Would gun control stop massacres such as that done at Virginia Tech?

Well, using a machete is not quite as efficient, but they did manage to kill a lot of people that way in Rwanda.

The dirty little secret about the Virginia Tech shooter is that he was mentally ill. Not in a private angry delusion like the Columbine shooters, who fed each other’s anger and were sociopaths and/or immature. And probably not a bipolar depressed teenager with a history of severe abuse, such as the boy who shot up Red Lake High.

When you hear “withdrawn loner”, think schizophrenia.

There are many types of mental illness, but schizophrenia, which exists in about one percent of the population, is the most severe. It is probably biochemical or viral in origin, and may get worse with stress (i.e. people prone to the problem may become pyschotic under increased stress).

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Usually we see a teenager who starts to get withdrawn, and then when you interview them, you find they are hearing voices. Often their “affect” is flat. When you talk to them, it is like talking through a window, hard to connect with them. If you talk furthur, you find they have all sorts of weird ideas, and their lives can get fixated on the ideas. Right now, flying saucers and Bush as the evil one are popular, but in the past, many who accused others of casting spells were psychotic, and many who were accused of being witches were psychotic.

I should explain “psychotic”. In Schizophrenia there are positive  i,e. psychotic symptoms (paranoia,anger, hallucinations) and negative (withdrawn, emotionally cold personality) symptoms.

Psychosis means hallucinations: You hear voices.
But not everyone who hears voices is psychotic: if a normal person has one or two episodes when he hears “God’s voice” but has no other symptoms, he is not psychotic.
If a person hears voices all the time telling him he is going to hell, and that person can’t keep a job, doesn’t bathe, is withdrawn from others, and has a complex delusional complex where Dan Rather talks to him via the television and the CIA is spying on him, then he’s probably schizophrenic.

Figuring out these things is hard for even those of us who are docs to do. Psychiatrists are trained but even then you will see these patients with half a dozen different “diagnoses” depending on if his angry paranoid symptoms, his depression, his delusions, or his quiet inability to function are the symptoms that were present when the person was seen.

Most of the delusions are harmless. Most of us have a “crazy uncle” like Mel Gibson’s father who has weird ideas but manages to cope with life. But sometimes the psychotic becomes paranoid and fixated in his anger, and then you have danger.

This does not solve the problem of the mentally ill who get guns. I’m for moderate gun control: make it like a hunting license or a driver’s license, where you have to pass a test.

But mixing the mentally ill with the right to carry a weapon is not a good mix.  Podcast here….the REAL problem may be the “civil rights” laws that make it impossible to mandate long term care (in patient or out patient) for the mentally ill…even scary ones. LINK

The dirty little secret is that psychiatrists are poor at predicting suicide or aggression by their patients.

The “clue” that was missed in Mr. Cho was a subtle one that cops call “street smarts”, women call intuition, and psychiatrists call “countertransference”. Mr. Cho frightened people.

Alas, the way our laws are written, we no longer can jail or hospitalize someone who “frightens people” even if they are stalking the innocent, writing about killing, and have a strong paranoid delusional system of anger and revenge.

Until the law starts recognizing that behavioral clues are a valid reason to keep a person hospitalized, such killings will continue.

The good news is that the majority of schizophrenics, even paranoid ones, live among us as eccentric uncles whose delusions are harmless.

The bad news is that once in awhile such paranoid delusions take over countries, and you end up with mass murder.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket

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