Treating mentally ill defies quick fixes

We want absolutes, urgent solutions, a clear plan to guarantee our safety. It’s the American way.

“Had this boy been required to take meds ... until his illness was controlled, none of this would have happened,” a reader said in an e-mail about the Virginia Tech shootings.

If only it were that simple.

I know from two years of trying to help someone who’s mentally ill that just because someone needs help doesn’t mean he’ll accept it.

I’ve given this a lot of thought this week. My friend Nathaniel, a musician who was homeless for decades, had his first breakdown in college 35 years ago.

The rampage on the Virginia Tech campus makes it shockingly clear that we haven’t seen much progress since then in recognizing warning signs and knowing what to do about them.

I don’t know what Seung-hui Cho’s diagnosis was, but judging from his disturbed rambling he clearly had snapped. He was just at the age when serious mental illness often first surfaces.

Cho, we later learned, had once been involuntarily committed. But as is often the case, that didn’t solve his problems.

It didn’t solve my friend’s either. After he began acting strangely in his second year at Juilliard, he was hauled off to a mental hospital in handcuffs. He hasn’t forgotten that -- or subsequent forced treatment -- all of which has made him vehemently resistant to giving any of it another try.

People who are obviously violently psychotic ought to be carted away, against their will if necessary, to prevent tragedies like the one in Virginia. But predicting human behavior -- especially among those who are impaired -- is virtually impossible.

Even in the hospital, patients can’t always be required to take medication. And if they agree to give treatment a try, finding the right course can take months. There are many people whose lives have been transformed by meds. But others decide they don’t need them anymore, and the cycle repeats itself.

I constantly struggle with questions about whether I’m doing enough to help Nathaniel. Experts I trust have told me that the biggest difference I can make in his life is to simply be his friend and patiently encourage him to seek treatment on his own. I still worry, though, that he’ll harm himself or someone else before that happens.

But the truth, I tell myself, is that the vast majority of mentally ill people don’t hurt anyone, unless you count the psychic pain they cause loved ones. The killer at Virginia Tech was an aberration.

Could that massacre have been prevented?

Maybe.

But laws designed to benefit people with mental illness can easily work against them, and against public safety, as well. Even family members, who might be able to help, are often kept in the dark about a diagnosis because of patient privacy requirements, as insane as that sounds.

One good thing that might come of this tragedy is the recognition that there can’t be too much education about warning signs on American campuses and across society. The United States still lags behind Norway, Australia and much of Western Europe in public campaigns to remove the stigma from mental illness and diagnose early, when the most good can be done.

There’s another obvious way in which we’re different from those countries: No matter where you live in the United States, it’s likely to be much easier to get a gun than to get help for mental problems.

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Reach the columnist at steve.lopez@latimes.com. And read previous columns at latimes.com/lopez.