The American Spectator

Reader Mail

Therapeutic Counsel

4.30.07 @ 12:01AM

DISTINCTIONS
Re: Yale Kramer's Thirty-Three Dead:

Although I agree with Dr. Kramer that some re-thinking of mental health law, and the "civil" liberties of the mentally ill is essential, especially as it applies to schools and communities where they reside, I am unsettled by his and other "professionals'" -- Dr. Phil, for instance -- and media accounts muddling the terms "paranoia," "schizophrenia," and "psychosis," which will probably result in further stigmatization and fear of those individuals suffering from severe mental illness.

It appears as though Mr. Cho suffered from paranoid personality disorder, which is distinct from schizophrenia. It is usually quite rare, and a life-long character disorder which does not have the problems with coherence, organization of thoughts (loose associations), and inappropriate and flat affect of schizophrenia. Those problems of disorganization in fact, in the rare instance that patients with schizophrenia have violent thoughts, make it improbable that they can accomplish any carefully planned act, such as the Virginia Tech or Columbine tragedies.

Paranoid personality disorder has more to do with a sustained, long-term world view which is thought to be more a problem of "hardware" (brain structure) than "software" (chemical aberration), and thus much less responsive to medication (anti-psychotic) than schizophrenia, which is much more likely to have at least partial and often moderate to full remission from appropriate treatment. Patients with schizophrenia in the acute and early stages, usually suffer greatly from their delusions and have some insight that they are "out of touch" with reality. Persons with personality disorder characteristically have little or no insight as to how disconnected they are, or that they have any illness at all, which makes those with the paranoid form so much more dangerous than patients with schizophrenia. "Psychosis" simply means generically out of touch with reality -- so patients with mania, depression, schizophrenia, can all suffer from this.

And finally, society has to consider when "liberty" and "privacy" are an excuse for abrogation of responsibility. Truly caring for someone identified as terribly troubled, and the community in which they reside, may indeed necessitate supervised treatment, temporarily limiting liberty in exchange for life. There is a place for "in loco parentis" where the community must use the Latin connotation of loco, and not the Spanish.
-- Kenneth R. Berv, M.D.
Clinical Faculty, Department of Psychiatry, Yale School of Medicine (1976-2006)

Dr. Kramer's article is by far the best I have read in a long time, on any subject. I urge the author and the editor to submit it immediately to Reader's Digest magazine so that it can have wider dissemination. Perhaps even to the New York Times or Washington Post, as an op-ed.

As much as I follow mental health issues, as well versed (for a laywoman) in these areas as I may have considered myself, I never have realized how the "therapeutic culture" has oozed beyond its proper boundaries and so created such malign "mischief."

Nobody who is from New York, and that would still include I presume, those running the N.Y. Times, will doubt Dr. Kramer's words. He has been at Bellevue, so he too has really seen it all.

We must pray to God that some of this uncommon sense may be listened to, before some other innocent people are killed by another hopeless, helpless maniac.
-- Jessica O'Connor
Bayonne, New Jersey

I think Yale Kramer has done a good autopsy on the Cho matter, but I seriously doubt that there will be any lessons learned. After the first shot, society lined up, on both sides to use whatever they could to reinforce what they already believed about gun control and the mentally ill.

Moving public policy in this environment is going to be difficult because when there is little or no difference in right or wrong or good and bad, the calculus of the consequences is always perceived as an imaginary number crafted without the use of plus or minus signs.
-- Danny L. Newton
Cookeville, Tennessee

I liked your article but please remember next time to write about the psychiatric drugs Cho was on.

Back in the day before antidepressants were handed out like candy there was not as many group killings, some people would take their own lives but didn't take down dozens of human beings with them.

Please stop overlooking the fact that these drugs cause violence, they don't stop it.
-- Joan Ramm

Please thank Yale Kramer for his excellent commentary on the value of common sense in every area of life. It is obviously absent in a society that has weakened itself by succumbing to a "therapeutic culture," political correctness, and other such destructive philosophies.

Letter to the Editor

topics:
Taxes, Education, Joe Biden, Nancy Pelosi, Harry Reid, Hillary Clinton, Sports, Environment, Law, Military, Iraq, Iran, NATO, Africa, Communism, Immigration, Alaska, Oil