If not now, when?

Cokie Roberts was wild-eyed on ABC’s Rountable this morning, calling for involuntary commitment, I’m trying to find the transcript. On Meet the Press Tim Russert interviewed the luminaries, among them Virginia Tech president Dr. Charles Steger:

Russert:

Let me ask you about the whole issue of mental health in, in students and refer you to an article from The New York Times, which I’ll share with you and our viewers.
“English professors and students appear to have worked harder than anyone to intervene in [Cho’s] life. Trying to balance the freedom needed to be creative against the warning” sign—“signs of psychosis, as many as eight of his teachers in the last 18 months had formed what one called a ‘task force’ to discuss how to handle him, gathering twice on the subject and frequently communicating among themselves.

“On at least two separate occasions they reached out to university officials, telling them as recently as this September that Mr. Cho was trouble. They made little headway, however, and no action was taken by school administrators in response to their concerns.”

In hindsight, looking back upon this, what could have been done differently, and what can be done differently in the future with troubled students?

Dr Steger:

Well, I think one, we, we need to examine the issue of the balance between the rights of the individual and those of collective society. I certainly hope, and I’m sure that the investigations that are under way, will give us a much more detail as to how this case was handled. But it is something that I think we should reflect upon very carefully and see what we can learn to ensure that this sort of tragic event doesn’t happen on another campus.

…Secretary of Health and Human Services, Michael Leavitt:

These are complex, mind-numbingly complex situations, and they, they cause festering conflicts that have already been part of our society to be inflamed again, and many of the kinds of questions you’re raising today are among them. How do we balance privacy with the need for security? How, how do we make certain that people have mental health treatment when they need it and not create a, a stigma for it? How do we protect privacy? These are the kinds of larger issues that are not just applicable to what happened at Blacksburg, but also what’s happening in this, this unexplainable pattern of nightmarish episodes of, of violence in our, in our society. And that’s what the president has asked Secretary Spellings and I, and Secretary, Secretary—or Attorney General Gonzales to look at. We’ll be going across the country asking that question, asking mental health professionals, asking governors, law enforcement, higher education officials, “Talk to us, tell us what you’re feeling, what suggestions, what can we learn from this?”

They can start here:

From 10 Myths About School Shootings based on a 2002 study by the U.S. Secret Service and the U.S. Department of Education:

* There really is no solid profile that applies to school shooters.

* Incidents like the Virginia Tech shooting rarely involve people “just snapping.” They are preceded by a long period of planning.

* Attackers are not all loners. In many cases of the past, attackers were active in school sports and such.

* Only one-third of previous attackers studied had a history of diagnosed mental illness.

If we’re opening up a national dialogue, it has to include the advocates, consumers, psychiatric survivors and critical psychiatrirsts. Anything less is horseshit. This Breggin post at Huffington is critical, so I’m clipping it in toto:

Focusing on Virginia Tech mass murderer Cho as a disturbed mental patient has led media analysts to ponder how he could have been more readily identified by the mental health system. But Cho is not someone who slipped beneath the psychiatric radar. Instead, he was frequently detected as a large object on the screen.

On separate occasions, he was involuntarily hospitalized, sent for psychological evaluation, and referred to the university counseling center. Consistent with getting him more psychiatric “help,” experts have also opined on how he might have benefited from medication. These are all the wrong lessons.

The mental health system was fully alert to Cho’s existence and to serious manifestations of dangerous behavior. A faculty member of the English department was so frightened by Cho’s behavior that she insisted on having him pulled him out of class. The police and the counseling center were notified and ultimately Cho was given individual tutoring, instead of quick removal from the campus. Also, a number of students called the campus police, probably at least twice in regard to his stalking behavior. Furthermore, he had previously been involuntarily hospitalized in Virginia as a danger to himself and others.

The answer to vengeful, violent people is not more mental health screening or more potent mental health interventions. Reliance on the whole range of this system from counseling to involuntary treatment failed. There is not a shred of scientific evidence that locking people up against their will or otherwise “treating” them reduces violence. As we’ll see, quite the opposite is true.

So what was needed? Police intervention. Almost certainly, the police were hampered in taking appropriate actions by being encouraged to view Cho as a potential psychiatric patient rather than as a perpetrator. It’s not politically correct to bring criminal charges against someone who is “mentally ill” and it’s not politically correct to prosecute him or to remove him from the campus. Yet that’s what was needed to protect the students. Two known episodes of stalking, setting a fire, and his threatening behavior in class should have been more than enough for the university administration to bring charges against him and to send him off campus.

Police need to be encouraged and empowered to treat potentially dangerous people more as criminals than as patients. In particular, men stalking women should be handled as definitively as any perpetrator of hate crimes. Regardless of whether the victims want to press charges, the police should. Cho shouldn’t have been allowed to get away with it a second time.

How would a police action have affected Cho? Would it have humiliated him and made him more violent? There’s no way to have certainty about this, but anyone with experience dealing with threatening people knows that a good dose of “reality,” a confrontation with the law, is much more of a wake up call and a deterrent than therapeutic coddling. Furthermore, involuntary psychiatric treatment is one of the more humiliating experiences in American society, and tends to make people more angry, not less.

Mental health interventions do not protect society because the person is almost always quickly discharged because his insurance coverage has run out or because mental health professionals, who as a group have no particular capacity to make such determinations, will decide that the patient is no longer a danger to himself or others. Indeed, in December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found “his insight and judgment are normal.” Need I say more about the hazards of relying on mental health screening and evaluation to identify dangerous perpetrators–even after they have already been threatening people?

Psychiatry’s last resort for presumably violent people is involuntary hospitalization. Not only does it almost always lead to rapid release, it does not help the involuntary patient. Coerced treatment is not perceived or experienced as “helpful” by the recipient but as unjust bullying. If coercion accomplishes anything, it teaches the “patient” to stay far away from all providers of mental health services.

And what about drugs for the treatment of violence? The FDA has not approved any medications for the control of violence because there are no such medications. Yes, it is possible to temporarily immobilize mind and body alike with a shot of an “antipsychotic” drug like Haldol; but that only works as long as the person is virtually paralyzed and confined–and forced drugging invariably breeds more resentment.

Instead of offering the promise of reducing violence, all psychiatric drugs carry the potential risk of driving the individual into violent madness. For example, both the newer antidepressants such as Prozac, Paxil, Zoloft and Celexa, and the antipsychotic drugs such as Risperdal and Zyprexa, cause a disorder caused akathisia–a terrible inner sensation of agitation accompanied by a compulsion to move about. Akathisia is known to drive people to suicide and to aggression. Indeed, these tragic outcomes of drug-induced akathisia are so well documented that they are described in the most establishment psychiatric book of all, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

For the past fifteen years or more, I’ve been writing about the capacity of psychiatric drugs to cause mayhem, murder and suicide. In early 2005 the FDA finally issued a warning that antidepressants cause both suicidality and violence. For example, the FDA’s new mandated warning label for antidepressants states that these drugs produce “anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania.”

Note the reference to “irritability, hostility, aggressiveness, impulsivity” in the label or package insert for antidepressants. That’s a formula for violence. Note the mention of akathisia, another source of both violence and suicide. And finally, note the reference to mania, yet another drug-induced syndrome associated with violence and suicide.

As a psychiatrist and medical expert, I have personally evaluated dozens of cases of individuals driven to violence by psychiatric drugs of every type, but most commonly the newer antidepressants. One of the cases I evaluated, the Columbine shooter Eric Harris, looks the most like Cho. Both were very emotionally disturbed in an extremely violent fashion for a prolonged period of time. For the entire year that Eric Harris was evolving his manic-like violence, he was taking Luvox, a drug known to cause mania at a high rate in young people

In my book Reclaiming Our Children, I analyzed the clinical and scientific reasons for believing that Eric Harris’s violence was caused by prescribed Luvox and I’ve also testified to the same under oath in deposition in a case related to Columbine. In my book the Antidepressant Fact Book, I also warned that stopping antidepressants can be as dangerous as starting them, since they can cause very disturbing and painful withdrawal reactions.

We have not been informed whether or not Cho was taking psychiatric drugs at the time he unleashed his violence; but even if he wasn’t, he might have been tipped over into violent madness weeks or months earlier by a drug like Prozac, Paxil, or Zoloft. He could also have been undergoing severe drug withdrawal. Investigators should set a high priority on obtaining and publishing Cho’s psychiatric drug history.

To focus on Cho as a “mental patient” or “schizophrenic” distracts from the real need to enforce security on college campuses, or in any setting, by reacting definitively to lesser acts of violence before they escalate. It also maligns people with serious mental problems, the vast majority who are, above else, inoffensive and overly docile.

The violence unleashed on the Virginia Tech campus should not lead to calls for more mental health screening, more mental health interventions, or more drugs. Instead, the violent rampage should confirm that psychiatric interventions don’t prevent violence and instead they can cause it. Early on, Cho should have been confronted by the police and by university administrators with the reality that his behavior was unacceptable and he should have been suspended. In other words, he should have been treated as a criminal who was stalking women, and as an obviously threatening individual, not as a potential mental patient. These measures might have confronted him with sufficient reality to nip his violence in the bud and more certainly would have removed him from the circumstances that the he found intolerably stimulating, while also removing him from so many targets of opportunity.

And David Oaks at MindFreedom rallies the troops: Speak out now!