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| Guest Columnist | Harry M. Covert | Jason Miller | Ken Kellar | Patricia A. Kelly | Cindy A. Rose |


As Long as We Remember...

May 2, 2007

Protecting Yourself from a Paranoid Killer

Patricia A. Kelly

The recent, catastrophic shooting at Virginia Tech is already fading into memory. We return to the business of living, gradually resuming our complacency about our daily personal safety. There are more psychiatric patients in the hospitals, though. They are acting out our uneasiness.

My deep sympathies go to the young woman who survived both Virginia Tech and Columbine. How ironic in that the Virginia shooter was emulating those two deranged boys. There's been another mass shooting since, of four people. This one hardly made headlines.

The largest school shooting in history has inspired a lot of talk, some relating to campus security. Can you believe that huge, loud alarms are being set up on campuses to alert people to go to ground? That text messaging networks are being set up so students can be notified of trouble quickly? Did you ever dream that you would live in a world that requires such measures?

Another issue discussed has been mental health on campus, a subject that should be broadened to include mental health and the public welfare.

Under present privacy laws, a hospital can inform callers that a patient is present, and of his general condition, unless he requests privacy. If he is mentally ill, his presence in the hospital cannot be disclosed at all. If he is transferred from the Emergency Department to a psychiatric hospital and is over 18, his own mother cannot be told where he is.

This is intended to protect the patient from discrimination because of his mental condition. It doesn't. It actually fosters discrimination by accepting the notion that mental and physical illnesses are different.

Is schizophrenia any less an illness than gout or cancer? Is it more blameworthy? I think not. Schizophrenia can endanger those who have it and those around them, just as bacterial meningitis can.

The difference, besides discrimination in insurance coverage, is that, if you have meningitis, you may be excluded from school until you are successfully treated. Your contacts may be informed and treated.

If you are schizophrenic, in a misguided effort to protect your privacy, no one can be told; medical care cannot be required; you cannot be excluded from anything, even if it puts your life or those of others at risk. Your contacts may not be told, even if they have the sense to want to avoid sitting in class with you because your behavior is making them so uncomfortable. Is that not discriminatory?

Schizophrenia is diagnosed at one time or another, in one to two percent of the population. This group is five times more likely than non-schizophrenics to report some kind of violent activity in their lives. The membership of the prison population is three times more likely to be schizophrenic than the general population. Active hallucinations and delusions increase the violence rate.

Schizophrenics and victims of paranoia are often quite lucid and aware of their symptoms. A schizophrenic patient once told me in the Emergency Department, "I came because the voices are getting louder."

When I asked what they were saying, he answered, "They're telling me to kill myself." He knew, though, that treatment would help get "them" under control.

People with simple paranoia, at least some of them, know that they are paranoid. They sometimes look for their imaginary enemies, knowing that they won't really be there, just to help themselves calm down. Schizophrenic people, who are completely out of touch with reality, can return to quite normal behavior within hours of being medicated. With adequate treatment, they may lead very normal lives.

Paranoid schizophrenia may be the most dangerous mental illness because its victims are convinced that they are in danger, and sometimes harm others to protect themselves from imagined threat. This illness is more difficult to control than simple paranoia because of increased delusions and hallucinations, and loss of touch with reality.

Danger signals, many exhibited by the Virginia Tech shooter, are secretiveness, hiding one's face or eyes from others, failure to make appropriate interactive contact with others, active delusions or hallucinations, active drug or alcohol use, collection of weapons, writing or speech associated with violence, etc.

Individual behaviors such as these are regularly seen on the street. There are people out there having spirited conversations, listening carefully to sounds you can't hear, and then answering back. There are people who are creating fortresses in their homes to protect themselves from imagined enemies, people peeking out of their windows in fear, people washing their food, or hands, over and over, etc. The vast majority present no danger to others.

If, however, someone is taping black paper over his apartment windows and carrying bulky objects home under his big, dark raincoat in 90 degree weather, and you hear whimpering through the wall, his behavior is worrisome.

If someone's behavior inspires unease or fear, that response should be taken very seriously. Normal instinct about abnormal behavior is often correct. If the right people had been able to really hear from the teachers and students of Virginia Tech, 33 people might be alive today. The shooter would undoubtedly be happy to be alive and on medicine and in a safe place.

Here in Maryland, police and sheriff's deputies have the authority to take someone to the hospital for psychiatric evaluation if risky behavior is reported to them and they have reason to believe it to be true. The person reporting may remain anonymous. The police file what is called an emergency petition to cause the person to be held for a period of up to 72 hours. During this time mental health professionals attempt to determine if the person is a threat to himself or others, and to stabilize him. If that is not enough, a judge may commit him for a longer period. An individual may also go to court to obtain such a petition, for example, for a family member.

I spoke recently with a crisis intervention professional who evaluates many people brought in to the hospital. She said that she often recommends inpatient evaluation for paranoid people, as she wants to take no chances with either their safety, or that of the public.

There is professional training out there for dealing with dangerously aberrant, psychotic people. Non-professionals could benefit from some of the information, whether caught in a threatening situation, or meeting someone in the checkout line of the local store.

Number one is to treat the person with respect. Never argue or make fun of them. Never try to talk someone out of a delusion. His delusion is as real to him as your right hand is to you.

Be very careful about intruding into his personal space, wherever he thinks it is. It's probably best not to encourage him to talk excessively about the details of his delusion, but learning a little might help you to know better how to respond.

Offer him the opportunity to make eye contact with you. If he avoids it, don't push it. Keep your arms open and your body relaxed. Keep things quiet. Excessive conversation can lead to increased agitation.

You might say, "I'm sorry you're having this experience," which conveys empathy and compassion without accepting blame.

You might say, "I don't hear the voice you're hearing", rather than, "There is no voice."

You might say, "Yes, you could kill me, but there might be another solution."

You might distract him with practical things, such as food or asking if the air conditioner is working.

This respect and empathy should be genuine, not just a safety measure in negotiations. Mentally ill people are truly sick, as sick as if they had cancer. Their suffering can be enormous. Imagine the pain of finding yourself unable to concentrate, to remember things, or feeling such agitation that you need to cut yourself physically in order to calm down. It must be really horrible to awaken, filthy and penniless, in an alley, hung-over and maybe robbed or raped after drinking too much to calm your internal demons.

The mentally ill need and deserve fair treatment, support and community awareness. Their right to privacy should not come above their right to treatment, in spite of their impaired judgment.

Mental health professionals should be involved in police decisions about whether to take mentally ill people to the hospital. The community should report alarming behavior and have their reports respected.

Case management should be provided for the mentally ill with potentially dangerous conditions, just as tuberculosis patients are monitored to insure that they take their medicine. It might require creative legislation, and creative funding, but what could be more of a necessity for the safety and well-being of the mentally ill, and of the community?

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