Reaction to the Virginia Tech Shootings: Part II

The first voices and themes we heard in the reporting on the Virginia Tech massacre had to do with security issues, SWAT team response, and the university's decision not to cancel classes after the first shooting. Then the politicians and activists began weighing in on second amendment rights and gun control. and now, finally, attention is where it belongs--on the shooter. Now we're asking the question that really matters: why did he buy the gun and pull the trigger, killing people he didn't even know? What was wrong with him?

As journalists tease out the story behind the story, it's all a bit too familiar. Cho Seung-Hui manifests familar symptoms of mental illness and personality disorder. He is described as a loner, someone who took keeping to himself to an extreme, someone who seethed with anger beneath a quiet surface, someone who wouldn't even sign his name on a clipboard on the first day of class, someone who would sometimes call himself Question Mark. A student who would not engage in conversation or discussion wiith other students in his dorm or in his class, someone who spoke in monosyllables, someone who was never seen with anyone else.  A student who left behind a written trail of angry, vitrolic, macabre violence, who had been investigated for stalking three women, who had threatened suicide, who preferred to sleep with the light on and the door open.

His roommates tried to include him in social activities, meals, conversations--only to be rebuffed. They kept an eye on him because of his strange behavior. When he threatened suicide, one of them let the police know and he was taken to the university's mental health center and stayed there for a time.

Then there is the English professor who found Cho's writing and behavior so disturbing that she pulled him out of class and tutored him one-on-one to protect the other students in his classroom and to see if she could break through to him. She encouraged him time and time again to get counseling at the university health center. Lucinda Roy, former chair of the English Department, did all that she could to intervene in his life and to protect her students.

She showed Cho's writing to university officials, told them she considered him a threat, but by her accounts, no actions were taken. Dr. Roy said university officials reminded her his writing didn't explicitly threaten other students, he produced it for a creative writing class so it was "fiction," and Cho had a right to free speech.  Dr. Roy, unnerved by Cho's behavior, didn't give up. She approached police and university officials multiple times but nothing was done because by legal definitions nothing could be done: Cho didn't break any laws in being anti-social, angry, emotionally disturbed, and presumably mentally ill.

It would be easy to leave the discussion here, to acknowledge that in America personal liberty and civil rights guarantee people the right to be as "crazy" as they want to be within the limits of the law. The price of being free is the knowledge that we will have to live with discordant voices and those who make us uncomfortable. No American wants to give the government or other authorities the power to silence or stop those who are deemed a threat to society before they actually break any laws.

But there's more to this story than authorities inability to force Cho to get help or leave campus or behave "appropriately" in the classroom. There's the question of what help was available to him, not just at Virginia Tech but in his hometown in northern Virginia. I haven't read anything yet about his upbringing or long term history, but from personal experience, I can tell you it's hard for ordinary people to get treatment for emotionally disturbed family members of all ages.

Within my extended family, I have someone who has needed mental health care for depression as well as drug and alcohol abuse. Like most people with that trio of issues, he has not been able to hold a job for very long, does not have insurance, and isn't in a position to make sound decisions. He has had the support of family members on and off for as long as he's had his problems. He doesn't have insurance and he doesn't have an income. He has a lot of debt and no way to pay for the mental health services he needs.

If you're broke, what treatment is availalbe? Not much. Not enough. Not anything that will support a person's recovery long term. At this point in his life, his problems are so entrenched that there isn't a quick fix available. Even if he had insurance, chances are his mental health coverage would be severely limited. I had a cousin with a long standing alcohol and prescription drug abuse problem. After she'd had multiple car accidents, her insurer finally paid for alcohol and drug treatments. Seven days in a residential treatment center. No follow up. Seven days? Seven days!?! Does her insurer really believe it's saving money by limiting her stay? What has her alcoholism cost them already? What has it cost her family? What if the next time she drives she kills someone? Her doctors believed she needed at least two weeks, maybe more, as  jumpstart for a long term treatment plan.

Several girlfriends of mine have brothers with mental health and alcohol issues that go back all the way to their childhoods. They have failed in their attempts to find a government agency or public organization that can help diagnose and treat their siblings' mental health problems and underwrite some of the costs of alcohol and drug treatment and the needed followup care. Sure there are mental health services but they're all limited in scope, overbooked, and overworked. Many just refer callers to other agencies who also can't provide direct help.

Why isn't there more available? We will always hear it costs too much to deal with the complicated psychological and mental health problems of alcoholics and drug addicts. This isn't news: we know it's expensive because we can't afford to pay for the treatments for our loved ones on our own.  We know there's a high rate of recidivism for addicts.  Still, I think the big myth is that the government is saving us money by refusing to adequately subsidize mental health treatments or by waging a "war on drugs" rather than a "war on mental illness and addiction."

Ignoring the problem doesn't make it go away.  Emotionally disturbed and drug addicted teens grow into emotionally disturbed and drug addicted adults. Some become criminals. Some become homeless. Most become the neighbors who fight and threaten one another, the people who neglect and abuse their children, the co-workers who are unreliable, the people who can't get or keep a job, the family members who break hearts over and over and over again.

So when a society draws the purse-strings tight and refuses to properly fund mental health services, how much money do we save? What does it  really cost us when ignore people who can't work, can't get along with others, who abandon their children and their families, who disturb their neighbors, who hurt others physically and mentally and essentially leave destruction in their wake? These folks don't support themselves, their children, their communities, the national economy. We all end up taking up the slack. They bring children into the world that are likely to grow up emotionally disturbed themselves and start the whole cycle over again. Some of them end up in jail where we support them for life AFTER they're wreaked havoc.

As a society, we pay for neglecting the mentally ill over and over again, in ways we can't even see clearly. Make no mistake, untreated addiction and mental illness costs us more than we can measure. It may even cost us 33 lives.

Did Cho ever really get help? Did he want help? Could anyone or anything save him? I don't know.  But there are plenty of people in less extreme circumstances that need access to mental health care in order to function and be productive members of society. I hope for all our sake that they get it.

April 18, 2007 

Comments

[Inside Out]

I was floored as I watched TV, and looked at my two youngest playing in the family room. I am scared to death for what the future holds for them. I almost wont turn on the news anymore. All you see is death and suffering...I/O

[furiousBall]

I think this incident could have been prevented if Cho had received help, but the honest to God truth is, there was probably another Cho out there that would be missed and commit a similar crime. There are many people out there that need help and can be helped. We'll never know if this could have been avoided for sure. But asking if someone needs help or letting someone know about eradict behavior is never a bad idea.

[Nance]

V--I can't stop thinking about the story of the girl I shared with you. So many cracks to fall through exist in "the system." And if someone with mental illness knows how to play the game and manipulate any cog in that system along the way...there's another variable. There aren't any easy answers here.

[J]

There are no easy answers, but this was a beautifully written post, and I'm glad you're asking the questions.

[Ortizzle]

Good plug for socialized medicine. And for those who don't have jobs, I would say that society is being penny-wise and pound foolish not to have some sort of government subsidized mental health program.

[Elisabeth]

This is an absolutely brilliant post. You unpack with utmost skill the real issues at stake here. There are obviously no easy solutions, unfortunately.

[wendy]

You nailed this. What is really starting to get under my skin...is the description of the shooter as South Korean. Yes he came from South Korea...but he grew up to be a disturbed youth in America.

So many parents don't want their kids labled by the system. They want to believe kids will grow oyt of these phases. They do not want them stigmatized.

This is an American problem.Health(mental)is becoming a priviledge for those with good jobs and good insurance or funds enough to support extended rehabs.

Thanks for being very clear headed, and seeing the root is not skin...or nation deep.

[cinnamon gurl]

Here in Canada, mental health services are covered by the state. So the issue is not cost, but getting someone to agree to get help, to see they have a problem. Someone can be clearly mentally ill, but if they don't see their problem, if they don't believe they have a problem, you cannot force them to get help. Only if they pose an imminent risk either to themselves or to others can they receive help against their will. And just being angry, paranoid or delusional is not considered imminent risk. I don't know what the answer is because mentally ill people deserve dignity and respect, to some extent. The trick is to being able to discern the moment of imminent risk, but of course the riskiest individuals tend to be antisocial and not have any people looking out for them. A vexed issue, and it is good to see your compassion in the face of such tragedy.

[t]

I do believe our problem addressing mental illness in our society is due in part to cost. Federal and state funding is existant, but rarely adequate. Absolutely the rights of patients must be upheld but perhaps the definition of what constitutes "danger to self and/or others" needs revision. Not simple, certainly, but necessary.
I don't know how much trauma and devastation must be endured before we learn our lessons and make significant positive changes.
Insurance driven care in the US is a problem. When insurance companies ignore agreed upon industry standards of care and refuse payment then there is a problem and people do not recieve the treatment they need and deserve. Also, negotiation takes place between medical pros and providers and I believe that too often patient care takes a back seat to financial concern. This is a general and simple statement, I know, but I think there's truth to it, in addition to more to it.

We are a nation that does not care for it's most vulnerable and that makes a tragic and shameful statement, in my opinion.

I really do understand that it is a complex situation and balancing the rights and responsibilities of all concerned is a sensitive and monumental task. I just believe that we haven't done the job and we'll continue to live with preventable tragedies of all kinds until we do. Can't catch and save every situation but surely we can do better than we are.

[Amber]

WELL SAID!!

This is the best post I have read in many months.

In California we have no more public hospitals for people who need them. This is why we have a population of ill people on our streets. Schools do not have anywhere near the counselors they need. One counselor will work five or more schools, only getting to a school maybe once a week, and then not being able to see even half of the kids they need to see. When I was working in a school, I had so many kids waiting to see me-- and I was just a crisis counselor!
And I tried for years to get my mom help. Years.The only time she had therapy or was seen by a professional was when I was in Foster Care. After it was too late to help much. And still it was not enough. As you say, her kids paid the price.

We need to really look at this issue! You are spot on.
This kid was very ill, probably for his whole life. People do not take it serriously enough, as a society.

:(

[Annie]

My sister works doing social work/therapy and used to work primarily with children. And she found that oftentimes, teh parents were more of a problme than the kids. It's so hard to find good services and good support. We also have several family members who have been lucky enough to find services when they've needed them, but, as you said, it isn't usually a one time treatment solution. And the problem seems to be getting bigger instead of smaller in this country. Everyone pays the price when we let someone slip through the cracks.

[Nancy]

V-Grrrl, I wanted to let you know that I read this last week but was too emotional to comment. You absolutely hit the nail on the head with this post -- so many excellent points and true characterizations of America's mental health system (and its issues).