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.

Comments

[stoner]

Amen!!

[Edward]

This is from bradycampaign.org
"In one year, firearms killed no children in Japan, 19 in Great Britain, 57 in Germany, 109 in France, 153 in Canada, and 5,285 in the United States"

You don't need a psychiatrist to tell you that U.S. is one crazy country when it comes to guns.

[Hooked on Innuendo]

Although legislators and judges pretend otherwise, psychiatrists are not any better at predicting which ones will than the rest of us are.

Jacob, I don't know how you can say that - it seems logical to me that people who spend their lives studying the way the human brain works are probably better at predicting future behavior than members of the general public are.

This doesn't mean they're perfect at it, obviously, but let's remember that we have no way of knowing how many VT-type massacres were prevented by successful intervention by the mental health profession.

[Cab]

Is this evidence of psychiatric incompetence? Yes, but it's the incompetence of psychiatry, as opposed to this particular psychiatrist.

That was perfect.

[Edward]

But wait, if those kids had themselves been armed, the stats would be much lower for the kids and higher for the shooters. We need to allow kids to carry concealed weapons. Sound nuts?

[snide remark]

"There are lots of troubled, lonely, angry, alienated people out there, and almost none of them ever murders anyone."

Well, not yet anyway.

[Matt]

Edward, interesting point. When confronted with this, my father, ever the NRA man, said "when you subtract 'urban' (wink, wink) crime out of the statistics, we come out about even with the rest of the westernized countries".

Jacob, can you speak to this?

[Mike Laursen]

I'm not buying it. There were some pretty clear signs that he should have been removed from the college campus. Like setting a fire in the dorm.

Don't know if a psychologist would be the best person to figure that out, but, evidently, the campus police had figured it out.

By the way, there's no way he should have ever gotten to a fourth year as an English major. His writing sucked.

[Warren]

Although legislators and judges pretend otherwise, psychiatrists are not any better at predicting which ones will than the rest of us are.

Exactly so. The real professional incompetence resides in the English profs that gave this semi-literate passing grades. I lay the whole tragedy at the feet of the VA Tech English Dept.

[Cab]

Speaking of predicting future behavior based on words today, Drudge is linking to McCain singing Bomb Bomb Bomb Bomb Bomb Iran to the tune of "Barbara Ann."

Doesn't take a shrink to figure that one out.

[Mike Laursen]

the English profs that gave this semi-literate passing grades.

I wonder if some people at the college realized the quickest way to get rid of a creepy fourth-year student would be to give him a diploma and send him on his way.

[Anti-flail]

This comes off as a flailing attack on psychiatry, along the lines of "This attack confirms everything I knew to be true." Psychiatrists diagnose and treat mental illness. In the vast majority of cases, thankfully, that is done on a voluntary, outpatient basis. This pyschiatrist diagnosed mental illness and recommended treatment. I do not know if his advice was heeded.

And seriously "less than a year and a half later"? How long must the shrink remain correct for you to give him any credit? Two years? A decade? Until the patient is dead? Is your internal medicine doc a failure if he tells you your cholesterol is too high and you have an elevated risk of heart attack, but the odds are on your side if you start taking Lipitor, then 18 months later you have a heart attack? If the answer is yes, you are desperately misinformed about the power of all doctors and medicine in general; if the answer is no, you are being completely unrealistic about psychiatrists.

[mediageek]

So, Edward, how, exactly, do you propose going about removing guns from US society?

[Tim]

"In one year, firearms killed no children in Japan, 19 in Great Britain, 57 in Germany, 109 in France, 153 in Canada, and 5,285 in the United States"

I think this just proves that kids in the States are too fat to be agile enough to duck when shot at. This is just more proof of how deadly Ding Dongs and Twinkies can be.

[Lincoln]

Although legislators and judges pretend otherwise, psychiatrists are not any better at predicting which ones will than the rest of us are.

Woah - hold up a second. Do you really believe psychiatrists are no better at predicting suicidal behaviors? Of course psychiatrists are better at this - just not by a huge margin. They are better at predicting who will kill themselves in the same way handicappers are better at picking football games and sociologists are better at predicting mob behavior. The truth is that we still don't know enough about the brain and human behavior in order for there to be true experts in what a human will do at any given time. But that does not mean a psychiatrist or stock broker is worse than the general public at their jobs. In some cases a decision is going to have to be made about someone's mental state. Forget the "average person" for a second because that animal doesn't exist. Are you really telling me you could make a decision on Hui's mental state as good as Albert Ellis could?

[John]

Of course Cho was crazy and dangerous, but we don't do anything to help the mentally ill any more. It used to be that their were very loose confinement procedures and the mentally ill were held in state hospitals for their own good. Then along came books like One Flew Over the Cuckoo's Nest and the liberal idea that there was no such thing as mental illness and that people who just wanted to pursue alternative lifestyles were being locked up and we closed all our state hospitals and dumped the mentally ill out onto the street. In Boston, when they closed the big hospital there they put the people on a bus and dumped them in downtown Boston with $20. Go to any major city and you will see the mentally ill wandering the streets homeless. We don't have a homeless problem in this country, we have a mental illness problem because we refuse to help people who can't choose to help themselves. Most of those people walk around harmlessly living in squalor and misery. Some of them, like Cho, are downright dangerous. But, thanks to the "reforms" of the 1970s, you can't hospitalize them for their own good and the public's safety. If you want to blame anyone for the VATech massacre, blame Ken Kessey and Jack Nicholson.

Were innocent people involuntarily committed back in the day? Sure. It is a question of what risk do you want to take, innocent people being unfairly committed or the occasional Cho hurting someone? I am not claiming I know the answer. I can see it both ways. But it is unfair to blame the Docs in this case. Cho not being involuntarily committed is the price we pay for making it hard to commit people. Maybe it is a price worth paying, but let's at least be honest about what it is.

[lunchstealer]

So what exactly are the conditions to place a flag in background check for a handgun purchase? Is it only a criminal conviction, or could this sort of thing been included?

I'm certain that Cho didn't show enough evidence to lock him up, or even to throw him off campus, but he'd shown some violent tendencies and some very questionable behavior (stalking and setting fires). So there was ample evidence that this was someone for whom a gun purchase might be a big red flag.

[Hooked on Innuendo]

I don't often agree with John but his above point is an excellent one (aside from his absurd notion that the "liberal media" thinks there is no such thing as mental illness).

[Hooked on Innuendo]

Edit: sorry, John only wrote "liberal", not "liberal media".

[Anti-flail]

To be less obtuse: Assigning failure to psychiatry for not predicting or preventing this attack, particularly based on an 18 month old interview, is equivalent to assigning failure to every internal medicine doctor whose slighly overweight 55 year old patient kicks it a year after the doc tells him to lay off the red meat.
Unless you believe that heart patient should be strapped to the bed and held in the hospital eating salads and taking his meds until he drops 30 pounds, then it is inconsistent to think the mentally ill should be treated differently.
We do not understand the human body nearly as well as many believe. And the damn thing, including the brain, is always gonna find a way to break down.

[peachy]

It may be true that children in the UK aren't being killed at a high rate by firearms, but knives and illegally-modified airguns are doing a fair job of making up the difference.

On a more general note, relying on statistics from someone who has a dog in the fight is less than perfectly prudent, not so?

[Guy Montag]

"In one year, firearms killed no children in Japan, 19 in Great Britain, 57 in Germany, 109 in France, 153 in Canada, and 5,285 in the United States"

When did self-animate firearms become available to you people the general public?

Warren,

[sarcasm]
English majors are nutty enough. Giving them bad grades to the ones who act like anarchists between protests just makes them nuttier and they might attack the Starbucks nearest them.

Shouldn't this guy have gotten more hugs? It is rough for spoiled suburban kids to see others spoiled more than them and at the same time reading about the underclass dropping in the streets because of a lack of public healthcare.
[/sarcasm]

[Bart]

Lincoln,

You are correct: Psychiatrists can predict better, by not a large margin. Why? Because the knowledge of the "suicidal ideation" has entered the mainstream, and most lay folks know what the warning signs are. Why? Oh, perhaps that incompetent psychiatry?

Secondly, I don't know of any psychiatrists who claim they can reliably predict human behavior, which is driven more by situational forces than anything else (the scientific evidence on this point is overwhelming).

Just because legislators and judges don't take the time to educate themselves as to what psychiatry (and psychology) can and does offer (and therefore what it does not offer) does not implicate in any way the competence of psychiatry.

What is missing from this blog is on what rational legal basis do you deny someone who had not been charged of a crime access to an educational institution?

Should government play a more aggressive role in segregating those individuals who they feel may be a danger based on some psychiatric profile, absent criminal behavior? Is that really what you're suggesting?

How...libertarian of you.

[mediageek]

Especially if they're the sort of organization to spew a press release calling for further restrictions on firearms before the bodies have even been removed from the scene of the crime.

[Guy Montag]

Is the NYT now advocating that private medical records be made generally available to anybody who expresses a need? Are they advocating that anybody who has seen a mental health professional be flagged for life, never to operate a drill press, air hammer, automobile, stapler, [other dangerous tool]?

[Warren]

No. Unt-uh. Sorry. I don't believe we are better off locking up the mentally ill on a 'better safe than sorry' standard. When it comes to depriving people of their rights and liberty I stand by phrases like "presumed innocent" and "beyond a reasonable doubt".

If you want someone to blame (besides the guy who, you know, pulled the trigger), I say again; This is the fault of the VA Tech English Dept.

[Guy Montag]

If you want someone to blame (besides the guy who, you know, pulled the trigger), I say again; This is the fault of the VA Tech English Dept.

I blame the creation of English as a major.

[R C Dean]

Is the NYT now advocating that private medical records be made generally available to anybody who expresses a need?

Now, now, Guy. The NYT is probably just making an observation here, trying to think about the problem without leaping to any conclusions, etc. etc.

Just ask joe.

[P Brooks]

Anybody who uses the term "ideation" should be shot.

[Kap]

So what exactly are the conditions to place a flag in background check for a handgun purchase? Is it only a criminal conviction, or could this sort of thing been included?

Cho was adjudicated mentally ill by a judge, and subject to involuntary commitment. This is sufficient to remove eligibility to purchase or posses a firearm.

The AFT form he filled out when buying his guns specifically asked him whether he had been adjudicated mentally diseased or defective; he obviously lied on the form.

It was my impression that these judicial orders are entered into the NICS database as well, so that he will fail the NICS (Brady bill) check, and therefore the system doesn't only rely on the honor system of the ATF form. It seems that this didn't happen. My understanding is that under the current legal system it should have, and he shouldn't have passed the NICS check.

[Tim]

What did he do that is "crazy"? His video clearly shows he had a reason for what he did and saw no other choice to remedy his situation than to shoot 32 people and then himself. I think that makes him angry and lacking good decision making skills. Just because something is abhorrent doesn't make it "crazy". It's really just meaness and disregard for the highest level of private property rights.

Do I really have to point out that locking peoople up because some sort of test shows they don't have their "mind right" is bad thing?

[squarooticus]

Edward,

Good propaganda attempt using the word "children" there. "Children" evokes images of 8 year old kids running around the park playing. In fact, most of the "children" you cited are teenage gang members killing other teenage gang members.

Why not target the gang problem instead of going after the rights of lawful gun owners? Last I heard, gang-on-gang violence is not a right guaranteed by the Constitution, while owning and carrying guns is. (I mean, for those of you who still believe in toilet paper.)

Kyle

[Warren]

They are better at predicting who will kill themselves in the same way handicappers are better at picking football games.

I think that says it best. Because the number of people that claim they're better at handicapping is an order of magnitude or two greater than those that actually are.

The analogy fails when it comes to being able to sift the former from the later. With dozens of games every week, it's not hard to tell if a guy is coming out ahead on average. OTOH the uniqueness of each patient make it virtually impossible to compare on therapist to another. Degrees, honors, and published works are no help either since the peers doing the reviewing aren't any better.

[Timothy]

Hey, at least now they're blaming "Oldboy", glad to know it's all Hollywood South Korea's fault!

[creech]

Heck, if he had just muttered the "n word" on campus, VT would have gotten him all the help he needed.

[lunchstealer]

Thanks Kap.

Hey Mediageek, this is sort of up your alley, do you know about the conditions for flagging NICS/Brady checks?

I know that libertarians are suspect of background checks for the purchase of handguns, but it seems worthwhile to explore whether the system as it stands should have prevented him from purchasing the guns used here. If it should have, then it seems plausible that the psychiatrist did indeed put reasonable precautions in place that didn't necessitate full involuntary commitment.

[Tara]

Everyone keeps talking about all these red flags. Were they really red flags? There was no evidence that he was considered a dangerous person besides the fire he had set in his room. We don't even know if he did it intentionally or not. (I know since his persnoality is unraveling before our eyes now,we can assume that he had done it on purpose) But when no one has seen him as a potential threat or someone very dangerous, it is hard to predict this outrage. Doctors suggest that past behaviors predict future behaviors. I also hear a lot of talk about his plays and how that was another red flag. In creative writing, you should be able to express the way you feel and there are many people who write in the same content as Cho. His professor even stated that if they analyzed each piece of violence a student had written, there wouldn't be anyone in the class because they all express these emotions. It doesn't necessarly mean they will act upon them.
Cho is of a minor population in terms of a paranoid schizophrenis with psychotic tendencies. I honestly don't think we can prevent these situations. The only thing we can do is prepare for that psychotic break. While someone like Cho starts his destruction, find a better motive of preventing massive damage, which is extremely difficult.
With your help, we can make a difference in taking a survey of the depravity scale. http://www.depravityscale.org A new method in forming a legal standard of what represents the worst of crimes

[Edward]

You know, I don't think the problem of gun violence in the U.S. can be solved. It's a mental derangement peculiar to American society, and we'll just have to live with it. I fear, though, that things will get pretty rough in our inevitable decline. Sigh...

[Zoomie Junior]

There are lots of troubled, lonely, angry, alienated people out there, and almost none of them ever murders anyone.

Most of them merely entertain their darker inclinations, but have enough sence not to really carry them out. It's the few that don't vent it out in constructive, non-destructive, or borderline self-destructive ways that "go nuts". A "normal" person may find the habits, interests, and/or hobbies of a "troubled" person disturbing, but in most cases (especially if it causes no harm to the individual or others) it is merely a coping mechanism; an over-flow valve, if you will, a means to focus their energies away from harming others.

Z?

[Guy Montag]

Everyone keeps talking about all these red flags. Were they really red flags?

Did you miss the zillion posts and news stories that he was an English major?

Good thing he was not a journalism minor or he would have really been causing trouble.

[Lincoln]

Should government play a more aggressive role in segregating those individuals who they feel may be a danger based on some psychiatric profile, absent criminal behavior? Is that really what you're suggesting?

Ben, I didn't really think I implied what you're suggesting anywhere in my post. Anti-flail really did a much better job than I did of explaining the point. In fact I agree with most of your points and bet we would agree on most issues regarding the government's role in mental health issues.

My point is that motive is key to the enforcement of some laws and getting a fair shake in a trial. Determining the mental state at the time of the act is very important. Yes the human race is bad at figuring this out. But that doesn't in any way mean we shouldn't try. In fact it's crucial - even if a psychiatrist is only 10% better than the average populace at figuring it out it is still better than the alternative. As a libertarian I would rather government not have to make the choice but if it does it should be with the absolute best we have to offer.

[Tara]

I don't think it can be solved either Edward. But then again other countries have a lot of guns but don't use them in the way we do. In our society, we act out our anger it seems and it shows how tough and macho you are (referring to gangs or the mob) Everyone loves "The Godfather", "Scarface". I'm not blaming the media at all. It only proves how heroic or cool it is to express violence

[Cain\'s Ability]

It's doubtless been said before, but these revelations of problems worry me.

I am tempted to think that VATech & everybody else should have done more--aren't we all? I even asked a mythologically-inspired question to that effect here a couple of days ago.

But I am really afraid that schools may overreact. I have this strange feeling that in the near future any shy kid, any loner, anyone who writes anything even moderately violent, anyone who has relationship problems, will be investigated by the police.

I know a lot of very decent people who were a bit weird at university. I was myself a loner in college. I imagine the writers for "24" wrote some horrifying stuff. Should we all be questioned?

Maybe. But...

[Toxic]

I've had this come from actual psychiatrists in the class I'm taking on mental health and the law: clinical evaluation is no better than chance at determining whether someone is dangerous or not.

No better than chance.

[Larry]

While it is certainly true that the Mental Health system in this country is woefully underfunded and inadequate, and many who need it's help are instead homeless, I can't support anyone who suggests we need make involuntary commitment much easier.

I've had the misfortune of having someone close to me under regular psychiatric care, and eventually in need of inpatient care at a psychiatric facility. These are truly unpleasant places (better than Jack Nicholson got in 1976, true, but that doesn't make them party houses). And the idea that we should be throwing large numbers of people (I don't know the true number but I've seen 100,000 or more thrown around) into such places without their consent is something that is truly reprehensible.

[Kap]

I should add that Cho may have inadvertently gamed the system by voluntarily admitting himself shortly after the involuntary commitment order was passed down. This may have had the effect of rescinding the involuntary order.

Also, as disclaimer, my wife is a licensed therapist. She works with folks who are in court-ordered psychotherapy: sex offenders, murderers, and lesser criminals. Prior to knowing her I was amenable to considering the Szaszist view of mental illness, but the clients of hers I have met and the stories she has told me have convinced me that brain disorders are as real as e.g. kidney disease. Some of the folk in her groups are just plain simple assholes trying to bargain their way out of prison, but most are pretty damn broken.

Cho shows signs of real mental illness.

[Tara]

Lincoln, knowing someone's mental state during a crime is not that difficult if you have all the right facts. The more evidence and facts there are on a person, the more you can tell if someone really knew what they were doing. You have to check out this article from Dr. Welner http://abcnews.go.com/Health/VATech/story?id=3050483&page=1. he points out that some people who have a mental illness may not have a psychotic break during a crime. This is what happened with Cho. People with his mental condition are very disorganized, but the entire event was very well planned and premeditated.

[mediageek]

Lunchstealer-

My understanding of the NICS thing is really more based on being on the receiving end of it, I'm not sure how it works once the .gov receives the request.

But basically, the gun shop submits pertinent info such as name, date of birth, address, and, at your option, Social Security number.

Then you wait for 45 minutes for a response.

The feds on the other end access databases to see if you've been flagged as a disqualified person- felony conviction, dishonorable discharge, and presumably whether you've ever been involuntarily committed.

If you get flagged, they respond to the FFL that the purchaser is a prohibited person. I'm not sure that they will give a reason why, only that the person is prohibited.

How tightly integrated the database(s) used by NICS are is up for some debate. I've known people, generally with a fairly common name like "John Smith" who will get a false rejection because there's a John Smith somewhere who did something to get flagged.

Certainly it's not a perfect system, and someone with a clean background who's bent on doing mayhem won't be stopped by a NICS check.

[MC]

It seems there is someone else out there who thinks that psychiatry could not have predicted this:

"Based on what I've seen in the news...there's no doubt that this act was Satanic in origin."

-Dr Richard Roberts
Oral Roberts University

http://www.foxnews.com/story/0,2933,266860,00.html

[mediageek]

Guy, your commentary in this thread is almost as worthless as Edward's.

Just a little FYI.

[Drunk Mel Gibson]

Frankly, I blame the Jews, they're the cause of all the school violence in the world.

[Lincoln]

It's really just meaness and disregard for the highest level of private property rights.

I'm not sure. I think this is righteous indignation. Cho is the victim and his actions are justified in his manner of thinking. This is the exact kind of thought pattern cognitive behavioral therapy teaches you to avoid. Cho has long since stopped asking what people are thinking and has instead made it up in his own mind. In his world he is being persecuted.

Because the number of people that claim they're better at handicapping is an order of magnitude or two greater than those that actually are.

Well duh but you are looking at the wrong end of the analogy. People bet on the Raiders because they're the home team. People bet on the Bengals because they wear pretty uniforms. Some don't bet on Vick because "black quarterbacks are not leaders" or "running quarterbacks can't win". If your life depends on the outcome of one game you'd rather have the five best handicappers on your side than five random people right? Saying Although legislators and judges pretend otherwise, psychiatrists are not any better at predicting which ones will than the rest of us are. is as rational as making your life altering game choice based on the advice of five random people. Your chances are higher with the handicappers.

[Kap]

From los federales:

Records contained within the databases searched by the NICS include those of the Interstate Identification Index (e.g., millions of criminal history records), the National Crime Information Center (e.g., protection orders and active felony or misdemeanor warrants) and the NICS Index, a database created solely for the use of the NICS which contains information provided by local, state and federal agencies pertaining to persons prohibited under federal law from receiving or possessing a firearm. Additionally, a fourth search of the applicable databases via the Department of Homeland Security's United States Immigration and Customs Enforcement will be conducted for background checks initiated on all non-United States citizens.

and

? A person adjudicated mental defective or involuntarily committed to a mental institution or incompetent to handle own affairs, including dispositions to criminal charges pertaining to found not guilty by reason of insanity or found incompetent to stand trial.

? The subject of a protective order issued after a hearing in which the respondent had notice that restrains them from harassing, stalking, or threatening an intimate partner or child of such partner. This does not include ex parte orders.

If his two stalkees had filed restraining orders that may have done the trick as well.

[lunchstealer]

Everyone keeps talking about all these red flags. Were they really red flags? There was no evidence that he was considered a dangerous person besides the fire he had set in his room. We don't even know if he did it intentionally or not.

Dunno about you, but the stalking is a bit of a warning sign. Especially stalking more than once. Stalking a girl once, maybe you just hadn't developed enough to spot that it was a problem. Doing it a second time to a different person, shows that you couldn't learn to control your emotions.

[Tara]

there are so many people who stalk others. It doesn't necessarly mean they are going to kill a bunch of people. of course it means he's weird, but it doesnt mean it will lead to that horrific event

[jtuf]

Plead barginning in the mental health industry is as common as in the prison system. Social workers sometimes tell patients they can sign in voluntarially or be committed. It saves them a lot of paperwork.

[Guy Montag]

Guy, your commentary in this thread is almost as worthless as Edward's.

At least I label my sarcasm.

[mikeyes]

Kap,

Cho was never ajudicated to be mentally ill or dangerous to himself or others if the account above is correct.

He was brought in for evaluation (each state has a separate way of doing this, but the basic format of how the evaluation proceeds is the same based on a Supreme Court decision and model laws), was probably put on a 72 hour hold during which time he was evaluated by the psychiatrist. There is a two step test that the psychiatrist looks at 1) is there a treatable mental illness present and 2) is the patient dangerous to himself or others? The definition of dangerousness is usually laid out in the state law and states differ somewhat in this respect. If the patient does not meet these criteria, then the patient is let go either at a hearing or before hand if the examiner agrees.

Usually there are two hearings: a probable cause hearing in which the evidence (examinations, police reports, testimony, etc.) show that these conditions are fulfilled, and then a final hearing ten days later to decide if the person should be declared dangerously mentally ill. In that ten day time the patient is examined by two more independent professionals (usually a psychiatrist and or a psychologist) who testify at the final hearing. The original examiner does not testify at the final hearing unless the judge asks them to. These are all civil procedures, by the way, and the burdens of proof differ from criminal courts (they are less strict.)

Any time during this period of time the patient can offer to stipulate to care under a contract that obliges them to get care or go back to the hospital. (The court has to accept the stipulation, however and if the treatment team has doubts, the patient may not get his wish, most of the time, anyway.) The patient is represented by a lawyer throughout the process.

Only if a judgement of being dangerously mentally ill is made, the patient is considered ajudicated mentally ill. Cho was released early in the process because he probably did not meet the criteria for dangerousness which means that he has to be immediately dangerous, not have the potential for danger to self or others. This decision is based on law and not on the diagnosis. The purpose is to preserve the rights of the patients because such an evaluation and subsequent treatment usually involves involuntary incarceration.

[lunchstealer]

there are so many people who stalk others. It doesn't necessarly mean they are going to kill a bunch of people. of course it means he's weird, but it doesnt mean it will lead to that horrific event

But it probably correlates pretty well. I would certainly guess that the percentage of people who've stalked more than once and then become violent is higher than the stalk-once or stalk-no-times populace. I'm not saying lock up all stalkers, nor lock up anyone whose dormroom gets singed. Just saying that they are warning signs.

[Mike Laursen]

I would separate the question of whether they had enough reason to commit him for psychiatric treatment from whether they had enough reason to temporarily or permanently expel him from campus.

Based on his stalking and his setting a fire, they had justification to remove him from campus. The dean should have the discretion to expel a student who may be dangerous, no matter whether it is a private or a public school. Of course, that wouldn't have prevented him from shooting a bunch of people off campus, or even on campus.

[josephdietrich]

The problem here is that people want psychological evaluations to work like a form of "pre-crime" detection like in the film Minority Report, and they just can't do that. Psychology is not precognition, it is more like meteorology: it can tell us something about general trends and large-scale probabilities, it can offer explanations about why people in general are the way they are, and it can offer some treatment for certain conditions. However, it cannot predict what any particular person will do in any particular situation.

[Tom Alciere]

The government never had any right to lock him up for evaluation in the first place unless he committed a crime, in which case he should have been jailed.

Having symptoms is not a crime.

If he was angry because of his being locked up for evaluation, he should have gone out and killed a bunch of cops, and died in the shoot-out, so he could go to Heaven. Resistance to tyrants is obedience to God.

If he was angry because he was having no luck getting dates, somebody should have voluntarily told him to try the internet, and perhaps coached him to succeed so he wouldn't be left out. More often, such persons don't get violent to vent their anger, they vent it nonviolently, and make people miserable.

[brotherben]

maybe I shouldn't go here but...

I saw all the experts saying about Cho's video rants that they were the ravings of a crazy man and are therefore nonsensical. I must disagree. I look at his past and the ridicule he suffered at the hands of his peers. This society professing values and spiritual ideals and refusing to adhere to them. The perverse gluttony of this "christian" society. Throw in a crack or two in his mental process. His rantings are very telling. Some folks, due to mental differences, are unable to cope with the bullshit we throw at them every day.
If you look at the school shooters in america, most if I recall, were ridiculed and bullied by their peers. The shooting is their way of winning. It is completely irrational. But I understand there thought process completely.

[R C Dean]

If you look at the school shooters in america, most if I recall, were ridiculed and bullied by their peers.

As is just about everybody, at some point.

The shooting is their way of winning. It is completely irrational. But I understand [sic] there thought process completely.

You mocked my highwater pants, therefore I bust a cap in your head is understandable?

[Mackie]

Bullying in schools is a big problem across America. It's no surprise that once in awhile a child with a fragile ego, raised in a society that celebrates violence, who never experienced peer acceptance, and was exposed to mericiless teasing will snap. I pity Cho.

[SIV]

"the ___________ in this country is woefully underfunded......."

Gotta love them libertarian comments

[brotherben]

When you mock my highwaters, or laugh at the way I speak or push me down or otherwise degrade or bully me, you are tring to establish your dominance. If I beat your ass or as you say bust a cap in your ass, then I have assumed that dominance. Most folks wont kill to be the winner, but some people, for various reasons, get to the point where they see that as the only viable option.
The truly unfortunate thing is that they tend to flock shoot instead of zeroing in on the asshole that started the ruckous.

I dont think you people really care to understand just how many kids and adults are walking around today that are right at that snapping point. How we treat our fellow man is vitally important to the future of society.

[TJ]

"The truly unfortunate thing is that they tend to flock shoot instead of zeroing in on the asshole that started the ruckous."

Are you stoned? Really, WTF? The truly unfortunate thing is that they haven't learned appropriate responses to societal stresses.

[brotherben]

I am not stoned. Being bullied or otherwise belittled isnt societal stress. It is the work of an asshole that demands a response. Murder is the ultimate response. It is no more or less justifiable than a bully fucking with someone for their own sick satisfaction.
Crazy people kill people as a response, not generally as an initial act.

[Larry]

"the ___________ in this country is woefully underfunded......."

Gotta love them libertarian comments

First: What, I can't post a non-libertarian thought here? Hope you like your cocoon.

Second: What exactly is your market-based solution to the treatment of mental-illness? It's not like those in need of psychiatric care are in possession of the money needed to incentivize the building of all kinds of for-profit private mental institutions (the thought of which, by the way, makes me feel all kinds of creepy). This is a serious problem, and even the most hard-nosed libertarian should realize we need to think long and hard about how society should handle mental illness and its treatment.

If society needs to do something to secure itself against people with dangerous mental illnesses, then there's a responsibility to do it properly and with compassion.

[Guy Montag]

Isn't it time to cue the Prozac connection? Waiting in the wings should be the government black-ops conspiracy.

For some reason these stories play out the same way as a Coast to Coast episode. They are way ahead of the excuse-for-flakes curve tonight.