“I have a Glock 9 millimeter, and I’m a pretty good shot,” Congresswoman Gabrielle Giffords told the New York Times last year. Alas, so did, and was, a deranged fellow Arizonan named Jared L. Loughner. Just what the Congresswoman hoped to accomplish with her semiautomatic pistol—beyond showing her support for an individual right to bear arms—remains uncertain. But Loughner’s intentions were made horrifically clear in the mass shooting in Tucson last week.

Several among those killed had government connections, as is frequently the case when lunatics start shooting. It’s difficult to imagine what insane animus Loughner bore his other victims, including the nine-year-old girl. The available information suggests that he was troubled for quite some time before becoming frankly psychotic in 2010. His behavior then became so eerie that fellow students and a teacher at Pima Community College were seriously afraid of him. He was expelled and informed that a “mental health clearance” was required before he could return. News accounts to date, however, make no mention of any effort to accomplish such an evaluation.

Nonetheless it’s unsurprising that responses to the tragedy have included calls for a more authoritarian approach to psychiatric patients. Some commentators believe we need not just more custodial care of the severely mentally ill and more scrupulous implementation of existing laws and guidelines, but a rewrite of the relevant statutes with probable implications for constitutional law. “We need legal reform,” exhorts the political philosopher William Galston in an article making a case for reforming our laws regarding “involuntary commitment” (January 11). “Those who acquire credible evidence of an individual’s mental disturbance should be required to report it to both law enforcement authorities and the courts, and the legal jeopardy for failing to do so should be tough enough to ensure compliance.”

Give us a break, Mr. Galston. At a minimum, 1 percent of the American population suffers from a major mental illness. What are the police and the courts supposed to do with those 3 million reports?

For over forty years as a practitioner and as chief of psychiatry at a large community hospital, I’ve been acquiring very credible evidence of people’s mental disturbance pretty much every day. Triage clinicians are called to the emergency department round the clock to evaluate psychotic cases, and the large group practice I belong to sees one hundred new patients every month. But so many patients certainly would not seek us out if we ran tattling to the police every time an irrational person said something menacing.

When we do sense imminent violence, however, the law poses no problems.  I don’t know about Arizona, but in Massachusetts virtually any psychologist or psychiatrist seeking to restrain a dangerous person just completes a simple form known colloquially as a “pink paper,” and faxes it to the police. They transport the patient to a hospital where he can be held for at least three days on the admitting doctor’s say-so. During that time, if the patient continues to be adjudged dangerous, the hospital requests a commitment hearing. The patient is then detained for as long as it takes—never less than a week—and provided with a lawyer. A judge is brought to the hospital. At that point the patient’s right to due process is honored.

The system for dealing with violent patients is fraught with problems, but not because of the law. It is nonviolent patients and their families who suffer most from the libertarian tenor of the laws on involuntary treatment that concern William Galston.

The great obstacle to proper involuntary treatment of the violent is that nobody wants these patients. Would you? They are uncooperative, devious, hostile, almost always frightening, and often dangerous to other patients and to staff. And of course they’re typically uninsured. The director of any inpatient unit to which too many of them are admitted will soon seek another line of work. The criminal-justice system, recognizing irrationality, naturally pushes them toward the mental-health system which, recognizing danger, pushes back. The Massachusetts Department of Mental Health, like that of many other states, has largely abandoned provision of direct patient care. Bridgewater, Massachusetts’s facility for the criminally insane, has room only for the egregiously violent and a disproportionate number of sex offenders. So the staff member in charge of psychiatric triage pounds the telephone in her emergency department through the long night hours, trying to find a place for the likes of Jared L. Loughner. It’s not the law that’s defective; it’s the system.

What the law really fails to provide for is the involuntary treatment of the nonviolent. I think of a fellow who, after a couple of widely spaced episodes of moderate depression, not nearly severe enough to require hospitalization, suddenly became manic. And this episode was severe. Delusionally grandiose, awake all night, talking constantly, spending absurd amounts of money, making dreadful scenes at work and at home, he began rapidly to destroy his career, his estate, his reputation, his marriage, and his relationship with his children. As usual in cases of manic psychosis, evidently no one could persuade him even to consider treatment. No one could tell him anything, in fact, because he wouldn’t stop talking. It was obvious that only involuntary hospitalization could prevent his ruin. But, “Hold it right there!” said the law. “Is he an immediate physical danger to himself or anyone else?” Immediate yes; physical—well no, not really. “Then,” our law declares, “he has a right to his ruin.” Had the law empowered me to get a bit of lithium into this poor chap a happy outcome was probable.

So, although I find that Massachusetts law does not impede adequate care of violent psychiatric patients, with regard to the nonviolent I share Galston’s concern that libertarianism does more harm than good.

In every nation on earth, however, no matter how wisely drafted its laws, the impulsively aggressive, the violently drunk, the desperate, the fanatical, and the insane will always be with us—mostly out and about. One wishes they weren’t so fond of firearms.

Since I began my training in psychiatry in 1965, a great deal of my work has been in hospitals. There, for one reason or another, from time to time I’ve taken a phone call running something like this: “Dr. Gault, this is X over in the Y department. I hate to disturb you, but there’s a (patient, visitor, staff member) creating a disturbance, and we hoped you could come over and lend a hand.” I believe this happened as often as once or twice every three years or so over a period of almost forty years. So let’s say, conservatively, twenty times. Only once, if I’m not mistaken (and I’m not), did the caller add, “and we think he has a gun.” Now, I’ve heard the gun-lover’s slogan, “It’s not guns that kill people; people kill people.” If that’s true, why was I so unafraid to lend a hand those other nineteen times? I’m not an especially courageous person, but when no gun was mentioned, I answered the call without any anticipation of dying. I’ve never heard anyone say, “It’s not atomic bombs that incinerate people, it’s aviators.”

The Glock pistol that enabled Jarod L. Loughner to become a celebrity has a magazine that holds more than thirty rounds. He didn’t waste them; more than half his shots hit somebody. Many solid citizens love to go hunting. If it’s birds or very small game he’s after, he uses a shotgun; for bigger game, a rifle. But pistols are for shooting people. Desperate souls like Loughner understand that perfectly. I’m told that pistols enable citizens to protect themselves. I understand the theory, but why does this so seldom occur in practice? Many Arizonans, after all, have taken the trouble to acquire and become competent in the use of a handgun, but none of the many dozens on the scene was prepared to deal with the madman in Tucson as he squeezed off thirty rounds. It was in Texas in 1966 that Charles Whitman sniped away from the university tower for an hour and a half before several brave police officers—not a pistol-packing undergraduate—finally dealt with him. Were there no self-defensively armed civilians within earshot who could have run up those tower steps and stopped Whitman before he’d shot forty-eight people, killing sixteen? Whether it’s Colorado or Oklahoma, Arkansas or Massachusetts, whether it’s a day-care center, a post office, a shopping mall, or a school, where the hell are those citizen sharpshooters when we need them? No, pistols do infinitely more harm than good. They always will.

Even if we enacted Galston’s impractical and Draconian precepts, innumerable desperate souls would remain at large among us. Must they have such easy access to automatic weapons?

Related: Sick Minds, by Cathleen Kaveny
Will We Ever Have Sane Gun Laws? and Tragic Prophet, by E. J. Dionne Jr.
Killings in Tucson, by the Editors
Forward Motion, by Joseph D. Becker

Barry Gault is a psychiatrist in private practice in Newton, Massachusetts.
Also by this author

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Published in the 2011-02-25 issue: View Contents
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