Sunday, January 09, 2011


One of the more interesting emails I received yesterday after the unfolding of the attempted assassination of Gabrielle Giffords and the murder of others, including a Federal judge in Arizona, was the following:
"This is what comes of spewing hate, you fascist pig!"

I find it interesting primarily because it encapsulates in an enlightening way the leftist mindset which has been described in the last several posts on Dr. Sanity.

I have not met or examined the individual who is in custody for this horrific attack. But I have read quite a bit of information about him now. Making a reasonable clinical determination (which will be impacted obviously by forthcoming information also); and based on his own writings and behaviors that were described prior to this incident, my best assessment is that Jared Loughner was likely suffering from paranoid schizophrenia.

Schizophrenia is a real physiological illness that usually begins in late adolescence, early adulthood; and it is like a youthful dementia; slowly tearing down the neural pathways in the brain and causing deteriorating cognitive functioning. The paranoia comes about as the person suffering from the disease tries to make sense of all the irrational, distorted and bewildering perceptions that their malfunctioning brain is attempting to interpret.

Paranoid schizophrenics almost always have bizarre political and/or religious agendas. Their delusions almost always have relevance to the current political situation and context within which they live. I can give you hundreds of examples from my personal experience treating them: the CIA or other "secret" agencies are tapping into their minds; the "government" (and I have seen U.S., British, and multiple other governments implicated depending on the national origins of the individual in question) is out to destroy them because they know something they should not; they alone understand the urgency of the threat. When the Patty Hearst kidnapping occurred decades ago, almost all the schizophrenics I saw had delusions related to Patty Hearst and the Symbionese Liberation Army. More recently, a paranoid schizophrenic that I evaluated thought that President Bush practiced dark magic to force people into 'volunteering' for the military and that this was why no military draft was needed to get recruits to go to Iraq.

The paranoid person himself is always at the center of some vast conspiracy that only he can see. He is special because of it--and this specialness likely compensates for whatever awareness he might have of his deterioring intellectual and social functioning. As that functioning gets more chaotic and dysfunctional, the paranoid gets even more desperate to explain what is happening to him and his world, and the delusions become more and more complex and eventually may have no connection at all to anything in the real world.

In my career as a psychiatrist I have encountered many psychotic and schizophrenic individuals with religious and anti-religious delusions.

One study suggests that those patients with religious delusions are suffering from a particularly virulent form of schizophrenia, where the potential for self-harm or harm to others is significantly increased. The study concluded that "religious delusions are commonly found in schizophrenia and that by comparison with other patients who have schizophrenia, those patients with religious delusions appear to be more severely ill."

Such delusions may even occur in people who were never religious prior to their illness. Or it may happen in reverse--if the individual was raised in a very religious household, their delusion takes on a virulent anti-religous form. And in the sickest individuals, it all may be combined with delusions of grandeur, where the person believes they are some figure of religious and historical import. I, myself, have personally met Jesus Christ (several times), St. Theresa, the Pope, Lucifer, and a variety of other assorted religious icons, demons, and devils.

At least, that was what they told me at the time.

Those raised in a predominantly Christian culture had delusions of a Christian nature. But I have also seen Hindus, Buddhists, and American Indians with religious delusions that took on the form of their own culture's predominant religion. Interestingly, the one person I saw who had been a committed atheist prior to becoming psychotic, thought he was the "Devil" and the "King of Evil" when his brain strayed from reality.

These people are truly sick in every medical/physiological/biological sense of the word.

It takes a truly 'sick' person, in every philosophical/moral/spiritual and ethical sense of the word to say that such an ill person's motivations are the exact motivations of those with whom they happen to disagree.

I have been treating schizophrenic patients for almost 35 years now. The point is that their illness impairs their cognitive functioning. Schizophrenics have a biological cause for their dysfunction.

I wonder what my emailer's excuse for his behavior is?

I suspect it derives from the voluntary suspension of his cognitive functioning in order to maintain a certain worldview or ideology that explains a disturbing reality he does not want to face.

This is exactly why I often speak of psychological defenses.

Those who read my blog know that I use psychiatric and psychological concepts to describe behavior; and because of that, many people on the left accuse me of labeling anyone who disagrees with me politically as having a mental illness.

This is not true; and it suggests that most of these critics know little about psychiatry, psychiatric diagnoses, or even the concept of psychological defenses.

While I do believe that some of the people I describe might indeed have a mental illness; and that some are actually perfectly healthy but simply malevolent or evil; it is simply not the case that by exposing certain psychological defense mechanisms that explain theiroutwardly observable behavior, I am giving the political opposition a medical/psychiatric diagnosis. Nevertheless, if a particular diagnosis fits, I am perfectly content to let them wear it.

In discussing psychological defense mechanisms, what I am trying to do is understand how and why people behave in the way that they do. Describing psychological defenses is not the same thing as "making a diagnosis" for one very simple reason. All humans utilize psychological defenses, all the time. Both Democrat and Republican; Left and Right. Good and Bad.

Psychological defenses are involuntary (usually), regulatory coping processes. By themselves, defenses are not evidence of "illness". However, when used, they may appear to be "sick," evil, or even irrational; but basically, they reflect a creative adaptation to the world.

Because of their cognitive impairment, schizophrenics invariably use the most primitive and low-level defenses like paranoia; delusional projection; psychotic denial. However, it is important to remember that such defenses are also available to anyone who willingly suspends cognitive functioning--i.e., thir mind-- in order to hold onto dysfunctional ideas or beliefs that buttress them against an unpleasant reality or truth. The latter individuals have no desire to return to the real world; while the schizophrenic sadly cannot return without medication (and even the ones we use to help them frequently work very imperfectly).

The old joke about "how many psychiatrists does it take to change a lightbulb" is appropriate here: "just one....but the lightbulb really has to want to change." Many people have no desire to change and conform to reality. They will maintain their dysfunctional defenses no matter what the cost. Self reflection and insight are far too dangerous for such people, and even death is sometimes preferable to altering their beliefs or fantasies about the real world.

Clearly, their distress about the possibility of changing themselves or their beliefs is far greater than any potential consequences they might experience by using an immature, unhealthy and dysfunctional psychological defense to avoid reality. This is 'sick' but it is a sickness of the soul; not a biological illness.

From the intense rage and irrationality expressed in his written words to me, I suspect that my emailer has such a sickness of the soul.

In the days to come, we will learn more about the mass killer in Tuscon and his supposed motives and background. He may not be schizophrenic--I am only basing my judgment on a limited, but highly suggestive, amount of information. If I am wrong in my analysis of the information about Loughner that is already publically available, then I will admit it willingly.

I do not think my emailer will do likewise because he will ignore any information that does not conform to his precious worldview. Either way--for Loughner and my emailer, a mind is a terrible thing to waste.

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