Privacy, Liberty and Another Mass Murder
Lloyd I. Sederer, M.D.
Privacy and liberty. These have become covenants in American law -- abiding agreements meant to protect individuals and communities from the intrusions of government. They also have become, as many a family and community will attest, inadvertent impediments to the very safety they purport to secure.
Seven people are dead, including the 22-year-old who perpetrated an attack of self-proclaimed retribution. Many more were injured. Families, friends and witnesses will bear the trauma for a lifetime. The Santa Barbara community will be emotionally ravaged for a very long time and our country has had its wound of the horror of mass murder opened once again.
This time a gun was not the only weapon, though it was the most deadly. All three handguns reportedly were legally acquired, as were the masses of ammunition found in the killer's home and car.
This time the perpetrator had repeatedly communicated his rage and severe psychological distress. His family knew, they even called the police. The police interviewed him but in the face of a young man who calmed to the moment and foreswore to no harm, the conventional standard of "no imminent harm" was met, and they went on their way. He even broadcast his intentions on YouTube. We see here a failure across multiple lines of potential defense.
I write (again) because we have ways to reduce the risk of catastrophes the likes of which we cannot learn to bear ("Violence and Serious Mental Disorders"). We will hear and read, once again, "We have no sure way of predicting violence," which is true when it comes to exactly who will do what, how and when. Statistics give us pretty good information about groups of people but fail us when it comes to identifying a person about to lose control. But we can rely on more than statistics.
Families, school personnel, coworkers and friends are our "early warning system" (The Wall Street Journal -- "The Tragedy of Mental-Health Law") when it comes to the emotional bomb ticking inside the mind of a deeply troubled individual. That proved true in this mass murder. But two long-standing legal boulders were there, once again, that created a very narrow corridor for people and systems meant to deliver safekeeping to all involved.
Privacy laws may help protect us from marketers who want to sell health-related products or cordon off information that might interfere with getting a job. But privacy laws, in health care and schools, can block important channels of communication between health care personnel and families, when consent is not given or a person denies any problem and typically blames others for his predicament. I am talking about information that could change how clinicians, law enforcement and courts might act -- like about the steady use of drugs, possession of a weapon or a progression of aggressive behaviors.
Liberty laws no doubt stopped the unbridled, involuntary use of psychiatric hospitals and medications that 30 to 50 years ago gave many people with mental illness good cause to avoid mental health care. But today it is harder, some quip, to get a person into a mental hospital than it is to get into Harvard College. This, however, is no joke.
The Opening Closed Doors Alliance is a distinguished and diverse group of individuals and organizations working to find a balance between coercion and cooperation, between silence and unprotected information, between hospitals and communities, and between rigid adherence to rules and a reasonable accommodation to reality. Two papers recently released by this group, on privacy and liberty, describe what choices exist now to better manage the dilemmas that derive from privacy and liberty constraints, real and imagined, that too often result in seriously ill people and their victims "dying with their rights on."
If you want to see what is possible beyond ideological posturing or helpless stasis take a look at these papers. Give your input, online, about what you think is how far we should push the envelopes of privacy and liberty interests. What we can assert, together, can influence clinical practice, judicial actions and may even help bridge what are critically important but bipartisan congressional mental health bills out forth by Representatives Murphy (R, PA) and Barber (D, AZ) ("A Defining Moment for Mental Health in America").
My heart goes out to all those grievously impacted by this rampage, the latest in an unnerving series of horrific events. It is, sadly, only a matter of time before the next potentially avoidable tragedy. That means we need our heads and our will, not only our hearts, to do more right now.
Dr. Sederer is a psychiatrist and public health physician. The views expressed here are entirely his own. He takes no support from any pharmaceutical or device company.