Bush’s Mental Health Madness.

John Sorboro MD

It has been obvious for quite a while to many who remain chronically crestfallen over the state of American politics that George W. Bush is not a particularly strong adherent of certain libertarian principles. Oh sure, the rabid, ultra lib Move On.org crowd thinks he is the spawn of some unholy union between Barry Goldwater and Ayn Rand with perhaps a little Stalin thrown in but we know better. It’s not hard to point out his big government foibles like the bloated Medicare drug plan and the biggest expansion of federal spending on education in decades. One that has gotten a lot less press among conservatives but has at least a few gnashing their teeth including me is his policy on mental health.

Soon after 32 innocent people were gunned down by a loner sociopath at Virginia Tech, GWB responded by announcing he was going to send clueless bureaucrats around the country to meet with an equally clueless band of educators, mental health experts and state and local officials in hopes they can tell him how to prevent violence by dangerously unstable people. After they are done perhaps they will meet with magicians nationwide in an effort to develop a plan to make the national debt disappear.

Almost immediately after the shootings folks everywhere began asking why and how such a thing could be prevented again as we always do after a school or workplace shooting. This is not a bad question to ask, it’s just not one that is easy at all to answer. The first responses were from the gun control advocates. "Just get all the guns out of people’s hands and this would never happen. In a perfect marshmallow world yes but not surprisingly, President Bush an avid supporter of 2nd amendment rights has stayed clear of any discussion of gun restrictions as a response to the Virginia Tech shootings.

Also not surprising given his tract record on mental health issues is his attempt to fall back on the myth of the usefulness of psychiatric practitioners as a tool for effectively screening and segregating those who will commit such crimes. (President Bush’s New Freedom Initiative calls for the screening of the entire US population. The fact that it can arguably be seen as little more than a customer fishing expedition for big pharma is another issue.)

At first glance it would appear as a completely sensible thing to do. What could be wrong with getting some expert opinions on how to identify those people who will commit violent acts before they actually commit them in an effort to intervene before someone gets hurt or killed? What reasonable person could be against such an approach? The problem with all of this is that your average person on the street is every bit as good at actually predicting such violent behavior as the best psychiatric expert.

Cho Seung-Hui is not someone who slipped through the psychiatric fence. On separate occasions he was involuntarily hospitalized, sent for psychological evaluation, and referred to the university counseling center. In December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found "his insight and judgment are normal." Some have seen this as a failure of psychiatry to respond in an appropriate and forceful way and that if Cho had been coerced into treatment and perhaps the taking of medication this would have never happened.

This failure is indeed a reflection of the failure of psychiatry to effectively deal with such an individual. Not because it did not in this particular instance but rather because it can never do so. Mental health interventions to determine future propensity for violence do not protect society because mental health professionals as a group have no particular capacity to make such determinations. Such determinations rely on the ability of the evaluator to know the state of mind of a detained individual, arbitrarily decide if his or hers expressed belief system is secondary to a mental illness and than predict how they will act based on it. There is no objective way of doing such a thing.

The English Royal College of Psychiatrists published a study in February 2007' on the science of risk assessment and the prediction of violent behaviors in those labeled as having Schizophrenia. The report estimated that for every homicide accurately predicted there would be over 3300 false positive reports. I wonder if President Bush would support 3300 involuntary detentions in order to protect one individual. I suspect if he were presented with such odds he would see it as an unacceptable cost of our civil liberties as most people would.

There are lots of holes in the practice of psychiatry. Re-branding individuals is at its core. Homosexuality was a disorder until the mid 1970’s but it got voted out of the psychiatric illness handbook the DSM. Now the American Psychiatric Association has a consensus statement in support of gay marriage. The incidence of Bipolar Disorder has risen from .1% at the turn of the 20th century to 5% at the present time. These changes have nothing to do with any real definitive science or specific tests that can effectively demonstrate who has a disorder. It’s little more than psychiatry repackaging people with different labels. Who gets what label has a lot more to do with politics and the economics of psychiatry than it does with any true understanding of the developmental or biologic underpinnings of specific behavior let alone whether we choose to see "different" as "disordered". This is why a group of young Muslims who murder 3000 people in the belief that Allah will reward their martyrdom with scores of willing virgins in the afterlife are labeled political and religious zealots but John Hinckley who shoots Ronald Reagan gets to be mentally ill and is entitled to weekend’s home with his folks.

In some ways psychiatry is a bit like Quantum Mechanics in its relation to specific sub-atomic particles. Broad predictions can be made but not specific ones about individual people and what and when they will do things. Rage filled, disconnected young men who abuse drugs and alcohol and who have committed past violent acts are the most likely to commit violence. Mental Health practitioners can offer little more than such generalities in regards to making predictions. Turning to them to make arbitrary distinctions of who should and should not be deprived of their civil liberties on a chronic basis in an effort to protect ourselves from the likes of Cho is foolhardy and dangerous in a society that reveres freedom. Mental health treatment may be helpful for those who willingly pursue it but like other types of healthcare, those who participate should be well informed and do so of their own free will. As seductive as the idea may seem, there is no evidence that forcing individuals into psychiatric treatment based on nothing more than the hunch of a psychiatrist is an accurate means of singling out the likes of Cho or a way of preventing what occurred at Virginia Tech.

Republicans should be embarrassed that they have a sitting president who perpetuates the myth that psychiatry can prevent such tragedies through coercion and encourages us all to pay the price for their attempts.