Mental illness is illness. But we’re not treating it as such.
On Aug. 7, that same Alexis had called police from a Newport, R.I., Marriott. He was hearing voices. Three people were following him, he told the cops. They were sending microwaves through walls, making his skin vibrate and preventing him from sleeping. He had already twice changed hotels to escape the men, the radiation, the voices.
Delusions, paranoid ideation, auditory (and somatic) hallucinations: the classic symptoms of schizophrenia.
So here is this panic-stricken soul, psychotic and in terrible distress. And what does modern policing do for him? The cops tell him to “stay away from the individuals that are following him.” Then they leave.
But the three “individuals” were imaginary, for God’s sake. This is how a civilized society deals with a man in such a state of terror?
Had this happened 35 years ago in Boston, Alexis would have been brought to me as the psychiatrist on duty at the emergency room of the Massachusetts General Hospital. Were he as agitated and distressed as in the police report, I probably would have administered an immediate dose of Haldol, the most powerful fast-acting antipsychotic of the time.
This would generally have relieved the hallucinations and delusions, a blessing not only in itself, but also for the lucidity brought on that would have allowed him to give us important diagnostic details — psychiatric history, family history, social history, medical history, etc. If I had thought he could be sufficiently cared for by family or friends to receive regular oral medication, therapy and follow-up, I would have discharged him. Otherwise, I’d have admitted him. And if he refused, I’d have ordered a 14-day involuntary commitment.
Sounds cruel? On the contrary. For many people living on park benches, commitment means a warm bed, shelter and three hot meals a day. For Alexis, it would have meant the beginning of a treatment regimen designed to bring him back to himself before discharging him to a world heretofore madly radioactive.
That’s what a compassionate society does. It would no more abandon this man to fend for himself than it would a man suffering a stroke. And as a side effect, that compassion might even extend to potential victims of his psychosis — in the event, remote but real, that he might someday burst into some place of work and kill 12 innocent people.
Instead, what happened? The Newport police sent their report to the local naval station, where it promptly disappeared into the ether. Alexis subsequently twice visited VA hospital ERs, but without any florid symptoms of psychosis and complaining only of sleeplessness, the diagnosis was missed. (He was given a sleep medication.) He fell back through the cracks.
I’ve been wondering about something else, connected, since the Navy Yard shooting too. That’s the role that violent video games may have played. Millions of people play these games every day without turning into monsters. But most of those millions don’t play them the way the Navy Yard killer did. He was said to go on binges, playing for so long that friends had to bring food to him to make sure that he ate. He would play for 16 hours straight.
Aaron Alexis, it’s clear now, was a fringe guy in life. He wandered around, rootless. He had almost been kicked out of the Navy over disciplinary issues. He worked unpaid at that Fort Worth restaurant just to have something to do. His behavior in that 2004 Seattle gun incident and in the 2010 incident in Fort Worth show that he had longstanding anger problems. He seems to have lived his life as a frustrated, disturbed young man.
Violent video games didn’t cause his problems, but in the absence of mental health treatment they have have given him what he was seeking: Centrality to something. They made him a big man. When you play any video game, you’re the center of that universe. That may have been what he was seeking — to matter. Even if it was in a fake world.