Jared Lee Loughner – Is Mental Illness the Explanation for What He Did?

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Clinical psychologist and writer Vaughan Bell has written a powerful piece, Crazy Talk, for Slate. Jared Lee Lougher, the suspect in the shooting of Representative Gabrielle Giffords and the death of six people in Arizona, is clearly a disturbed young man – The Huffington Post rounds up a quick profile of the man, including his MySpace page and odd YouTube videos.

As Dr. Bell points out, many media sources and comments online are already focusing on the idea that Loughner is schizophrenic, and that explains what he did, end of story.

This is wrong. It is wrong scientifically, where excellent research shows that the link between mental illness and violence is minimal, and it is wrong socially, where naming a person as mentally ill then closes off a deeper explanation of what happened and why.

For many, the investigation will stop there. No need to explore personal motives, out-of-control grievances or distorted political anger. The mere mention of mental illness is explanation enough. This presumed link between psychiatric disorders and violence has become so entrenched in the public consciousness that the entire weight of the medical evidence is unable to shift it. Severe mental illness, on its own, is not an explanation for violence, but don’t expect to hear that from the media in the coming weeks.

Bell turns to the work of Oxford psychiatrist Seena Fazel (website here), who has done epidemiological work on mental illness and violence. Fazel’s article in PLoS Medicine, Schizophrenia and Violence: Systematic Review and Meta-Analysis, examined data on 18,000 individuals with schizophrenia and other psychoses. The research highlights the link between alcohol and drug abuse and violence, but not schizophrenia per se. In other words, if you’re looking for violence, head to your local bar.

Bell takes us through an analogy. If Loughner were obsessed with soccer, would normal people take that as an explanation for his violent acts? No. Knowing somebody is a soccer fan does not tell you much about his or her propensity for violence. The same is true of mental illness – knowing someone is mentally ill tells us little about that person’s propensity for violence.

If you found evidence on the Web that Jared Lee Loughner or some other suspected killer was obsessed with soccer or football or hockey and suggested it might be an explanation for his crime, you’d be laughed at. But do the same with “schizophrenia” and people nod in solemn agreement. This is despite the fact that your chance of being murdered by a stranger with schizophrenia is so vanishingly small that a recent study of four Western countries put the figure at one in 14.3 million. To put it in perspective, statistics show you are about three times more likely to be killed by a lightning strike.

The fact that mental illness is so often used to explain violent acts despite the evidence to the contrary almost certainly flows from how such cases are handled in the media. Numerous studies show that crimes by people with psychiatric problems are over-reported, usually with gross inaccuracies that give a false impression of risk. With this constant misrepresentation, it’s not surprising that the public sees mental illness as an easy explanation for heartbreaking events. We haven’t yet learned all the details of the tragic shooting in Arizona, but I suspect mental illness will be falsely accused many times over.

Link to Vaughan Bell’s Slate piece, Crazy Talk

Update: Two profiles below of Loughner that I have found useful. In terms of his violence, I’d probably go with one of the most prosaic factors – his father was a “very aggressive” man. And this also seems a case which is a good representative of a lot of epidemiology – the more risk factors, generally the worse the outcome. Aggressive father, alcohol and drug use, loss of a guiding social institution (community college, suspended due to his erratic behavior), lack of mental coherence, involvement in extreme ideologies, and so forth.

New York Times: Suspect’s Odd Behavior Caused Growing Alarm

Guardian: Jared Lee Loughner: Erratic, Disturbed and Prone to Rightwing Rants

Also, Martin Robbins at The Guardian has just published an important essay, Diagnosing Arizona: The Quest for the Mind of Jared Lee Loughner.

When confronted with dramatic events like this, people demand a narrative, a story that provides a neatly satisfying explanation of what happened. In this instance the most powerful narrative to emerge after the shooting was the idea that Loughner was mentally ill; a crazed lone gunman unleashing his insanity on the unsuspecting world.

It’s all very neat and tidy, but the critical flaw with this story is that so far we’ve little proof that he was mentally ill, and there’s no good reason to believe that any hypothetical illness contributed to the shooting…

What’s fascinating is why his mental health was seized upon, rather than his political extremism, history of drug use, lack of involvement with social institutions, the bullying he claimed to have suffered from in school, or the alleged aggressiveness of his father.

For those looking towards the ideological/cultural side of things, two new pieces provide some good initial takes. Jessica Valenti writes that “The shooting of Gabrielle Giffords highlights the ‘man-up’ culture in US politics.” After highlighting how women politicians, particularly on the right, are using “violent imagery and language” and that “man up” was one of the most popular phrases in the 2010 elections, she writes, “In a country that sees masculinity – especially violent masculinity – as the ideal, it’s no wonder that this type of language resonates.”

Maya provides a round-up of “The Giffords shooting and violent political rhetoric“, a great place to find a number of good reactions. In her point she highlights the importance of context. We still wants our causes to be on the cause-effect model. In this case, it’s more like the “social causation” model I discussed in How experience gets under the skin.

A number of epidemiological factors seem to be at play in this case, including likely learning aggression from his father, social isolation, and involvement in scenes where violence is more likely (alcohol and drug scenes). But context is cause too – the context of an aggressive home, the context of losing contact with others through community context, and so forth. And ideology forms part of our context.

Maya writes:

And here’s my take: Of course, Sarah Palin—or Glenn Beck or the Tea Party or right-wing talk radio or any other political leaders—didn’t cause Jared Lee Laugher to get a gun and shoot a Congresswoman and 17 other people on a Saturday morning. The causes of such an act are as complex as the mind of the individual who commits it, and the influencing factors–psychological, political, and societal–damn near impossible to tease apart.

But it’s not about cause. It’s about context.

Please also read Greg’s most recent post on delusions, early risk for schizophrenia, and the links between our experience and our social and cultural contexts. He writes:

As Aviv discusses, delusional concepts may appear to be divorced from reality, but they are acutely sensitive to the zeitgeist, elaborating upon society’s own contemporary fears and anxieties.

To keep with the updates, Mother Jones has a relatively interesting interview in the piece Loughner Friend Explains Alleged Gunman’s Grudge Against Giffords. The violence side seems to have come rather later in his young life:

One of the last times Loughner and Tierney saw each other, a mutual friend had recently purchased a .22-caliber rifle. Until then, Loughner had never shown much interest in guns, Tierney says. “My friend had just gotten a .22, and Jared kept saying we should go shooting together.” But Tierney and the friend who had bought the .22 demurred. “We were sketched out,” Tierney says, “and we were like, ‘I don’t think Jared’s a good person to go shooting with.’”

Over at Time, Maia Szalavitz gets some more at the science behind different purported causes in her piece, Politics, Parenting, Pot or Psychosis: What Caused the Arizona Shootings? The basic message is “it’s complicated,” though Szalavitz stays relatively focused on a cause-effect approach (marijuana, alcohol, parenting, schizophrenia as potential causes) and on mental disorders as those causes, though she does finish mentioning cultural context and Greg’s post on delusions.

Both substance misuse and psychosis are linked with violence and with each other and the causal pathways can go in both directions. For example, people may self-medicate psychosis with drugs and that makes it worse rather than better— and substance misuse can be a response to violence as well as a cause of it…

Given all these complications, it’s highly unlikely that we’ll ever know the exact cause of Saturday’s awful events. But blaming pot, parents, politics or psychosis alone is insane.

Over at Psychology Today, Ira Rosofsky writes “Don’t Jump The Gun On Diagnosing The Arizona Shooter.” Here’s a very relevant section:

Schizophrenics in general, as well as paranoid schizophrenics in particular are too disorganized to organize premeditated, multi-step acts of violence. In fact, paranoid schizophrenics tend to isolate themselves and more likely become violent when they feel their personal space is being violated. They don’t go out looking for trouble.

Over at the Guardian, SE Smith writes “‘Psycho Killer’? The Jared Lee Loughner case brings out the usual abuse“, with the following quote:

While speculating about the mental health status of the shooter, people also reinforced social attitudes about violence and mental illness, asserting that violence is an expression of mental illness and that mental illness makes people violent. The belief that mentally ill people are a danger to others persists – despite the fact that mentally ill people are actually 11 times more likely than the general population to be victims of violence, according to a Northwestern University study. People with “severe mental illness” are responsible for an estimated one in 20 violent crimes, a rate much lower than the general population usually supposes.

And Josh Rosenau at Thoughts from Kansas gives us “Asking ‘why’ without the blame game“, with a focus on how individual variation and narratives can come together. Here’s a snippet, but there’s a lot more there:

Given the violent rhetoric directed at Giffords, though, it isn’t unreasonable to look past Loughner himself to find some external factors that might have given his rage direction. It’s entirely possible that violent rhetoric from Glen Beck or Sarah Palin influenced Loughner without Beck or Palin having intended any such thing. But research described by John Sides at The Monkey Cage suggests that it isn’t enough to say “we didn’t mean it.” Experiments by Nathan Kalmoe, for instance, show that “even mild violent language increases support for political violence among citizens with aggressive predispositions, especially among young adults.”

This effect is not uniform. Most people reject any attempt to justify political violence, and for most people, seeing a violent political ad doesn’t change that. But Sides explains:

Seeing violence political ads DID have an effect among those with a predisposition to aggression, as measured with a standard psychological battery. Among those with the greatest predisposition to aggression, being exposed to a violent political ad increased their support for political violence by about 20 points on a 100-point scale.

Benedict Cary at the New York Times has the piece Red Flags at a College, but Tied Hands. I want to highlight what Randy Borum, an expert on threat assessment at the University of South Florida, said:

“This guy wasn’t a missed case,” Randy Borum, an expert on threat assessment at the University of South Florida, said about Jared L. Loughner, the 22-year-old college dropout who is accused of trying to assassinate Representative Gabrielle Giffords of Arizona on Saturday.

“It wasn’t a case of ‘Gee, no one saw this coming,’ ” Dr. Borum said. “People saw it. But the question then was what do you do about it? Who do you call? The whole thing speaks to the need for some coordinated way to detect such threats”…

“We tend to want to dismiss these people as unstable types that snapped,” Dr. Borum said, “but there’s a whole process that occurs between conceiving the idea and executing it.”

At the Daily Kos Jared B. has an interesting interview with Mark Heyrman, who teaches on law and the mental health system at the University of Chicago. Heyrman discusses how mental health assessment could have worked in the case of Loughner, and then talks about an insanity defense.

After the Hinckley assassination attempt on Reagan and his successful insanity defense, Congress amended the federal insanity defense—returning it to Mc’Naghten—unable to appreciate the criminality of one’s conduct. The defendant must prove this by clear and convincing evidence.

Of course it is stupid to diagnose someone based upon newspaper accounts and particularly stupid if you are a lawyer and not a mental health professional. However, I am willing to bet that Loughner has a serious AXIS I diagnosis—some type of psychotic disorder. My guess would be schizophrenia. I think that it is very sad that he did not get appropriate attention from someone who could help. Even if true, that does not mean he has an insanity defense. 15% of the folks in our prisons have serious mental illnesses. That fact does not mean that they should have been acquitted by reason of insanity.

Next, at the Saint Louis Beacon, Nancy Fowler brings us some good assessment of the Loughner case from multiple views, including campus safety, mental health, and individual intervention. Here’s one excerpt from Giffords shooting: When does ‘bizarre behavior’ warrant concern?

Following Saturday’s shooting at the Tucson grocery store, the internet tweeted and blogged armchair diagnoses for the suspect, the most popular of which was schizophrenia. But there is no record that Loughner was ever diagnosed with a mental illness.

Furthermore, there’s no reason to believe mental illness was a contributor to this act of violence.

“Normally, I don’t see individuals with mental illnesses doing these sort of crimes,” Eckert said.

Stigma and hysteria link mental illness to violence and crime to a greater degree than is actually substantiated, according to Jackie Lukitsch, the executive director of the National Alliance on Mental Illness in St. Louis.

And over at MSNBC’s Open Channel, there is good discussion of a Secret Service study on people who carry out assassination attempts, Few assassins fit the ‘profile.’ Most had no mental health treatment, made no threats.

Although the lay person may think that any person who commits an act of political assassination is, by definition, mentally disturbed, a 1999 Secret Service study of 83 people who made assassination attempts against public figures in America found that only one-third had ever received a mental health evaluation, and fewer than one-fifth had been diagnosed with a mental health or behavior disorder prior to the attack…

The Secret Service study rebuts the common notion that there is a “type” or “profile” of a kind of person who commits such an act. Some are the stereotypical loners, and some have many friends. Some did well in school, and others did not. They were male and female, young and old.

No profile, no type of person, can fit all the attackers, and any profile would include far too many people who are not dangerous, the researchers found. In short: Profiles don’t help law enforcement prevent attackers, but do tie up law enforcement resources…

The Secret Service did find that the attackers shared behaviors in common. The researchers are saying there is not a type of person, but there is a type of action, such as acquiring a weapon, and communicating their intentions (though not a threat) to others. Time after time, in the days after such attacks, the news emerges that the shooter had described the plans to others, who often took no action to alert anyone. This is similar to school shootings, in which the young people commonly warn others what is coming, without making a direct threat to the school, the Secret Service found in a later study.

One other piece to include comes from the Christian Science Monitor, Nihilism or Sarah Palin: What motivated Arizona shooting suspect? While it does repeat the mental illness mantra in the article, there is more content there than in a lot of other places. Here’s some relevant stuff:

But at this early stage, no clear links have emerged between Loughner and the current political climate. Rather, acquaintences and criminologists point to a convoluted worldview that appears largely incoherent – ranging from a fascination with dreams to an apparent penchant for nihilism.

His writings merge everything from the Communist Manifesto to discussions of the gold standard to the government’s oppression by use of grammar…

Investigators have unearthed a direct connection between Loughner and Giffords: a letter from Giffords’ office thanking him for participating in a “Congress on Your Corner” event in 2007. Loughner reportedly asked Giffords: “What is government if words have no meaning?” Giffords reportedly responded to him in Spanish and moved on with the meeting.

“Ever since that, he thought she was fake, he had something against her,” Tierney tells Mother Jones.

Hate-crime experts say they’ve seen such mergers of ideology and personal motives result in other attacks, including the shooting of two Army recruiters in Little Rock, Ark., in 2009 by an American-born Muslim convert, Abdul Hakim Mujahid Muhammad.

In many cases, there’s “a mix of personal and ideological motives in an actual attack,” says Mr. Pitcavage at the ADL. “It’s a pattern we see sometimes with hate crimes and sometimes with crimes against the government … that personal factors may be the primary mover to violence, and it’s the ideological component to their belief system that often will help them choose the target when they do decide to strike out.”

In 2009 Eric Elbogen and Sally Johnson published the paper The Intricate Link between Violence and Mental Disorder in the Archives of General Psychiatry. Using a longitudinal data set representative of the US population, they concluded:

Because severe mental illness did not independently predict future violent behavior, these findings challenge perceptions that mental illness is a leading cause of violence in the general population. Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors, and history of violence.

What I am finding interesting, writing now on Wednesday morning, is how the mainstream media are settling onto a narrative of “troubled young man” who was “anti-social” and “disturbed,” with fingerpointing now pointing at his “mental state” and at his family. In other words, the political side of things is getting increasingly whitewashed, and while claims about him being schizophrenic have started to quiet, his mental state and his family are where the implicit blame are being cast. Here are three examples, all of which provide us with more information about his life, all more-or-less within this narrative:

Associated Press:

In addition to the new details about the hours before the shooting, interviews with those who knew Loughner or his family painted a picture of a young loner who tried to fit in.

Before everything fell apart, he went through the motions as many young men do nowadays: Living at home with his parents, working low-wage jobs at big brand stores and volunteering time doing things he liked.

None of it worked. His relationship with his parents was strained. He clashed with co-workers and police. And he couldn’t follow the rules at an animal shelter where he spent some time.

ABC News:

While this is the first statement from Loughner’s family, others who knew the 22-year-old before the attack have spoken out. One former close friend of Loughner’s said he went from a stable high school student to a violent, self-medicated “monster” after his girlfriend dumped him during his junior year of high school…

Meanwhile, in the search for clues to understanding why Jared Loughner allegedly plotted an attack on Giffords’ constituent event Saturday, his relationships with his parents and home environment are of increasing interest…

[Some] neighbors painted a picture of a single-child home that was intensely private and increasingly insular and standoffish as Jared Loughner grew older…

“There was times when we’d be out with other neighbor kids, and Jared wouldn’t be allowed out. He’d be watching from the window or door,” he said. “They all became very isolated. Randy was isolated, Amy wasn’t out anymore. Something changed. They just kept to themselves.” …

“Contempt breeds contempt,” said a female neighbor who asked to remain anonymous because she scared of Randy. “The family was contemptuous. It wasn’t the son. It was the father.”

But Smith, who also lives on the block and is reported to be the only neighbor in contact with the Loughners since the shooting, suggested earlier this week that the family’s isolation was rooted in a sense of personal privacy.

“They don’t really interact with the neighborhood because they’re very private people,” he said.

Newsweek:

Whatever his motive, Jared Loughner was, by all accounts, an antisocial character whom most found odd and off-putting. Wearing a hoodie even in the scorching Tucson summer, and sealing the world out with his iPod earbuds, Jared would walk the family dog around the neighborhood, oblivious to those who tried to greet him.

“I’ve said ‘hi’ multiple times, but he’s ignored me and continued with whatever he’s doing,” says Anthony Woods, a 19-year-old airplane mechanic who’s lived next door to the Loughners for seven years. “He seems very depressed, he was hunched over at all times.” (By contrast, neighbors say Jared’s mother is very friendly and outgoing, although his father, Woods says, is “very aggressive, very angry all the time about petty things—like if the trash is out because the trash guys didn’t pick it up, he yells at us for it.” The Loughners couldn’t be reached for comment).

In recent weeks, Jared seemed to grow even more antisocial. “I’d try to engage him in a conversation and he’d run or walk away” says Jason Johnson, 33, who lives across the street and met Jared for the first time a few weeks ago. “I saw him two days ago and I said hello. He turned and walked back into the house. He had a look in his eyes like something wasn’t right,” Johnson says. “You know how it is when you talk to someone who’s mentally ill and they’re just not there? It was like he was in his own world.”

Loughner’s world was indeed a strange and unsettling place. “He was very disconnected from reality and from our class,” says Lydian Ali, a classmate of his in a poetry writing class at Pima Community College. “I remember him being incoherent when he contributed to class discussions. He would make a comment about someone’s poem and none of us would know what he was talking about.”

In contrast, one of the most encouraging things to me in the past few days have been the readers’ comments on David Brooks essay in the NY Times, where Brooks basically says, politics is not at fault, this guy was a crazy. Here is the link to the comments that readers themselves have liked, and thus showing us a readership who wants more than this type of split narrative – either politics or mental illness. I will highlight the most popular one below.

George Jackson:

While all these facts may be true, they are incomplete David.

The most foundational fact, is this: Jared Laughner shot a politician. Jared Laughner did not shoot and kill incoherently. He did not shoot the taxi driver. He do not shoot the clerks inside the Safeway. He did not (at first) shoot the staffer who placed him in the back of the line. He did not start shooting from within the line.

Jared Laughner, deliberately planned and tried to assassinate a very prominent United States Congresswoman. A Politician.

To believe that his act did not stem from the root of some political causation, is illogical based on these facts. It is also a fact, that Jared Laughner held strong anti-government, anti-authority/establishment beliefs.

He is a loser, a failure early in life. He looked to blame others and institutions for his own failings. For him, his life was a cup of failure, a load of non-achievements, a future of no promise. He lacks an ability to discern the positive future offered to all Americans, albeit with hard work and sometimes hardship.

He needed a tipping point to go over the top in a negative way. The proverbial straw that broke the camels’ back. For such an unstable person, that tipping point, in my opinion, and many people’s opinion, very likely was provided by the political vitriol, hate-speech, and direct and indirect, not-subtle targeted “call to action”. The political climate, the political environment on talk-radio, and TV. Words heard have shaped man’s history. Jared Laughner became a weapon of hate, stemming from the word-environment around him.

I’ve just come across a couple pieces written earlier this week which are also instructive, particularly with respects to ideology. In Slate Jacob Weisberg writes on The Tea Party and the Tuscon Tragedy. He comes on extreme rhetoric, access to guns, and limited mental health care in his post. It’s a bit over the top, but was written Monday:

First you rile up psychotics with inflammatory language about tyranny, betrayal, and taking back the country. Then you make easy for them to get guns. But if you really want trouble, you should also make it hard for them to get treatment for mental illness.

Robert Wright’s piece in the NY Times, First Comes Fear, provides us with an important distinction to think about.

In that sense, the emphasis the left is placing on violent rhetoric and imagery is probably misplaced. Sure, calls to violence, explicit or implicit, can have effect. But the more incendiary theme in current discourse is the consignment of Americans to the category of alien, of insidious other…

To be sure, at this political moment there is — by my left-wing lights, at least — more crazy fear-mongering and demonization on the right than on the left. But that asymmetry is transient.

What’s not transient, unfortunately, is the technological trend that drives much of this. It isn’t just that people can now build a cocoon of cable channels and Web sites that insulates them from inconvenient facts. It’s also that this cocoon insulates them from other Americans — including the groups of Americans who, inside the cocoon, are being depicted as evil aliens. It’s easy to buy into the demonization of people you never communicate with, and whose views you never see depicted by anyone other than their adversaries.

In terms of getting more information on Loughner’s life, I have found two sources that work relatively well. The Wall Street Journal’s Suspect Fixated on Giffords provides a lot of background information on Loughner. We even discover he used to play video games, but no one has gone on to blame violent video games yet (it’s probably a matter of time).

Over at NPR, A Missed Chance to Intervene in Tucson? gives us more details on his erratic behavior, including a screen grab of a diagram on mind control from one of his YouTube videos.

CNN gives us two of Loughner’s poems, Meat Head and Dead as a Dodo. Unlike the widely circulating mug shot and the YouTube videos, these reveal a different mind – not someone quite as crazy as we’re making out. They were written last spring. This snippet from the first poem strikes me as so utterly normal for a 22 year old college student working out at the gym:

Looking around, the cute women are catching my eye
Probably waiting for their hot boyfriends wandering in the locker room
All the men are in shape with their new white tank shirts, basketball short, and
Nike shoes
Confusing look on my face of no idea what to do
Deciding to copy other men’s routines of
Arm Curls, Leg presses, Rows, Squats, Military something’s, and Isolated
whatever’s

While I don’t quite buy “culture of honor” as an overall cause, particularly since it doesn’t seem to fit some of what we’re learning about Loughner, nonetheless it’s one of the first attempts to link ideas for social psychology and cultural anthropology to the shootings. Richard Florida writes in The Atlantic on The Psychogeography of Gun Violence.

The culture of honor, as Nisbett describes it, sees violence as an “appropriate response to insults” and as “a means of self-protection.”

Numerous media reports note that Loughner grew more obsessed with Congresswoman Giffords after he felt she did not give him a respectful answer to the question he asked her at an earlier forum. Then there are the results of the University of Oklahoma study which finds the culture of honor to be a particularly robust predictor of high school violence, especially among young males who have been marginalized, bullied, rejected, or faced other “honor threats.”

Tom Insel, head of the National Institute of Mental Health, has just put out a press release, Tragedy in Tuscon. It provides a summary of his take on what the scientific evidence says about schizophrenia and violence, mental illness and violence, and the need for treatment.

Finally, a must-read in this whole debate, SAMHSA’s (Substance Abuse and Mental Health Services Administration) excellent page on Violence and Mental Health: The Facts. You can find an effective summary there of many points made here, complete with links to published research.

And onwards. Blaming mental illness was the easy one. But Loughner also played video games and listened to music. These tastes are also getting framed in the blame way. Here’s the Wall Street Journal on his video gaming past, and Yahoo on his heavy metal interests. Here is one of the most telling comments from the WSJ on his writings on online game forums:

Anger increasingly permeated his postings.

On Thursday morning, here’s a relevant piece I found, Arjun Appadurai’s The Ecology of Anger. This is likely closer to Loughton’s life – a culture of anger rather than a culture of honor.

It is time we looked more seriously at anger as a cultural fact of American life, and not just as a subject for entertainment and infotainment. Anger is not just a private valve to release toxic internal sentiments. Anger is the membrane between our emotional gyroscopes and our public social environments… A public discussion of the culture of anger in American life is long overdue. To treat Jared Loughner’s anger with elected officials as totally independent of a wider culture of rage is to deny the most obvious of realities.

For some time now, anthropologists and linguists have urged us to pay attention to the “mission of metaphor”, to the ways in which metaphors are not simply ways to enrich our speech when we choose but are woven into our deepest assumptions about human life, behavior and communication… The great English philosopher J.L. Austin spent a lifetime studying the speech acts he called “performatives”, those words that do something when they say something, like the judge’s words, “I pronounce you man and wife”. When metaphors become performatives, words morph into weapons instead of serving instead of them.

And here is information on lucid dreaming from Liz Landau at CNN:

A lucid dreamer is a person who is aware that he or she is dreaming and is able to manipulate the plot and outcome of the dream, like a video game…

There is the possibility, however, that in combination with mental illness and other factors such as hostility and drug use, an obsession with lucid dreaming could become harmful, Schwartz said.

“If you develop the belief that what you do in the dream world, you can do in the real world, in the hands of someone who is mentally deranged, it can become extremely dangerous,” he said.

On Friday, I came across this new article in the NY Times, Breaking the Cycle of Violence. It highlights the work of Carnel Cooper, a Baltimore physician and public health practitioner, and his Violence Intervention Program.

While still in the hospital, patients who agree to enroll in Dr. Cooper’s Violence Intervention Program, or VIP, receive a “plan of action” based on their particular needs. Members of the intervention team include social workers, a parole and probation agent and physicians specializing in psychiatry, trauma, epidemiology and preventive health. They visit with the patient throughout the hospitalization and on a regular basis after discharge, helping to provide access to services like substance abuse rehabilitation, job training and G.E.D. tutoring and offering the support necessary for successful completion of the patient’s plan.

I highlight this because of the push towards Loughner as defined only by mental health problems, and calls for improvements in mental health care. These improvements are urgently needed; however, they are not necessarily the only way to think about how we deal with violence.

A program I highlighted a couple years ago, Gary Slutkin’s Cease Fire, highlights a more grounded, or anthropological, approach to thinking about how to deal with violence:

So why do I say he’s an anthropologist? Three reasons, really. First, Slutkin is critical of received ideas, in this case that punishment drives behavior: “He was convinced that longer sentences and more police officers had made little difference… ‘Copying and modeling and the social expectations of your peers is what drives your behavior’.” He sees this approach as more akin to stigmatization and moral punishment than effective policy: people are afraid, so they turn to old reactions “like putting people away, closing the place down, pushing the people out of town.” This combination of a critical cultural take on present practices, and an informed social perspective, makes his approach inherently anthropological.

Second, Slutkin approaches problems as a participant observer, stressing the value of inside knowledge, relationships built on trust and rapport, and the importance of language. The twist is that the violence interrupters are the ones who do this sort of work. They are the local experts, the ones who spend the time on the streets. They are the anthropological advocates.

Third, Slutkin places violence in the context of the inequality and culture that shape people’s everyday lives.—the street code, the things happening off the radar, the way one act of enmity spirals into another, the mix of desperation and reputation that fuels violence.

And here’s a striking article by Dennis Embry, a prevention scientist and psychologist, called Loughner More Than a Deranged Individual – He Is One of Millions.

He will be a young man. He will have a history of behavior problems that go back in time. He will have markers of instability, impulsiveness and ruminating or obsessive thoughts. More than likely, the young man will have had problems with drugs or alcohol, too. His school experiences will show run-ins with staff and students. And, the young man will likely have some political obsessions.

Twelve hours later, all that I suspected appears true…

The Institute of Medicine reported in 2009 on the availability of “behavioral vaccines” against mental illness, addictions, violence, emotional problems, suicide and other behavioral ills. This is not voodoo science. These are the findings of our most respected medical and scientific researchers as published in peer-reviewed journals…

What are the behavioral vaccines for curbing the metastatic madness affecting millions of children, youth and young adults? Consider these examples from the Institute of Medicine report.5

o A behavioral vaccine, called the Good Behavior Game, enables first-grade teachers to help children learn to control their attention and resist negative peer attention.6 This dramatically increases time for teaching and learning immediately. Overtime the benefits grow to prevent ADHD and Oppositional Defiant disorder by 3rd grade.7 By the 6th grade, bullying has been reduced. As have conduct disorders—just from the first grade “inoculation.”8 The same behavioral vaccine increases high-school graduation and college entry.9 From the early twenties to age 30, the behavioral vaccine prevents involvement in violent crime,10 suicidal behaviors,11 adult addictions and psychiatric disorders.12 And the cost of this behavioral vaccine? About $50 dollars per child’s life. No single medical vaccine prevents this many costly diseases or disorders that touch every family in America.

The Institute of Medicine report is called Preventing Mental, Emotional, and Behavioral Disorders Among Young People.

Over at Zero Anthropology, Max Forte has a powerful and provocative post, When it Comes to Political Violence, the U.S. Sets an Example for Itself. Forte’s questions, and his images of Giffords and the military, point us towards broader considerations – a view from the outside – that have been barely addressed. A culture of anger, meet the institutional exercise of violence…

We get to pick and choose our violence; we have the right to bring death, but we shouldn’t have to suffer it ourselves; we can live by the sword, but it is inconceivable that we should die by the sword. The state orchestrates violence on a massive scale, the media sanctify it, and citizens are trained to accept it as the norm. Who knows what finally motivated this one shooter to finally act, when others just imagine themselves acting.

Saturday. Seena Fazel, writing in the Wall Street Journal, turns in one of the best summaries of what is known about mental illness and violence that I have seen in the article, The Line between Madness and Mayhem. Implicit in the article is that Loughner is mentally ill – but the piece itself is about the broad issues involved. It also frames everything as risk, rather than cause. Most people will not.

This increase was typically two to five times higher in men with schizophrenia and over four-fold higher in women with schizophrenia. As one expert commented, clinicians have to face up to this “unpalatable” evidence “for the sake of our patients.” A similar review on bipolar disorder and violence from 2010 found similar increases in risk.

These investigations also found, however, that only 3% to 10% of all violence in society is committed by individuals with severe mental illness. In other words, at least 90% of all violent crime in Western countries is committed by people who are not suffering from such conditions. In Sweden, for example, from 1988 to 2000, there were 45 violent crimes per 1,000 persons, of which two to three were attributable to persons with severe mental illness.

Moreover, the vast majority of patients with severe mental illness are not violent during their lifetimes. The largest and longest study of schizophrenia and violence, conducted in Sweden over the course of 30 years, found that only 13% of patients had violent convictions after receiving their diagnoses. For most patients, the risk of becoming a victim of violence is higher than the risk that they will commit violence.

Nor should we make the mistake of assuming that a correlation between mental illness and violence somehow establishes a causal connection between them. It may be that schizophrenia is simply a marker for other factors that increase the risk of violence. Of these factors, one of the strongest is alcohol and drug abuse. Estimates from the U.S. indicate that around half of patients with schizophrenia also have problems with substance abuse. One study in American urban centers found that nearly a third of patients who were discharged from the hospital and also diagnosed with substance abuse were violent within one year.

It is not entirely clear how substance abuse increases the risk of violence in these patients. It may make them less inhibited, prompt them to criminality in order to fund their habits, or increase the likelihood of their mixing with an antisocial peer group. It may discourage them from taking their medication regularly and thus controlling their symptoms. And it may be a marker or trigger of destructive personality traits that are inherited or determined by early childhood and family experiences.

Three other factors consistently increase the risk of violence in mentally ill patients. The first is the overall extent of their psychotic symptoms—the worse the symptoms, the more likely the risk of violence. Another is a history of antisocial behavior, usually manifested in problems at school, previous arrests or fighting. A final risk factor is a family history of criminality, suggesting possible genetic and early environmental contributions to violence.

In contrast to this, we find the police’s reports on Loughner, as reported in The Statesman article, Police depict busy, focused Loughner on morning of shooting.

Far from the undisciplined, semi delusional dropout described by friends, Jared Loughner appeared to be a young man with laser focus when it came to planning and carrying out a shooting spree outside a Safeway last Saturday, local law enforcement authorities said Friday.

They released new information showing that, starting shortly before midnight the night before the shooting, Loughner, 22, zigzagged across Tucson for hours checking off a final to-do list: He booked a room at a Motel 6, bought ammunition at a Walmart and purchased more items at Circle K and Chevron stores.

The New York Times has published an extensive look at Jared Loughner’s life, Looking Behind the Mug-Shot Grin of an Accused Killer. Well-worth reading – “the pattern of facts so far presents only a lack of [a clear picture], a curlicue of contradictory moments open to broad interpretation.” Here’s one section from the beginning:

What the cacophony of facts do suggest is that Mr. Loughner is struggling with a profound mental illness (most likely paranoid schizophrenia, many psychiatrists say); that his recent years have been marked by stinging rejection — from his country’s military, his community college, his girlfriends and, perhaps, his father; that he, in turn, rejected American society, including its government, its currency, its language, even its math. Mr. Loughner once declared to his professor that the number 6 could be called 18.

As he alienated himself from his small clutch of friends, grew contemptuous of women in positions of power and became increasingly oblivious to basic social mores, Mr. Loughner seemed to develop a dreamy alternate world, where the sky was sometimes orange, the grass sometimes blue and the Internet’s informational chaos provided refuge.

He became an echo chamber for stray ideas, amplifying, for example, certain grandiose tenets of a number of extremist right-wing groups — including the need for a new money system and the government’s mind-manipulation of the masses through language.

In the last three months, Mr. Loughner had a 9-millimeter bullet tattooed on his right shoulder blade and turned increasingly to the Internet to post indecipherable tutorials about the new currency, bemoan the prevalence of illiteracy and settle scores with the Army and Pima Community College, both of which had shunned him. He also may have felt rejected by the American government in general, and by Ms. Giffords in particular, with whom he had a brief — and, to him, unsatisfactory — encounter in 2007.

Nearly four years later, investigators say, Mr. Loughner methodically planned another encounter with her. Eight days ago, on a sunny Saturday morning, he took a $14 taxi ride to a meet-your-representative gathering outside a Safeway, they say, and he was armed for slaughter.

I want to finish with Ryan Anderson’s reflection on our search for causality, our desire for one simple explanation and that reality just isn’t that way. In his post Root Causes: Where Does Violence Come From? he writes:

Events like this happen within larger social environments, and taking stock of those environments is probably a good starting point. At the same time, it also makes sense to look closely at the biographical details of the person who committed the act itself. All in all, the point is that it’s a good idea to avoid the knee-jerk, reactionary explanations. Look at the histories, look at the biographical details. Trawl your way through the news media, through articles and reports–take time to think things through. Accept the fact that the desire to find a clear “cause” might be like heading down an endless rabbit hole. There probably isn’t a single cause–but there may be certain factors, trends, and signs that arise that help to not only understand these types of events, but also to find ways to avoid them in the future. Maybe.

After chronicling these different takes, the ones that get at the complexity and the reality more than the dominant discourse, I have written my own post:

Jared Loughner Has a Violence Problem, Not a Mental Health Problem

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