Mental Evaluation: Jared Lee Loughner

 


I’ll admit it; I wasn’t very interested in Jared Loughner’s attempted shooting of Congress member Giffords at first. I simply thought it was a horrible action of an unhealthy person. Mere hours after it occurred, the event was being heralded as a referendum on the extreme partisan divide that has been filled with increasingly incendiary statements. I was cool with that. It’s out of hand. I tweeted and posted. ‘Nuff said, I thought. As the Congress member was a Democrat, I could see them being upset. As Ex-Senator Palin once had materials with the Giffords in a gun sight, I could see her now being a target. I’m all for bringing the media-frothed exchange back down to civil debate and I am always in favor of self-examination. But from that first Saturday to this past one, I’ve heard a change in tone from “We all share a piece of this problem climate” to “We all share a piece of this problem climate; and it’s the Republican’s fault.”

I’m not here to defend Republicans or Democrats, or, incidentally, unhealthy people. Regardless of the incendiary partisan climate, Loughner’s actions were, in great part, the result of failures of the Arizona Mental Health System which, “is one of the most liberal in the nation in allowing anyone who is concerned about another’s mental stability to request a mental evaluation” as long as they can show that the evaluee is “a danger to self or others.” (3) It’s a no-brainer now that this guy should have had a write up. In the spirit of “better late than never” I offer one here. It is not a Psychiatric Evaluation, as I am not a psychiatrist. I have read hundreds of Psychiatric Evaluations, and contributed data to many as well. I work with people like Loughner, who’ve made claims, had delusions or extreme actions, just like him. With one main difference. They’re in treatment. 

Media Mental Evaluation

 Name: Jared Lee Loughner
Date of Birth: September 10, 1988
Date of Admission: January 8, 2011

Relevant Information
The patient is 22 years old, Caucasian, the child of Randy and Amy Loughner of Tucson, Arizona. He is casually dressed with blunted affect and euthymic mood. He is “charged with shooting Congress member Gabrielle Giffords (D-Ariz.) in the head among other crimes. Loughner is the alleged shooter in the rampage Saturday at a Tucson Safeway that killed six people, among them 9-year-old Christina Taylor Green, and wounded 12 others.”(3) He has a reported history of delusions, disruptions to social environments—such as Pima Community College—paranoia, egocentric and narcissistic tendencies and drug abuse. Other assessments have pointed to “one of the psychotic disorders – delusional disorders, or schizophrenia, for which the average age of onset is roughly 20, about when Loughner started showing symptoms.” The patient endorses the use of hallucinogenic drugs.(2) It is reported that, directly following the incident, the patient showed “no remorse; nothing.”(1)

Family & Social History
The Loughners are reported to be a quiet and isolative family. Randy Loughner appears to have a distant relationship with his son. The patient has so rarely mentioned him to friends that they “assumed that his parents were divorced.” Mr. Loughner has been characterized as “private, standoffish, even a bit scary.” A neighbor noted that, rather than encounter Mr. Loughner “if your child’s ball came to rest in the Loughners’ yard, you left it there.” Amy Loughner has been observed to dote on the patient.

There is reported to be “a palpable sense of estrangement hovered in the Loughner home” and that the patient would often tell a previous girlfriend that “he didn’t want to go home because he didn’t like being home.”(1)

The patient is a talented saxophonist and was a member of the High School Jazz Band. He was socially active at that time. In early 2006 the patient was removed from school to a local hospital for being extremely intoxicated. He later dropped out of High School and began keeping to himself. (2)

The patient has lost a reported four to six jobs in the four years following dropping out at such places as Eddie Bauer, Quiznos, a dog walking agency and a hamburger restaurant, that he lost because he left while in the throes of what he called a “mental breakdown.” (1)

“As he alienated himself from his small clutch of friends, grew contemptuous of women in positions of power and became increasingly oblivious to basic social mores, Mr. Loughner seemed to develop a dreamy alternate world, where the sky was sometimes orange, the grass sometimes blue and the Internet’s informational chaos provided refuge.

Gradually, friends and acquaintances say, there came a detachment from the waking world — a strangeness that made others uncomfortable. The patient had become so unsettling a presence that tellers at a local bank would feel for the alarm button when he walked in.” (1)

The patient was served a Notice of Immediate Suspension from Pima Community College by police for “a litany of troubled and disruptive behavior, including the recent posting of an unsettling video titled ‘Pima Community College School — Genocide/Scam — Free Education — Broken United States Constitution.’ The serving officer, Officer Mattocks, later reported that the patient “stared at him as if in a ‘constant trance’ and only broke his silence to sum up the suspension by saying, ‘I realize now that this is all a scam.’ ” (1)

Substance Abuse/Sexual History
The patient has recreationally “used marijuana, mushrooms and, especially, the hallucinogenic herb called Salvia divinorum. When smoked or chewed, the plant can cause brief but intense highs.” He has been cited in September 2007, for possessing drug paraphernalia. (1) 

The patient appears to be sexually active, and have had girlfriends throughout High School who have termed him a “great boyfriend.” A break up with a High School girlfriend has been speculated to have been part of the causality of the patients decompensation of condition. It should be noted that “Law enforcement officials said they have multiple photos of Jared L. Loughner posing with a Glock 9mm pistol next to his naked buttocks and dressed in a bright red g-string” but the ramifications of such actions are as yet unknown.(4)

Narrative
Within the time span February to September 2010; Loughner had around five contacts with Pima Community College police for classroom and library disruptions.

February: Patient disrupted the class with a “strange reaction to the reading of another student’s poem, taking a huge leap from its context to abortion, wars and killing people. The school official described him as creepy. They would keep an eye on him.”

May: Instructor reported to the campus police that “when she informed the patient that he had gotten a B in her Pilates class, he threw his work down and declared the grade unacceptable. Things got so tense that the instructor felt intimidated, and feared that the moment might become physical.”

June: The patient caused a disruption in math class. A counselor investigated and the patient “first said that he was offended by the inquiry, then explained, ‘My instructor said he called a number 6, and I said I call it 18.’” The patient then “went on to strike the increasingly familiar theme of persecution: that he was being ‘scammed.’”

Delisa Siddall, College counselor, reported that the patient has been warned and that “He has extreme views and frequently meanders from the point. He seems to have difficulty understanding how his actions impact others, yet very attuned to his unique ideology that is not always homogeneous. … Since he reported that an incident such as this occurred in another class, administrators will have to help this student clearly understand what is appropriate classroom dialog.” (1)

September:  A teacher allowed the patient only “half-credit for handing in an assignment late, and he was declaring this a violation of his right to freedom of speech.” The campus police were summoned. At this point the patient’s mother was called to a meeting to discuss a behavioral contract with administration. College officials noted that throughout the meeting, the patient “held himself very rigidly and smiled overtly at inappropriate times.”

September 29, 2010: “College police discovered a YouTube video shot by Loughner, in which his spoken commentary stated that the college was illegal according to the United States Constitution under the first amendment.  He also said that all the teachers are paid illegally and that the college is one of the biggest scams in America.” (1)

At this point the patient was suspended and informed that he “needed to resolve his Code of Conduct violations and obtain a mental health clearance indicating, in the opinion of a mental health professional, that his presence did not constitute a danger to himself or others.” However, it appears that this evaluation was not completed. (2)

It is reported that the patient “became intrigued by antigovernment conspiracy theories, including that the Sept. 11 attacks were perpetrated by the government and that the country’s central banking system was enslaving its citizens. His anger would well up at the sight of President George W. Bush, or in discussing what he considered to be the nefarious designs of government. He became an echo chamber for stray ideas, amplifying, for example, certain grandiose tenets of a number of extremist right-wing groups — including the need for a new money system and the government’s mind-manipulation of the masses through language.” (1)

Hobbies and Interests
The patient has sought refuge in the Internet, in which he has frequently made posts that “bemoan the prevalence of illiteracy” and his need to “settle scores with the Army and Pima Community College, both of which had shunned him.” His posts were often disjointed, such as “If 987,123,478,961,876,341,234,671,234, 098,601,978,618 is the year in B.C.E then the previous year of 987,123,478,961,876, 41,234,671, 234,098,601, 978,618 B.C.E is 987,123,478,961,876,341,234,671,234,098, 601,978,619 B.C.E.”

The patient enjoys reading books such as “Animal Farm,” “Fahrenheit 451,” “Mein Kampf” and “The Communist Manifesto.” Also: “Peter Pan.”

The patient has an avid interest in dreams. “It started off with dream interpretation, but then he delved into the idea of accessing different parts of your mind and trying to control your entire brain at all times,” she said. “He was troubled that we only use part of our brain, and he thought that he could unlock his entire brain through lucid dreaming.” (1)

Discussion
It has been reported that the patient was rejected for Military Service and “by Ms. Giffords in particular, with whom he had a brief — and, to him, unsatisfactory — encounter in 2007.” (1) The patient has a history of “aggressive, often sexist” statements including “a dispute with a female branch employee after she told him that a request of his would violate bank policy. He brusquely challenged the woman, telling her that she should not have any power.”(1)

I heard a snippet of an interview with the patient’s reported best friend who said that Mrs. Giffords did not respond at all to the patient’s unusual question during an open meeting. If she would have responded with an answer that he deemed superior, he may have chalked her up as part of “the scam.” If he had seen her answer as inferior, likely no further action would have been taken. But he was ignored, and that may have proven to be the crisis point.

When we couple aggression with delusion, paranoia, sexism and rejection by a woman in power a pattern of behavior seems to emerge. Though horrific and reprehensible, the shooting of Mrs. Giffords seems to have been in the potential course of action for a patient struggling with untreated mental illness and seeking to make an extreme statement that he, in turn, has “rejected American society, including its government, its currency, its language, even its math [since] Mr. Loughner once declared to his professor that the number 6 could be called 18.” (1)

Diagnosis
Deferred, because I am not a psychiatrist, though most psychiatrists think paranoid schizophrenia fits. I won’t disagree. I just wish it would have been diagnosed before he ever picked up a gun.

Recommendation
Let’s stop pointing fingers and start solving problems. Even if the internet was full of fluffy bunnies, Loughner may still have shot Giffords. I’m not advocating any change to the Internet, I’m advocating that we share our information, as confidentiality can be breached if the patient is a threat. His counselor made a report, where did that report go? The campus police said they would “keep an eye on him,” what did they do with what they saw? In Pennsylvania, and other states, we have a hotline for reporting child abuse, and we are legally required to report suspected abuse for investigation. I suggest a similar one for gun purchases.

Ultimately, I recommend that Loughner be treated for his illness and in some significant way, make amends for his actions. In some small way, that is what I have tried to do here. Making amends for a lapse of my profession by providing the mental evaluation that, if completed, may have helped save many lives.

 

References
(1) http://www.nytimes.com/2011/01/16/us/16loughner.html

(2) http://www.ibtimes.com/articles/101659/20110117/jared-loughner-tucson-massacre-suspect-rep-gabrielle-giffords-pima-community-college.htm

(3) http://news.yahoo.com/s/ac/20110112/tr_ac/7586928_arizonas_psych_evaluation_law_and_missed_opportunity_in_giffords_shooting_1

(4) http://gawker.com/5733978/jared-loughner-took-pictures-of-himself-in-a-g+string-with-his-gun?skyline=true&s=i

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