Treating The Sick

If any good comes from the Virginia Tech killings, it may be a heightened awareness of the way we neglect mentally ill people. Americans have endless sympathy for those with physical disabilities. Yet when someone has a problem in the brain, they are usually ignored, sometimes ridiculed, and all too often left to live on the streets. It is far easier for a mentally ill person to get a gun than it is to get treatment.

Cho Seung-Hui had obvious problems. He came to the U.S. from South Korea at age 9 and apparently had trouble adjusting. Classmates from middle school and high school recalled him as painfully shy and unable to speak. The video he sent to NBC shows a person with the kind of rage and anger that is familiar to relatives of the mentally ill.

At Virginia Tech, Cho was referred for psychiatric evaluation over a year ago due to his bizarre and frightening behavior. A judge ruled he was a danger to himself, but not so dangerous as to require hospitalization. He was ordered to receive outpatient treatment; it is not yet clear if he did so, or what kind of treatment he received.

This is where it gets difficult. People with schizophrenia, bipolar, or other serious mental illnesses often seem perfectly normal at first glance. Their condition becomes clear only after lengthy observation. Courts are reluctant to confine people long enough to get a fair evaluation - as they should be. Fake charges of psychiatric illness are a favorite weapon of totalitarian regimes against opponents.

Even if courts would confine people, the question then becomes where? Private psychiatric hospitals are increasingly rare and expensive. State hospitals are often nothing more than prisons with a few extra doctors.

If they can somehow get help, many people with these conditions will show dramatic improvement with proper medications. Unfortunately, finding the right medicine involves a long trial-and-error process. With an infection, you can take antibiotics and a blood test will confirm the germs are gone. Mental illness is not so simple. Even doctors don't understand how the various medicines work. We know more about the surface of the moon than we do about how our own brains function. The same treatment can have different results in different people, and there are often troublesome physical side effects.

When someone goes over the edge like Cho, it seems clear in hindsight someone should have done something. But the legal-medical-political complex that we all think should have helped him did not. In fact, it probably could not help him, thanks to a thick web of laws and a serious lack of resources.

I recently ran across an organization called the Treatment Advocacy Center that promotes solutions to this dilemma. Mentally ill people will usually not seek treatment on their own; often they are convinced there is nothing wrong with them. TAC argues that the courts must step in and force these people into treatment. That is what was done until a movement in the 1970s to "de-institutionalize" mentally ill people.

With proper support, TAC believes most psychiatric patients can be helped on an outpatient basis. They have found that with proper support from the judicial system, these people can have much better outcomes , and families and communities will be safer from potential violence.

After what happened this week, this may seem like an obvious solution. Unfortunately it is not always so clear. The line between people who should be expected to take care of themselves, and those who need help whether they want it or not, can be hard to draw. We have a system that makes treatment optional for those who need it most. Here's how one psychiatrist sees it:

A lot of times, a family will say: 'Please treat our son. He's ill.' And I say: 'I'm sorry. I can't.' I know it's the best thing for him medically. But as a society we have decided you have the constitutional right to be very psychotic and medically ill — and miserable."

We must find ways to distinguish between people who are simply evil, and people who are mentally ill. Sometime both exist in the same person. What drove Cho Seung-Hui to murder and suicide? We may never know. By helping others like him, we will help everyone. Now is a great time to start.