The evidence is thin right now of what motivated Jared Lee Loughner to walk up to a “Congress on Your Corner” meeting outside of a Tucson grocery store, shoot Representative Gabrielle Giffords in the head and then open fire on the crowd, killing six people and wounding twelve. There is strong reason to believe from Loughner’s online writings and past behavior that he suffers from some kind of mental illness, possibly schizophrenia.  This, along with the scattershot of book titles that included the “Communist Manifesto” on his YouTube profile, is being used by those on the right eager to suggest there cannot be a link between the violent, over-the-top rhetoric that’s become common on the right and acts of violence such as this. 

These arguments miss the point.  The book one is silly, of course—the YouTube profile featured a scattershot of books (including “Mein Kampf”) mostly linked by being famous, which disinclines me to think that such a list has any meaning beyond that.   As for possible mental illness, I would caution against dichotomous thinking on this subject.  Mentally ill people, even schizophrenics, aren’t living in bubbles where their delusions have no relationship to the environment they live in. 

If you want a good example of how this works, I highly recommend—and in general just recommend, because it’s really good—the documentary “The Devil and Daniel Johnston”, about the genius songwriter who suffers from severe bipolar disorder.  Johnston was raised in a fundamentalist Christian environment where Satan is blamed for everything.  Unsurprisingly, this resulted in Johnston developing delusions that the devil is out to get him, which resulted in some bad episodes, disturbing art, and an unsettling but beautiful song “Devil Town”.   The relationship between environment and mental health can be contemplated without defensiveness or the emotional need to downplay the effect that breathy, paranoid right wing rhetoric that is spewed 24/7 from the likes of Glenn Beck and the mass of right wing radio could have on someone whose brain is geared towards latching onto that paranoia and taking it a step further.  It’s tough to believe that Loughner would have developed a delusion about Giffords or that women who have abortions are terrorists if that over-the-top rhetoric wasn’t in the air for him to grab on to.

It’s worth noting something else from this documentary and in general, which is that mental illness does not usually or even all that commonly result in violence.  Most people that have mental illnesses that result in delusional breaks do not act out violently.  Like Jeff Kaye noted, schizophrenics “are far more likely to be victims than victimizers.” In addition, most violent people are not  suffering from delusions.  When asking why someone makes the move towards violence, it’s not enough to dismiss them as mentally ill.

But beyond the political and environmental questions of motivation, one thing really should be clear from the New York Times profile of Loughner—at this point in time, he seems to be another example of someone who slipped through the cracks.  It appears that many people noticed that Loughner was suffering from some kind of mental health problems, and yet so far there’s no indication that he got a diagnosis or even saw a mental health professional.  If he had, there’s a chance that this tragedy could have been averted. 

But how does such a thing happen?  Loughner was pressured by his school to get a mental health evaluation, but he chose to drop out instead.  This is no surprise.  It’s possible that he just didn’t want help, but it’s also true that most people have no idea where to even begin if they need mental health services.  Some people are lucky enough to have insurance that not only covers mental health services, but makes referrals, but those people are rarely 22-year-olds attending community college.  It’s not like there’s a centralized, low-cost mental health service similar to Planned Parenthood for reproductive health services.  Maybe there should be, but in our country, getting more funding for this kind of necessary health care infrastructure is like pulling teeth. 

The problems with our mental health systems in the U.S. are just part of a larger problem with health care in general—people fall through the cracks, diseases that could have been prevented or minimized with early interventions instead fester and become bigger, more expensive problems down the road, and we don’t do enough to connect the available services with the patients in need.  This is something that Rep. Giffords understands.  Giffords supported health care reform because she understands that a universal system actually saves us money (and grief) through the “ounce of prevention” method. Giffords is also a supporter of Planned Parenthood, which provides an excellent model for patching up holes in health care access, both by being low cost but also by having a recognizable brand that points people in need in the right direction. 

If a community college student with poor access to health care needs contraception, she knows who to call: Planned Parenthood.  We need something like that for people who find themselves in need of mental health services.  Unfortunately, the push towards cuts for social services means that we’re running away from and not towards that goal. Take the state of Arizona, where all this went down. Mental health services were cut by $36 million in 2010, a 37 percent budget cut.  That’s introducing a lot more cracks to an already cracked system.  And it’s increasingly looking like Loughner is one of the people who fell through the cracks in the system.