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In the aftermath of the shootings in Newtown, two subjects are being discussed at length: mental health treatment and guns.

The mental health issues are, to my mind, the most problematic. I, myself, haven’t reached any satisfying conclusion. This post is just a rambling stream of consciousness.

Everyone is assuming, and for good reasons, that the shooter was mentally ill. Very few people would argue that his actions were a rational response to a political, economic, or any other kind of stimulus. So what to do, what to do?

It’s easy to say that the mentally ill should not be able to obtain weapons. It’s easy to say that the dangerously mentally ill should be medicated. It’s easy to say that the dangerously mentally ill who refuse to be medicated should be institutionalized.

There’s was an old joke that went more or less like this:

If you think that a secret committee of people meeting behind closed doors is planning to lock you up for the rest of your life, you’re insane.

If you’re insane, a secret committee of people meeting behind closed doors is planning to lock you up for the rest of your life.

The potential for abuse was obvious, and drove the plot of many a novel and movie. Eventually groups like the ACLU got the laws changed. At this point it’s pretty hard to get an adult treated or institutionalized against his or her will.

Does that put us all in danger? Perhaps — but not to a great degree, or there would be even more blood running in the streets than we already have. Many, if not most, mentally ill people are not dangerous. You’ve probably dated one or two — I know I have.

There’s another significant problem to be considered: even if we knew that certain people were born with a genetic predisposition to looniness, or were raised in a family that could drive them to it, could we tell if they were going to be great comedians or mass murderers? Maybe they would be both.

We can’t know the future actions of anyone, no matter how much we know about them. The Donner party didn’t set out thinking that they would eat one another. They probably would have been friends for life, had there been a convenience store nearby when they needed it. Could we have labeled them as cannibals when they were just beginning their journey? Of course we couldn’t. They earned that sobriquet only after they had committed the acts of cannibalism for which we remember them.

That same unpredictability is true for any one of us. Think about how often mass murderers or serial killers are described as quiet, well-mannered, even charming. That’s also the way a person with good manners is described.

Our system of justice deals with criminal actions — not criminal thoughts. No matter how many times you fantasize about beating your boss to a pulp, as long as you don’t raise your fist you’re in the clear. We don’t know what people are thinking until they say something or do something. Here in the United States we don’t (except in egregious cases) criminalize speech, let alone thought.

So suppose Adam Lanza had lain in bed at night, dreaming about killing school children. Could anyone have intervened if they knew about it? Fantasies are not actionable.

Suppose he went further, and set up cutouts of children to use as target practice. (So far as we know, he didn’t do that.) Now he’s standing on the border and, if he is showing signs of other mental problems, could probably be forced into some kind of treatment; but what?

There aren’t a lot of options for handling someone who is insane. If someone is acting out they can be brought to an emergency room and, if there is space, perhaps admitted for short-term psychiatric care. More likely he or she will be discharged as soon as he or she calms down. The doctor on call might prescribe some fast-acting psychoactive medication, perhaps a week’s worth; and a psychiatric social worker would probably hand over a list of mental health agencies in the area.

Lots of luck with that. Even if you have medical insurance, it can take weeks to find a mental health professional who is accepting new patients. If you are uninsured, you’ll find that the free or low-cost mental health agencies have long waiting lists. In any case, nobody is going to hand out medications on the first appointment.

Here in our immediate area there is a crisis intervention agency. If you call them up and say “I think I’m going to kill myself” they will actually send someone out immediately to talk you down. They will also treat you on a short term basis until they can get you signed up for follow-up care. It’s my understanding that agencies like that are not common. Getting immediate intervention, even for someone who is crying out for it, is not easy.

Let’s return to Adam Lanza. According to some accounts, his mother knew he was troubled. We don’t know what kind of “troubled” she thought he was. She might have been able to have him involuntarily committed. It’s very difficult to admit that your child would ever reach the point where commitment is necessary.

Anyone can petition the probate court to have a person involuntarily committed because he is a danger to himself or others, but it’s not just a matter of picking up the phone. Here in Connecticut,

  • Two court-selected physicians examine the person to be committed and a hearing is scheduled 10 days later.
  • The court must order commitment if it finds by clear and convincing evidence that the person meets the commitment requirements.
  • Involuntary commitment is subject to appeal, and you aren’t likely to be institutionalized forever even if you’ve killed someone.

So how troubled would Adam Lanza had have to have been? Enough to convince his mother to do something, and enough to get the probate court to do something.

A person can be committed on an emergency basis if a qualified mental health professional signs off on it. If Adam Lanza had said “Mom, I’m going to take your guns and go shoot up a school; I’ll be home for supper,” then she could have called the police. In Connecticut a police officer can take a person with psychiatric problems into custody and deliver that person to a hospital on a court warrant or a reasonable belief that a qualified professional would have signed off on it.

How insane do you have to be, and in what ways, in front of how many observers, and as diagnosed by how many people, before we place restrictions on you?

We shouldn’t allow insane people to own or purchase guns, right? Does it matter what kind of insane they are? If you believe that there are fairies in the bottom of your garden, should that prevent you from buying a gun so long as you don’t plan to shoot them? Who makes the decision that a person is insane in the wrong way? A clerk at Wal-Mart?

Unless you have a record, this is unknowable because it’s literally all in your head. Unless you’ve previously been judged a danger to yourself or the general public, is there any reason why you should be allowed to own a chainsaw and not a gun?

I don’t have a good answer, and I don’t think there is one. What I do think is that the discussion of mental health treatment will be a distraction from the issue of gun control.