The real issue in Arizona: Schizophrenia (Part 1)
Missing from much of the wall-to-wall coverage of the horrific Arizona shooting have been credible facts regarding schizophrenia. Bizarrely, the national debate has raged on almost everything but the issue of schizophrenia. In fact, had reporters and pundits alike had some expert information on the subject before debating whether a political graphic or, more generally, the "political atmosphere" set off accused shooter Jared Loughner, the entire debate might have been short-circuited. And instead of a raucous argument over phenomena unrelated to the mass murder, we then might have had a serious discussion about mental health.
On the off chance that it's not too late to introduce actual science into the punditry, I spent several hours yesterday talking to some experienced mental health professionals.
On the most basic question as to whether political discourse, even utterly inappropriate rhetoric, affects schizophrenia, the answer is virtually certain: no. Dr. Stephen Marder, one of the country's premier experts on schizophrenia and the Director of the Section on Psychosis at the UCLA Neuropsychiatric Institute, explained in a telephone interview: "Schizophrenia is an illness that arises during brain development." And, yes, he continued, "there is a strong genetic element." For example, with identical twins, if one twin is a schizophrenic, there is a 50 percent chance the other twin will be. "That tells us that genetics isn't everything," Marder said. Among the other factors that may contribute to the abnormal brain development, "we do know that some infections of the mother" may be one, he said.
That assessment does not seem to be seriously in dispute in the mental health field. Charles Currie, a former administrator of the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), confirmed in a separate interview: "This is about fetal brain development. It is biologically based." He pointed out that in addition to being a danger to others, schizophrenics are at risk of being the victims of crimes, since they are often are unaware of, or have a distorted impression of, their surroundings.
Writing in the Wall Street Journal this week, E. Fuller Torrey, the founder of the Treatment Advocacy Center, echoed these findings:
Mr. Loughner's delusions fixated on Arizona Congresswoman Gabrielle Giffords, one of 12 seriously injured in the shooting. Some have speculated on the possible relationship of our acrimonious political climate to the incident. It is, however, unlikely that there is any such relationship, since similar tragedies occur in politically harmonious times as well
The motivation for such killings is usually based on psychotic thinking, not political thinking. Dennis Sweeney killed Allard Lowenstein [Sweeny's mentor in the civil rights movement] because he believed that Lowenstein had implanted a transmitter in his teeth that was sending messages to him. Russell Weston stormed the Capitol [in 1998, killing two] because he believed the government had hidden a machine there that could reverse time.
If we looked at a group of schizophrenics and a group of healthy people, would their brain scans look different? There is variation among individuals, but yes, Marder confirmed, a trained professional could looks at the two sets and see a difference.
Is the patient's immediate life experience -- parenting, child abuse, etc. -- a contributing factor in the illness? Marder said, "maybe a small one." But again, he emphasized: "The most risk is in fetal development." There is some evidence, he said, that child abuse may be an influence. (One can surmise that this is because abuse can result in brain trauma which may aggravate or heighten schizophrenia.) Currie also noted that the use of recreational drugs does make schizophrenics much more likely to become violent. (And media reports have disclosed that Loughner was a frequent marijuana user.)
Do external factors, such as violent media or politics, contribute to schizophrenia? There is powerful evidence that there is no connection. Marder explains: "The prevalence of schizophrenia is pretty uniform" across countries. In other words, the percentage of schizophrenics in the U.S. is no greater than that in Australia or Iceland.
Although the percentage of schizophrenics who commit violent crimes is small, their violence tends to be more "bizarre, unpredictable and with a focus often on celebrities," according to Marder. That is because of the nature of the disease. Schizophrenics are sometimes plagued by "self-referential thinking," which converts ordinary events or experiences into episodes with personalized, "special meaning." For a schizophrenic, the TV is not merely on. The TV is speaking to him. This makes the illness incredibly difficult for "tormented" family members who are trying to help the loved one, only to see interactions converted into diabolical threats and dangers in the patient's mind.
In that regard, an interaction with a politician or celebrity can set a schizophrenic on "a mission." Marder declined to speak on the Loughner case specifically. When I gave a hypothetical, "Would an interaction with a famous figure who gives the schizophrenic a disappointing response be a trigger for violence?" He answered without hesitation, "yes." We do know, as The Post reported:
[Bryce] Tierney, described as "an old and close friend with whom he had gone to high school and college" in the Mother Jones report, said that Loughner had repeatedly called Giffords a "fake," and that his hatred of Giffords intensified after he attended a campaign event where he posed a question to the congresswoman. According to Tierney, Loughner's question was, "What is government if words have no meaning?"
"He said, 'Can you believe it, they wouldn't answer my question,' and I told him, 'Dude, no one's going to answer that,'" Tierney recalls. "Ever since that, he thought she was fake, he had something against her."
That certainly seems like a schizophrenic's potential motivation for a horrid crime.
Schizophrenics also suffer from anosognosia, the medical term for the inability to have insight into one's own mental illness. It is not simply that schizophrenics are being difficult or are in denial when they refuse treatment; they actually don't see that they are sick. For this reason, many resist treatment or imagine that those trying to help them are actually conspiring to harm them. This puts an enormous burden on family, teachers and administrators to spot the illness and get treatment for the schizophrenic.
I'll come back to the subject in a second post today, looking at how capable lay people are in recognizing the illness, what changes in the mental health system, if any, are needed and whether schizophrenics, once treated, can function normally without endangering themselves or others.
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