Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995 ...Read More
In the wake of the Giffords shooting a few days ago, the media and discussion on some social networks have focused in part on the idea that the shooter, Jared Loughner, was/is/must be mentally ill and insane. This assertion is based in part on the outlandishness of his action in murdering multiple people, and in part based on a partial review of his internet postings and other documents which appear paranoid and which mention various conspiracy theories. There is no official diagnosis yet to my knowledge and so we will have to wait to see what the psychiatrists and psychologists who will inevitably interview the guy will come up with.
My sense is we want Loughner to be insane because we want to marginalize him. We want him to be suffering from something that makes him not one of us, not normal. We want him to be a bad apple who we can safely remove from the barrel containing the rest of us apples so that we do not get contaminated.
In my view, the question of Loughner’s insanity is important but only a piece of the larger context. Whether or not Loughner ends up diagnosed with some mental disorder, there is no possibility of containing the “illness” he has acted out by simply containing or executing this young man. Loughner’s actions are some product of whatever intrinsic issues he has (part of which may include mental illness), and the toxic, paranoid culture around him.
The toxic culture I’m referring to is the intense and politically charged paranoid talk that permeates the right-wing media in American these days. It is a mark of this paranoid culture that it is acceptable, even perceived as a sign of strength, for Sarah Palin’s website to feature a marksman’s cross-hairs over sections of the country which voted Democrats into office (even conservative Democrats such as Giffords herself).
I’m certainly not the first to point this out, and I daresay I will not be the last. Perhaps I can add something of worth to the observation by pointing out one of the mechanisms through which such inflammatory, targeted talk can contribute to violence.
If Loughner does have a mental illness, it is likely, given his actions, that it will turn out to be one characterized by paranoia and delusions. Delusions are fixed false beliefs which are resistant to reality testing. Paranoia, of course, is the belief that other people or entities are out to get you or (in milder versions) are wanting to leach off you. Paranoid delusions are frequently observed in certain types of mental illness conditions, notably the paranoid variety of Schizophrenia, and in Alzheimer’s. In these two cases, the delusions are thought to be secondary to some problem in the brain; a physical problem which gets writ into a psychological and behavioral problem by way of crossed wires (if you will). However, it should be kept in mind that delusions can occur in the absence of of brain damage or illness.
There are several conditions listed in the DSM which are consistent with paranoid delusions in the absence of brain problems. Non-exhaustively, these are Delusional Disorder, Paranoid Personality Disorder, and my personal favorite, Shared Psychotic Disorder or “Folie a Deux” – ; more or less translating to “shared madness”. I want to focus on Shared Psychotic Disorder for a moment, not because I believe that is necessarily what the shooter suffers from, but because it seems to me likely that the process underlying Shared Psychotic Disorder is in operation in producing individuals like Jared Loughner and very likely motivated him and provided him a tragic direction whether or not some other diagnosis also applies in his case.
If I may quote from the DSM:
“The essential feature of Shared Psychotic Disorder (Folie a Deux) is a delusion that develops in an individual who is involved in a close relationship with another person (sometimes termed the “inducer” or “the primary case”) who already has a Psychotic Disorder with prominent delusions (Criterion A). The individual comes to share the delusional beliefs of the primary case in whole or in part (Criterion B). The delusion is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder with Psychotic Features and is not due to the direct physiological effects of a substance (e.g., amphetamine) or a general medical condition (e.g., brain tumor) (Criterion C).”
then later in the same section:
“Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person. Individuals who come to share delusional belief systems are often related by blood or marriage and have lived together for a long time, sometimes in relative social isolation.”
“Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur among a larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parents’ delusional beliefs.”
You’ve probably figured out where I’m going with this already. The contemporary American media landscape is littered with examples of pundits promoting conspiracy theories and other paranoid and often outright delusional belief systems. These pundits have large followings in many cases; people who are repeat listeners to their shows and who fall under their sway in one fashion or another. Given a large enough sample of such listeners there are bound to be a few who come more or less completely under their sway for whatever reason and who may then take it upon themselves to act out what was previously just an insane suggestion. These people may not be delusional or otherwise psychotic to begin with, but rather become that way as a result of their deep immersion in a paranoid culture. It helps to be young and stupid too – obviously most people are not vulnerable to such extreme lapses in reality testing – but the fact that such induced psychosis can occur and does occur in some small population of vulnerable people should be reason enough to give those media outlets who produce such toxic material pause to reflect on what they’ve been putting out. It is unlikely they will, of course. That would require compassion, moral restraint and a willingness to take responsibility for their actions; qualities such individuals and institutions lack.
It may seem like I’m suggesting that Loughner is not really mentally ill, or that he was normal once and the paranoid culture he immersed himself in made him crazy. Both of those interpretations would be wrong. I do not understand Loughner’s true diagnosis, and won’t until it is announced, if it ever is announced. What I am saying is that the mental health professions know and have institutionalized the knowledge that delusional cultures can induce delusions in vulnerable people. I’m suggesting that it seems likely that this has happened here. I’m saying that the contemporary paranoid right-wing culture is creating an environment in which vulnerable people will, on occasion, run with the paranoid themes being broadcast and end up doing horrible things. Protecting people from Loughner’s delusionally-fueled actions will not protect people from the larger problem of a paranoid culture designed (however unintentionally or unconsciously) to incubate murderous thoughts in vulnerable listeners.