The American Spectator

Reader Mail

p> DISTINCTIONS br> Re: Yale Kramer's Thirty-Three Dead : /p>

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.

p>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. br> --

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