Alex Lerman is a practicing psychiatrist with a background in crisis intervention and community psychiatry.
I have no knowledge of alleged mass-murderer Jared Loughner that does not come straight from the headlines, and I am sure the world does not need more low-fact speculation about him.
But Loughner has given us a video statement that is generally referred to as "rambling" or "incoherent" in press accounts, but which is in its own way more articulate than a panel of expert witnesses. It affords us an unfiltered experience of what the word "psychosis" actually means: a terrifying breakdown of the capacity to differentiate between self-experience and the external world.
In the months or year before he made the video, Loughner appears to have displayed the signs of someone suffering the onset of a major mental illness, growing withdrawn and prone to bizarre outbursts. People who have gone through similar experiences describe the process as terrifying, like entering a nightmare or a hallucinatory drug experience you can’t wake up from – and this is especially true of "first break" psychotics who have never traveled the road into, and out of, madness before.
In his video Loughner narrates a brief walk through the campus of Pima Community College, where he has been taking classes. He begins with a series of statements that make no coherent sense, yet are guided amid their incoherence by a clear and simple set of principles: a) something is wrong; b) people are suffering; c) a basic principle of individual autonomy and justice is being perverted; d) people are being destroyed and killed.
The remarkable thing, in my view, is that all of these statements are arguably correct, although not in the way Loughner means them. He is confusing the torment within himself with what is occurring in the world around him - a "self-other" confusion of that is one of the hallmarks of a psychotic state.
Loughner opens his narrative stating:
We’re examining the torture of students. We are looking at students that have been tortured.
Loughner is correct that students are being tortured: he is, by the torment of a mental illness he does not understand. The sequence of his thoughts is garbled and tangential, yet he is attempting to understand and communicate. Note how Loughner externalizes and universalizes his distress: it is not just he who is suffering, every student is suffering, at the hands of a malevolent school. He goes on to say:
Their low income pay in two wars. The war that we are in right now is currently illegal under the constitution. What makes illegal is the currency.
Loughner can again be understood to correct, as long as we understand that the "war" taking place is occurring within Loughner’s own disintegrating mind. Likewise, we should understand Loughner’s sense of illegality and corruption to represent an externalization of his own struggle with conflicting impulses, possibly including a terrifying sense of being physically invaded, with or without frightening sexual impulses (a question raised by reports that Loughner photographed himself wearing a g-string, and holding a gun near his buttocks).
It's foolish to speculate unduly about sexual ideas that Loughner may, or may not have been struggling with. But it's not foolish to be aware that many psychotic people, perhaps particularly young men, are terrified by sexual impulses, sometimes experienced as the threat of sexual attack, or delusions of feminizing body transformations. While such experiences may represent the emergence of previously-repressed sexual desire, it’s often nearer the mark to understand them as a sexualization of self/other confusion – but this is a distinction that frightened, disturbed people tend not to make, sometimes responding violently to a perceived impending assault.
Loughner’s own confusion is evident in the video, as he goes on to describe his sense of disorientation and unreality; incorrectly attributing the problem to a malevolent external "control":
The date is also wrong. It’s impossible for it to be that date. It’s mind control.
Loughner mentions his concern about "low income" at the start of the narrative, and his anxiety about his future resurfaces after a momentary encounter with a former teacher, after which he appears to be laughing, weeping, or both:
I lost my freedom of speech to that guy, and I’m in a terrible place...This is my genocide school, where I’m going to be homeless because of this school......Here’s the microwave I’m going to use when I’m homeless...
Yet again, Loughner illustrates his confusion between self and non-self, and simultaneously expresses his anxiety about the trouble he is in. He appears to be worried about becoming homeless, possibly with good reason, depending on his situation at home.
Near the end of his narrative, he frames the problem almost head-on:
If the student is unable to locate the external universe, then the student is unable to locate the internal universe. Where is all my subjects? I could say something sad (?sound) right now, but I don’t feel like it.
Loughner is indeed unable to locate either universe, and he appears to be concerned about losing his home - real problems which likely compound his sense of anxiety and despair.
Many psychotic people report sensations of impending universal doom, which once again can be understood to represent a distorted externalization of a sense of personal disintegration. Loughner's vision of doom takes a particularly ominous form - genocide.
But he did take the trouble to let the world know, by public posting this video. The administration at his college reportedly responded by suspending Loughner from class and barring him from campus.
It’s tempting to retroactively blame school authorities for the ensuing tragedy; but the question of whether the school acted appropriately hinges on what options were available. They could certainly have contacted the police, but Loughner did not explicitly threaten violence, nor did he engage in any illegal act - leaving the police very few avenues of intervention.
If a mobile psychiatric service – such as exists in my own Westchester County -- was available, a two person team could have gone to Loughner’s home and interviewed Loughner and his parents. Such teams operate collaboratively with the police, and can quickly implement either hospitalization or fast-track outpatient treatment, with follow-up to monitor compliance. My brief research suggests no such resource in Tucson.
If a complaint was filed with police, Loughner’s identity could have been cross-checked with a list of gun owners. But to the best of my knowledge, efforts to make such a data base have been blocked by pro-gun advocates and the politicians they control, some of whom see such an effort as an expression of a dangerous conspiracy to "disarm America".
Certainly, had Loughner’s video would have triggered intense concern, had it come to the attention of a competent mental health clinician, and led to questions in a diagnostic interview which likely would have led to a psychiatric hospitalization.
The deficits that accompany acute psychosis do not favor concealment, and many psychotic people – even paranoid and dangerous individuals – respond to sympathetic concern by speaking openly about their experiences.
A great deal of speculative ink has been spilled over the question of whether Loughner’s murderous assault was or was not influenced by the politics of our times. I obviously have no idea; but I note that Loughner’s central theses – i.e. that America is being corrupted by perverse, covert, constitutionally "illegal" forces, that the use of paper currency is destroying the US economy, that this process is the result of a secret conspiracy masked as legitimate governance – are highly concordant with far-right political discourse.
At the same time, Loughner’s ready access to guns and ammunition - including his ability to impulsively purchase ammunition on the day of his assault, even after reportedly having been refused at another store due to his bizarre behavior – are far more obvious factors.
The bottom line is that psychotic people need our help and support, help that in these days of brutally restricted public services is less likely to come. Mass murders are only one bad outcome of our turning a deaf ear to the cries and "inchoherant" youTube videos of our most vulnerable neighbors.
Before we blame others, perhaps we should look at ourselves, and the society we have built, with all our wealth – in which desperate young people like Jared Loughner are left to fend as they can on their own disintegrating resources.
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Following is a complete transcript of Loughner’s video:
All right , so here’s what we’re doing. We’re examining the torture of students. We are looking at students that have been tortured. Their low income pay in two wars. The war that we are in right now is currently illegal under the constitution. What makes illegal is the currency.
The date is also wrong. It’s impossible for it to be that date. It’s mind control.
(calls out to passing professor:)
How’s it going? thanks for the b- I’m pissed off!
(appears to weep, or laugh and weep)
I lost my freedom of speech to that guy, and I’m in a terrible place. It’s the school I go to. This is my genocide school, where I’m going to be homeless because of this school.
(appears to weep)
I didn’t forgot the teacher who gave me a b for freedom speech. That’s where my sociology class was.
And Here’s the microwave I’m going to use when I’m homeless. Here’s the cafeteria, whenever you have transactions.
This is pima community college, one of the biggest scams in America. The students are so illiterate, it affects their daily lives.
The bookstore, the bookstore the bookstore the bookstore. It is so illegal to sell this book under the constitution. We are also censored by our freedom of speech. They’re controlling the grammer. They control the grammer.
This is the police station. This is where the whole shaboozie goes down with illegal activity.
If the student is unable to locate the external universe, then the student is unable to locate the internal universe. Where is all my subjects? I could say something sad right now, but I don’t feel like it.
All the teachers that you have right now are being paid illegally, and have illegal authority over the constitution of the United states under the first amendment. This is genocide in America. Thank you.
This is Jared, from Pima College