Psychologist Jonathan Kellerman writes a thoughtful Wall Street Journal op-ed piece , with which I largely agree, grappling with the ethical responsibility of the mental health profession with respect to violence:
Kellerman does, however, place too much responsibility at the feet of the “liberationists” and “libertarians”, exemplified by R.D. Laing and Thomas Szasz for the historic failure of the mental health system to effectively address such issues. Would that Laing’s thought had had more of an influence! Kellerman summarizes the Laingian perspective as the principle that “[not] only wasn’t psychosis a bad thing, it was evidence of a superior level of consciousness”. But Laing’s opposition to psychiatric medication and hospitalization were just the window dressing on his more essential contribution — an existential perspective which gives inroads into the inner world of our psychotic patients that inherently humanizes our care. This is not incompatible with the responsible mainstream practice of clinical psychiatry, IMHO, and I can cherish Laing’s influence on my psychiatric philosophy without cognitive dissonance even though I medicate and hospitalize patients. About Szasz I have less kind things to say, especially given his collaboration with the Scientologists.
Deinstitutionalization and the failure of the community mental health system were not driven nearly as much by such idealistic philosophical vision as they were by the fiscal betrayal of the severely mentally ill — a socially insignificant constituency without serious advocates, and one our society is all too ready to shun and stigmatize — in the service of budgetary constraint. As Kellerman observes, “this was baby-and-bathwater time.” The crux of the matter, he goes on to observe,
I would amplify on that; schizophrenia (and other major mental illness) involves not only a general degradation of reasoning but also a specific loss of insight into the nature of one’s illness and recognition of the need for treatment, known as anosognosia, that can be understood both in terms of psychological denial and neurochemical dysfunction of particular brain regions, and which makes noncompliance with followup treatment and medication the single most important cause of deterioration and relapse.
While exercising due diligence in raising caveats, Kellerman infers that Cho had a serious mental illness and, unfortunately, all we will have is speculation:
I would be the first to assert that psychiatry is a markedly imperfect tool at best for the prediction and prevention of violence, and that once on the slippery slope of preventive detention the dangers outweigh the benefits. But Kellerman’s conclusion, that
should give us pause.