Help The Ill Before They Kill

By E. Fuller Torrey
New York Post

The killing of 32 students and staff at Virginia Tech is a tragedy which did not have to happen. It is yet another rampage killing, in which many people are killed at one time by a single perpetrator.

Such killings have been carried out by men and by women, such as Sylvia Seegrist, who killed three and wounded seven in a Philadelphia shopping mall.

A common denominator in about half of all rampage killings is that the killer has a severe psychiatric disorder that is not being treated. This was almost certainly the case with Cho Seung-Hui, who exhibited classic symptoms of paranoid schizophrenia. He was ordered by a judge to have a psychiatric evaluation in December 2005, and even ordered to get treatment. But our mental-health-care system is more disorganized than the minds of the sickest patients, so, as commonly happens, there was no follow-up and no treatment.

Like Cho, most mentally ill rampage killers are known to the mental-health system. Sylvia Seegrist, for example, had been hospitalized for schizophrenia 12 times, had tried to kill her mother and had even stabbed her psychologist, yet she was receiving no treatment at the time of the killings. A study of 102 rampage killings carried out between 1949 and 1999 strongly suggests that these episodes are occurring increasingly frequently in recent years.

And why shouldn’t they be? We emptied the state psychiatric hospitals but did not ensure that those who need continuing treatment get it. Most mentally ill people are not dangerous but a small subset of them are. And they tend to be individuals like Cho, who think people are doing things to them and have other paranoid ideas. Studies suggest that such people are responsible for about 5 percent of all homicides in the United States – almost 1,000 a year – but approximately 50 percent of rampage killings.

A fundamental problem is that our state laws are written in a way that makes it exceedingly difficult to involuntarily treat someone until they have demonstrated dangerousness. Virginia, for one, requires that someone be “imminently” dangerous before they can be involuntarily treated. In effect, that means that you have to be either trying to kill your psychiatrist or trying to kill yourself in front of your psychiatrist. The students and faculty at Virginia Tech correctly identified Cho as being very disturbed and potentially dangerous but that only resulted in a virtually universal refrain: “There was nothing we could do.”
We know all too well that changing the laws is just the first step. In fact, even when the law is clear, the people implementing it are often ignorant of it or simply ignore it. Take, for instance, Virginia’s outpatient-commitment law that the judge used for Cho.

The state’s law says the local mental-health agency shall monitor the person’s compliance with treatment. And yet, when asked, a spokeman for the agency that should have helped Cho said, “The matter of the individual actually following up and going to that appointment is his or her prerogative.” Not just untrue, but ridiculous. He also said that the court order “can’t actually be enforced,” despite the fact that the law says that upon failure to adhere to the treatment order, the judge can rescind it and order hospitalization.

The answer, of course, is to change state laws so clearly psychotic individuals who are exhibiting signs of dangerousness can be hospitalized and treated before they kill, not merely after – and then to make sure those laws are used. The Treatment Advocacy Center ( has a model statute that permits treatment when needed but, at the same time, protects individuals’ civil rights so that the law should not be abused.

Until we correct such laws, episodes such as we observed this week will continue to occur with shocking regularity. They don’t have to happen.

E. Fuller Torrey, M.D., is the president of the Treatment Advocacy Center (, a national nonprofit dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses.

New York Post
April 23, 2007