Psychiatrist Lewis Mehl Madrona on the Tragedy in Tucson and Jared Loughner

Psychiatrist and clinical psychologist, a core faculty in the clinical psychology program at Union institute and university and private practice in Brattleboro Vermont, with Otter Creek Associates

Author healing the mind through the power of story, the promise of Narrative Psychiatry.

Raw notes from the interview

Cady study of 40,000 schizophrenic patients found that after one year only 20% of schizophrenics were taking meds.

Pima college suspended him-- they should nothave, should have engaged him.

This isn't about reducing people's civil liberties. There are calls for involuntary hospitalization, requiring people to take medication...

People with schizophrenia that I treat are nowhere near the capability for violence that was manifested in Tucson.

Any actions that would abridge civil liberties would not have affected Jared Lochner because he was not in the mental health system

People on medications, when they go off them can get worse.

He is definitely representative of the people that I treat who have the diagnosis of schizophrenia.
By and large these are wonderful people who are suffering and struggling, drowning... and sometimes the medication makes them worse.

Is it appropriate to say that he's mentally ill?

Mentally ill is a value judgement. Thomas Szas wrote about this, how people who don't agree with us are considered mentally ill.

John Hinkley-- 12 psychiatrists evaluated him. Six concluded he was mentally and six concluded he wasn't.

There have been a number of studies on the association between schizophrenia and violence and they are not conclusive.

People with mental illness tend to have the same level of violence as people without mental illness in the same zip code.

Rob: in an attempt to find meaning in the tragedy, this has become a national Rorschac test

Instead of isolating and ostracizing these kids who act differently, we should reach out to them, provide them with mentors.

Think about some of the major tragedies that have happened-- Columbine, Virginia Tech, the guy in the tower in texas-- all of these people were ostracized, humiliated, isolated. Couldn't we do better. Couldn't we reach out to them. They couldn't reach out to us because they were wounded and angry. Could we have better means to heal their isolation, reduce their humiliation to bring them back. The true mark of community is our ability to bring in the odd people, the annoying people... The only way that community works as an idea is if everybody is included, including the annoying people, not just the cool people. We have to connect.

I want to argue that harm reduction is better than zero tolerance. If our goal is to reduce harm we tolerate people

Marijuana could have made him psychotic. There is a percentage of the population that can't smoke marijuana because they become psychotic.

if you have a strong family history of psychosis or bipolar disorder it is wise to not smoke marijuana. There are also people who are helped by Marijuana.

We shouldn't try to diagnose Loughner, but people don't like that. People don't like to not have a story to explain things.

violent language,

story, photograph, suggestions. People who are prone to violence can be influenced to violence.

These kinds of images are not helpful. They are prone to trigger people who are susceptible to acting out in these ways.

I object to violent imagery in politics because I think it is destructive-- triggering people who are at a low threshold for acting out.

Studies on suicides-- communities where nobody every killed themselves until a very popular, well loved person killed himself and there were were a lot of suicides.

When somebody popular and respected makes it seem glamorous and useful and desirable, more people are going to do it, whether they are imbalanced or not. Sarah Palin.... Â Some people are going to pick that up and run with it. . It is bound to have an impact. We know that when someone popular and well respected, like Sarah Palin, create this implication or suggestion, people will follow suit.

How to prevent:
I'd target elementary school. I would look at kids who are violent, bullying, who are diagnosed with conduct disorder and develop programs that would help them to save face and develop stories and mentors that will help them live in the world. Â I would go after kindergarten and first grade-- to look at the kids who were becoming trapped to become marginalized and isolated, to become the future criminals. I would develop programs to reconnect with them.

Is there anything like that happening? Not so much. There are projects in some cities to give kids alternatives to joining gangs. In Saskatchewan that was happening.

largely, in our society, we label and reject. Look what happened at Pima College-- they labeled and ejected-- "wrong, expelled, go get evaluated before you come back."
So many people what they need is for someone to care about them and listen.

I bet he had a history of having strange ideas, being ostracized, marginalized, pushed to the periphery. In general we need to more to bring people back into the fold, who have been pushed out.

I suspect that at some level, he felt that he was a hero. If you listen to his tape, he thought that he was avenging wrong.. Timothy McVeigh had the same view of himself, that he was taking arms against a wrong government, a wrong situation. Conditions are created through complex means for some people to come to this point of view. That's wheer we need to go. What are the conditions for making tragedy heroic for some people.

And there are a lot of people on the far right andleft talking about violent revolution. Where do you draw the line between crazy and reality based-- what with a real revolution having just occurred in Tunisia? Â Â

Ghandi's non-violence provides the answer