Monday, January 17, 2011

Crazy in Tucson

How inconvenient for the pious revisionists wagging their fingers and tongues at those who see an obvious link between violent political rhetoric and the attempted assassination last week of Rep. Gabrielle Giffords. How inconvenient that Ms. Giffords herself drew that link between hate-agitation and potential violence.

All week, sentinels of Approved Wisdom have been at it, trying to crank the mighty narrative machine to the safe position that the Tucson shootings were solely the work of a lunatic, nothing more. After all, goes the claim, there is no direct evidence that this Jared Loughner, who everybody agrees is crazy, acted in any way that indicated political motivation.

Uh, except that with premeditation, he shot in the head a United States congresswoman who has long been the target of nasty, vile hate directed at her by national, and less often local, elements of this amorphous Tea Party movement.

But again, how inconvenient to this argument that Gabby Giffords, who happens to be my congresswoman, herself had expressed grave concern about the barely disguised violent threats being made against Democratic congressional candidates, not just herself but many others, during the last election campaign.

I'm referring partly to the infamous online political ads backed by the invincibly awful Sarah Palin, a woman who imbues the old-fashioned word "grifter" with new vitality. The most notorious of these ads appeared last March and depicted a map of the United States with bulls-eyes imposed over those congressional districts that the most rabid elements of the Tea Party had deemed, with Palin acquiescence, to be metaphorical targets. Accompanying this particular Palin abomination was her battle-cry "Reload!"

Now, no one has ever accused Gabby Giffords of being a sissy. No one has ever accused her of being a gun-hater, either.

In fact, Giffords owns and knows how to use a Glock semiautomatic pistol, just like the one Jared Loughner used on his Tucson rampage to shoot her in the head, kill six people and wound a dozen others. Giffords is a well-known supporter of gun-ownership rights. But she was also sufficiently motivated by the vile Palin ad, in an atmosphere of very nasty vitriol, to express her concern in an interview with MSNBC during the campaign.

The Palin ad, Giffords noted, put "the crosshairs of a gun-sight over our district." Those who do things like this, or who talk like the awful Sharron Angle, the Nevada senate candidate who referred merrily to seeking "Second Amendment remedies" when civil politics fail, "they've got to realize there's consequences to that action," Giffords said.

Yes, yes, there were. As we saw in Tucson.

Around the same time Gabby Giffords was discussing the gun-sights on her, someone shattered a window in her campaign headquarters in the dead of night.

It is of course clear to everyone that the young man who shot Gabby Giffords and those 18 other people in Tucson is crazy. The act was, by its very definition, crazy. I do not require the consensus of a blue-ribbon panel of learned psychiatrists to confirm for me that this Loughner is an obvious, violent paranoid schizophrenic. After all, we have been this way before.

Crazy people by definition do crazy things. But when a lunatic, acting out on a premeditated plan that is rational by definition, tries to assassinate a political candidate in an intense atmosphere of reckless political hate-rhetoric directed against that candidate -- that connection, to me, is not disputable.

Take Lee Harvey Oswald. To this day, there is no direct evidence that Oswald acted out politically when he decided to assassinate President Kennedy. Yet he did act (and conspiracy theorists aside, we know for a fact that Oswald had that rifle, that he took that rifle to the Texas Book Depository, that he hid on the 6th floor of that building, that he fired that rifle at the presidential motorcade passing below) in an atmosphere in Dallas of virulent, violent anti-Kennedy hatred. That hatred was assiduously fanned by right-wing nut jobs, the most prominent of whom was the crackpot oil billionaire H.L. Hunt. So nasty was the atmosphere in Dallas back then that Kennedy was warned, including by people like Adlai Stevenson, not to go there that day.

Yet he did, and he was shot to death.

When I heard of the shootings in Tuscon, I rushed over to the Giffords campaign office on the busy corner of Pima and Swan in central (not downtown) Tucson. This is the office where the window-smashing (or shooting, the police aren't sure) vandalism had occurred during the heat of the campaign last March.

Within an hour after the shootings, about 50 Giffords supporters, many of whom knew her personally and had volunteered in her campaigns, were gathered quietly on the corner in front of the office. Out back in the parking lot, some listened tearfully to conflicting reports blaring from NPR on a car radio about whether Giffords was dead or not.

During the campaign and even afterward, they told me, noisy political-opposition demonstrations were regular occurrences there on Saturdays. The Giffords district office is about a block south of the modest condominium complex where Giffords lives when she is in town, which was nearly every weekend. Typically, I was told, hundreds of Tea Party anti-Giffords demonstrators gathered on Saturdays on three of the four corners of the intersection of Pima and Swan, and a much smaller group of supporters usually gathered on the fourth corner.

This being Tucson, a city of enormous civility, the Tea Party demonstrations were usually lower-key than some Tea Party mob scenes elsewhere. But some ugly signs with clearly violent messages were often on display, and ugly chants were common. (Local Tea Party people, who also tend to be civil, lay this bad behavior to out-of-towners, incidentally, and I don't doubt them on that).

One recurring theme was the depiction of Giffords, an indomitably cheerful, pretty young woman who was widely liked in her district even by people who wouldn't vote for her, as a witch flying away on a broomstick. One sign that especially bothered the Giffords supporters showed a silhouette of a witch with the message: "Gabby: One Way Or Another, You're Gone."

This was the crazy atmosphere in which a crazy person began the descent that would lead him to act, with clear intent, to assassinate Congresswoman Giffords.

Surely, mental-health spending must be increased. But not so fast. Let's give that one some rational thought about just where that spending is going, because it sure as hell hasn't been going into protecting society from the likes of Loughner.

At the vigil outside the Giffords office on the day of the shooting I noticed one more thing. Within hours of the shooting, a small contingent of Red Cross mental-health crisis workers arrived. They were there, one of them told me, "to assist the emotionally wounded."

Now, I spoke with most of the people on the corner that Saturday and the next day as well, and while all of them were shocked and horrified and sad, none of them described themselves as being in need of mental-health intervention.

And there's a rub.

In 1994, a book of mine was published by St. Martin's Press, "Bedlam: Greed, Profiteering and Fraud in a Mental Health System Gone Crazy." The book has long been out of print.

Bedlam was written at a time when for-profit corporations had been rapaciously pillaging the mental-health insurance system, because a large amount of insurance money had become available for the treatment of "mental disorders," as defined by the growing psychiatric and addiction industries. Despite its myriad deficiencies, Bedlam did trenchantly describe how this system worked.

Back in the 1960s and 1970s, hugely expensive state hospital mental asylums were closed, and their patients released onto the streets, in a phenomenon called deinstitutionalization.

In exchange for closing down the tax-draining state hospitals, the plan was that an efficient network of community mental-health centers (including crisis centers) would be developed all over the country to treat serious mental illness, rather than merely confining the seriously mentally ill to those dreadful state institutions.

Lots of insurance money poured into mental-health services, partly as a result of lobbying by various interest groups.

But the promise of community mental-health networks for the seriously ill was broken. Instead, the money was diverted into insurance coverage for a rapidly growing industry dominated by for-profit hospitals and paid-for psychiatrists who were hired to essentially bid-rig diagnoses. The purpose was to channel new patients into the system, where their insurance coverage could be profitably and thoroughly milked, even if it meant "diagnosis-flipping" -- that is, certifying a new diagnosis code when the insurance-reimbursement allocation for the old one ran out. Essential to that scheme was a vast increase in the number of behaviors that could be classified and coded, for insurance-reimbursement purposes, as mental illnesses.

Our mental-health system became fully medicalized. And one scandalous upshot of that phenomenon was that the really seriously mentally ill got left out of the equation. After all, treating the seriously crazy is frustrating and not profitable. Instead, starting in the 1970s, we started seeing people who really needed psychiatric intervention on the street, and we were conditioned to think of them instead as being among the "homeless."

The central fact about our mental-health system (and the caution to be exercised amid calls to fund more mental-health services) is this: It is not designed to treat serious mental illness in any serious manner.

Oh, how I wish I could ask Jared Loughner's mother and father: How did you try to get appropriate mental-health treatment for this sick boy (because I am pretty sure that you did)? What were you told when they turned you away? How deep was the frustration and misery suffered by you and the other families of seriously mentally ill people who have nowhere to turn?

There is no money to be made from the chronic paranoid schizophrenic, the violent psychotic. The truly crazy have no constituency besides their families, assuming they have families. While decent counseling is often available for those facing debilitating life crises (who have insurance, that is), most mental-health resources flow into treatment of what has long been known among honest psychiatrists and psychologists as the "worried well." As Willie Sutton said, that's where the money is.

I heard some woman on NPR last week whining about how she was seeking mental-health counseling because she was so emotionally distressed by the Tucson shootings -- which she had not even witnessed or been directly affected by. She was treated with gentle reverence on the radio. Yes, precious mental-health resources will flow her way.

Our mental-health system is broken. And it's a lot more systematically corrupt than our political system.

Serious, severe mental illness like that exhibited for a long time by Jared Loughner goes untreated, or more to the point unsupervised, because the system is designed mainly to make money.

We need to understand that better, in a society where even the crazy people are armed.



Anonymous said...

You make many good and valid points in your blog.

My wife has worked at the intersection of the mental health and community college roads.

In Pennsylvania, the concept of deinstitutionalization took off. At the time my wife left the MH field, there was a patient at a state hospital who was, over some objections, admitted to a group home in the community. Except that he was THE group for at least a significant number of months, costing the taxpayers about $300,000 to $350,000 per year.

We've observed, those of us who are watching, that a new concept has taken over. Transinstitutionalization.

We continue to empty and close our mental health state hospitals, and have transferred many of the occupants, after a somewhat brief period of transition, to another state institution - one with bars.

My only significant disagreement with your comments is that there have been some local MH service providers who have undertaken to work with violent paranoid schizophrenics and others who have serious MH conditions. As you stated, there also have been large for-profit companies working very hard to get a big chunk of the funding pie.

With a new governor pledging to balance a budget that is $4 billion in deficit with no new taxes, I can foresee that what small amount of decent MH services for the seriously ill exists now will soon be trimmed significantly.

Then we will wonder why when the next incident arises.

I always enjoy your take, especially on social issues where you bring refreshing sanity.

Don S.

Ian said...

I still have the copy of the first edition of the Diagnostic and Statistical Manual that defines mental problems, primarily for purposes of insurance reimbursement.

The first edition is 130 pages, about 7 by 10 inches. The current edition of DSM is 940 pages (the "quick reference" version is 370 pages).

A new edition is in the works, and will surely be fine-tuned to accord with what's reimbursable and what's not.