The three other men wounded in the assassination attempt against President Reagan brought suit on March 18 against John Hinckley Jr.'s psychiatrist.
The suit alleges that Dr. John J. Hopper Jr. "knew or should have known" that Hinckley would attempt a political assassination. Further, Hopper is accused of negligence in "failing to warn law enforcement officials of Hinckley's dangerousness."
There are several important issues at stake in this case, which, if ignored, may bring about changes in psychiatric care and practice in this country that will be to no one's best interest. Take, for instance, the issue of whether or not dangerousness can be predicted.
In a paper prepared for the Secret Service on "the state of the art in the area of predicting violent behaviors," John Monahan, professor of law and professor of psychology at the University of Virginia Law School in Charlottesville, stated:
"A fair summary statement of the existing literature on the prediction of violent behavior would be that mental health professionals are accurate at best in one out of three predictions of violent behavior that they make."
One of the reasons for psychiatrists' poor batting average in this area stems from the large number of people who seek help from psychiatrists because they are having trouble handling their aggressive impulses. The majority of these people will never commit a violent or dangerous act. Besides, as the Monahan data suggest, it's not an easy matter picking the one out of three who might actually act out a violent impulse.
Further, some of the patients who have the most violent fantasies are statistically the least likely to carry them out. For instance, obsessive compulsive patients as well as some patients with epilepsy are often tortured with the thought that they might "lose control" and harm someone. They rarely do.
As a result of the Brady-McCarthy-Delahanty suit, and others that may follow, patients troubled with violent impulses may be unwilling to discuss these problems. Psychiatrists, in turn, may elect to omit certain lines of inquiry or treatment approaches that demand total candor in regard to their patients' feelings and impulses.
In light of the present suit, it is clearly in the psychiatrists' best interest that violence and the prospect of violence not be discussed. It isn't at all clear that avoidance of the subject is in the public's best interest. But even in those instances where violence is freely discussed, there remain several thorny issues.
If the psychiatrist doesn't inform the authorities of the patient's potential violence, the patient may legitimately question how seriously his communications are being taken. But if the psychiatrist does act on his hunch, the patient may deny the allegations and seek legal redress by claiming that confidentiality has been violated. While such a situation could perhaps be avoided via the use of tape-recorded sessions, this is a measure that seems unlikely to strengthen the patient's trust in the psychiatrist.
Another spinoff from the suit may be an increase in dishonest record-keeping. It hardly seems likely that a psychiatrist would record in his office notes that a patient threatened some violent act. Such selective "omissions" affect not only the psychiatrist's professional integrity but also the best interests of the public. Society in general is the loser when professionals begin fudging their records in order to avoid lawsuits about matters that they feel, rightly or wrongly, they can do little to influence.
Further, there are good reasons why psychiatrists may feel unjustly singled out for responsibility when it comes to warning authorities regarding a potentially dangerous person. The majority of statements threatening violence are made in a social setting and to nonprofessionals. So far, no one is requiring that the average citizen should contact the authorities in those instances when, in his judgment, he believes someone may act violently.
There are also difficulties predicting different kinds of violence. For instance, it isn't always possible to predict whether a person may hurt himself or others. Since potentially violent people often fail to fit into any of the commonly accepted definitions of insanity, they can't be hospitalized against their wishes.
And how direct must their threatened expression of violence be? Suppose someone merely states that the world would be "better off" without a particular political figure or private citizen. Is this a threat?
How certain does the psychiatrist have to be before notifying the authorities? Does he call the police immediately or should he wait until the patient purchases a gun and ammunition?
In addition, different kinds of dangerous behaviors are carried out by individuals with strikingly different personality profiles. "The predictors of political violence--of violence against protected persons--may not be at all synonymous with the predictors of street violence," writes Dr. Monahan.
And what about the potential for violence against oneself? Should those who knew of Arthur and Cynthia Koestler's plan to take their lives have communicated this to the authorities? Such questions plug into the larger issues of just how much responsibility one person has for the acts of another. This certainly isn't an issue pertaining only to psychiatrists. Did the TV cameramen in Anniston, Ala., have a responsibility last week to stop Cecil Andrews from attempting the violent act of self-immolation?
Throughout all this it should not be forgotten that even in those situations where the authorities are properly informed regarding potentially violent or dangerous people, clear-cut limitations exist on what can be done. For better or for worse, the current orientation of law enforcement remains geared to dealing with crimes after the fact. With the exception of making threats against the president or high government officials, people are not usually apprehended on the basis of "loose talk" or simply because someone else thinks they "might" carry out a dangerous or violent act. A similar situation exists when the informant is a psychiatrist.
A psychiatrist as a matter of routine deals with people who are often erratic and sometimes irrational. The psychiatrist can't be sure what the patient may do from moment to moment. Even in those instances where he is reasonably certain of his patient's intentions he can't be absolutely certain the patient hasn't changed his mind five minutes after leaving the office.
Psychiatry is not a science like physics or chemistry, and it cannot and should not be judged according to standards appropriate to an exact discipline. Society has little to gain by holding psychiatrists to a standard of performance beyond the limits of their capabilities.