Dr. Peter Breggin

The Real "Mental Health Lessons" from Virginia Tech

Focusing on Virginia Tech mass murderer Cho as a disturbed mental patient has led media analysts to ponder how he could have been more readily identified by the mental health system. But Cho is not someone who slipped beneath the psychiatric radar. Instead, he was frequently detected as a large object on the screen.

On separate occasions, he was involuntarily hospitalized, sent for psychological evaluation, and referred to the university counseling center. Consistent with getting him more psychiatric "help," experts have also opined on how he might have benefited from medication. These are all the wrong lessons.

The mental health system was fully alert to Cho's existence and to serious manifestations of dangerous behavior. A faculty member of the English department was so frightened by Cho's behavior that she insisted on having him pulled him out of class. The police and the counseling center were notified and ultimately Cho was given individual tutoring, instead of quick removal from the campus. Also, a number of students called the campus police, probably at least twice in regard to his stalking behavior. Furthermore, he had previously been involuntarily hospitalized in Virginia as a danger to himself and others.

The answer to vengeful, violent people is not more mental health screening or more potent mental health interventions. Reliance on the whole range of this system from counseling to involuntary treatment failed. There is not a shred of scientific evidence that locking people up against their will or otherwise "treating" them reduces violence. As we'll see, quite the opposite is true.

So what was needed? Police intervention. Almost certainly, the police were hampered in taking appropriate actions by being encouraged to view Cho as a potential psychiatric patient rather than as a perpetrator. It's not politically correct to bring criminal charges against someone who is "mentally ill" and it's not politically correct to prosecute him or to remove him from the campus. Yet that's what was needed to protect the students. Two known episodes of stalking, setting a fire, and his threatening behavior in class should have been more than enough for the university administration to bring charges against him and to send him off campus.

Police need to be encouraged and empowered to treat potentially dangerous people more as criminals than as patients. In particular, men stalking women should be handled as definitively as any perpetrator of hate crimes. Regardless of whether the victims want to press charges, the police should. Cho shouldn't have been allowed to get away with it a second time.

How would a police action have affected Cho? Would it have humiliated him and made him more violent? There's no way to have certainty about this, but anyone with experience dealing with threatening people knows that a good dose of "reality," a confrontation with the law, is much more of a wake up call and a deterrent than therapeutic coddling. Furthermore, involuntary psychiatric treatment is one of the more humiliating experiences in American society, and tends to make people more angry, not less.

Mental health interventions do not protect society because the person is almost always quickly discharged because his insurance coverage has run out or because mental health professionals, who as a group have no particular capacity to make such determinations, will decide that the patient is no longer a danger to himself or others. Indeed, in December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found "his insight and judgment are normal." Need I say more about the hazards of relying on mental health screening and evaluation to identify dangerous perpetrators--even after they have already been threatening people?

Psychiatry's last resort for presumably violent people is involuntary hospitalization. Not only does it almost always lead to rapid release, it does not help the involuntary patient. Coerced treatment is not perceived or experienced as "helpful" by the recipient but as unjust bullying. If coercion accomplishes anything, it teaches the "patient" to stay far away from all providers of mental health services.

And what about drugs for the treatment of violence? The FDA has not approved any medications for the control of violence because there are no such medications. Yes, it is possible to temporarily immobilize mind and body alike with a shot of an "antipsychotic" drug like Haldol; but that only works as long as the person is virtually paralyzed and confined--and forced drugging invariably breeds more resentment.

Instead of offering the promise of reducing violence, all psychiatric drugs carry the potential risk of driving the individual into violent madness. For example, both the newer antidepressants such as Prozac, Paxil, Zoloft and Celexa, and the antipsychotic drugs such as Risperdal and Zyprexa, cause a disorder caused akathisia--a terrible inner sensation of agitation accompanied by a compulsion to move about. Akathisia is known to drive people to suicide and to aggression. Indeed, these tragic outcomes of drug-induced akathisia are so well documented that they are described in the most establishment psychiatric book of all, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

For the past fifteen years or more, I've been writing about the capacity of psychiatric drugs to cause mayhem, murder and suicide. In early 2005 the FDA finally issued a warning that antidepressants cause both suicidality and violence. For example, the FDA's new mandated warning label for antidepressants states that these drugs produce "anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania."

Note the reference to "irritability, hostility, aggressiveness, impulsivity" in the label or package insert for antidepressants. That's a formula for violence. Note the mention of akathisia, another source of both violence and suicide. And finally, note the reference to mania, yet another drug-induced syndrome associated with violence and suicide.

As a psychiatrist and medical expert, I have personally evaluated dozens of cases of individuals driven to violence by psychiatric drugs of every type, but most commonly the newer antidepressants. One of the cases I evaluated, the Columbine shooter Eric Harris, looks the most like Cho. Both were very emotionally disturbed in an extremely violent fashion for a prolonged period of time. For the entire year that Eric Harris was evolving his manic-like violence, he was taking Luvox, a drug known to cause mania at a high rate in young people

In my book Reclaiming Our Children, I analyzed the clinical and scientific reasons for believing that Eric Harris's violence was caused by prescribed Luvox and I've also testified to the same under oath in deposition in a case related to Columbine. In my book the Antidepressant Fact Book, I also warned that stopping antidepressants can be as dangerous as starting them, since they can cause very disturbing and painful withdrawal reactions.

We have not been informed whether or not Cho was taking psychiatric drugs at the time he unleashed his violence; but even if he wasn't, he might have been tipped over into violent madness weeks or months earlier by a drug like Prozac, Paxil, or Zoloft. He could also have been undergoing severe drug withdrawal. Investigators should set a high priority on obtaining and publishing Cho's psychiatric drug history.

To focus on Cho as a "mental patient" or "schizophrenic" distracts from the real need to enforce security on college campuses, or in any setting, by reacting definitively to lesser acts of violence before they escalate. It also maligns people with serious mental problems, the vast majority who are, above else, inoffensive and overly docile.

The violence unleashed on the Virginia Tech campus should not lead to calls for more mental health screening, more mental health interventions, or more drugs. Instead, the violent rampage should confirm that psychiatric interventions don't prevent violence and instead they can cause it. Early on, Cho should have been confronted by the police and by university administrators with the reality that his behavior was unacceptable and he should have been suspended. In other words, he should have been treated as a criminal who was stalking women, and as an obviously threatening individual, not as a potential mental patient. These measures might have confronted him with sufficient reality to nip his violence in the bud and more certainly would have removed him from the circumstances that the he found intolerably stimulating, while also removing him from so many targets of opportunity.

My scientific papers describing medication-induced violence and some of my cases can be found on www.breggin.com/