In Shooting's Wake, Psych Community Worries About Added Stigma

It wasn't long after Jared Loughner was identified as the shooter that people began to suspect he suffers from some form of mental illness.

In YouTube videos posted three weeks before the shooting, Loughner ranted (in on-screen text) about the counting of B.C.E. years and the ability of each person to create his/her new kind of currency. He showed some telltale signs of paranoid schizophrenia, psyciatric experts agreed--delusions that showed a psychotic break from reality.

Mental health has now become a focus as we try to understand the Tucson shooting that left six dead, and the mental-health community is worried that this tragedy will lead to greater stigma for schizophrenics and mental health patients in general. In the week after the shooting, I talked to two psychiatric experts who raised that concern.

"One case like this gets so much attention and adds to stigma," said Dr. Donald Goff, director of the Schizophrenia Program at Massachusetts General Hospital and a psychiatry professor at Harvard.

And, Goff said, it's an inaccurate stereotype that this shooting has fed.

"The most important thing to get across is that violence is extremely rare in schizophrenia [cases], but when it rarely occurs it's often so bizarre that it makes headlines like this," Goff said.

The professional literature is split on whether schizophrenia leads to violence, with some studies suggesting that violence is not much more frequent in schizophrenics than it is in the general public. Other studies have claimed that 20 percent of schizophrenics behave violently before receiving treatment, while that rate drops below 10 percent after a patient is discharged from a treatment facility.

But, as Goff said, violence motivated by paranoid delusions leads to stranger crimes and more publicity.

"Most people with paranoid delusions believe that the conspiracy, or the sort of persecution, is far greater than they are and that it would be futile to fight against it," Goff said. "It's very very rare for someone to believe that they should or can fight back."

Social stigma has always been a huge obstacle for the mental health community. When mental illnesses are looked down upon, or treated by society as fictitious, those who suspect they suffer from them are less likely to seek treatment. When it comes to government policies, mental-health advocates have long struggled for health-care and employment laws that treat mental illnesses the same as other illnesses. In recent years, Sens. Ted Kennedy and Pete Domenici have pushed mental-health parity policies, making strides in how mental health is recognized under federal law.

To the mentally ill and to those who treat them, the way we talk about mental illness is important. Cultural views have a lot to do with how patients and the government treat mental health issues. And as we discuss the shooting in Arizona, we might be flunking the test.

"Just hearing the radio and the way people talk about it, it's just appalling at some times," said Dr. Anthony Lehman, chairman of the University of Maryland School of Medicine's department of psychiatry.

"Folks who otherwise seem very about 'lunatics,' and being 'unhinged.' Even Bill Clinton refers to the 'delirious,'" Lehman said. "All these terms are insensitive at best. ...

"Even someone on NPR said ... that people with mental illnesses should be separated from society. Now, I don't think these are mainstream views, but those are things that are said at best in the heat of the moment, and at worst reinforce a negative view of people with mental illness and stereotyping," Lehman said.

Treating schizophrenia as a sign of evil or degeneration does not make patients feel comfortable seeking help; nor does it encourage friends or family members to recognize symptoms and encourage someone to get treatment. Which is a problem for schizophrenics, especially: Since the condition is marked by false beliefs and hallucinations, schizophrenics often don't know there's anything wrong with them, and treatment often has to be involuntary. Friends, family members, and teachers play a big role in addressing it.

One thing is certain: If Loughner had received treatment, this statistically unlikely tragedy would have been even less likely to occur. With medication, paranoid schizophrenics can overcome their delusions; had someone recognized Loughner's mental deterioration and encouraged or forced him into treatment, six people could still be alive and Loughner could have avoided the path he took.

It is with that in mind that the mental-health community hopes we all try to be a bit more careful, thoughtful and compassionate as we talk about what happened in Tucson.

Updated Jan. 18. The post initially identified Dr. Anthony Lehman and Dr. Donald Goff incorrectly as professors of psychology, not psychiatry.