The bizarre behavior of the suspect in Saturday's shooting spree in Tucson sounds sadly familiar to psychiatrists who have come face to face with some of the country's most infamous killers.
Anti-government rants, anti-social behavior, talking to oneself, and the belief that one's mind is being externally controlled - all are consistent with serious mental illness or with brain wiring that's been fried by illegal drug abuse, they said.
It's entirely possible such people could be provoked to violence by rising levels of vitriol in public discourse, they said. It's often hard to convince them they need psychiatric help - or to force them to get it if they resist.
None of the experts interviewed by the Arizona Daily Star have met Jared Lee Loughner, 22, who is accused of killing six people and wounding U.S. Rep. Gabrielle Giffords and 13 others.
And they stressed that it's impossible to diagnose someone based on media reports.
However, they shared general impressions about the types of behaviors being reported.
"To me, it suggests possible paranoid schizophrenia," said Dr. Jonas Rappeport of Maryland, a retired forensic psychiatrist who assessed defendants convicted in assassination attempts on former President Ronald Reagan and former Alabama Gov.George Wallace.
Abuse of drugs such as methamphetamine can sometimes cause similar symptoms, Rappeport added.
Schizophrenia tends to show up in the late teens or early 20s, said Dr. Robert Sadoff, a forensic psychiatrist based in Pennsylvania, who has assessed more than 10,000 criminal defendants, about 3,000 of whom were charged with homicides.
"Most mentally ill people are not violent at all," and can lead productive lives with proper treatment, Sadoff said.
Untreated, a small percentage become so disconnected from the external world that they can't judge what's real and what isn't.
That's when delusions can take hold, said Dr. Phillip Resnick, a forensic psychiatrist who has assessed high profile killers, including Oklahoma City bombing conspirator Timothy McVeigh and Ted Kaczynski, the Unabomber.
The most dangerous type of delusion is the belief that one is being persecuted in some way, because "it's the one that most often leads to violence," Resnick said. Such people can strike out in the belief they're protecting themselves from future harm, or in retaliation for imagined past harm, he said.
Still, defendants who raise the insanity defense typically face an uphill battle in court.
About one in 1,000 defendants pleads not guilty by reason of insanity, but the defense succeeds only about 20 percent of the time, he said.
It's common for schizophrenia sufferers to think there is a conspiracy against them, said Tyrone Cannon, a neuroscientist and expert in schizophrenia at UCLA's Brain Research Institute.
"The focus is generally on government agencies, often secret-service agencies," Cannon said. "The themes tend to run around ideas of being watched, monitored."
Loughner spoke of government conspiracies in his online writings, during high school conversations with friends and in outbursts in classes at Pima Community College. In a recent YouTube video, he complained of mind control and brainwashing.
Often, schizophrenics hear voices, sometimes commanding them to do things, Cannon said.
Cannon cautiously agreed with Pima County Sheriff Clarence Dupnik's claim that extreme political rhetoric could influence the actions of mentally unbalanced people. Though it's hard to prove cause and effect, it's possible such talk could reinforce a person's existing fears or delusions, he said.
"It's already happened," said Rappeport, the Maryland psychiatrist, citing the 1994 case of a Colorado man who sprayed the White House with gunfire in what he thought was an attack on President Bill Clinton.
The suspect said he'd been motivated by a conservative talk show host in Colorado Springs. The host later quit.
Sadoff, the psychiatrist from Pennsylvania, said the use of violent metaphors to target political opponents - such as former Alaska Gov. Sarah Palin's putting Giffords' district on a map in what looked like rifle cross hairs - can create "an extreme kind of symbolism" for unstable people.
"They might pick it up as a message that it's all right to do what they had in mind," he said.
When Pima College officials, alarmed by Loughner's erratic behavior, banned him from campus last fall, they told him and his parents he couldn't come back without a mental-health evaluation saying he wasn't a danger.
It isn't known whether any action was taken as a result.
Some mentally ill people don't seek help because they don't realize how sick they are, said H. Clarke Romans, executive director of the local branch of the National Alliance on Mental Illness.
Family members may not understand or may be unwilling to face the situation.
Even if they do accept the severity of a loved one's illness, it still may be difficult to get help. Courts typically require proof that patients are a danger to themselves or others before they can be committed against their will.
In part because of such challenges, many sufferers don't get treatment.
Studies suggest there are 60,000 to 100,000 seriously mentally ill people in the Tucson area, but fewer than 20,000 are being treated in the public mental-health system, Romans said.
The problem has been exacerbated by cuts in the funding of mental-health treatment, Romans said, which "greatly increases the probability of something like this happening."
Contact reporter Carol Ann Alaimo at firstname.lastname@example.org or at 573-4138.
OTHER FAMOUS CASES INVOLVING MENTAL HEALTH
History offers many examples, locally and elsewhere, of murder suspects who exhibited bizarre behaviors and beliefs.
2008 - David "Nick" Delich: Delich, then 25, was arrested in the shooting death of Tucson Police Officer Erik Hite and wounding of two Pima County sheriff's deputies. He is is awaiting trial. Defense psychiatrists said Delich is a schizophrenic, who believes he can raise people from the dead, set people on fire spontaneously and carry out "mind communication" with a porn star on the Internet.
1998 - Gracie Verduzco: Her Tucson shooting spree killed one man and injured four others. Verduzco, then 35, claimed she was possessed by spirits and was provoked to kill by satellite transmissions sent to a device implanted in her ear. She was sentenced to 20 years in the Arizona State Hospital.
1994- Francisco Martin Duran: Then 26, he sprayed the White House with gunfire in a bid to kill a man he thought was then-President Bill Clinton. Duran pleaded not guilty due to insanity but was found guilty. The Washington Post said he claimed "he was trying to save the world by destroying an alien 'mist,' connected by an umbilical cord to an alien in the Colorado mountains."
1978-1995 - Theodore J. Kaczynski: Known as the Unabomber, he was sentenced to life in prison without parole for a mail-bombing campaign that left three dead and 23 injured over a 17-year span. A loner who lived in a remote mountain cabin, he was diagnosed as paranoid schizophrenic and held extreme anti-government views.
1981 - John Hinckley Jr.: The recluse, then 25, was found not guilty by reason of insanity for trying to assassinate President Ronald Reagan. Hinckley also harbored romantic delusions about actress Jodie Foster.
1972 - Arthur Bremer: Then 22, he tried to assassinate former Alabama Gov. George Wallace. News reports of his trial said Bremer was a social outcast who once lost a job as a busboy because he talked to himself while marching around the dining room. Bremer's lawyer said he was schizophrenic, but some experts disagreed. He was sentenced to 53 years in prison.
Staff and wire reports