A Dark Night

On July 20th, shortly after midnight, a 44 year old neuroscientist suffered a massive heart attack while driving down the freeway.  His car spun out of control, killing 12 innocent bystanders and wounding scores of others.

This didn’t actually happen (that I know of).  But I hope for the reader to take a moment and reflect on how they reacted to the above paragraph, and compare it to the paragraph below:

On July 20th, shortly after midnight, a 24 year old neuroscientist opened fire in a crowded theater.  Twelve people were killed, and scores of others were injured.

A very different reaction to that news, I would think.  Unfortunately, however, the second event did occur, and many innocent lives were lost as a result.

The reaction to the first paragraph is usually a feeling of remorse, and a reflection on the fragility and randomness of life and death; accompanied by a feeling of sympathy for all the victims (including the driver).  However, feelings about the second paragraph are more often going to be dominated by anger, blame, and sympathies for the victims (exclusive of the shooter).  Therein lies a major key to understanding this human tragedy.

In our society, mental and psychiatric illness is not treated in the same vein (no pun intended),or with the same degree of respect, as physical illness.  Despite countless years of research indicating the physiologic basis for psychiatric disease, the basic feeling remains that somehow the person suffering from the illness, whether it be depression, psychosis, neurosis, or any other manifestation, is to blame to some degree.

Gun control advocates have been quick to blame lax gun laws for the shooting, and they have been anxious to use this shooting to restart a national discussion about gun control.  I don’t disagree with them, or with the premise that our gun control laws are too lax in this country.  Unfortunately, while they are addressing an important issue, they are missing the true root of the problem.  The fact is that this man suffered from a severe psychiatric illness which hijacked his actions.  And the sad fact is that even if guns were illegal, his illness would have demanded of him that he either find a way to obtain them, or use whatever weapons were at his disposal (such as tear gas and explosives–which he did use) to wreak the havoc that he did.

Assuming news reports are correct, the man, James Holmes, considered himself to be the “Joker” from the second Batman film–a character who sees himself charged with a mission to expose society’s ills through the institution of anarchy.  The shooter’s methods, like the Joker’s, were deliberate, highly organized, and intelligent.  I am not a psychiatrist, but these characteristics are highly consistent with psychosis, likely schizophrenia.  It is unclear whether this was ever even diagnosed, much less treated.  In fact, when the suspect’s mother was called, her first words were “you have the right person.”  This intimates that the family was potentially aware of these tendencies, even if they were in denial.

I would contend that Mr. Holmes’ psychiatric disease was allowed to progress to this homicidal conclusion precisely due to our inability as a society to deal with it as a true medical illness.  The taboos associated with psychiatric disease of all variants are so strong and pervasive that patients are often unwilling to seek treatment, families remain in denial, and proper precautions and treatment are not undertaken.  Imagine the reaction among his peer circle or his employers if he told them he was taking medications to control schizophrenia, and compare that to the reaction they would have if he told them he was taking high blood pressure medication.  These social mores are a strong disincentive to seek treatment; and a lack of treatment is what leads so many psychiatric patients to end up at the end stage of their disease–gravely disabled, a danger to themselves, or a danger to others.  The end stage manifestations then reinforce the social taboo, and the vicious cycle continues.

What happened in Colorado is inexcusable, and I am not suggesting a lack of culpability on the part of the shooter by any means.  However, if we are to use this tragedy as a springboard to a social discussion, let’s make sure that we at least have the correct discussion.   I believe that as a society, we should grieve for all the victims of this heinous, preventable strategy, including for the young man whose brain was hijacked by a relentless disease.

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  1. Salima

     /  July 21, 2012

    Dear doctor, read your column. High blood pressure, heart disease, arthritis are all defined diseases. Who can accurately define depression or psychosis? Symptoms are sometimes hazy and therefore diagnosis is always” may be this or that.”. Mental illness is difficult to define and because of such obscurity it must be difficult to treat. A broken bone is easy to fix but a broken psych is extremely difficult to fix. Years of therapy and yet results are sometimes marginal. In this case seems like mother knew best and yet no action was taken.
    Denial of reality becomes a reality eventually. A movie can trigger such violence in people is unbelievable.

  2. Shk. Mazher motiwala

     /  July 22, 2012

    Frost m foremost the man who did this must be be headed or shot to death, irrespective .should b advertiSedT. Mazher

  3. Shk. Mazher motiwala

     /  July 22, 2012

    Do not waste money on court trials ect. But spend for solutions, what to do in future . punishment is given so that to creat fear in the minds of people so should not do in future.

  4. One of my friends from internship is a psychiatrist in the Bay Area. Our discussions were an impetus to write this. He sent me his comments privately, but I will post them here publicly (but anonymously) for posterity’s sake:

    Just read your post.
    empathy and fostering removal of stigma are worthy points.
    and i always enjoy your writing.

    take care

    my thoughts (unedited)

    the situation is far more complex:
    1. 26 yr old neuroscientist killed 12 in car accident after having seizure despite refusing to take seizure medications due to side effects, pick any other medical illness where the individual fails to take full responsibility and others are hurt. or even a smoker who develops cad and costs tax payers money or raised my premiums for that matter
    2. the tricky part of mental illness is also that many psychotic symptoms result in lack of insight not just shame or side effects that prevent rx
    3. associating violence with mental illness is also a disservice (though ironicaly can improve funding streams for public mental health), most violence is done by those without a ‘true’ psychiatric diagnosis
    4. often when psychosis is associatd with violence, comorbid drug/etoh abuse is involved
    5. the sick role, which allows for behavior to be explained, forgiven or punnishment lessened, is a social construct not medical. i beleive that many people with schizophrenia who hurt others are too impaired to tell right from wrong, but sociopaths- who are just ‘evil’ in the traditional sense, are likely to have biological explanations for behavior but should not receive any societal protection visa vis the sick role. then there are those who are both psychotic and antisocial, or have borderline or narcissitic personaltiy disorders. or perhaps a college football coach with depedent personality disorder. i guess my point is that just having a biological basis and abarant behavior does not make one

  5. Another friend, a clinical psychologist, had this to say:

    Great blog! Psychotic disorders are often overlooked in these cases and gun control and profiles of such disturbed people become the hype. What’s even more discounted are personality disorders and psychopathy. Ted Bundy and John Wayne Gacy were not psychotic, they were psychopaths. But most people don’t want to believe that a “normal” law student or person who spent his free time at childrens hospitals as a clown are capable of such heinous crimes. I find it interesting that society would rather focus on what we think we can control. Take down paterno’s statue as a way to divert are attention from the fact that sanduskys not only exist, but we trust them with our children. It almost seems like mental illness is a new discovery. 

  6. Jake Meffley (Sr.)

     /  August 7, 2012

    Looking beyond the obvious is looking for answers that will have lasting consequences. What dialogue should have occurred after 911? Instead of looking for the “enemy” to punish, might we have talked about the differences between peoples, cultures, and religions that could spawn such violence? Couldn’t Americans have looked within, both the country as a whole and within each individual, to determine how to proceed peacefully to better understand what had occurred?

  7. Taher

     /  August 24, 2012

    Aamer, thank you for your thoughtful post. I don’t mean to pick on your writing, but I take an issue with one very subtle phrase you used. “…Mr. Holmes’ psychiatric disease was allowed…”, Whether intentionally or unconsciously, your post implies, at least in my interpretation, that someone other than James Holmes is at fault. A physician? A parent? or anyone else?

    I think the spirit of your post is to have the ‘right’ discussion that results from a tragedy like this. I agree that the right discussion is not a gun control one. I am pro gun control, but I have seen some compelling data that suggests gun control is not causal to decreased gun violence.

    I am not a medical professional, but I also don’t think the ‘right’ discussion is about a stigma around mental illness vs physical.

    I would argue that the underlying assumption that responsibility lies elsewhere is flawed and distracts from the discussion. I pose another hypothetical – a 26 year old causes a several car accident killing 11 innocent bystanders caused by texting while driving. Does this evoke a different reaction than your hypothetical or the very real tragedy in CO? Should it?

  8. Shk. Mazher motiwala

     /  October 18, 2012

    He did not kill be he got an attack n this happened .act of Allah

  1. License to Kill « Notes From The Heart

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