Jared Loughner's separate reality

What is schizophrenia?

It’s the most serious and intractable form of mental illness, marked by delusional thinking, hallucinations, and an inability to function in daily life. Schizophrenics often hear internal voices that issue commands or make terrifying statements—a symptom that inspired the coining, a century ago, of the term “schizophrenia,” from the Greek for “splitting of the mind.” Modern psychiatry has identified several forms of schizophrenia, with symptoms ranging from bizarre emotional affect and fragmented and wandering attention to poor self-care and strange thought and speech patterns. “A running vacuum cleaner called me filthy names,” said Marcia Murphy in a published account of her schizophrenic episodes. “Laundry machines, air conditioners, cars, and motorcycles all taunted me. The flame on the gas stove also spoke. Sometimes I thought I heard footsteps of huge invisible men following me. As the wind blew, it whispered messages in my ears.”

How do people develop schizophrenia?

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It appears to be at least partly genetic. Recent research suggests that genes predisposing a person to the disorder may also be “turned on” in the womb or in early childhood by environmental influences, including exposure to viruses and the cat-borne protozoan Toxoplasma gondii. Use of drugs, including marijuana, may also trigger and exacerbate underlying symptoms. Contrary to what psychiatrists once thought, schizophrenia is not the result of poor parenting or trauma, though trauma, too, can accelerate its onset. Studies of schizophrenics’ brains show clear biological indicators, including chemical dysfunctions and structural anomalies. Throughout much of human history, schizophrenia and other mental illnesses were attributed largely to demonic possession, and one common treatment was drilling a hole in the skull to let the demons out. In the mid-20th century, “modern” doctors in the U.S. renewed that barbaric practice by performing 18,000 lobotomies, in which the prefrontal lobe of very difficult patients—mostly schizophrenics—was surgically removed to make them more docile.

How common is the disorder?

Roughly 1 percent of adults will be diagnosed with schizophrenia in the course of their lifetimes. This rate has varied little over time and across borders, suggesting that a nation’s culture has little direct effect on the onset of the disease. In the U.S. there are about 2.4 million diagnosed schizophrenics, making the disease almost 10 times less prevalent than mood disorders like depression and bipolar disorder. Most schizophrenics appear to function normally in childhood and into their teens. (Loughner, for example, has been described by friends as sweet, caring, and basically normal until about age 15.) Among men, the average age of onset is 19; among women, it’s 22. Sometimes, schizophrenics show no symptoms into their mid to late 20s.

Are schizophrenics violent?

The vast majority are not. Advocates for the mentally ill say schizophrenics are no more likely to commit crimes than other people, and the damage they inflict is usually on their own lives. (The average life span of schizophrenics is about 15 years shorter than the general population’s.) But for people suffering from the most problematic form of the disorder, paranoid schizophrenia, the risk of violent behavior is real. Paranoid schizophrenics combine a grandiose sense of self-importance with delusions that they’re being followed, persecuted, or controlled. Dr. E. Fuller Torrey, a psychiatrist who’s studied the connection between schizophrenia and crime, concluded that about 1,000 homicides are committed by schizophrenics every year. (This estimate has been disputed by advocates for the mentally ill). Whatever the exact numbers, it’s clear that some schizophrenics do respond to their delusions with murder. In one grisly case in 2008, schizophrenic Vince Li suddenly pulled out a large knife while traveling on a Greyhound bus in Canada, and severed a sleeping passenger’s head, holding it aloft and taunting passengers and police. Li later said that he’d been told by the voice of God that his victim was evil.

Can schizophrenia be treated?

Treated, yes; cured, no. Anti-psychotic drugs, first developed in the 1950s, can bring delusions and hallucinations under control, and remain an invaluable tool for allowing some schizophrenics to lead reasonably normal and productive lives. But these medications are far from perfect. Even so-called second-generation anti-psychotics, introduced with considerable fanfare in the 1990s, tend to lead to considerable weight gain and deaden normal emotions. “When I take my drugs, I feel like a kitchen counter: no lows, no highs,” said one young woman, who canceled her own wedding because she wasn’t feeling the joy she thought she should. Many unsupervised patients go off their drugs for that reason, and some 20 percent of diagnosed schizophrenics don’t respond significantly to the drugs in any case. Untreated schizophrenics often wind up homeless; as many as 200,000 are living on the streets, according to several studies. Despite progress on alleviating symptoms, says Patrick Cockburn, the father of a schizophrenic, “its treatment now is at about the level of the treatment of physical sickness a century ago.”

The price of deinstitutionalization

No one laments the broad-scale closure in the 1960s and 1970s of dozens of hulking state mental hospitals, where crusaders for the rights of the mentally ill chronicled systematic abuse, filthy conditions, and unprincipled medical experimentation. States made commitments to provide support and supervision so that schizophrenics and others with serious mental illnesses could live at home with relatives or in group homes. Now that safety net—which always had big holes due to lack of funding—is under siege as governors are forced to trim budgets. (Among them Arizona’s Jan Brewer, whose own schizophrenic son has been institutionalized for 20 years after he committed a sexual assault.) In the last three years alone, state mental-health budgets have been slashed by $2.1 billion, and the trend is only accelerating. Advocates warn that if schizophrenics don’t receive adequate care and supervision in the community, tens of thousands more of them will wind up in jail or on the streets.