Jared Loughner and the Gabrielle Giffords Incident: Schizophrenia Unravelled

This is an image of Jared Lee Loughner taken shortly after his arrest for the attempted assassination of US Congresswoman Gabrielle Giffords, the killing of six others including a nine-year old girl and the shooting of twelve other victims.

Remind you of anyone? The shaved head, the staring eyes and that entirely inappropriate smirk. A movie director couldn’t come up with a more perfect casting for the role of the classic, crazed lunatic. Jack Nicholson may have had more hair but his character in The Shining is not a million miles away from the caricature of Loughner’s grinning, haunting image. But unlike Nicholson’s Jack Torrance, Loughner killed and maimed people for real. And this is one tragedy fuelled not by ghosts, but by a severe and devastating illness called Schizophrenia.

Yesterday Loughner was judged by an Arizona court to be ‘unfit to plead’. The UK mental health system is in many ways very different to that in most American states, but it’s a basic fundamental of most judiciaries that an accused cannot stand trial if they’re unable to understand the workings of a trial or to be able to communicate meaningfully with their legal defence. It is reported that Loughner has been ‘paranoid’ and distrustful toward his legal representatives, and his bizarre behaviour in court yesterday would certainly suggest someone who would struggle to co-operate with the rigours of any trial, let alone a case as high profile as this.

Medical reports submitted to the court reveal that Loughner has been diagnosed with a severe mental illness called Schizophrenia. He may be many thousands of miles away but Schizophrenia is Schizophrenia in whichever part of the world it manifests, generally at a rate of around one in a hundred of the population.

And other than the fact that he was able to buy weapons and ammunition as easily as we in the UK can pick up a pair of scissors, the history, the behaviour, the disturbed thoughts and the resulting tragedy are as familiar to us as the language we share. But it’s the stigma and misunderstanding surrounding conditions such as Schizophrenia which also struck me as being a common theme to both sides of the Atlantic. A quick summary of comments left on the Yahoo News website suggested that many Americans believe Loughner should be strapped to the nearest electric chair and plugged into the national grid. Asap. Crazy or otherwise.

If you’re already convinced there’s no such thing as a psychiatric defence even to a crime as horrific as Loughner’s, then you may as well click away now and take a look at Photoshopped cats dancing to Justin Bieber. 

But as a UK mental health trainer I’d like to take you on a brief tour around an illness which very, very occasionally leads to events like this, but more often results in despair, loneliness, shattered lives and in some cases death. Not of other people but of the Schizophrenic him or herself. If you’re willing to persevere, read on.  

What is Schizophrenia?
Schizophrenia is a severe, psychotic illness which affects approximately 1% of the population worldwide, including Jared Loughner. ‘Psychosis’ or ‘psychotic’ is one of those horribly misused words beloved of tabloid sub-editors as a shorthand for ‘dangerous’ or deranged’. To be psychotic is to be detached from reality, usually as a result of a mental illness, to the extent that the person becomes trapped in a mental world which is not only very real (and often terrifying) to them, but bizarre and incomprehensible to those of us on the outside not sharing this strange reality.

There are critics who object to the labelling of someone like Loughner as ‘Schizophrenic’. They would rather see mental illness as a complex collection of problems and expressions of distress as opposed to a neat little box of medical symptoms. While it’s certainly true that our key diagnostic ‘bibles’ such as DSM-IV and ICD-10 promote disorders such as Oppositional Defiant Disorder (aka moody teenager) or Hypoactive Sexual Desire Disorder (aka your partner doesn’t fancy a shag), the tendency for psychiatry to medicalise the tiniest tic of human behaviour does at times lead itself to ridicule and there are plenty of examples of the psychiatric ‘system’ treating the diagnosis rather than the person.  

Personally I have little problem with the term Schizophrenia. It’s a distinct form of mental illness clearly describing for hundreds (if not thousands) of years much of the disordered thought, conflicting emotions and perplexing behaviour of people like Jared Loughner.

What are the effects (or symptoms) of Schizophrenia?
Auditory hallucinations are perhaps the first common feature of Schizophrenia to be happily reeled off by the exam room student psychiatrist. The rest of us just refer to ‘hearing voices’.

Voices are neither ubiquitous nor necessary for a diagnosis of Schizophrenia. If you’re hearing the voice of your partner right now telling you to get off that bloody laptop and go do something a little more useful, this may be for real (in which case you’d better save the rest of this for later and do as he or she says!) or the sort of imaginary voice that many of us hear or live with without need for particular concern.

It is difficult to tell outwardly that a person is hearing voices. Unless they’re responding verbally to their voices or laughing/grimacing at what they can hear, or decide to actually tell someone about the voice(s) in their head the soundtrack of Schizophrenia is often a private conversation.

Interestingly, the word ‘hallucination’ may have become something of a misnomer. We are now aware that the brain’s audio pathways respond to ‘hallucinations’ in the same way it responds to sounds that are as real as the radio playing away in the background as I write this. So the voice of God, or Barack Obama or Satan may be a little more real to the Schizophrenia sufferer than the term ‘hallucination’ may suggest. 

Jared Loughner’s psychiatric notes were not released to the public so we have no way of knowing whether he heard voices. It is quite feasible that he was receiving what are known in the trade as ‘command hallucinations’ to do what he did. 

What is not in dispute is the very strange, erratic behaviour he was presenting to everyone that came across him in the years and months prior to the shooting of Gabrielle Giffords and the eighteen other targets of his rage. For some years following his premature departure from college he was reported as displaying an increasing preoccupation with politicians and their shortcomings. Now he definitely isn’t alone on this one. While this doesn’t warrant a psychiatric diagnosis on it’s own merit (imagine the waiting lists for a consult), the significant aspect here is the increasingly focused descent into an all-encompassing obsession, where all that mattered where his own particular objects of attention. As can be seen in what has become a macabre YouTube hit, Loughner became fixated on subjects such as ‘grammar’ and ‘currency’ and the descent of the American dream.

This sort of odd, incomprehensible behaviour is driven by what mental health professionals call thought disorder. Loughner’s strange, jumbled and rather macabre videos paint a picture of just the sort of thought disorder that will be familiar to anyone who has known or worked with a Schizophrenia sufferer. What is said, done (and in Loughner’s case) written may seem like a random collection of words and repetitive ideas, but in the mind of the Schizophrenic they make perfect sense. It’s the thought disorder and behaviour propelled by those thoughts which, often accompanied by voices, become the visible face of someone suffering a severe psychotic illness.

What causes Schizophrenia?
Neuroscience, genetic heredity and good old ‘nurture’ all appear to play an important role in the development of the illness, but long-term studies suggest that a genetic potential for the illness is by no means a guarantee that the symptoms will erupt into Schizophrenia.

When Schizophrenia does emerge, it does so usually in late adolescence or early adulthood. We have known for many years how the environment of a younger person who may already be susceptible to Schizophrenia can play a vital role in flicking the ‘On Switch’ for the effects of psychosis.

It is well reported that Loughner had quite a troubled childhood and was an enthusiastic teenage user of Cannabis and hallucinogenic substances such as Magic Mushrooms, although his use of drink and drugs came to an abrupt end some years before the murders, quite possibly as a response to the increasingly puritanical and quasi-religious ideas that were coming to dominate his thoughts, feelings and behaviour. It has been widely reported that drugs can ‘cause’ Schizophrenia, but this has yet to be proved and is almost certainly not the case. What is looking more likely is that heavy substance use does play a role in impacting an individual’s susceptibility to mental illness, particularly where the young brain has yet to physically mature.

How come he’s ‘mad’ but could drive a car, buy a gun, make videos and post them on YouTube?
If you’ve seen Loughner’s YouTube postings and read or seen the accounts of his descent into illness from people who knew him well, you may well wonder how someone this ill can possibly drive a car, buy ammunition from a Walmart, deal with a traffic cop who stopped him for jumping a red light, and know that a particular politician will be in a certain place at a certain time one Saturday morning. He also has the skills to upload his video contributions to the world wide web.

Well, Schizophrenia involves an unravelling of the personality (not a split personality) and a brain which almost certainly would look slightly malformed and peculiar to the expert eye armed with an MRI scanner. But it only takes a quick skim through Google or YouTube to see that mental illness has little effect on an individual’s ability to perform tasks such as using the internet, uploading a video or driving a car. 

In the UK, one of our most well-known serial killers drove an articulated lorry during a killing spree which led to the violent death of thirteen women. Peter Sutcliffe claimed to have killed his victims as a direct command from the voice of God and was diagnosed with Schizophrenia shortly after his conviction. He remains in a maximum security mental hospital many years later and will never be released. Severe mental illness is not necessarily a barrier to performing complex tasks.

In Conclusion
It may seem strange to a British mental health professional that someone so clearly unwell and tormented by psychosis has not yet been treated with, for example, anti-psychotic medication during the four months of his incarceration, but a severe and chronic shortage of in-patient psychiatric beds means we in the UK are in no position to moralise over this state of affairs.

It would appear from reports that Loughner will now be located at a secure psychiatric facility in an attempt to relieve enough of his symptoms to allow further attempts at a trial later in the year.

A mental illness such as that experienced by Jared Loughner is not to be wished on anyone. Our current drug and psychological treatments are far from perfect and will probably remain so for many years until psychologists and neuro-scientists are better able to advance the understanding of what causes the sort of cataclysmic events seen in Arizona this January. If it’s true that Loughner had a troubled childhood this would have corollaries with many mentally ill people who in turn become violent and just goes to show we cannot look purely at neurotransmitters and genes in explaining his extreme aggression.

It should also be stated very clearly that for every Jared Loughner there are hundreds if not thousands of people just as disordered, distressed and bewildered who will be far more likely to harm themselves either by violence or self-neglect than injure another human being.

This man suffers from a severe mental illness and may possibly have other underlying personality problems. He has planned and committed a crime which has ruined the lives of many, many people, but I hope this post has made you condemn a little less and understand a little more.

Empathy, Psychopaths, Nature and Nurture: All in 1200 Words

Re: ‘Zero Degrees of Empathy: A New Theory of Human Cruelty’ by Simon Baron-Cohen


I haven’t actually read this book yet, which isn’t a promising start. So if this isn’t a book review, what the hell is it? Well, it’s a brief attempt to combine the main plank of the book (the clue’s in the title) with a discussion on the nature/nurture debate topped off with a completion of my rather long previous post on Personality Disorder. The latter was in fact so long I fear some readers actually died and decomposed long before they got to the end. Apologies to you if you’re reading this in the after-life.

Professor Baron-Cohen is a well-known specialist in the study of autism, and yes, if you’re trying to place the surname it’s his cousin Sacha’s various alter egos doing the jumping around in G-Strings and spoofing ‘da voice of da yoof. Innit’.  As a mental health trainer I’ve often referred delegates to the professor’s work whenever autism is discussed, but his latest theory takes a slight step away from the study of disorders such as Aspergers Syndrome and zooms down to one key aspect of the human condition: empathy. Or rather, lack of it.

Most people have a basic understanding of empathy. The ability to see the world through the eyes of another person or to understand how it might feel to be ‘the other’ is the key construct of an individual empathy rating which Baron-Cohen calibrates from zero to six. If you’re the sort of person who instinctively knows when your friends really can’t cope with your 407th holiday snap or you descend into floods of tears before Holby City has even got past the opening credits, you probably score in the upper regions of Professor Baron-Cohens empathy scale.

Looking at the reviews and in particular the commentary from Guardian readers, it would appear the unfortunate professor has been left with a bit of a scorched arse, at least from the more liberal end of the mental health/psychology spectrum. Firstly, he dares to suggest that something as subjective and nebulous as ‘empathy’ can be scored and rated with a questionnaire. Secondly, and perhaps even more heinously to some, he suggests the existence of an ‘empathy circuit’ consisting of various interconnected brain bits which are either turbo-charged, mid-range saloon or phutting away like an old Skoda. In the latter case (the ‘zero empathy’ range), we have the ‘psychopath’. This is the man or woman who simply doesn’t understand why the elderly lady whose fingers they’re breaking could possibly get upset: “Look, I’m only after the housekeeping money. What’s yer problem, luv?”

This ‘hard science’ approach to the explanation of complex mental disorders is often described as  ‘biological reductionism’ and is to many mental health professionals, sociologists and service users the psychiatric equivalent of a devastating fart in a crowded lift. Hence the less than favourable reviews from those for whom the ‘social model’ of mental health is sacrosanct.

We live in an age where huge brain scanners are soon to be miniaturised to the size of hat. These will no doubt be available at PC World with a Wi-Fi link to YouTube, leading to multiple postings from Baz in Thurrock: “This is my brain while I’m doing a poo”. Yeah, can’t wait for those clips. But more seriously, the previously complex and highly secretive brain is opening up to neuroscience like a ripe melon. 

Advances in genetic research are another major tool in the investigation of mental illness. In the not too distant future our personal genome will be available to anyone who wants to know how much Viking they have rattling around them, or more seriously, how susceptible they might be to Alzheimers Disease or Schizophrenia. Look out for the ‘Test your Genome Here’ booths at Tesco.

So far, so biological, but as a very experienced mental health professional I’m also only too aware of the devastating effects that trauma, abuse and childhood neglect have on the adult mind. Our surroundings, our circumstances and the events to which we’re exposed are crucial in determining whether we crash and burn with a handful of Seroxat or skip gaily through life like one of those ridiculously smiley people at folk festivals.

I like to think that, when asked to explain the causes of this or that psychiatric disorder, I can give a reasonably balanced overview from both sides of the ‘medical v social model’ debate. But even my balanced approach hasn’t always prevented me getting the ‘stare of death’ treatment at the merest mention of a gene, MRI scanner or (say it very quietly) Serotonin.

But here’s the thing. The ‘versus’ part of the ‘nature v nurture’ debate is gradually becoming as redundant as the public phone box. Remarkable evidence has been hitting the journals of the malleability of the brain long into adulthood. We’ve known for some time now how, for example, the memory circuits of London cabbies literally rewire themselves during ‘The Knowledge’. These changes can be observed with MRI scanners, although as far as I’m aware a predilection for TalkSport radio and an opinion on immigration has yet to evidenced by neuroscience. Even our genetic make-up is far from being the indelible clump of Cs, Gs, As and Ts formed at conception. Like our brains, our genes are susceptible to ongoing renovation long into adulthood and courtesy of the outside world.

Those of us who have worked with Baron-Cohen’s ‘zero empathy psychopaths’ will be all too familiar with the histories of childhood neglect, trauma and abuse described by patients/clients/service users. But can we infer a cause of personality disorder from these stories?

Of course not. Lots of people have experienced awful childhoods which haven’t turned them into serial killers, ethnic cleansers, concentration camp guards or sadistic sexual predators. There has to be some other factor gnawing away at the nascent mind to generate what some may refer to as ‘evil’. And if you’re a sociologist thinking ‘infamous Stanley Millgram experiments’ around about now, I did promise to keep this post brief.

Recent evidence is not pointing at previously simplistic nature or nurture explanations for psychiatric disorder, but toward a ‘perfect storm’ of environmental conditions, genetic predisposition and physical brain changes. There is certainly a worthwhile body of evidence that, in the case of Personality Disorder, a congenital potential for anti-social, callous and non-empathic behaviour exists in many of us at birth. Whether or not this genetic On-Off button is left on standby or blows up the microwave is highly dependent on the sort of environment we experience both as we grow up and long into adulthood.

I would like to think that someone as undoubtedly insightful as Professor Baron-Cohen doesn’t  seriously consider a wonky neural empathy circuit as the sole cause of human barbarity and that he’s been unfairly ‘dissed’ (to quote Ali G) by opinions which are perhaps not empathic enough to see both sides of an argument. But to find that out for sure I’d better get out the debit card and head over to Amazon books.

Visit JCK Training for details of in-house courses on Personality Disorder and our other health and social care subjects.