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So, what about political rhetoric? If Loughner had developed a psychotic condition, such rhetoric might have sounded more extreme to him than it really was, according to Jeffrey Swanson, a psychiatry professor at Duke University School of Medicine. "Take something you or I might find mildly threatening. For the person with impaired perception of reality, that can get exaggerated to the point of being incredibly threatening."
We also know that delusional patients in different cultures have different kinds of misperceptions of the world. One study, by the Tokyo Metropolitan College of Allied Medical Sciences, compared schizophrenic delusions among patients in Tokyo and Vienna and found that European patients tended toward fantasies about poisoning and odd religious ideas, while the Japanese had delusions that they were being "slandered," which the authors surmise "may derive from the group-oriented self in Japanese 'shame culture.'" Such studies suggest that the broader culture which would include the political climate could affect the content of a psychotic person's delusions, including what or whom the person perceives as threats.
But those who say right-wing rhetoric was the one factor tipping Loughner misunderstand the complex nature of psychosis. "No single variable explains violence in schizophrenia," write Swanson and eight colleagues in a 2006 paper published in the Archives of General Psychiatry. "Rather, violent behavior occurs within a social-ecological system involving a 'whole person' with a particular life history and state of health." In short, saying Sarah Palin or Glenn Beck caused Loughner's actions is, to put it charitably, completely idiotic.
Looking for Risk Factors
At some point, Loughner did something few people with psychotic disorders do: he began buying guns and planning violence. Last year he bought a shotgun from Sportsman's Warehouse in Tucson. On Nov. 30, he went back and purchased the Glock he used in the Safeway massacre.
Many people are blaming mental illness for the massacre, but a more reliable set of predictors of violent crime are age (arrests for violent crime peak at about 18), gender (each year men commit roughly 80% of the violent crimes in the U.S.), lower socioeconomic status and history of arrest. (Loughner fits all four.) Still, Swanson's data show that the lifetime prevalence of violence in those with schizophrenia or a mood disorder is 33%, compared with 15% for those with no major disorder. Combine schizophrenia or a mood disorder with substance abuse and the prevalence soars to 65%. One reason is that psychotics and addicts exhibit a high level of what psychologists call arousal; they get agitated very easily.
Psychiatrists who treat Loughner will look for other risk factors that predict violence aside from (and better than) psychosis: childhood abuse, alcoholic parents and, again, heavy drug use. And the rest of us will wonder whether more could have been done to recognize Loughner's warning signs before he got to that Safeway. According to the American Association of Community Colleges, most of the nation's nearly 1,200 community colleges do not employ a psychologist to treat troubled students. Virtually all have campus counselors, but their level of training varies.
Still, one imagines that someone at Pima Community College should have responded more directly to Loughner's warning signs: the paranoia, the jumbled speech, the scary outbursts. According to Charles Arnold, an Arizona attorney who specializes in the state's mental-health laws, the college had a legal responsibility to refer Loughner to authorities for possible commitment to an institution if officials there thought he had a "substantial probability" of causing harm. Instead, when Loughner displayed persistent behavioral problems that indicated a possible psychotic illness, Pima asked him to withdraw from school until he got outside mental-health help.
The Loughner case is similar to that of Seung Hui Cho, who in 2007 shot and killed 32 people at Virginia Tech. For at least 18 months before the massacre, Cho had shown disturbing signs: bizarre class essays that included revenge fantasies; the stalking of at least three women; near total silence, including with roommates; and even involuntary commitment to a mental institution. The university did little to follow up after Cho returned to class. Schools should devote more resources to students with obvious problems. They could, at the very least, ask them to check in with counselors on a regular basis.
It will never be possible to stop every unhinged person from committing awful crimes. But in the wake of the Tucson tragedy, we should be talking about how to provide more mental-health care to those who display signs of needing it, not having a debate about whether rhetoric on TV and Twitter killed those six people.
This article originally appeared in the Jan. 24, 2011 issue of TIME.