Everyone’s in shock and disbelief about this Loughner fitness issue. 

The Huffington Post has this Op piece from Rep. Slaughter.  She writes:  

“Yet, despite the belief that Mr. Loughner could be a danger to himself and others, our federal laws, and our mental health system, were unable to live up to the commonsense belief that those who are mentally ill should not be able to purchase and own a gun.”

This is the type of simplistic comment, used to spurn outrage for political support (her follow me on twitter link is practically the piece’s conclusion), that it irks the crap out of me. This issue puts the mental health practitioner at the intersection of constitutional law, violence prediction, patient privacy, and the dicey situation of defining “mental illness” altogether. It is also such a straw man: who exactly is the person that is pro-Loughner?

I’d offer a bet that few physicians decide to become a psychiatrist because they are looking to protect the public from mass murder, or because they are looking to restrict a person’s freedoms. The Secret Service or local police force is far more likely to see such candidates. We generally go into a mental health field to help people overcome mental illness.

The media loves to alternately portray mental health practitioners as oracles, able to pinpoint the future dangerous decades out, and lazy hippies (or overpaid charlatans or gun-right-protecting idiots), who would rather innocent victims continue to fall than do something.

My take is simply this:

We can not predict the distant future, and are often bad at predicting whether someone will enter into a dangerous state even within days to weeks.

When we can predict dangerousness, it’s because very dangerous people will continue to be very dangerous; never dangerous people are unlikely to become dangerous; and, while close monitoring and follow-up treatment is the best option for those in between, in a system of non-socialized healthcare, monitoring is not only voluntary but must be paid for by persons who lack insight into its necessity at best, or are paranoid of all others at worst. 

It also goes without saying that anyone interested in the safety of others would restrict access to all weapons (and all substances, including alcohol, which reduce inhibitory tone). That said, who’s got time to start showing up in court to discuss which who deserves to be able to shoot someone when scared and who doesn’t? I’d vote neither, except as psychiatrists, we also hate to see our patients stigmatized when it comes to rights (i.e., reproductive, voting, marriage, holding office, holding a job, etc.)

[On a side note, one in three substance abusers will be violent in the next year while of those with strict schizophrenia, it’s around one in six.  What if you look at substance abusing persons with schizophrenia?  Back to one in three.  To me, this means that alcohol and other substances pretty much level the playing field when it comes to mental illness-dangerousness discussions.  An alcohol-dangerousness discussion is far more important!]

However, to totally undo everything above, Paul Appelbaum once astutely observed that funding for mental health always gets a boost after a violent incident.  So, if this press coverage gets more attention to the needs of the chronically ill, and a few more people get helped, isn’t that a good thing?

Sort of?

Rep. Louise Slaughter: Unfit to Stand Trial, Yet Fit to Have a Gun