Adam Blatner

I as talking with an acquaintance who was dismayed and a bit angry at the murders by nuts around the country. “Why don’t they lock ‘em up?” It turned out that she really believed that psychiatrists were able to tell with some degree of accuracy who was really dangerous and who wasn’t. She was a little sobered by my telling her that we don’t know how to tell who’s dangerous other than the very obvious ones who can’t lie: They say they’re planning to kill someone or themselves. That’s enough to justify an “involuntary hold.”

But the vast majority of people who are dangerous, if asked by docs, “Are you dangerous?”—no matter how cleverly, can tell that this is a trick question. They sense that they’re being asked if they want to be locked up for their own safe-keeping or the safety of others. A very few are relieved and answer frankly—they want protection. Many, though, just lie: “Of course not!” And psychiatrists really can’t read minds! If they’re not acting up right then, or have been caught in the act or have a lot of evidence that they were planning something violent, mental health personnel don’t know much more than anyone else!

The advances in psychiatry  have been made only with folks who voluntarily enter the sick role. Or they have already been adjudged as dangerously mentally ill. But that is usually based on what they did, not on what they haven’t done yet. Another way to say this is that there may be one hundred people who have the profile or are quirky in their mind that would be pretty suspicious, but only one who then does it, and we don’t know how to select that one who really is trouble. There are also five out of a thousand at the next level, folks who are mildly troubled, but the five who start shooting up their family or neighborhood may well not have been among the top one hundred who might arouse suspicion.

So two realities need to be noted: (1) We can’t begin to afford to lock up the suspicious ones, and (2) there are humungous civil rights problems over who is thought to be “dangerous”! In a culture of innocent until proven guilty, justification for “locking someone up” needs far more than mere suspicion. Psychiatry is credited with a power to read minds, to peer into and see our darkest fantasies. It isn’t so. Well, there’s a slight—very slight—art in seeing through phoniness, but I’m not sure it’s something shrinks can do better than street-smart folks who say, “You can’t bulls**t a bulls**tter.”)