are idealized by the left as some sort of utopian nirvanas. [Do not say I advocate this, it's simply an example]

So you see the argument is really not about the tools of violence nor the innate capability of human beings to be violent but it is about a careful examination of several of our dysfunctional bureaucracies, all of our rights and privileges and the need to interdict the course of these human weapons of mass distraction.

P.S. I have written about this previously in another blog. You can find that here: Crazy People with Guns http://beverlyhillsshrink.blogspot.com/2009/03/crazy-people-with-guns.h…