By Gault, Barry
Commonweal , Vol. 138, No. 4
"I have a Glock 9 millimeter, and I'm a pretty good shot," Congresswoman Gabrielle Giffords (D-Ariz.) told the New York Times last year. Alas, so did, and was, a deranged fellow Arizonan named Jared L. Loughner. Just what the congresswoman hoped to accomplish with her semiautomatic pistol--beyond showing her support for an individual right to bear arms--is unclear. But Loughner's intentions were made horrifically clear in the mass shooting in Tucson last month.
Several among those killed had government connections, as is frequently the case when lunatics start shooting. It's difficult to imagine what insane animus Loughner bore his other victims, including a nine-year-old girl. The available information suggests that he was troubled for quite some time before becoming psychotic in 2010. His behavior then became so eerie that fellow students and a teacher at Pima Community College were seriously afraid of him. He was expelled and informed that a "mental-health clearance" was required before he could return. News accounts to date, however, make no mention of any effort to accomplish such an evaluation.
It's unsurprising that responses to the tragedy have included calls for a more authoritarian approach to psychiatric patients. Some commentators don't believe we need simply more custodial care of the severely mentally ill and more scrupulous implementation of existing laws and guidelines, but a rewrite of the relevant statutes with probable implications for constitutional law. "We need legal reform," exhorts the political philosopher William Galston in an article on "involuntary commitment" at the New Republic's Web site (January 11). "Those who acquire credible evidence of an individual's mental disturbance should be required to report it to both law enforcement authorities and the courts, and the legal jeopardy for failing to do so should be tough enough to ensure compliance." Give us a break, Mr. Galston. At least 1 percent of the American population suffers from a major mental illness. What are the police and the courts supposed to do with those 3 million reports?
For over forty years as a practitioner and as chief of psychiatry at a large community hospital, I've been acquiring very credible evidence of people's mental disturbance pretty much every day. Triage clinicians are called to the emergency department round the clock to evaluate psychotic cases, and the large group practice I belong to sees one hundred new patients every month. But so many patients certainly would not seek us out if we ran tattling to the police every time an irrational person said something menacing.
When we do sense imminent violence, however, the law poses no problems. I don't know about Arizona, but in Massachusetts virtually any psychologist or psychiatrist seeking to restrain a dangerous person just completes a simple form known colloquially as a "pink paper," and faxes it to the police. They transport the patient to a hospital where he can be held for at least three days on the admitting doctor's say-so. During that time, if the patient continues to be adjudged dangerous, the hospital requests a commitment hearing. The patient is then detained for as long as it takes--never less than a week--and provided with a lawyer. A judge is brought to the hospital. At that point the patient's right to due process is honored.
The system for dealing with violent patients is fraught with problems, but not because of the law. It is nonviolent patients and their families who suffer most from the libertarian tenor of the laws on involuntary treatment that concern Galston.
The great obstacle to proper involuntary treatment of the violent is that nobody wants these patients. Would you? They are uncooperative, devious, hostile, almost always frightening, and often dangerous to other patients and to staff. And of course they're typically uninsured. The director of any inpatient unit to which too many of them are admitted will soon seek another line of work. …