From Littleton to Washington

Two weekends ago, Andrew Solomon, the writer and author of The New York Times best-selling book, The Noonday Demon: An Atlas of Depression, took a podium at the National Book Festival.
Solomon had narrated his own devastating struggle with depression in The Noonday Demon and had now chronicled the struggles of parents whose children were very different than them in his latest book, Far From the Tree. In the book, Solomon examines those who are deaf, dwarfs, prodigies, those with Downs Syndrome, schizophrenia, autism and other conditions that are both considered illnesses and identities.
In one section of the book and in his speech, Solomon discusses children who commit crime and asks Susan Klebold, the mother of Dylan Klebold, one of the teenage perpetrators of the Columbine High School massacre, what she would tell her son if she had the chance to have one more conversation with him.
Solomon said that Susan looked down at the floor before saying, “I would ask him to forgive me, for being his mother and never knowing what was going on inside his head, for not being able to help him, for not being the person that he could confide in.” She later added, “I’ve had thousands of dreams about Dylan where I am talking to him and trying to get him to tell me how he feels. I dreamed that I was getting him ready for bed and I lifted up his shirt, and he was covered with cuts. And he was in all this pain and I did not see it; it was hidden.”
And so are many tragedies of the mind.
Unlike a leg or an arm or a foot or a hand, a mental wound often remains hidden, often hidden until it’s too late to do anything.
The tragedy of these illnesses are that they, like any other illness, become worse over time, the longer they are not treated. They become worse with self-medication, avolition and inaction.
So when we hear that voice that calls out for help, we should heed that call in a set of illnesses that are not as obvious as others but are equally devastating.
And that is what did not happen on Wednesday, August 7.

On that day, in Newport, R.I., Aaron Alexis, 34, a civilian contractor with the United States Navy, called the police from a Marriott, according to The Washington Post.  He told the police that three people were following him, sending microwave signals through the walls, making his skin vibrated and preventing him from getting any sleep. He told the police that he had changed hotels to get away from the men, the voices and the radiation.  

You do not need to be a psychiatrist, or even an emergency medical technician, to know that delusions, plus paranoia, plus physical hallucinations, plus auditory hallucinations equals some type of psychotic break, a most likely schizophrenia. In any rational world, this is a clear cry for help from a panicked psychotic man.
What did happen?
Instead of being taken to the nearest hospital, the police told, this obviously psychotic man, to “stay away from the individuals who are following him.” Then, they left.
Forty days later, he was at the Washington Navy Yard. He opened fire, killing twelve.
I can’t imagine what forty days of delusions, paranoia and constant voices will do to a man’s mind. But we most likely saw one of the potential results in blood that day. And it saddens me that it was likely preventable.
Just as cancer researchers spend billions of dollars a year on finding a cure while only a fraction of that is spent on changing behaviors that contribute the 62 percent of cancers that are preventable, sometimes we do not intelligently distribute our force.
There is no question that guns, bombs, knives and nunchucks are a part of the problem. There is also no question that people with major mental health disorders – excluding the personality disorders – are less likely to carry out an act of violence than those in the general population. But there is also no question when serious mental illness meets with violence, the results are often spectacular destruction.  
Sandy Hook. Auroa. Littleton. Blacksburg. Tucson. Now, Washington.
It feels like it is time for a new conversation about mental health and it’s an unpleasant one. Charles Krauthammer, the writer and non-practicing psychiatrist who made breakthroughs in the research of mania, wrote, in a powerful column last month, on the Navy Yard shooting saying that we should pause when we hear stories of individuals crying out for help in mental health crisis. He also said that we should have a debate about involuntary commitment to psychiatric facilities.
As someone who is involved in that process, I recognize that it can be hard under some circumstances to get someone involuntarily committed. More often than not, it’s merely a lack of knowledge or will, or the presence of laziness, that get in the way of commitments. In some ways, if you know the magic words and are willing to push the limits, it might actually be a little too easy to get someone committed. In Virginia, at least, I don’t feel the problem is so much the tool as how it is so ineffectively utilized.
So, I would put the focus somewhere else. My next temptation is to take a look at policing. I am happy to work  in a part of the country, Fairfax County, Virginia, where officers are much better trained when it comes to working with the mentally ill. I can’t imagine it happening in the areas around my offices in Centreville and McLean. I’ve worked with the officers there to make sure friends were safe and I’ve worked with them to make sure my clients and clients of others were as well. Several weeks ago, two officers spent three hours in our waiting room talking to a paranoid schizophrenic woman who was presenting with symptoms in order to assist me in coaxing her to take her medication and going to the hospital. It was impressive. My esteem extends to the federal police in the area. I’ll never forget the family that told me about how the CIA special police officers had brought their paranoid and delusion son to get mental health care several times when he showed up over-and-over again at their headquarters.  I know it’s not perfect, and I know there are some places where the training officers receive is deplorable. The Navy Yard case is a good argument for Crisis Intervention Training.
I have little doubt that if Alexis had been in Centreville, as opposed to Newport, R.I., he would have been well into a hospital stay at the time of the shooting and would probably be recovering from his paranoia and delusions.
The police in Newport, R.I. become a part of the ones who missed the signals or were hamstrung by the system. Hindsight is 20-20, but it’s no less painful, regardless of your position, to be the one who missed the single. Ask Susan Klebold. Ask the police officers who took the report from Dr. Lynne Fenton, the psychiatrist of the shooter who killed many at the movie theater in Auroa, Colo. As Dr. Fenton. Ask the teachers at Westfield High School who taught Seung Cho, the shooter in the Virginia Tech shootings in 2007, one of whom was my mother.
As someone who has coached many students who were at Virginia Tech during Cho’s shootings, I don’t want to see many more victims – whether they are the dead, the injured, the witnesses, the shooters, the police or the mothers.

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