The ruling by an Arizona federal court judge today that Jared Lee Loughner is not competent to stand trial for murder is one small step in our society’s understanding of the true nature of serious mental illness, but the larger picture of the Loughner case shows how far we still have to go.

US District Judge Larry Burns ruled that defendant Loughner was unable to comprehend the felony criminal charges against him, nor was he able to assist in his own defense, all because of his mental illness. Loughner has been diagnosed in the past, and two additional court-commissioned medical assessments confirmed, that he suffers from paranoid schizophrenia, a condition in which the individual’s whole sense of reality is distorted, leading often to hallucinations, delusions, disordered thinking and in some cases hearing voices. When you are detached from reality, of course you cannot think logically and rationally. That is what schizophrenia is: a major detachment from reality due to, science thinks, still little-understood malfunctions in the neural circuits of the brain. Schizophrenia is NOT a split-personality problem, despite common misunderstanding. It is a seriously disabling condition, the mother of all gravely impairing mental disabilities.

I know: my oldest sister suffered from paranoid schizophrenia all her life, from age 17 (though science now thinks signs of onset are likely to appear in early childhood) until her death at age 66. I witnessed first-hand over many years the manifestations of schizophrenia, the incoherent statements, the outbursts, the unexplained hysterical laughing and/or hysterical crying. My sister was lost in a world we “normals” still can’t comprehend. But at least we family members have a keen insight into the true nature of what schizophrenia is, and how those with it, suffer through absolutely no fault of their own. And we must keep bring that insight and that voice to public awareness.

As a behavioral health advocate, I also fully understand how little of this true picture of what patients with schizophrenia go through is understood by the larger society. Unless you have someone in your family with this devastating illness, it is nearly impossible to imagine its ghastly true nature.

And, as a lawyer, I am appalled at how our legal system treats defendants with serious mental illness, incarcerating those diagnosed with an illness that has robbed them of their very ability to think rationally, sometimes leading them to violent acts over which they have no control. Where is the requisite mens rea in that? Hospitalizing seriously mentally ill until they are “rehabilitated enough” to stand trial, when their brain dysfunction robbed them of the ability to knowingly commit a crime at the time of the act in the first place – is itself nonsensical.

So it was encouraging to see Judge Burns absorb the truth that Loughner cannot comprehend rationally much of the world around him, including his own legal case. But it was also very painful to hear how sheriff deputies threw Loughner to the floor and dragged him out of the courtroom when he had an uncontrollable outburst during his court hearing, and to hear of his parents distress witnessing all of that. My heart went out to them, in understanding and empathy; and in a resolve to continue to work to change our society’s shortcomings in coming to grips with understanding serious mental illness and adequately funding research for a cure.

My heart also goes out to all the Tucson shooting victims and their families of this untreated horrific illness. Wouldn’t it be a wonderful legacy to them, and particularly to little Christina Green whose young life was ended by this illness, to move our culture beyond ignorance, fear and prejudice to a place of real knowledge and understanding and humanity in how we treat those of our members gravely ill with brain disease? And to move towards finding a cure to save future sufferers and members of the public.

Medical costs account for only 25% of employers’ total health costs; the other 75% is attributed to absenteeism and presenteeism

(Goetzel et al, JOEM, 46: 398-412, 2004)