After the recent shooting rampage in Tucson, Ariz., the psychiatrist E. Fuller Torrey, writing in The Wall Street Journal, said such crimes are "the inevitable outcome of five decades of failed mental-health policies."
Time blogger Joe Klein regretted that "we no longer lock up the mentally ill." Syndicated columnist Mona Charen faulted "laws that require proof of dangerousness before a person can be involuntarily subjected to treatment."
These and other critics argue that innocent people could be saved if it were easier to imprison lunatics like Jared Lee Loughner before they commit crimes. But the champions of involuntary psychiatric treatment rarely consider the innocent people who would be stripped of their freedom under a legal regime that allowed the government to lock up potential Loughners based on little more than their wacky beliefs and off-putting behavior.
Blogging at The New Republic's website last week, University of Maryland political scientist William Galston argued that "a delusional loss of contact with reality" should be enough to justify involuntary treatment. He wrote, "Those who acquire credible evidence of an individual's mental disturbance" -- including "parents, school authorities and other involved parties" -- "should be required to report it to both law enforcement authorities and the courts," under penalties "tough enough to ensure compliance."
In short, Galston wants a system that compels Americans to keep a close eye on their odd relatives, friends, neighbors, students and employees, reporting them to the authorities when their strange ideas escalate into "a delusional loss of contact with reality." That distinction may prove hard to draw.
Many of the things Loughner said on subjects such as grammar, mathematics, lucid dreaming and monetary policy were inscrutable or demonstrably false. But if that were enough to signal a break with reality justifying involuntary commitment, our mental hospitals would be overrun.
The fuzzy line between Loughner's opinions and his "mental disturbance" is apparent in a remark one of his friends made to The New York Times: "He was a nihilist and loves causing chaos, and that is probably why he did the shooting, along with the fact he was sick in the head." Was Loughner's nihilism a symptom of his illness, a cause of it, or an independent motivation for his crime?
As difficult as such matters are to disentangle after the fact, it is even harder to say ahead of time which deluded malcontents will become cold-blooded murderers. In retrospect, every strange thing Loughner did or said marked him as a dangerous madman, including not just overtly crazy stuff like his video linking Pima Community College to genocide, but borderline behavior such as singing to himself, talking out of turn, pestering teachers about grades, smiling and laughing inappropriately, and making weird comments in class. But it is not hard to see why administrators and police officers might have considered him a nuisance rather than a menace.
Even among people diagnosed as schizophrenics, Torrey says, only 10 percent become violent. So assuming that Loughner qualifies for that label, a policy of detaining people with similar symptoms would sweep up nine harmless individuals for each future criminal.
Although they are routinely called upon to say whether people pose a danger to themselves or others, psychiatrists are notoriously bad at it. "Over 30 years of commentary, judicial opinion and scientific review argue that predictions of danger lack scientific rigor," notes University of Georgia law professor Alexander Scherr in a 2003 Hastings Law Journal article. "Scientific studies indicate that some predictions do little better than chance or lay speculation, and even the best predictions leave substantial room for error about individual cases. The sharpest critique finds that mental health professionals perform no better than chance at predicting violence, and perhaps perform even worse."
The current system of involuntary commitment rests on predictions of dangerousness that are appallingly inaccurate. Abolishing the requirement of dangerousness would avoid that embarrassment at the cost of imprisoning even more people who pose no threat to others.
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