Everyone is in agreement about the terrible event in Tucson: It was a very public tragedy. How ironic that it should occur in front of a store named Safeway. It points out that there are no safe places when insanity roams unchecked.
There are so many facets to the shooting that it is difficult to get one’s mind around it. To be sure, the victims, particularly those killed and their families are foremost in our thoughts. Those wounded, especially Congresswoman Gabriella Giffords, have had their lives changed forever. That her recovery and the 12 others will be complete and speedy are the hopes of all.
The shooter, obviously responding to a mind disordered beyond comprehension, is all too familiar to us. April 16 is a date we will never forget. The missed warnings in both the Virginia Tech massacre and Tucson are alarmingly similar. These will not be the last of such events, sad to say.
As a physician I am acutely aware that the pharmaceutical industry has made an invaluable contribution to the treatment of mental illness. Until the mid 1950s there were no effective drugs to control potentially violent patients. The advent of Thorazine changed that: Many who were seriously psychotic were then able to be managed as outpatients.
The unanticipated consequences of that miracle drug and countless others that followed allowed thousand upon thousands of incarcerated patients to be released. Across the nation the number of long-term inpatient psychiatric beds fell to a fraction of their former numbers. Funding was cut, psychiatric hospitals were closed; the released patients often had no family to care for them or they chose to disengage themselves from their families. Worst of all, many stopped taking their medications. Sometimes it was because of side effects, because of the expense, or because they felt they no longer needed them.
Without medications many were grasped by the demons which had been held at bay. Such patients became a large component of the homeless, a problem with which every city struggles. Many are not potentially dangerous; some are and the differentiation between the two is very difficult. This huge population of the mentally walking wounded is largely ignored and that’s an unseen tragedy.
Both the Blacksburg and Tucson killers were identified as being potentially dangerous yet few realized the magnitude of their insanity. Whether or not medication and treatment might have altered their actions is extremely problematic. Even when authorities are notified of psychotic behavior the police can hold such a person for only a brief time. I have seen cases where, after 72 hours they were back in the neighborhood terrorizing everyone. Authorities would come get them again but in 3 days, they were released. Some of these incidents terminated in the death of family members, friends, or police. That’s another tragedy that ought to have been prevented.
The outcry for gun control will be ratcheted up and therein lays the next layer of tragedy. There will be an equal furor from the gun advocacy groups. The second amendment says nothing about the right to buy 500 rounds of ammunition and extended clips for a Glock 9 mm; the only purpose of such weaponry is to kill a lot of people with the convenience of not having to reload. When the Supreme Court rules on such cases, they protect the rights of those who would murder, not the rights of the overwhelming population who are law-abiding. The failure of the courts and congress to address the problem in a realistic way is another tragedy.
Few are so naïve as to believe that legislation can solve this problem. Guns are everywhere and laws to prevent their distribution will affect only the non-criminal and sane citizens; so says the NRA and they may be right. But that’s no reason to ignore the dangers we have brought on ourselves by the total accessibility of guns and ammunition.
Finally, the last unseen tragedy is in families who have a seriously psychotic member. The pain and anguish of watching a child whom they love caught in the ravages of schizophrenia must be beyond comprehension. If you have not seen the struggle through which they go to get meaningful help, I can tell you it is heart rending. If you aren’t rich then you are on your own.
There is no totally safe way but at least we can acknowledge the need for reform in the care of the mentally ill and see that weapons do not fall into their hands with no more concern than if a credit card will finance the transaction.
