Thursday, April 19, 2007

Mental health in Virginia

Catholic blogger Mark Shea has said that history has two phases -- "what could it hurt" and "how was I supposed to know." I suggest that what makes this cycle last, as a continuous dynamic, is found in the "what could it hurt" phase. Namely that "it" is, as often as not, a backlash or reaction against some previous "how was I supposed to know." Metaphors involving generals fighting the last war, 20/20 hindsight, and horses and barn doors, come to mind also.

We're seeing some of that dynamic in the Virginia Tech shootings. I'm convinced there is not really any meaning to be gleaned from them -- crazy, evil people do crazy, evil things. But the number of people who commit acts this extreme are so few that, even when some reason can be attached to a particular case, those cases can only be spotted in retrospect. As the Times blogger notes:
There are millions of American college students, and only one of them has ever committed such a horrific massacre. The factors cited by Miss Paglia affect all students; only one reacted as Cho did. ... Extremely rare events are difficult to explain by theoretical reference to general factors.
But that doesn't stop us from trying to explain such events, and therefore worse yet, to try to "fix" them. Other people can take up gun control or concealed-carry laws (Virginia Tech may have been a gun-free zone, but, to quote Gen. Turgidson, "Well, sir, I would say that [Cho] has already invalidated that policy!") Or violent entertainment. But I can speak to my experience with one thing -- the metal-health laws of Virginia, which have been taking a beating. In an Associated Press article headlined "Va. law makes intervention tough," a variety of "warning signs" in Cho's pre-shooting behavior are alluded to.
The 23-year-old immigrant -- an outcast by his own account, a bully and a perverted loner by others' -- who took his life and 32 others at Virginia Tech this week had troubled classmates and professors more than a year earlier with his dark writings and brooding.
He had been kicked out of class, and two women complained to campus police that they had received annoying and unwanted messages from him. Their complaints and an acquaintance's concern that Cho was suicidal were enough to get him taken for a psychiatric evaluation.
And then, the criticisms that this didn't amount to reason under Virginia law to force the commitment of Cho.
But they weren't enough to have him committed under Virginia law, one of the most restrictive in the nation when it comes to forcing treatment on a person showing signs of mental instability. Mental health experts say his case will heighten a discussion about whether it is time to revise those laws. ...
State law allows involuntary commitment only if a person is determined to pose an "imminent danger" to himself or others or is "substantially unable to care for himself."
Only Georgia, Hawaii, Montana and Ohio have similar standards, according to the nonprofit Treatment Advocacy Center in Arlington, Va. Other states don't use the word "imminent" in conjunction with danger or harm, making it easier to force treatment.
Retired state police superintendent Col. W. Gerald Massengill, who was appointed by Gov. Timothy M. Kaine to head an investigation into the shootings, said he expects the review will cover mental health issues as well as law enforcement response.
As a Virginia resident, this law has affected me too. I first went to a therapist at the behest (the politest possible term) of my confessor and the strong counsel (ditto) of some of my Courage brothers, in response to some behavior that they said proves that "this is not about sex." I had always resisted seeing a head-shrinker for a variety of reasons -- a bad experience with a psychiatrist as a pre-teen; my intellectual-moral distaste for the whole psychiatrist-therapy racket as excuse-making witch-doctory for atheist New Yorkers with too damn much money; my general stoic temperament, which detests complainers and emotional exhibitionism.

But I relented. I went into this Catholic psychiatric ministry late one Friday afternoon, near weekend closing time because ... well, just because. And the therapist on duty, who I think was just hanging around at 6 to finish some work, agreed to take me on after an hour's meeting. But at the first appointment proper, I asked him something that mattered a great deal to me -- what are the circumstances under which I could be committed against my will. After all, I knew it wouldn't take Freud to diagnose me as suffering from depression and recommend putting me on meds; I had a suicide attempt in my past (not a very competent one, but still ...); I had deliberately engaged in some dangerous sexual behavior (barebacking, anonymous sex, masochism); in many respects, my life was out of control. "I'm at the end of my rope" is something I have said more than a couple of times.

But I told the therapist that if I judged that involuntary commitment was a plausible risk, I would not come. Under no circumstances was I gonna be publicly humiliated like that.

As it happened, he told me, I had nothing to fear. He told me that Virginia law is fairly restrictive on commitment and it would take much more than the kinds of things I quickly outlined to him. He said, close as I can recall, "you have to be more than just badly depressed." I don't recall that he used the word "imminent," but post-Cho reporting makes it clear that this is part of the law, as is the phrase "can't take care of yourself," which I do remember my therapist using. He also later told me that the records of our sessions would be destroyed after a set time (five years, if memory serves). So, I was satisfied and went to see him once or twice a week for several months.

Now, I'm not gonna pretend I'm anything like as disturbed as Cho. I'm also known to be a bit moody, and had many of the same problems in grade and high school, common to loner boys with academic inclinations. I can always function as a normal person day-to-day (as could Cho, who was evaluated thus: "his insight and judgment are normal"). But the chances of me going postal like Cho are effectively zero, because even in the darkest times, I turn inward in despair, not outward in anger. The chances of me committing suicide are thereby greater, but not high.

Still, if in my judgment Virginia had made it too easy to commit me against my will, merely on the basis of suicidal thoughts, occasional "weirdnesses" (aka "warning signs") and the kinds of things I knew I would have to tell the therapist, I would certainly have walked out of that Arlington office, never to return. And I fear that Virginia and several other states, in their eagerness to do something -- anything -- to respond to this massacre, will do something stupidly counterproductive, like make it easier to commit people beforehand based on fears about what they might do. Even apart from the fact that almost all the time, these cases wouldn't have resulted in something like Virginia Tech, easier commitment will make the marginal cases -- the person sane and competent enough to decide whether he should seek psychiatric help -- from doing exactly that.

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