On Sunday night the television news program 60 Minutes broadcast "Untreated mental illness an imminent danger?" Correspondent Steve Kroft introduces the report by stating: "The mass shooting at the Washington Navy Yard two weeks ago that resulted in the deaths of 13 people, including the gunman, was the 23rd such incident in the past seven years. It's becoming harder and harder to ignore the fact that the majority of the people pulling the triggers have turned out to be severely mentally ill--not in control of their faculties--and not receiving treatment."
I'm a long-time fan of 60 Minutes, which produces the kind of tough investigative journalism that is increasingly rare these days. But "Untreated mental illness an imminent danger?" overstates the degree to which psychiatry can explain and treat mental illness—and hence prevent violent outbursts by the mentally ill.
The problems with the show begin with its basic premise. Contrary to Kroft's assertion, some mass shooters have received psychiatric treatment--including prescriptions for medications--prior to erupting into violence. The Navy Yard shooter, Aaron Alexis, was prescribed the antidepressant trazodone in August. James Holmes saw a psychiatrist before killing 12 people in a Colorado movie theater last year. According to the Los Angeles Times, police found the antidepressant sertraline and sedative clonazepam in Holmes's apartment.
As I reported last month, some studies indicate that psychiatric medications, and especially antidepressants, might increase the risk of violence. "Violence and other potentially criminal behavior caused by prescription drugs are medicine’s best kept secret," says psychiatrist David Healy, who recently created a website, called RxISK.org, to gather data on adverse effects of medications.
Kroft's discussion of the pros and cons of drug treatment is cursory, at best. He notes that anti-psychotic drugs can make patients "listless or groggy, which is one of the reasons people with severe mental illness often stop taking them." Kroft says to Mike Robertson, a young man diagnosed with schizophrenia, "A lot of people with your illness say the drugs make them feel worse. They just hate it." Robertson replies, "Yeah. I can see that with the side effects. But it's better than having schizophrenic symptoms."
Viewers hear nothing about other serious side effects of anti-psychotic medications, which range from obesity and diabetes to uncontrollable tremors, or tardive dyskinesia. Nor does Kroft acknowledge that, even disregarding side effects, medications for mental illness do not work very well.
As Harvard psychiatrist Stephen Hyman, a former director of the National Institute of Mental Health, wrote recently, "many individuals with mental disorders remain symptomatic and often disabled despite existing treatments … For some significantly disabling conditions, such as the core social deficits of autism and the cognitive impairments of schizophrenia, there simply are no effective treatments."
In his 2010 book Anatomy of an Epidemic, journalist Robert Whitaker contends that psychiatric medications may on balance harm more patients than they help. Thomas Insel, director of the National Institutes of Mental Health, recently acknowledged that although anti-psychotics can "safely and effectively help people through the crisis of acute psychosis," the drugs might "worsen prospects for recovery over the long-term."
Instead of airing these critical views, Kroft interviews Jeffrey Lieberman, a psychiatrist at Columbia University and adamant proponent of biological theories of mental illness. Lieberman tells Kroft that brain scans of schizophrenics reveal "structural abnormalities." But according to the National Institute of Mental Health, "No scientific studies to date have shown that a brain scan by itself can be used for diagnosing a mental illness or to learn about a person's risk for disease."
Kroft's primary source is psychiatrist E. Fuller Torrey, who asserts that if mentally ill shooters "were being treated, [mass killings] would've been preventable." By "treatment," Torrey means detainment in a mental-health facility. For decades, Torrey has advocated legal reforms that would make it easier to hospitalize and medicate patients against their will.
Torrey has one legitimate point: that an unfortunate consequence of the wide-scale closing of state mental institutions a half century ago has been that many mentally ill people now end up homeless or in prison. Kroft interviews Sheriff Tom Dart, who oversees Cook County Jail in Chicago, which houses as many as 2,800 mentally ill inmates.
"The irony's so deep that you have a society that finds it wrong to have people warehoused in a state mental institution," Dart says, "but those very same people were okay if we warehouse 'em in a jail."
The large-scale incarceration of indigent, mentally ill Americans is indeed a national disgrace. But surely there are better solutions to this problem--and to mass shootings--than rolling back the rights of the ill so many more of them can be forcibly hospitalized and medicated . After all, Dart says that his disturbed, destitute inmates are usually imprisoned for nonviolent offenses such as theft and trespassing.
One reason why I was so disappointed by "Untreated mental illness an imminent danger?" is that 60 Minutes has produced hard-hitting exposes of the pharmaceutical industry, including Kroft's 2007 report "Under the Influence." To redeem itself, I'd love to see 60 Minutes investigate the thesis of Anatomy of an Epidemic that psychiatric medications—far from helping reduce severe mental illness in the U.S.—may be increasing its incidence.
Photo: CBS News.