Essays January 2011

Listening to Jared Loughner

Mary Seeman and Neil Seeman

When faced with danger, and Jared Loughner represented danger, the natural human reaction is to either fight or flee. Fighting would have meant wrestling him to the ground when he was obstreperous at Pima Community College and dragging him kicking and screaming to the nearest mental health facility.

Many prominent commentators say the College administrators who dismissed Jared Loughner last spring should have brought him to the attention of mental health authorities. Would this have averted the tragedy in Tuscon? Likely not.

Laws in every jurisdiction are somewhat different but administrators generally have five options to bring someone like Mr. Loughner to the attention of mental health professionals.

First, they could have persuaded him to see a psychiatrist. They tried to do this and the attempt was unsuccessful.

Second, they could have called the police to accompany him against his will to a mental health facility for examination. The police could only have done so if they witnessed disruptive behavior (shouting, throwing things around, running about in an agitated manner). There is nothing in the reports that suggests that this would have been so.

Third, they could have contacted Mr. Loughner’s parents to persuade them to bring him to psychiatric attention. Strictly speaking, they could not have done this without Mr. Loughner’s permission but, in an emergency, this might have been possible. It is unclear whether they did this, or how Mr. Loughner’s parents would have responded. They might have shared Mr. Loughner’s views about the College and ignored their advice, they might have been too afraid of their son to do anything about it or they might have followed through with an attempt to either persuade their son to seek medical attention or have gone to a Justice of the Peace to ask for a mental health assessment.

Fourth, the College administrators themselves could have sought out a Justice of the Peace, presented their evidence of mental illness and potential violence and asked for a police escort to bring Mr. Loughner for mental health examination. Depending on the Justice of the Peace, this request may or may not have been granted. There would be more chance of having it granted if the request came from the parents and if there were solid evidence of a threat to safety – Mr. Loughner’s own or that of others.

Fifth, the administrators could have called in a physician to examine Mr. Loughner and to fill out a form that would have allowed him to be legally brought to hospital for mental health examination even against his will. Mr. Loughner probably would not have co-operated with such an examination but, perhaps, there would have been enough evidence of mental illness and potential violence to warrant signing such a form.

As a result of any of these options, it is possible that Mr. Loughner would have been brought to a mental health facility and examined. The examining psychiatrist, in order to detain him in hospital for a maximum, in most jurisdictions, of 72 hours, would have had to be convinced that Mr. Loughner suffered from a mental illness. This would not have been difficult since there were evident signs, as reported in the news media, of a profound disorder of thought. But the psychiatrist would also have needed to be convinced of a danger to safety. Mr. Loughner would have been asked about possessing firearms. At that point he probably did not have any. Ascertaining a threat to safety would have been problematic and Mr. Loughner might have been released home unless he voluntarily wanted to stay.

If the psychiatrist were convinced that there was a safety threat, Mr. Loughner would have had access to a lawyer and 72 hours to show that he was not dangerous. At the end of that time, he would have had to be released unless there were signs of potential violence, in which case he could have been detained for a further two weeks (a period varying from jurisdiction to jurisdiction). During that window he could not have been treated unless he consented. If he did not consent and was found to be competent (understanding that he was ill, understanding the pros and cons of treatment), no treatment could be administered. If he were found incompetent (not understanding that he was ill for instance), surrogate consent (through one of his parents) would have been sought. His mother or father, as surrogates, would have needed to consent to treatment or not as they thought their son would want them to were he competent. This would have been a difficult decision for the parents.

Chances are Mr. Loughner would have left hospital sooner or later untreated. Even if treated, there is no guarantee he would have continued treatment. Many people suffering from serious mental illness, once they are treated and realize they have been ill, will continue their treatment and do well. However, had he been released without treatment or had he discontinued treatment, his first target during a psychotic rage would have been the College that tried to obtain treatment for him. Perhaps, then, the College administrators thought all this through and made a rational decision.

Taking any of the five options as described here would have been akin to the “fight” reaction to danger but the College decided instead to take the “flight” option or, more precisely, to ask him to leave. Could the College administrators have done anything different? Another response to a dangerous individual, one less natural for most of us, would be neither to fight or flee but to “tend and befriend”. Listening to Mr. Loughner, hearing him out, taking an interest in his preoccupations, staying friends despite his seeming irrationality, might have worked. He pushed people away, but he might have been willing to confide in a friend. He might have been willing to go along if a friend accompanied him to a mental health appointment. Tragically, we’ll never know, but the offer of friendship is a safer bet than either ostracism or straitjackets.

About the Author

Mary Seeman, OC, MD is professor emerita of psychiatry at the University of Toronto. Neil Seeman is Director of the Health Strategy Innovation Cell at Massey College.

 


Comments

Alexander Franklin wrote:

Posted 2011/01/25 at 10:13 PM EST

"Institutional Neurosis" by Late Rochester State Hosp Director Dr. Russell BARTON a UK Psychiatrist whose 1959 monograph changed
World psychiatry causing mental hospital closures.

 

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