The Saturday massacre at a shopping mall in Arizona, US has set off gut-wrenching questions on a host of issues - mental health services, gun laws, political discourse and so on.
Six persons were killed and 15 others injured as Jared Lee Loughner. 22. opened fire indiscriminately. The incident has attracted international attention because among the injured was Congresswoman Gabrielle Giffords, a moderate Democrat. Her condition is stable, though still critical.
America has recoiled in horror, but throughout the country some 30,000 people die each year of gunshot wounds — about one-third of the 98,000 who are shot.
The police report said Loughner admitted to other acts of vandalism in the area. The case was ultimately dismissed after he paid a $500 fine and completed a diversion program.
But what about the mental health services? Apparently none took note of the looming danger. However, experts caution it is a tricky business to identify whether a person who is mentally ill might become violent, so that those in his path can be protected from potential harm and he can get the treatment he needs.
People diagnosed with schizophrenia, for instance, most often begin showing signs of the illness in their late teens or early 20s, when they suffer episodes of hallucinations and become preoccupied with delusions — for instance, of persecution or conspiracy.
Loughner's apparent embrace of notions such as mind control, a new currency and "conscience dreaming" — all mentioned in a YouTube posting he reportedly made —are the signs of a clinical thought disorder, all hallmarks of a paranoid schizophrenic.
Still they do not necessarily reveal little actual propensity for violence, said Dr. Mark A. Kalish, a forensic psychiatrist who teaches at UC San Diego.
The mentally ill, Kalish noted, are no more likely to engage in violent behavior than members of the general population.
Some activists, citing Loughner's apparent early signs of instability, suggest that state laws need to be broadened to allow involuntary commitment of the potentially violent mentally ill. Most states require that a mental health professional find an individual not only to be severely disabled by mental illness but also to be an imminent danger to himself or others before allowing involuntary commitment to a psychiatric facility, writes Dean Reynolds in Los Angeles Times.
"It isn't that we don't know how to get people to help. We're just not doing it," said Robert Bernstein, executive director of the Bazelon Center for Mental Health Law in Washington.
"Community-based programs are so underfunded they don't have the resources to respond appropriately" to evidence that a person may be teetering on the edge of violence, he added. "Every day, people with mental illness are failing to receive services, and every day, people experience preventable crises — are taken to the emergency room or arrested and jailed."
Arizona's budget crisis — among the worst in the nation — has prompted deep cuts in community mental health services. According to Tim Schmaltz, chief executive of Protecting Arizona's Family Coalition, some 14,000 residents who earn too much to receive Medicaid have lost access to all mental health services, except medications, in the budget cuts.
"You don't want to be seriously mentally ill in Arizona, unless you're very poor or very sick," Schmaltz said.
Among the red flags a forensic psychiatrist might look for to predict violence are extensive substance abuse, gun ownership, whether a person has a specific target in mind and whether he or she has thought through details of an attack, Kalish said. But screening all those showing such symptoms could be a very dicey proposition, it is pointed out.
The other aspect of the story is gun control. Arizona's laws allow lethal weapons to be concealed as well as easily purchased. And, says the Washington-based Violence Policy Center, there is a strong link between lax laws and shooting deaths.
"Laws keep down the gun population," says the centre's executive director Josh Sugarmann. "But states with the most lax laws and the highest gun density tend to have the highest overall deaths."
Arizona is ninth in state firearm deaths. Its rate for 2007 was about 15 per 100,000, exceeding the national average of 10.
Louisiana, where 46 per cent of households have guns, has highest figure, of 20 per 100,000. In the lowest ranking state, Hawaii, with a gun death rate of 3 per 100,000, only 10 per cent of households have guns, according to U.S. statistics.
"When you look at the rates of homicide without guns in the U.S. it's only slightly higher than in Canada," says Ryerson University professor Wendy Cukier, author of The Global Gun Epidemic. "But rates of homicide with guns are much higher. It shows that the availability of guns is very important."
Both state and national laws have been crucially weakened over the past decade — including a Supreme Court ruling that makes home ownership of guns a right, and the expiry of a federal ban on extended ammunition clips for automatic weapons, which police say permitted Jared Lee Loughner to attach a clip that could fire up to 33 bullets without reloading.
Critics say even the laws that exist are poorly enforced and monitored.
On Tuesday, gun-control advocates called for reforms of the federal background check system that allowed Loughner to buy two weapons in the past two years: a shotgun and a semi-automatic pistol that attracts gun lovers with its "fantastic firepower."
"The Arizona tragedy has once again exposed fatal cracks in our background check system," said New York Mayor Michael Bloomberg, who joined with other civic leaders and police Tuesday to outline ways of keeping guns from the hands of the violent and unstable.
"It should be clear to everyone that the system is broken and it is time for our leaders in Washington to step up and fix it," he said.
The increasingly violent political discourse is coming up for a lot of discussion too. Longtime Giffords adviser Mike McNulty has faulted Giffords' opponents in last year's elections for stirring up emotions in the campaign to an unacceptable level.
"She is not just a centrist; she is the center. She is the fulcrum of American politics. She is what people fear there is no more of. People are fleeing the left and the right, and Gabby Giffords stands staunchly in the center. And here we have somebody who put a bullet in her brain. The center is in trouble," he told CNN's John King on Monday.
Florida conservative radio host Joyce Kauffman took heat after remarking at a Tea Party rally, "If ballots don't work, bullets will."
Back about 150 years ago, a hot-headed congressman from South Carolina caned a New England senator for his strenuous opposition to slavery right on the Senate floor. The Civil War started brewing from then on, so vicious was the beating. Abolitionist Charles Sumner, the senator from Massachusetts, took years to recover. And the same may be so for Giffords, said Jamie Stiehm, a noted columnist.
"We're on Sarah Palin's targeted list," Giffords said last year, almost prophetically, "but the thing is...the way she has it depicted has the crosshairs of a gun sight over our district. When people do that, they've got to realize there are consequences to that action." There was eventually.
But right wingers are furious. Charles Krauthammer quoted President Obama himself as saying at a fundraiser, "If they bring a knife to the fight, we bring a gun."
But he was hardly inciting violence, the columnist asserted. Why? "Because fighting and warfare are the most routine of political metaphors. And for obvious reasons. Historically speaking, all democratic politics is a sublimation of the ancient route to power - military conquest," asserted Krauthammer.
Whatever the jousting, non-political personalities too are expressing their concern. Hours after Saturday's attack, Pima County Sheriff Clarence Dupnik suggested that "vitriolic rhetoric" in political debates could have deadly consequences like the ones in Tucson.
"When you look at unbalanced people, how they respond to the vitriol that comes out of certain mouths about tearing down the government; the anger, the hatred, the bigotry that goes on in this country is getting to be outrageous. Unfortunately, Arizona, I think, has become sort of the capital," he said. "We have become the mecca for prejudice and bigotry." That is a highly disturbing scenario.