When Chris Harper Mercer went on his murderous rampage on the Umqua College campus in Roseburg, Oregon, it was more than just a killing carried out in high dudgeon, it was iterating a scenario that has become all too familiar in America.
Just weeks prior to this, Vester Lee Flanagan (AKA Bryce Williams), a troubled man with a turbulent employment history, shot a television reporter and a cameraman in the midst of a live interview in Bedford, Virginia. And in the preceding month, Vincente Montano, a 29 year-old man with a documented history of mental illness, entered a movie theater in Nashville, Tennessee with a pellet gun, hatchet and can of mace intending to hurt people. The week before that, John Russell Houser went on a shooting spree in a Lafayette Louisiana movie theater killing three people and wounding eight others.
This series of events follows a litany of similar mass killings committed in recent years that are too numerous to name; think Seung Hui-Cho at Virginia Tech, Jared Loughner in Tuscon Arizona, Aaron Alexis in the Washington D.C. Navy Yard, Adam Lanza in a Newtown Connecticut to mention some of the more heinous and notable.
What all of these wanton attacks, call to mind is the movie Ground Hog Day. Like Bill Murray’s character in the 1993 film “Groundhog Day,” America seems to be experiencing the same events over and over again. But unlike the movie in which the misanthropic weatherman, played by Murray, experiences the events of the eponymous annual winter holiday over and over again, in our macabre scenario, a person, usually male, commits a shocking act of violence with a gun, targeting multiple innocent victims and, sometimes, family members. In most cases, the assailant seems to have no rational motive and often posts an angry trail of messages on the internet.
The setting for this violence could be a school, college campus, movie theater, shopping mall, street corner or government facility. We then learn that the perpetrator has had a troubled past in which they exhibited bizarre and disruptive behavior, and frequently a history of diagnosed but untreated mental illness. The media and public erupt in outrage but after the chest thumping and soul searching, the requisite question “why” is asked along with calls for action to prevent such events in the future. Government officials then solemnly weigh in with sanctimonious platitudes and eventually the argument devolves into narrow and tangentially related partisan issues mostly focused on gun control in which no consensus is ever reached and nothing is done.
Mass violent incidents are part of the glaring array of social pathologies, along with mentally ill homeless persons and prisoners, which emanate from our country’s failed mental health care policy and system (disturbingly documented in E. Fuller Torrey’s expose American Psychosis Oxford University Press 2013). We find it tragically lamentable that our society still cannot connect the dots and take effective action. The vast majority of these tragedies are preventable. We must and can do more to deliver better mental health care to people. This means recognizing troubled people, and providing them with effective treatment.
A key strategy in this regard is identifying mental illness early and intervening before the person’s symptoms become full blown and disrupt their lives and society. One way to do this is to embed mental health professionals in emergency rooms and primary care settings. Since many mental disorders begin in adolescence, another approach is to train school personnel and guidance counselors in what to what to look for in students and provide them with screening instruments and referral sources for mental health care.
In addition, we must make comprehensive mental health services available to people at all stages of their life but particularly for youth as this is when the seeds of mental illness are sown and the first signs emerge. For people with diagnosed mental illness, the key is to provide effective care and maintain engagement so they don’t drop out of treatment and fall through the cracks. This includes medical management, psychoeducation, psychotherapy, rehabilitation services and supervised residential facilities. Because many chronic mental patients have problems with substance abuse and lack good primary medical care, such services should be co-located with their mental health care. This is simply good disease management as is required in non-psychiatric conditions like hypertension and diabetes, which use medication, education, diet and exercise to control the illness.
In many instances mentally disturbed people lack awareness of their illness (a condition called anosognosia). Consequently, they are unwilling to accept treatment. Almost every mentally ill perpetrator of mass violence had been symptomatic and untreated for lengthy periods of time prior to their crime either because they (or their families) did not seek treatment or they refused it. Statutory mechanisms like Assisted Outpatient Treatment have been enacted in 45 states. They enable doctors to obtain a court order that requires patients deemed dangerous to accept treatment. However, these legal mechanisms are controversial, and only infrequently used despite their proven effectiveness in reducing violent incidents and hospital readmissions of patients.
We are understandably reluctant to infringe on a person’s civil rights by forcing them to accept treatment, even though we do just that for communicable infectious diseases such as tuberculosis and sexually transmitted diseases, as they are considered a threat to the community. But we must start using the provisions of this law to be able to treat patients in need, over their objections if necessary. This more aggressive strategy would only apply to a small number of people who have predominantly psychotic disorders, and known risk factors for violence, such as drug abuse, homelessness and past history of violent behavior.
The good news is that these strategies have been proven highly effective and really work. The bad news is they have not been widely applied.
Albert Einstein stated that, “the definition of insanity is doing the same thing over and over again and expecting a different result.” Our society needs to act rationally if it wants to stop the violence caused by those among us who are unable to do so due to their mental illness. Otherwise, like Bill Murray in Ground Hog Day, we will repeatedly be reliving these tragic events.
Jeffrey Lieberman is Professor and Chair of Psychiatry at Columbia University and New York Presbyterian Hospital, past President of the American Psychiatric Association and the author of Shrinks, The Untold Story of Psychiatry (Little, Brown and Company, March 2015).
About the Author/s
Dr. Jeffrey A. Lieberman, a globally acclaimed psychiatrist and bestselling author, spearheaded groundbreaking research into the neurobiology and pharmacology of behavioral brain disorders. His work has significantly advanced our comprehension and treatment of mental health issues, particularly offering a transformative approach for early detection and prevention of schizophrenia. Dr. Lieberman has garnered accolades such as the Lieber Prize for Schizophrenia Research, the Adolf Meyer Award from the American Psychiatric Association, and the Research Award from the National Alliance of Mental Illness. As a vocal advocate for mental health, he has played a key role in shaping healthcare policies and federal legislation to enhance mental health care accessibility, quality, and diminish stigma. Notable publications include "Malady of the Mind: Schizophrenia and the Path to Prevention" and "Shrinks: The Untold Story of Psychiatry," the basis for the PBS series, "Mysteries of Mental Illness."