Let’s talk about that mug shot, because it’s pretty striking. This guy is getting booked on six murders. Why is he smiling?
That’s pretty bizarre, and that’s something a person with schizophrenia will do, because their emotions are disconnected from what’s going on. When you tell a schizophrenic your mother died, they might smile instead of cry.
Early on, I wondered: Are we jumping to conclusions with this guy’s diagnosis? But you’re the expert, and you’re saying you feel pretty confident.
If it walks like a duck and quacks like a duck, I will call it a duck until somebody tells me it’s really a chicken in disguise. Is there any chance it’s not schizophrenia? Sure, but I’ll give you 100 to 1 odds.
I was struck by his obsession with “lucid dreaming.”
When someone comes in and talks about lucid dreaming, drugs are the first thing I wonder about. But with schizophrenia, you can get almost anything that’s weird like that. In itself, it didn’t stand out to me.
And there was some evidence of drug use with Loughner. It sounds like he was smoking marijuana, and then got off of it. Did anything stand out to you about that part of the story?
Certainly anyone in his age group using substances is not unusual. We do commonly find that when people have schizophrenia or bipolar they tend to increase substance abuse. I don’t know if he’s hearing voices, but what I see frequently is young kids hearing voices, and they start using acid or PCP because then they can explain why they’re hearing voices. It’s a way to avoid the reality that, hey, I’m getting sick.
We have a strong correlation in our minds between schizophrenia and dangerous behavior. What is the real connection between this mental illness and violence?
There is a very small number of people with schizophrenia who are, indeed, dangerous and do things like this. It’s very important to emphasize that the vast majority of people with this disease are not dangerous, and there are certain predictors in terms of who will be dangerous. Past history of violence, substance abuse, both of which are predictors for non-schizophrenics, too. But I’ve followed schizophrenia for 30 years, and I have never seen one of these high-profile homicides where the fellow hasn’t been off his medication when he did it. Being off medication is a clear risk factor for people who have a past history.
Then there are certain kinds of symptoms as well. Thinking people are controlling your mind will increase the risk of violence, also having what we call command hallucinations, so that you’re hearing voices that tell you to do things.
Whenever these horrible events occur, people often say: Oh, it was probably a paranoid schizophrenic. Why has this behavior become so strongly associated with tragedy?
If you have grandiose delusions [caused by other forms of schizophrenia or mental illness] – if you think you’re the king of Washington, for instance – you’re not likely to kill anyone. If, on the other hand, you have paranoid delusions [consistent with paranoid schizophrenia] and you become convinced that the woman who lives across the street is sending signals into your brain, then you may try to hurt her first.