Peril in Unwatched Madness

Posted: Apr 26, 2007 12:01 AM
Peril in Unwatched Madness

Psychiatrists of my acquaintance tell me they've got a lot of work in the wake of the massacre at Virginia Tech. Parents who had buried their heads in the sandbox since Johnny or Chloe were young children behaving badly are dragging their late adolescent and young adult sons and daughters in for checkups and treatment. Many of them, says one psychiatrist, lapsing into the politically incorrect language the rest of sometimes use, are "lunatics."

We've whitewashed language about the mentally ill. Labels that once got immediate attention are obfuscated with evasion and euphemism so as not to offend. Psychiatric diagnoses are couched in frilly language to obscure so we don't "stigmatize" or "victimize." Calling an illness a "personality disorder" doesn't frighten with the urgency of "paranoid schizophrenic." Sometimes new diagnoses are tailored to persuade the green eyeshade men at the insurance companies. Sometimes the professionals don't want to lower the "self-esteem" of their patients, so they make them sound more normal than they really are. Trends in caring for the mentally ill run in several directions.

For eight years in the long ago I edited a mental health magazine for professionals, called "Innovations." We featured new treatments and attitudes toward those suffering from a wide range of mental illnesses. Some of the new approaches were promising; others were useless. They all were lumped together, entangled in public policy, abetted by a philosophy that one size fits all. That was a deadly formula for cost-cutting state legislatures.

Typical was a headline on one community program: "From the back ward to the front porch." A copy editor had put into neat perspective what we all wanted to believe, that new drugs could do what Freud never dreamed of. No soul searching or long sessions on the couch. Independent living in the community was the best way to treat mental disorder. States radically reduced their patient populations or closed mental hospitals, which cost more to run than luxury hotels (without the luxury). Patients moved into rooming houses or halfway houses with poor supervision. Neighbors protested. Hallucinating bag ladies and delusional men headed for warm climates to sleep on park benches and sidewalk vents. The golden age dawned.

If they stayed on their meds (an enormous "if"), some of them could manage in group homes, but they often discarded their prescriptions because of uncomfortable side effects. For decades, society, driven by a variety of vested interests, began camouflaging the kind of mental disability exhibited by Cho Seung-hui, the shooter at Blacksburg. Parents were embarrassed to seek help. Civil liberties lawyers rigorously defended the rights of the nuts. Authorities were afraid of getting sued. Friends were protective. Hospitalization was expensive. We can't know whether psychiatry could have prevented Cho's murderous rage, but the tragedy should shake us up enough to think again about attitudes toward mental illness and how to treat it.

Parents who refused to commit their children before the massacre may be more willing to get help for them now. Commitment laws have to be examined closely and sometimes changed. Parents and policy makers as well as friends and family -- including sisters, cousins and aunts -- must realize that seriously mentally ill patients must be observed by professionals for a long time to see how they function on drugs and therapy. The complexities of mental illness do not often, or even usually, become apparent in outpatient treatment. Symptoms can mimic a wide range of human behavior that can pass for normal, or merely eccentric. Psychopaths are particularly clever in fooling us.

We still don't know a lot about the different causes and cures for mental illness. While Cho's "creative writing" is supposed to have offered clues to his potential for violence, many of our best writers have depicted, albeit far more stylishly, similarly violent themes. It's comforting to blame the violent messages on movies and music, but young men in other cultures who get different cultural messages -- Islamic messages, for example -- become suicide bombers, and many are as crazy as Cho. Culture can enable a mentally sick person to sublimate his craziness in forms that are either approved, rewarded or go unchallenged by society. It's unlikely to be the root cause of sickness.

Scientific research has uncovered parts of the brain that trigger psychopathology (including tumors) and is beginning to reveal how genetics, brain circuitry and biological predispositions play into mental disorders. But common sense is as important as science in confronting somebody who consistently seems a little "off." We don't have perfect knowledge or absolute cures, but we should at least act sensibly on what we do have. To paraphrase Hamlet: "Madness in ordinary ones, must not unwatched go."