Psychiatric Mystery: Diagnosing Jared Loughner

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It seems clear that Jared Loughner was developing a mental illness in the two years or so before the Tucson killings, but which one? Many signs point to one of the psychotic disorders—delusional disorder, say, or schizophrenia, for which the average age of onset is roughly 20, about when Loughner started showing symptoms of nonsensical speech and disorganized thoughts. The Diagnostic and Statistical Manual of Mental Disorders includes “substance-induced psychotic disorder,” which is also a possibility in Loughner’s case because he told an Army recruiting official that he smoked pot excessively; Kylie Smith, who had known him since preschool, says he also used mushrooms and acid.

By several accounts, Loughner had become fascinated with lucid dreaming, a dream state you can enter when you’re half asleep. You are aware while you’re in that state that you’re dreaming. Loughner’s interest in his lucid dreams is significant because last year the European Science Foundation reported that lucid dreaming “creates distinct patterns of electrical activity in the brain that have similarities to the patterns made by psychotic conditions.” Loughner’s drug use could have kept him from falling into deep sleep and encouraged this dream state. The European group said paranoid delusions can occur when lucid dreams are replayed repeatedly after the subject wakes up.

Loughner was replaying his lucid dreams in an extensive dream journal, according to his friend Bryce Tierney, who spoke with Mother Jones magazine. (Department of Side Notes: Lucid dreaming is the concept that drives this year’s mind-bending thriller Inception, in which a main character commits suicide because she can no longer tell dreams from reality.) Loughner told several friends that he believed Congresswoman Gabrielle Giffords was “a fake.” If he had started to confuse his dream world with the real world, he might have meant this literally.

But could political rhetoric have tipped his illness over into violence? 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 they perceive 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.

Credit goes to my colleagues Massimo Calabresi and Mark Thompson over at Swampland for helping report this post.

Follow my health columns on Twitter @JohnAshleyCloud