Charles Krauthammer: It’s cruel and reckless not to treat mentally ill

09/21/2013 12:00 AM

09/20/2013 4:45 PM

In the liberal remake of “Casablanca,” the police captain would come upon the scene of the shooting and order his men to “round up the usual weapons.”

It’s always the weapon and never the shooter.

But as was the case in the Tucson shooting, the origin of the rampage at the Washington Navy Yard lies not in any politically expedient externality but in the nature of the shooter.

On Aug. 7, Aaron Alexis called police from a Newport, R.I., Marriott. He was hearing voices. Three people were following him, he told the cops. They were sending microwaves through walls, making his skin vibrate and preventing him from sleeping. He had already twice changed hotels to escape the men, the radiation, the voices.

Delusions, paranoid ideation, auditory (and somatic) hallucinations: the classic symptoms of schizophrenia.

So here is this panic-stricken soul, psychotic and in terrible distress. And what does modern policing do for him? The cops tell him to “stay away from the individuals that are following him.” Then they leave.

But the three “individuals” were imaginary. This is how a civilized society deals with a man in such a state of terror?

Had this happened 35 years ago in Boston, Alexis would have been brought to me as the psychiatrist on duty at the emergency room of the Massachusetts General Hospital. Were he as agitated and distressed as in the police report, I probably would have administered an immediate dose of Haldol, the most powerful fast-acting antipsychotic of the time.

This would generally relieve the hallucinations and delusions, a blessing not only in itself, but also for the lucidity it brought on that would allow him to give us important diagnostic details – psychiatric history, family history, social history, medical history, etc. If I thought he could be sufficiently cared for by family or friends to receive regular oral medication, therapy and follow-up, I would have discharged him. Otherwise, I’d have admitted him. And if he refused, I’d have ordered a 14-day involuntary commitment.

Sound cruel? On the contrary. For many people living on park benches, commitment means a warm bed, shelter and three hot meals a day. For Alexis, it would have meant the beginning of a treatment regimen designed to bring him back to himself before discharging him to a world heretofore madly radioactive.

That’s what a compassionate society does. It would no more abandon this man to fend for himself than it would a man suffering a stroke. And as a side effect, that compassion might even extend to potential victims of his psychosis – in the event, remote but real, that he might someday burst into some place of work and kill 12 innocent people.

Instead, what happened? The Newport police sent their report to the local naval station, where it promptly disappeared into the ether. Alexis subsequently twice visited Veterans Affairs hospital emergency rooms, but without any florid symptoms of psychosis and with him complaining only of sleeplessness, the diagnosis was missed. (He was given a sleep medication.) He fell back through the cracks.

True, psychiatric care is underfunded and often scarce. But Alexis had full access to the VA system. The problem here was not fiscal but political and, yes, even moral.

We cannot, of course, be cavalier about commitment. We should have layers of review, albeit rapid. But it’s both cruel and reckless to turn loose people as lost and profoundly suffering as Alexis, even apart from any potential dangerousness.

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