The New Republic

With all due respect, Mr. Galston, yours is an idiotic argument. Laws governing involuntary commitment are designed to impose physical segregation and medical treatment on individuals who are deemed by medical and legal authorities to be a danger to themselves or others, but "mental derangement" is not itself an indicator of any such threat. In fact, even people who are floridly psychotic are very rarely a danger to others and are most often a danger to themselves only insofar as they fail to adhere to routines of basic self-care. By your own report, Loughner had several contacts with police. We may presume that those officers saw no indication that Loughner was "bent on mayhem," for if there had been any such indication, existing law would have permitted his commitment. It is easy, in retrospect, to say, "That person should have been locked up and treated against his will. Had that occured, X number of victims would still be alive." But the real problem is how to identify such individuals prospectively, and neither you nor anyone else has an answer to that one. For every schizoid loner who goes on a shooting spree there are a thousand schizoid loners who never hurt a fly. Do you want to lock all of them up? And the fact is that as a practical matter a true "delusional loss of contact with reality"--i.e. frank psychosis--is already usually enough for commitment on danger-to-self grounds. A corolary is that such acutely sick people are not usually much of a threat to anyone else--they're too disorganized. If on any one of the five occasions police had dealings with Loughner they found him to be howling at the moon, they could and likely would have transported him to an ED for an assessment and were he deemed to be actively psychotic he likely would have been comitted. The fact that this did not happen suggests that he did not present in such an obvious manner. If you can design a method of screening that effectively sorts those persons who are likely to shoot others from those who aren't, I'd love to see it in action. But given that most crazy people don't shoot anybody and that most shooters aren't crazy, craziness isn't even remotely a useful indicator.

- AaronW

January 11, 2011 at 1:04am

I do wonder if the pendulum has swung too far in the direction of not institutionalizing people. I am amazed that anorexics who starve themselves to the point of organ damage and people who serious attempt suicide often spend only a few days in commitment before being freed. But this article goes way too far. By the most conservative estimates, there are at least one million people in this country who exhibit schizophrenia at some point in their lives and five million who are bipolar. Many of these people exhibit some form of "mental disturbance" at some point. It would be extremely cost ineffective, not to mention unfair and counterproductive, to warehouse them all in mental hospitals. It would be one thing if institutionalization meant a quick, or even slow, cure for these people, but sadly psychiatric treatment isn't like a regimen of penicillin, and being able to stay with family and friends and to continue working and studying is often far better for mental health than being shut away in a mental institution. At the same time, a surprisingly small percentage of murders are committed by psychotic people, at least outside of television. Slate cited a study this week that showed that the odds of being killed by a schizophrenic stranger in any given year are 1 in 14,300,000. While the study in question is probably underestimating, as it used data for four countries with lower homicide rates than the US (our schizophrenics can get guns!) the fact is that the vast majority of homicides are committed by non-psychotic sorts who don't run screaming down the streets. Yes, a lot of killers probably have some sort of mental disorder, it's easy to retroactively diagnose murderers with sociopathy or excessive impulsiveness or whatever, but it's hard to know which of the millions of relatively badly behaved people need to be locked away pre-emptively. Remember that even of our school shooters, perpetrators of an especially deranged and pointless crime, Cho Seung-Hui was kind of an exception in that everyone knew he was nuts. More often it's "he seemed like a nice kid" or "he was a little weird, but no weirder than lots of high school kids." Imposing serious punishments for failing to report that someone is "mentally disturbed" is an especially dangerous rule. At least 10% of people consider suicide at some point in their lives for example, and most of them tell a friend. I had a friend with depression who told me that she was scared of telling anyone at her college how unhappy she was, because the administration encourages kids to immediately report any signs of other students' depression to a counselor, which in turn can lead to a forced terms of absence. Galston would impose a more hostile version of that arrangement on the whole society.

- WillPastor

January 11, 2011 at 1:52am

The warning at the beginning of this should have instead stated: "This article will make people interested in making conclusions based on empirical data rather than emotionality and ignorant stereotypes unhappy."

- WandreyCer

January 11, 2011 at 7:16am

Not surprisingly, in Brooks' column today he concludes that what we have in this country is a mortal threat from the mentally ill: "If the evidence continues as it has, the obvious questions are these: How can we more aggressively treat mentally ill people who are becoming increasingly disruptive? How can we prevent them from getting guns? Do we need to make involuntary treatment easier for authorities to invoke?" Fortunately there are those who rely on science rather than prejudice, including Vaughan Bell in an article posted Sunday in Slate in which Bell, citing academic and medical research, points out that the mentally ill have no greater propensity to violence than you and I. But isn't that the source of the prejudices held by Brooks, Galston, and so many others, that you and I, being free of mental illness, don't shoot people, and anybody who does must suffer from mental illness. Of course, motivations for violent acts take many forms, an unfaithful spouse, a capricious boss, a constant drumboat of charges that our freedoms are being slowly drained away by a President who isn't even an American. Do we lock up all husbands and wives of unfaithful spouses, all employees of capricious bosses, all Americans who express outrage and anger over an imposter President who would deny our freedoms.

- rayward

January 11, 2011 at 8:15am

Let's assume for the moment that your argument makes practical sense -- it doesn't, because the ratio of homicidal psychotics to self-destructive psychotics is very low -- how, exactly, would you administer and pay for such an approach? Would we create agencies that citizens could call to "denounce" their mentally-ill neighbors, so that they could be involuntarily committed? And who would pay for this? A number of years ago, there was a tragic murder case in NYC, in which a schizophrenic man pushed a young woman in front of an oncoming subway train. The man had repeatedly sought professional treatment and shelter for his illness, but there were insufficient public funds available to help him. If there wasn't enough funding in liberal New York City, what hope would you have for providing adequate public funding for treating (not punishing) mentally ill people in places such as Arizona?

- ekoral

January 11, 2011 at 9:44am

I understand the sentiment, but the implications of what Galston is saying are terrifying. There is far more danger, I would think, in giving incompetent school administrators, vindictive parents and so-called "friends", and ill-informed judges and social workers the power to take away an individual's liberty. This piece ignores the ignominious history of involuntary commitment in the United States. You can be sure that if standards are relaxed innocent people will suffer. Commitment is a very dangerous weapon.

- ngever

January 11, 2011 at 9:55am

The problem is not "being committed", the problem is there were these 5 occasions where the police had to be called in -- yet this individual had easy access to purchase a handgun. What happened to the permitting process that such a clearly disturbed individual was able to legally purchase a handgun? Didn't the police keep records? Weren't those records checked? Aren't those records SUPPOSED to be checked? Out of all the people "worthy of commitment", a tiny minority go buy handguns. I'd hate to treat every crazy person as if they were a crazed killer, when that's appropriate in so few cases. Limiting their access to a handgun, that makes more sense.

- AllanL5

January 11, 2011 at 10:08am

As far as I can see, the irrational emotion here is coming from those who have a violent reaction to the mere suggestion that we might want to rethink our society's commitment to the "rights" of psychotics to refuse all treatment and purchase dangerous weaponry.

- mgorvine

January 11, 2011 at 10:10am

More people are injured and killed (in vehicle crashes) by drunk drivers and poor drivers and angry drivers then are injured or killed by psychotic people. We just have a more emotional reaction to a psychotic break than we do to a careless driver break.

- skahn

January 11, 2011 at 10:21am

No, I'd have a pretty strong reaction to a psychotic driver break too. If the nut-job was merely "careless" with his hand-gun, I think I'd find it easier to cope.

- AllanL5

January 11, 2011 at 10:44am

As to commitment, it is a very tough issue since years ago they committed gay people, and being that you can not prove you are sane, (like with a blood test) you can only hope to convince people you are. Are you going to commit young people who sometimes express the wish that they were dead? Do they need a counselor, sure, but locking them up might have far more long term damage, not to mention having such information on their medical record. But lets be honest, nowadays society doesn’t commit people because of the money involved. It is helluva expensive. They are cutting children off from basic medical care in places like Arizona, there is no way in hell they are going to spend that kind of money to care for and support the mentally ill. It is far cheaper to lock up the few who go violent and let the rest fend for themselves.

- blackton

January 11, 2011 at 10:46am

Two related issues homeless and mental problems are attached to Ronald Reagan who closed mental institutions filling the streets of California with homeless mental patients. Since then the US never looked back and continued filling the streets with those poor people. There has to be a solution to sick people like the shooter of the Congresswoman in Tucson to prevent them from destroying the country.

- Poupic

January 11, 2011 at 10:48am

I nominate AaronW to right all of Galston's blogs and Galston to comment below (if he can think of something to say).

- roidubouloi

January 11, 2011 at 12:39pm

If you've had up-close experience with mental illness, as I have, I think you're much more likely to support Galston's argument. Getting a mentally-ill loved one committed is very difficult, and it puts an extra and unnecessary strain on family bonds. (Keep in mind that those family bonds are necessary to the mentally ill person after they've been stabilized and are out of hospital trying to find their footing, cope with the emotional impact of what's happened, and cope with medication side-effects, etc.) Even once a person has been committed to a mental institution, they can't be forced to start taking regular anti-psychotics until after a formal judicial process that takes two weeks. Some mental hospitals quite like this, since they can pocket two weeks' worth of free insurance money (more if they draw out the process) while the person roams around the ward untreated. Of course, we also need more public and private money allocated to treating mental illness. The Reaganesque policy of emptying the state mental hospitals onto the streets may be less expensive in the shorter term (and perhaps even longer term, I dunno), but it's a pretty hollow victory for personal liberty to let people wander around in their own private hell, cut off from loved ones, struggling to comprehend reality, and homeless.

- bmoodie

January 11, 2011 at 1:13pm

The fundamental problem is the absence of a functional "wisdom" concept. In many indigenous communities really difficult issues are brought to wise leaders whom all agree are beyond "self interest". We have taken to glorifying "self interest" and make rules to define it as acceptable. This automatic pistol and what I do with it is OK because I want it and whatever I want is OK because, bloody hell, it's a desire that came out of my own wonderful mind (so what if the Founding Fathers were talking about single shot muzzle loaders). What is wisdom and how do we connect with it as individuals and as a society? Forget the fancy big money religions, they can be part of the problem. And forget, for a moment, the nice prohibitive rules we make after something else terrible happens.... Where are the likes of Desmond Tutu and the Dalai Lama when we need real clarity that goes beyond self interest? How do we get to descriptions of how we can respect life and avoid distorted emotions like desire for control, power, and killing? A few years back (c. 1960) the Danish head of the U.N.'s office in charge of quantifying global mental health wrote: "If the same instrument we use in Denmark to measure mental health were used in the U.S. I am certain that fully 50% of the adult American population would be certifiable." There are some deep societal issues and questions that we are not asking and the most fundamental of these is, "How does society of disturbed "me-firsters" get [back] to the wisdom that spans generations?"

- JohnC

January 11, 2011 at 1:19pm

More to the authors point, don't change involuntary commitment rules. Just set a (much) higher standard of mental health for buying guns than for avoiding involuntary commitment. And let's start pressing the NRA: who needs a 30+ round clip for self-protection?

- hrlngrv

January 11, 2011 at 3:07pm

I knew it was coming: a new round of blame on the mentally ill. Galston strings three shooters together and makes a sweeping case for involuntary commitment. Well, what Oswald, Sirhan, James Earl Ray, the numerous serial killers American has been plagued with for decades, the antrax stalker, the guy who tried to bomb Times Square. All of these people were ab-normal in that they murdered people. Then again, murders and assassinations are rather common in the US compared to most developed (and undeveloped) countries. Sarah Palin is not responsible for the Arizona murders. But the mendacity of many politicians f (Palin: Obama 'pals' around with terrorists; Ginrich: Muslims are trying to 'destroy' our civilization) create a hedonistic, permissive atmosphere of 'anything goes' in political competition. And that license to indulge political fantasy is a cancer in the body politic

- CAMtwo

January 11, 2011 at 3:08pm

Given that, at ldeast to this layman, Loughner's classroom outbursts sound more like Tourette's syndrome than violent pshychosis I feel it is something of an exaggeration to assert that he obviously should have been committed. None of the faculty and administrators with whom he had contact had as complete a picture as has been gleaned over the past few days. Expecting non-medical personnel to make a determination of psychosis is unrealistic.

- dabowers

January 11, 2011 at 5:16pm

Strengthen gun control laws, anyone? That seems like a more direct and efficient way to deal with potentially violent mentally ill. I remember from high school drive ed that a permit to drive is a privilege, not a right. Likewise for guns. (Forget the 2nd Amendment for a moment.) Applicants for a gun license should be required to supply 3 references attesting to their maturity and emotional stability. Of course that won't be a perfect barrier to determined assassins, but it would likely have deterred Arthur Bremer and Jared Lee Loughner. Galston wrote, "the authorities at Pima Community College finally suspended him after five contacts with the police and conditioned his return on clearance from a mental health professional. Police delivered the letter of suspension to Loughner’s home and talked with him and his parents. We do not know what happened next." Surely, circumstances like that should have been a sufficient red flag to stop the sale of guns and ammunition to someone like Loughner. He wasn't just some oddball disliked by capricious authoritarians.

- amidut

January 11, 2011 at 10:41pm

yes, amidut, people who buy guns should be required to pass a written and skills test and carry insurance, just like they do for owning and driving a car. Since gun control laws are different in each state, and the Congress is so afraid of the NRA that they let the Clinton-era bans on semi- and automatic weapons lapse in 2004, I think not much will change. Galston's post is truly frightening. Perhaps he should go undercover, call 911 and threaten suicide, and then write about his experience ten days later, if he can recover from being force-fed the wrong meds by a chain of 'professionals' who will presume he is guilty of mental illness without any evidence except the suicide threat. Anyone else come from a family where "I'm going to kill myself" was standard dinner talk if anything went wrong that day? I believe it is a Polish-Jewish thing that means nothing except a way to vent frustration before doing the dishes:)

- K2K

January 12, 2011 at 9:43am

Great post--has drawn some excellent comments on both issues--access to handguns and access to "treatment". Both deserve serious attention, but shouldn't be conflated. Anyone who's required numerous interventions by public officials should be on the data bank as someone with an asterisk when the already-existing background checks for a firearm purchase are done. Not a panacea, but would help. On the larger issue of public health, we cannot afford to "treat" everyone who might seem weird, and only in an Orwellian nightmare would we try. But people with clearly identifiable, debilitating mental illness deserve better than being ignored or incarcerated as the only two alternatives.

- Robert Powell

January 12, 2011 at 1:04pm

This article is totally full of crap. How many people do you think we should lock up in order to prevent these random acts of violence? It seems to me that there is plenty of room for stronger regulation to keep guns out of the hands of killers. It also semms to me that the mental health system, as is, would have worked if people had responded as they should have when the shooter was obviously unstable. You can't lock up everyone who has psychatric symptoms, and you can't lock people up indefinitely because you think they might do something. And of course, if the country is really worried about more recurrences of the Gifford tragedy, people might try to tone themselves down and knock off the incitements to violence. But of course making these tough choices, like taking away maniacs' sacred gun rights, is more difficult than locking up annoying, strange, and harmless people that no one even cares about until something like the Arizona shootings focuses our tiny, simple minds. We should remember that 9/11 probably would not have occurred if people had done their jobs, but it was easier and less embarrassing to enact a lot of meaningless reforms (intelligence czar, homeland security), and go bomb everybody, than to hold the true culprits responsible. enact a lot of meaningless refors

- mlottman

January 14, 2011 at 6:15pm

In all innocence, I would like some information on the extent to which people who suffer from severe mental disorders that could result in irrational violent behavior, but whose disorders are remediable by medication, 1) get treatment and 2) maintain their dosages of the medications prescribed.

- lsernoff

January 15, 2011 at 10:52pm