Posts Tagged ‘Paranoid Schizophrenia’

Revise Civil Commitment Laws II

January 13, 2011

Revise Civil Commitment Laws II

A few days ago I presented the educated assumption that the man who shot and killed six people and wounded Congresswoman  Giffords along with 12 others, was suffering from Paranoid Schizophrenia. I reviewed the deinstitutionalizing/community mental health initiative of the early 1960’s and also the change in our civil commitment laws that made it almost impossible to get psychiatric and psychological help to those who are in psychotic states and who refuse to seek or accept help for their condition.

Many facts are now available that were not then. Professionals interviewed on the media have tentatively diagnosed his condition as paranoid psychosis. Neighbors had seen symptoms of psychosis in this young man for a long time, high school classmates and friends reported his increasing symptoms of psychosis, college classmates and a math professor reported their fear of this man in their class. The students feared he would bring a gun to class and the professor was afraid to turn his back to do math problems on the blackboard for fear that the actively psychotic person  might shoot him in the back. These fears were present despite the fact that no one reported ever seeing him bring a gun to class. Also, the man’s  disturbed and and forboding ramblings were publicly posted on the internet.

This tragedy could have been, and should have been, avoided.

Once again,  America has hog-tied itself with our laws and we see the inhumane outcomes of our attempts to be humane. It is a sad truth that mental patients were once locked away and many were never released. It is a happy truth that, with the discovery of antipsychotic medications, many were able to benefit and lead more normal lives. It is a sad truth that a large proportion of hundreds of thousands of mental patients who were once released from hospitals did not get medications, or refused to take them, or were ones for whom the medications did not work very well.  A great many of these former mental patients joined the legions of our mentally ill homeless and those in our prisons.

So I ask, what is humane about this outcome for nonviolent psychotic? And what is humane about America allowing an obviously dangerous paranoid psychotic to wander freely amongst our citizens who were fearfully trying to get help for this individual, while our mental health systems and our legal systems were unable to provide the help and protection needed?  So now a man is a mass murderer who likely never would have hurt anyone. All of thishappened because of his untreated paranoid psychosis. So now a congresswoman has been brain damaged,  twelve more have been wounded and nine other citizens have been killed.

In response, our government predictably swings into frenetic and futile action. It proposes that we limit the capacity of firearm magazines (use two guns, or poison, or several knives and a sword). It proposes that we limit the zone around a public official in which citizens may possess a gun to 1000 feet.  What does it matter?  How would such a law be enforced and how likely is the law to control the behavior of a dedicated sane assassin or someone in a murderous  psychotic rage? Finally, the grand absurdity emerges among these lesser ones: it was Sara Palin, Fox News, Rush Limbaugh, etc., who need to be silenced!

No, dear friends, what really needs to happen is a revision of our civil commitment laws.

 Although murderous attacks by paranoid psychotics can never be prevented 100% of the time, the probability of it happening again can be cut dramatically, if we will only behave rationally.

It is essential that our licensed doctoral level mental health care providers (psychiatrists and Ph.D. clinical psychologists) once again be given the authority to commit actively psychotic citizens, who refuse help,  to mental health care facilities.  This new commitment procedure can be much more humane than the previous ones. The new commitment procedure would be for evaluation and medication assistance (remember medication for psychosis was once unavailable). The first goals of this intervention would be to quell the ongoing psychotic episode, educate the patient as to their particular mental disease, and teach them how to effectively cope with it through medication and stress management.  The final goal of this commitment would be discharge the patient as soon as possible with mandatory supportive follow-up.

It should be understood that such a treatment approach would need to be refined through outcome analyses and further revisions, to the point that it reflects our best efforts to protect the rights of all citizens concerned, including the patient under treatment.

V. Thomas Mawhinney, Ph.D.       1/13/11

P.S. You will note that I have omitted the paranoid psychotic murderer’s name. I did so because that person did not do the killing. Rather, it was a dangerous mental disease (paranoid schizophrenia) that America allowed to wander freely amongst its citizens that did the killing.

To those who ask: What about individual freedom? I will ask: What about the individual freedoms of those students and the professor terrified  in the classroom? What about the freedoms of the professionals who were called to help, but who were restricted from providing help? What about the individual freedoms of those killed and injured by a paranoid schizophrenic’s murderous attack? What about the individual freedoms of all of the victims?

 The list of victims includes the paranoid schizophrenic who did the shooting, those who were killed and injured, and all of their friends and relatives and the rest of us who have been traumatized by this and similar tragedies.

Some say that this suffering is “the cost of freedom”. I say it is the cost of our own cultural design mistake and a loss of freedom that must now be repaired.

Revise Civil Committment Laws!

January 9, 2011

The following is a republication of a blog that I did on 1/9/11. My reference to a recent mass shooting, at that time, will certainly date this blog. However, nothing has changed with the many mass shootings in America since then. These are almost to painful for us to bear. The school shootings are even, somehow, even more gut-wrenching.

Nothing has changed and so neither has the contents of this post.

Revise Civil Commitment Laws!

It is true, as I taught for 36 years as a professor of psychology, and as I validated during 40 years as a psychotherapist; people with mental illnesses are generally no more dangerous than people without these afflictions. However, there are some exceptions. 

Those who are severely depressed are prone to suicide and in rare cases, also homocide. Those who suffer from Bi-Polar disorder can be prone to suicide while severely depressed, or other dangerous behaviors when in high manic phases.

Instances of bizarre and senseless violence, such as the recent case of Congresswoman Gabrielle Giffords and the others who were gunned down with her, a severe mental illness (probably Paranoid Schizophrenia) was the cause. A person suffering from paranoid schizophrenia, a more dangerous form of mental illness, was allowed to wander free among us, and it was this (or possibly another psychotic mental illness) that repeatedly pulled the trigger on our innocent and precious citizens.

Paranoid Schizophrenia is a specific and sometimes dangerous form of mental illness, especially when delusions of persecution are prominent. This should make sense to anyone. Delusions of persecution are false beliefs, often bizarre in nature, that others are “out to get me”, “spying on me”, “taking my property”, or “trying to harm or kill me”.

Of course, many “normally functioning” people would become very angry and tempted to “defend” themselves by attacking the “perpetrators” if they really believed that someone, or some people (perhaps the government, the next door neighbor, etc.), were trying to harm them or destroy their lives. But those in a paranoid psychotic state with with this psychotic mind-set can be very dangerous and no amount of security will protect the innocent from their unpredictable violent psychotic aggression.

The deinstitutionalization movement culminated in 1963 when the Federal Government ordered that mental patients be freed from mental hospitals and be treated within their communities. Congress passed the Community Mental Health Act which provided funding for the construction of community-based facilities to treat mental patients on an outpatient basis. With cases of acute mental states, patients could be admitted for short terms, evaluated, medicated, stabilized and released back into the community. They were oftentimes referred to out-patient therapists within their community for continuing therapy and support. 

All of this happened shortly after the discovery of anti-psychotic medications. In 1955 there were around 600,000 mental patients in state institutions. By the year 2001, there were only about 60,000 in state institutions. Where did the rest of the 500,400 mental patients go? These individuals with severe and sometimes dangerous mental problems went back to living free withing all of our comminities.

Following 1963, if hospitalization was necessary, patients were to be admitted on a short-term basis, medicated, stabilized and then released. This led to a “revolving door policy”, in which patients frequently were admitted, medicated, stabilized, and released, but, then stopped taking their medication and again became actively psychotic and were likely to be re-hospitalized for the same course of treatment.

Also, in the name of  civil rights and humane treatment, the criteria for “civil commitment” (commitment to mental hospitals against one’s will) were narrowed to the point that only those who were a clear and present danger to themselves or the public, could be committed without their permission. This meant that even those who were actively hallucinating, ranting and raving, homeless, filthy, or in some cases starving could not be hospitalized against their will. 

These criteria are far too restrictive and great suffering among the mentally ill,  as well as the rest of us, continues as a result.

It is pure stupidity to insist that an actively psychotic individual make a rational decision about what is best for themselves to do about their psychotic condition.

Once again an over-reaction in the name of personal freedom and humane treatment has gone too far. In doing so it predictably has resulted in more social chaos and tragedy, with a net loss of personal freedoms for all.

Once again, I must judge that the true governmental motivation for extending the definition of “personal freedom” ( in this case for mental patients) was largely revenue savings.

It is true that those patients who seek help at Community Mental Health Centers tend to benefit. But on a yearly basis, 40 to 60 percent of all people suffering from schizophrenia “and other severe mental disorders receive no treatment at all”. While poor coordination, or a shortage of available services, are frequently named as the cause for this shortfall, no one is willing to face the other obvious fact.  Giving an active psychotic and potentially dangerous the right to refuse treatment is an absurdly self-destructive big part of our problem!

While institutions may become more effective in their treatment, there is no happy feel-good remedy for psychotics who are unable to make rational decisions in their own best interests, who do not seek treatment, or who refuse treatment when it is offered.

New Laws with  more nuanced civil commitment capabilities,  intensive medication and psychological treatment strategies are essential.  Mandatory close follow-up with streamlined recommitment capabilities are essential.

Also glaringly clear, and most costly, is the need to increase America’s mental hospitals, once shut-down, in order to provide long-term care for those who simply cannot be stabilized and returned to open society.

Wake-up America!  Advocate for a Revision of our Civil Commitment Rules!

V. Thomas Mawhinney, Ph.D.   1/9/11

P.S. (I).  The history and statistics of the Community Mental Health Movement and its failings are based upon the college textbook Abnormal psychology, by Ronald J. Comer.

P.S. (II).  Schizophrenia is a life-long mental disease with strong heritability. There is no cure for schizophrenia, though medication can imperfectly help to control its most bizarre and incapacitating symptoms.

P.S. (III). A factor in our social decline is that since deinstitutionalization, the reproductive rates of people with schizophrenia and other severe mental illnesses have naturally increased and are thought to now approximate that of the “normal” population. I believe this has led to a growth of a variety of genetically-based schizophrenic spectrum and other serious mental problems within our population. 


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