Editore"s Note
Tilting at Windmills

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January 10, 2011

RAND PAUL'S BILL FRIST MOMENT.... For those of us covering Saturday's events in Tucson, it's almost unavoidable to engage is some armchair psychology. Very few people in media have professional training in mental health issues -- and I certainly include myself in this media group -- but we nevertheless feel comfortable characterizing Jared Lee Loughner as obviously being a deeply sick young man.

Of course, when we say this, we're not making a medical diagnosis or claiming any kind of professional expertise. We haven't met Loughner or conducted any first-hand psychoanalysis. We've just seen the publicly available information and made a commonsense judgment -- this guy looks like a madman.

At a minimum, then, it's annoying to see Sen. Rand Paul (R-Ky.) weigh in on the subject, not as a political observer, but as a medical doctor. (thanks to reader V.S. for the tip)

Sen. Rand Paul (R-Ky.) said Sunday that, based on Internet writings attributed to a 22-year-old accused of shooting Rep. Gabrielle Giffords (D-Ariz.), he believes Jared Lee Loughner is a paranoid schizophrenic. [...]

"I looked at some of the writings of this young man, and from a medical point of view there's a lot to suggest paranoid schizophrenia and a really sick individual," Paul said on "Fox News Sunday."

Look, for all I know, Loughner is a paranoid schizophrenic. This isn't my area of expertise, but from what we saw over the weekend, that hardly seems like a stretch.

But what rankles here is Rand Paul's comfort with offering his "medical point of view" on national television. With due respect to the freshman senator, he's a self-accredited ophthalmologist. He's worked as a medical professional, but has treated patients' eyes not their mental health, and as best as I can tell, he has no background as a psychiatrist.

Rand Paul, in other words, isn't qualified to diagnose mental disorders by reading some stuff on the Internet. He shouldn't pretend otherwise.

If this sounds familiar, it's because we saw a similar situation six years ago. Sen. Bill Frist (R), at the time the Senate Majority Leader, weighed in on the Terri Schiavo matter on the Senate floor. Relying on his background as a surgeon, Frist said he'd watched Schiavo videos in his office for about an hour, and felt comfortable telling his colleagues that the woman may not have been in a persistent vegetative state, despite the judgments of medical professionals who actually treated the patient.

I'm entirely comfortable with physicians seeking elected office, but I wish they wouldn't do stuff like this.

Steve Benen 9:25 AM Permalink | Trackbacks | Comments (39)

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Comments

Next he'll be defending Arizona's gun laws which practically encourage people to own guns, carry them concealed, and remain armed at all times ... Why else would they make it so easy to own a gun, permit people to carry the gun in bars and parks, or not require training? Yes, people with guns kill people... But that bit of sophistry presupposes people have the guns in the first place. And it is not true that a gun owning society is a polite society, such societies have ritualized processes for murder. Think Tombstone, think of dueling and Burr v Hamilton. And they have inflamed rhetoric.

Posted by: KurtRex1453 on January 10, 2011 at 9:30 AM | PERMALINK

Didn't he already politicize this by going to the "Guns don't kill people" bit?

Posted by: Fr33d0m on January 10, 2011 at 9:31 AM | PERMALINK

Frist also was wrong when it was found Schiavo was blind after am autopsy. He then protested that he never gave a diagnosis and we were all expected to believe him.

Posted by: CarlP on January 10, 2011 at 9:33 AM | PERMALINK

There will be an attempt to deflect attention from the right wing hate language and onto mental illness.

The next step is to blame the Congresswoman for not having better security. (I have already seen this one.)

Then we will have, "If only those citizens had been carrying guns, they could have stopped the attacker."

Any rhetoric that is stronger than, "Vote them out of office" or "Work to support an opposing candidate" needs strong condemnation.

Posted by: bakho on January 10, 2011 at 9:36 AM | PERMALINK

Ditto. I am as qualified as he is.......well, more so, actually, as, even though I am an OB/GYN, I am accredited by ABOG, and not some organization I created in my basement. My last real experiences with psych diagnosis were back in medical school (when it was my second choice for possible career path).

But I would never try and diagnose something like this without meeting the patient. Even then, I'd have to dig up a current version of the DSM to make sure I knew what I was talking about.

Posted by: dr. luba on January 10, 2011 at 9:37 AM | PERMALINK

A mature take on how to think about those ramblings and the malevolent effect of general tone, regardless of just who listens:
George Packer
BTW any update on whether Loughner tied to the racist/nationalist group?

Posted by: neil b on January 10, 2011 at 9:40 AM | PERMALINK

I think state medical boards should be protecting the public from this sort of misuse of medical credentials.

Posted by: larry birnbaum on January 10, 2011 at 9:41 AM | PERMALINK

Well, to give Paul some credit, as a self-certified opthamologist, maybe he can tell a crazy person by looking in their eyes.

Has he looked in a mirror lately?
Snark.

Posted by: c u n d gulag on January 10, 2011 at 9:41 AM | PERMALINK

The right (seem) to be in agreement with changing the political discourse - Why is it that the right are the ones attacking the sherriff in Tuscon for his comments?

Posted by: JS on January 10, 2011 at 9:43 AM | PERMALINK

Dr. Paul should probably keep an eye on his instinct to be conclusive - most anyone (not a doctor) who's spent time around doctors can tell you, there's a certain sense of arrogance they can come with. I'm not surprised that Paul considers himself professionally able. Tom Coburn shares the quality, as did Frist.

Still, I wouldn't issue a blanket dismissal of his qualifications - he's got a medical degree which means time spent as an intern and a resident as well as in his specialization - or his ability to draw an assessment based on Loughner's writings. And I would point out, even examining Loughner's writings to determine his state of mind is way more substantive than Frist watching selectively edited clips of Terri Schiavo to determine her presence of mind.

The point is... yes, bald speculation about Loughner may not help; but if that's true, it's been no more helpful that many angry liberals have cited causal links from Sarah Palin based on less. And it's beyond embarrassing that no major news organization has particularly sought out the professional expertise of a psychiatrist or a psychologist to at least start a discussion of mental health issues in relation to the shootings. And that sad state of affairs is not new.

Posted by: weboy on January 10, 2011 at 9:47 AM | PERMALINK

Yeah, Bill Frist also famously stated that one could contract HIV from sweat and tears..

Yesteryear's Fuck-up!

Posted by: Trollop on January 10, 2011 at 9:48 AM | PERMALINK

I would loosen up here. I am no Rand Paul fan (I sent Conway money), but when you spend time in med school in psychiatry some things just jump out. I am a cardiologist, but I would guess the same thing. He seems to be a paranoid schizophrenic. There will be many easy opportunities to belittle Rand Paul, I wouldn't start here.

Posted by: Josh on January 10, 2011 at 9:50 AM | PERMALINK

Agreed on Rand Paul posing as an expert on what may be the exact mental issue that afflicts Loughner. I've got a BA in Psychology myself and also thought paranoid schizophrenia but that BA sure doesn't equal "expert" anymore than training in ophthalmology makes Paul an expert. Rand Paul had no business lending authority to his opinion by labeling it a "medical point of view".

Posted by: CurtMinIn on January 10, 2011 at 9:51 AM | PERMALINK

Right and left, we have all adopted an us v. them world view. That guy is a "liberal." He must be trying to destroy American. He has to be stopped at any cost. That woman is a conservative "nutjob." She must be stopped at any cost or America will slip into the abyss. It is all oh so tribal. I know I am guilty. I know my conservative friends are too. So are many of the regular readers of this board.

I think it might have something to do with instant communication. We pop off here without thought. It undoubtedly has something to do with the Fox News, us v. them mentality that converts every contraversy to a tribal death match. We don't even take the time for real journalism anymore. We just shoot from the hip and call it good enough. We dash to the next earth shattering topic.

I reserve the right to disagree with conservatives, but I am going to do my best to make sure my comments are thoughtful and respectful. I don't want it to be said that I am part of any tribe other than the American tribe or that I am part of any race other than the human race.

Before people accuse me of high Broderism, I can't change what anybody else writes. I can only change myself.

Posted by: Ron Byers on January 10, 2011 at 9:52 AM | PERMALINK

I read the gunman's thesis
And I made my diagnosis

He looks a little crazy
His judgment, sort of hazy

Dr. Seuss

Posted by: wishIwuz2 on January 10, 2011 at 9:53 AM | PERMALINK

...but does he need glasses?

Posted by: SaintZak on January 10, 2011 at 9:53 AM | PERMALINK

I am a cardiologist, but I would guess ...

I'm a vegitarian and it would be my guess that most Republicans are paranoid schizophrenic. My question is whether it is a socialized condition or a chemical one.

Posted by: Danp on January 10, 2011 at 9:54 AM | PERMALINK

It's not Rand "Aqua Buddha" Paul's medical experience that is relevant.

It's is political experience.

Because Rand, as a TP dude and for a long-time hanging on the libertard and conservitard circles, comes in contact with far, far, more people with very serious mental issues.

Drooling morons? Check! Paranoid schizophrenics? Check! Delusional shouters-at-clouds early-stage Alzheimer's people? Check!

Rand may be as ignorant as they come, but he knows crazy. You might say it's in his genes.

Posted by: Snarki, child of Loki on January 10, 2011 at 10:00 AM | PERMALINK

My wife is a board-certified psychiatrist, and I asked her what the thought of this man's writing/behavior. She said it wasn't nearly enough to say if he was clinically ill or just non-clinically weird.

Posted by: rweaver on January 10, 2011 at 10:04 AM | PERMALINK

As long as Republicans are asking us to respect their medical credentials when they make half-assed medical judgments, why don't they start respecting the scientific judgments, based on undisputed evidence, of genuine experts on climate change?

Posted by: Basilisc on January 10, 2011 at 10:06 AM | PERMALINK

Neil, I like Packer well enough, but that essay amounts to "Jared Loughner's probably unbalanced.... but here's an unrelated issue that we ought to spend time arguing over." There's been a lot of that in the hours since the shooting, and I sympathize with the general sense that the tome of our politics has become extreme, largely pushed by the far right. But that being the case doesn't necessarily tell us anything about the specifics of this shooting, or the mental problems of this shooter. That's the problem - a does not equal b. And it's why Rand Paul is probably being more helpful suggesting that there's an appropriate mental health issue to be raised, rather than blaming anyone's politics first, than many want to admit.

Posted by: nycweboy on January 10, 2011 at 10:09 AM | PERMALINK

I'm going to have to disagree with you on this one. I'm not a Rand Paul fan, but I think what he said was okay. First, he didn't offer a diagnosis, he said that there was a lot to "suggest." Second, his statement "from a medical point of view" I think is another way of saying that schizophrenia truly is caused by physical issues with the brain (basically the brain chemicals not working correctly). Third, I think he was trying to avoid terms like "madman" because he didn't want to stigmatize the millions of others who suffer from serious mental illnesses.

I won't go into a discussion of issues regarding mental illness at this point, but there are many excellent web sites with tons of information regarding the symptoms of mental illnesses. The National Alliance on Mental Illness has an fine one (www.nami.org).

Paul will say lots of dumb things while he is in the Senate. I don't think that this is one of them. Indeed, in this instance, I think he actually said something sensible.

Posted by: Mike on January 10, 2011 at 10:12 AM | PERMALINK

"I looked at some of the writings of this young man, and from a medical point of view there's a lot to suggest paranoid schizophrenia and a really sick individual,"

During the campaign I looked at Rand Paul on my TeeVee, and there's a lot to suggest paranoid schizophrenia and a really sick individual.

Posted by: DAY on January 10, 2011 at 10:16 AM | PERMALINK

As a physician with 30 years of practice in Emergency Medicine and plenty of exposure to schizophrenia (but not a psychiatrist), I have to agree with Mr. Paul, although I probably wouldn't say it on national TV. The evidence is that this person probably has a thought disorder, and schizophrenia, particularly the paranoid type, fits. I'm a raving left-winger, but I guess I don't think you should be making a big deal out of this. I think assholes like Jon Kyl should be called out for their comments, however.

Posted by: Joeb on January 10, 2011 at 10:17 AM | PERMALINK

bakho: There will be an attempt to deflect attention from the right wing hate language and onto mental illness.

Right Wing hate language IS mental illness!

Posted by: chrenson on January 10, 2011 at 10:17 AM | PERMALINK

Ron - it's Broderism if you think "both sides" (already oversimplified) are equally guilty, it's OK to just call for better tone and self-improvement. Your choice.

As for what kind of rhetoric is "really bad" - I'd say, the kind that is literally directive of violence. The different political factions do indulge in sporting/war-gaming rhetoric per se - talk of targeting districts, beating opponents (same word as - beating!), hit back twice as hard, etc. but we understand that as metaphor because it doesn't describe literal indulgence in real violence. It's like "wiping out" another football team when you win 24-0. etc. Indeed, Palin's pastiche at http://www.facebook.com/note.php?note_id=375184908434 is based on real quotes from Democrats or allies, in an attempt to Broderize the issue.

We mostly get that, and in that context I think Palin's targets (er, surveyor's symbols) are overblown as a really bad example. (I think it's more pathetic that her people would try the surveyor wrangle instead of just admitting it was what it was, saying either sorry or I didn't mean it that way and in terms as I describe above, etc.)

I think the truly bad rhetoric is the deeply demeaning talk like of "traitors", the impugning of motives like "so and so is trying to destroy this country" (instead of just, on the take to some extent from lobbyists and interest groups); and then the direct threats of real violence like "ballot box or bullet box" (Crabill), "Second Amendment solutions" (Angle). Just my two cents, and coming down too hard on the former type of expression will look overbearing and be subject to genuine charges of shared blame (the blame is shared, but so unequally.) Finally, we do have some elements on the left side that could use toning down too.

"Fine minds make fine distinctions."

Posted by: neil b on January 10, 2011 at 10:17 AM | PERMALINK

From an onanological point of view, Paul sounds to me like a real jerk-off.

Posted by: hells littlest angel on January 10, 2011 at 10:29 AM | PERMALINK

I agree, I've looked at the writings of that man and, from a political point of view, there's a lot to suggest Rand Paul's a really sick individual.

Posted by: biggerbox on January 10, 2011 at 10:38 AM | PERMALINK

I see this morning that Matt Drudge and the right-wing elves of the lunatic conservative media machine are trying to spin the shooter as a "leftist" and a "liberal". I'm sure the corporate-owned mainstream media will offer no rebuttal and the vast majority of the ignorant American sheeple will believe a "liberal" looney shot one of their own and nothing at all about the toxic right-wing propaganda tsunami will change.

Posted by: Sam Simple on January 10, 2011 at 11:12 AM | PERMALINK

Bill Frist was also wrong her entire ability to think, as I remember the autopsy also revealed her cortex was destroyed.

NOTE also, the right to yell inflammatory statements does not include yelling "fire" in a crowded theater. America is crowded and income inequality is increasing and we are in a recession. The atmosphere is tense and the Limbaughs and Palin's of the world do not help.

Posted by: KurtRex1453 on January 10, 2011 at 11:14 AM | PERMALINK

As someone who spent my salad days working the nut wards of Miami, I'd say that this is the very sort of guy they used to scrape up and bring in to Jackson Psych whenever the moon was yellow and the stars were high. People who thought and used language in this manner did generally wind up diagnosed as schizophrenics. His language, however, suggests more than that. It is full of both grammatical idiosyncracies and memes that suggest molding by the Sovereign Citizen movement and Patriot groups. Whether the molding was intentional or simply a product of all the red vitriol in the mediasphere/blogosphere, this crime would not have occurred without it. Even if the present state of tension has not reached the Beauharnais threshhold, it is incumbent on public figures to restrain their invective and the FCC to determine if carriers are operating in the public interest. Moveon.org has an electronic petition which every concerned citizen shoul review and seriously consider signing. You may ad your own commentary to the petition.

Posted by: La Piovra on January 10, 2011 at 11:18 AM | PERMALINK

I don't see why Paul should be prohibited from making a medical judgment. He is a doctor. It's legitimate for him to do so, in the same sense that it's legitimate me for diagnose Paul as suffering from narcissistic personality disorder. And I speak as a fully qualified forklift operator.

Posted by: herostratus on January 10, 2011 at 11:46 AM | PERMALINK

Keep in mind, Paul is someone who claims to be an ophthalmologist and has never taken the recognized board exam for that specialty. He decided to create his own certifying board and passed himself. This is not someone who should be making professional pronouncements of any kind, unless they have to do with his own mental condition.

Posted by: digitusmedius on January 10, 2011 at 12:09 PM | PERMALINK

why can't we have a civil discussion without all the hatred I read in these comments.

Posted by: Ginny D on January 10, 2011 at 12:34 PM | PERMALINK

Rep. Jim McDermott (D-WA) is a former psychiatrist whose practice was with children and adolescents -- his observations about this person's mental state would be far more informed than those of Rand Paul.

Posted by: nancy on January 10, 2011 at 1:40 PM | PERMALINK

Soon we can expect Rand Paul to create a new psychiatric certifying organization. He will be its first client.

As to his "medical" judgment, he has not performed any examination. His judgment is made without a basis in direct fact. It is no better than that of any of us here. However, medical school is largely an organization designed to socialize individuals to the strange social practice of cutting into living human bodies without feeling guilt or uncertainty.

It should be expected that such socialization should include both training in and selection for extremely high self-regard. You wouldn't be able to perform surgery without that attitude. You'd kill or mangle too many people through indecision and uncertainty. (A great many other qualifications are also required, but that self-regard and ability to act with certainty in critical situations is a large one.)

I'm sure that Rand Paul's clear narcissism was a major asset in passing that selection criteria in medical school. His own self-regard does not qualify him as a psychiatrist, however.

Posted by: Rick B on January 10, 2011 at 1:40 PM | PERMALINK

"Keep in mind, Paul is someone who claims to be an ophthalmologist and has never taken the recognized board exam for that specialty. He decided to create his own certifying board and passed himself. This is not someone who should be making professional pronouncements of any kind, unless they have to do with his own mental condition."

This is not true. Paul was certified by the American Board of Ophthalmology from 1995-2005.

Posted by: mjkidd on January 10, 2011 at 2:03 PM | PERMALINK

I'm entirely comfortable with physicians seeking elected office, but I wish they wouldn't do stuff like this.

Actually, most physicians who get involved in running for office are the kind of doctor you don't want messing around with anything vital in your own body, because they're usually pretty obvious morons.

I always check the politics of any doctor I am going to deal with and I never let myself be taken care of by a Republican. I want a competent medical professional, not an idiot.

Posted by: TCinLA on January 10, 2011 at 2:13 PM | PERMALINK

I see this morning that Matt Drudge and the right-wing elves of the lunatic conservative media machine are trying to spin the shooter as a "leftist" and a "liberal".

This is definitely the Talking Point of the Right on this. I put on my sou-wester and went slogging through Freeperville yesterday, and this is the line all of those droolers and wannabe brownshirts were taking.

That and the "we're a persecuted minority" because everyone ties him to the Right or at least to the atmosphere they create with their rhetoric.

Go read Richard Hofstadter's "The Paranoid Style in American Politics" (Google it, it's online) and you'll be amazed how the only thing you have the change is the words used to describe "the enemy".

Posted by: TCinLA on January 10, 2011 at 2:21 PM | PERMALINK




 

 

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