May 8, 2007

Another Final Word On Cho's Mental Illness

Hi.  Not surprisingly, many peoples have not liked my Cho comments.   Here's an example from a psychiatrist, and I responded with a comment there that I might as well put here.

As background, most people are yelling, "how the hell can you say this guy wasn't crazy?  He was talking to imaginary friends, he thought he was an Ax, etc."  As point of fact, these weren't delusions because he knew they weren't true, but that's a side point. 

Psychiatric pathology exists on a spectrum. It's not binary  "ill" or "not ill," and impairment in one realm doesn't explain impairment elsewhere. A diagnosis does not define all of your existence, or even all of your actions.

I should not, however, have said he wasn't mentally ill. What I should have said was he was not insane: he knew what he was doing, he knew what he was doing was wrong, and he had the ability to control himself. So he is entirely to blame, i.e., the mental illness, even if substantial, is incidental.

You might  say, ok, he's not insane, but only someone with a mental illness would do this.  It  doesn't lessen his culpability, however.

Well, actually, it does: you can't execute the mentally ill, for example.  Forget about your personal stance on the death penalty.  Fact is, mental illness is rapidly becoming an exclusion to a sentence that everyone else is subject to.  I know, it seems so righteous to say the mentally ill shouldn't be executed.  Ok, here: it would mean you can be sentenced to death, but he can't.  Does that make any sense, moral or legal?

Clearly, maladjusted and sexually frustrated college kids don't often go on rampages, so there was something in him that moved him to this.  Perhaps that was the mental illness.  But add up the body counts in the past twenty years. What's in common in mass murderers isn't mental illness, but frustration, impotence (metaphorical) and anger. Or are all those suicide bombers in Israel bipolar?

You'll say, "but he wasn't a suicide bomber."  His mental framework had much more in common with a suicide bomber than with John Wayne Gacy.

But let's put this aside and ask a different question, about us, not him:  why do so many people want him to be mentally ill?  Because its an explanation that doesn't implicate society, or themselves.  It means the world can be divided into "us" and "them," which is always fun.  It's the easy scapegoat that seems to be so obvious as to be unassailable.

And if it is mental illness, what do we intend on doing about it? My bias implies harsher sentences, societal changes, etc-- we can debate that later. But if it is all mental illness, then what? Do we lock up the "mentally ill" like we do pedophiles and terror suspects, before they even commit a crime, just on suspicion? And who decides who is suspicious?  Psychiatrists?  Do you trust every psychiatrist to be good at this? Or should it be the government?

Would you have been happy-- I mean this in all seriousness-- if George Bush had Cho arrested last year for being a terror suspect? Which part of that bothers you? It would have been legitimate, because he was dangerous. So is it that he was arrested before he committed a crime, or that George Bush did it?  See?  This is what you'll have to contend with with these policies. 

Oh yeah.  Treatment.  You want to make "treatment" mandatory? Great. Tell me exactly who should decide who needs treatment, and for how long, and what kind. And tell me how this treatment is going to work-- what is the specific end point?--  and for how long, and tell me what we should do when the treatment doesn't work.

You can't just make this stuff up as you go along, enacting policies which are politically expedient   but destroy the society.  Ask Vladimir Putin.  Oh, wait, bad example.








Comments

You're responding to critic... (Below threshold)

May 9, 2007 5:48 PM | Posted by Anonymous: | Reply

You're responding to criticism that Cho WAS mentally ill by redirecting everything to a discussion of how society should respond to the mentally ill -- EXCEPT that your whole first post was about how the general public was irrelevantly fixating on society's response to mental illness, irrelevantly because Cho wasn't ill. Now you say he's not NOT mentally ill.

Just say you were wrong, or stick to your guns, or say you don't know; but this subterfuge is ineffectual and dumbing.

The arguments in this new line of thinking don't hold up anyway because:

1) All the hypotheticals you proposed (e.g. locking up the mentally ill before they commit crimes) aren't being proposed by anyone and seem utterly implausible (sorry, Minority Report).

2) You're conflating clinical terms (clinical mental illness and clinical insanity) with legal ones (criminal insanity). They are related, but not at all the same.

3) You are also conflating mental retardation in Atkins v. Virginia with general mental illness. Again they aren't the same.

4) The justices in Atkins didn't find mentally retarded people any less culpable, they just said the death penalty is cruel and unusual for the mentally retarded because of "standards of decency".

Admin's response:This comment is exactly the counterargument, so I'll take some time on it, and make two points. The first is about whether he was ill and/or insane; the second, entirely separate one, is why people are so quick to assume he is ill.

I think he may have had "mental illness." Does that mean anything? Is Depression a mental illness? What about antisocial? What about Dysthymia? I don't see much schizophrenia here, but I'm certainly open to the possibility he was. However, saying he is "mentally ill" as an explanation is meaningless. The term "mentally ill" is empty.

And so we have Atkins. I am aware it's about the retarded; but the movement is towards a categorical exemption for all people with "mental illness." And so again-- depression? Borderline? The exemption for retardation IS NOT that you were too retarded to understand your crimes; it is simply THAT you were retarded. It is a CATEGORICAL exemption. That's the problem I have with Atkins, and that is precisely the problem with the attempts at a categorical exemption for the mentally ill.

It's so important I'll say it again: this exemption of mental illness isn't competency, it isn't insanity. It is "if you have X, you cannot be executed." Not "if X impacted on your crime." Simply having X. And X, in this case "mental illness" is preposterously vague and undefinable. At least with retardation we have an IQ test.

And so my second point about "why do we want him to be mentally ill?" is about this rush to an easy answer that isn't an answer at all; and which has immense societal implications, of which the death penalty is simply one example.

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Jason from Neurotransmissio... (Below threshold)

May 9, 2007 8:30 PM | Posted by Jason Thompson: | Reply

Jason from Neurotransmission here. I share some of your misgivings about reflexive attributions of mental illness to Cho.

Never having met Cho, I don't claim to know categorically that he wasn't mentally ill, but I'm equally skeptical of the commentary I've read that attempts to gloss what little we really know of Cho's inner world in diagnostic terms. To the extent that DSM terminology has genuine clinical or explanatory efficacy, it surely lies in providing clinicians with a mutually comprehensible framework to guide the psychiatric treatment of living patients over a therapeutically meaningful period of time-- not as a forensic postmortem of a killer-suicide of whose thoughts and behaviors only glimpses remain.

Mentally ill or not, the point you raise of Cho that resonates from my perspective is the societal dimension of his actions. If neither psychosis, schizophrenia, romantic disappointment nor Glock 9mms by themselves (or even in combination) truly provide sufficient reason to render the massacre comprehensible, we're forced to consider wider factors. For me, one wider thought is that Cho perceived himself to be a loser in the starkly polarised winner/loser culture of American hyper-capitalism -- that his intrinsic sense of the social contract by which he determined the shape of his life's final act was harshly attenuated by longterm social isolation. Like Milton's Satan, Cho thus resolved that it was "better to reign in Hell than serve in Heaven."

I wonder if the challenge of acknowledging such deeper structural causes lies perhaps in our sense that reconfiguring the social contract more equitably amounts either to a discredited Marxist delusion or a potential threat to the status quo.

For more on this theme, see "Others Must Fail: Cho Seung-Hui and the bloody cost of American individualism" at: www.neurotransmission.org

Admin's response: your comment about Cho's (and others') reactions to perceived hypercapitalism is perfect-- It's the flip side of the Marxist tendency in psychiatrists. There's no easy answer, which is precisely the point: how could there be an easy answer to such a complex behavior as deciding to be angry, buy guns, kill people, etc.

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Once again, I agree with yo... (Below threshold)

May 10, 2007 10:55 AM | Posted by D Cootey: | Reply

Once again, I agree with your assessment of this situation. I am not a psychologist, but my gut feeling from studying his statements and behaviors that have been revealed is that he may have been a troubled man, but lots of people are troubled and don't murder 32 strangers. Blaming Cho's behavior on mental illness doesn't really explain his behavior. As you have pointed out, it is an answer that doesn't explain anything. I see it rather as a scapegoat.


I wonder if people who believe that the mind can overcome its problems are more likely to feel Cho was responsible for his actions as opposed to those who blindly trust Big Pharma and it's network of doctors, psychiatrists, and prescriptions feeling the opposite.

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Yes yes a thousand times ye... (Below threshold)

May 12, 2007 3:02 AM | Posted by Robert Lindsay: | Reply

Yes yes a thousand times yes! I have blogged a lot on Cho, and I agree with you completely. I do not see any evidence whatsoever of any psychosis, nor any schizophrenia. I think he was autistic, probably Asperger Syndrome. That explains a lot of his weird stuff. I think the so-called delusions are just autistic fantasy. The whole picture simply does not look like paranoid schizophrenia at all.

He was depressed, yes. He was paranoid and narcissistic, yes, all mass shooters are. Psychotic? Don't think so. That's one of the best organized "psychotics" I've ever run into. Shooting up the neighborhood is not necessarily the work of a "madman". Maybe he's just pissed off? And as you allude to, one would have to diagnose the endless suicide bombers slaughtering innocents in Iraq every week as "psychotic". Surely they are not much different than Cho. Schizophrenics and psychotic people have enough problems as it is without being lumped in with every homicidal maniac who comes along.

And of course, if he recognizes it's not true, it's not delusion or psychosis! I run into clinical psychs and psychiatrists who cannot seem to fathom this obvious fact.

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I strongly suspect that a g... (Below threshold)

December 3, 2008 11:52 AM | Posted by La BellaDonna: | Reply

I strongly suspect that a good many people are arguing "mental illness" as a cause of his behaviour because they perceive mental illness as being treatable. It's 21st century magical thinking. If people do wicked, evil things because they are ill, we have doctors who can cure illness! If it is an illness, why then, it's preventable! On the other hand, if he did it simply because he was wicked and evil, then there is no safety, there is no prevention, there is no cure, and they themselves may become victims of just such another wicked, evil person.

And that, of course, is absolutely true - they can.

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This is boring to say but i... (Below threshold)

July 31, 2009 11:50 PM | Posted by R. Kevin Hill: | Reply

This is boring to say but irresistible: you are exactly right, and I said it myself to a crowded usenet NG shortly after the episode, and received no agreement, even from the most righteously moralistic. They took it primarily as an opportunity to discuss gun control and gun rights. Weird.

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I agree that Cho's actions ... (Below threshold)

April 27, 2014 10:41 PM | Posted by johnnycoconut: | Reply

I agree that Cho's actions were probably volitional, which would make him accountable for them. But paranoia takes away a lot of healthy choices until you realize/break free, which he didn't, though he may have thought he did. I don't even think you disagree, though I don't know what you think of this now, seven years later.

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