Cho Seung-Hui and Psychiatric Incompetence

The recriminations about the failure to lock Cho Seung-Hui up in a mental hospital back when no one had any idea that he would one day kill 32 people betray a misplaced trust in psychiatry. Today, under the (online) headline "Officials Knew Troubled State of Killer in '05," The New York Times reports that in 2005 "Mr. Cho's sullen and aggressive behavior culminated in an unsuccessful effort by the campus police to have him involuntarily committed to a mental institution." The "aggressive behavior" consisted of unsolicited communications with women that they characterized as annnoying rather than threatening, and the psychiatric evaluation he underwent was based on an acquaintance's report that Cho was suicidal, not homicidal:

Mr. Cho went voluntarily to the Police Department, which referred him to a mental health agency off campus, Chief Flinchum said. A counselor recommended involuntary commitment, and a judge signed an order saying that he "presents an imminent danger to self or others" and sent him to Carilion St. Albans Psychiatric Hospital in Radford for an evaluation.

"Affect is flat and mood is depressed," a doctor there wrote. "He denies suicidal ideations. He does not acknowledge symptoms of a thought disorder. His insight and judgment are sound."

The doctor determined that Mr. Cho was mentally ill, but not an imminent danger, and the judge declined to commit him, instead ordering outpatient treatment.

So the psychiatrist charged with determining whether Cho posed an imminent danger to himself or others decided he didn't, and less than a year and a half later Cho went on a shooting rampage that ended with his suicide. Is this evidence of psychiatric incompetence? Yes, but it's the incompetence of psychiatry, as opposed to this particular psychiatrist. There are lots of troubled, lonely, angry, alienated people out there, and almost none of them ever murders anyone. Although legislators and judges pretend otherwise, psychiatrists are not any better at predicting which ones will than the rest of us are.