More than a week after the Oxford High School shootings in Michigan, the episode still bristles with implications that drain the will and resources of mental-health advocates. Granted, we are not (yet) nearly as overwhelmed as, say, hospital staffers in the resurgent Covid plague, though there is some psychic overlap.

School shootings have haunted our collective consciousness for decades—a hoary specter that still grips us with dread—but this case brings new horrors to consider. It was not just any old spree of classroom murders carried out by a mid-adolescent with a semiautomatic handgun bought for him as a Christmas present by his Dad on Black Friday. This one dropped some new elements on us—and managed to bypass an element of omission. Advocates and all people of conscience must grapple with them, no matter the tedium and the elusiveness of solutions. Our sanity as a nation is at stake.

So, what must we grapple with?

First, a recap: the 15-year-old shooter, Ethan Crumbley, faces 24 felony charges for slaughtering four classmates and wounding seven other people with that semiautomatic handgun lying around in his parents’ bedroom. The charges include first-degree murder and terrorism. Ethan was captured before he could turn his Christmas present on himself. This is relatively rare, as is the high count of charges. The terrorism count may be unprecedented, and might set a legal precedent. Or it might set a legal obfuscation: The Oakland County Prosecutor Karen McDonald told CNN, last week:

“There is no playbook about how to prosecute a school shooting and candidly, I wish . . . it didn’t occur so I wouldn’t have to consider it, but when we sat down, I wanted to make sure all of the victims were represented in the charges that we filed against this individual . . . If that’s not terrorism, I don’t know what is.”

Well, with all respect, Ms. McDonald, it might be mental illness. More on that in a moment.

The most striking new element is that the boy’s father and mother, James and Jennifer Crumbley, have been charged with four counts of involuntary manslaughter. This fact turns the spotlight on the criminal culpability of parents who leave lethal weapons unconcealed and unlocked in the household. Its implications could be seminal. The Crumbleys, as media accounts have made clear, are appalling and stupefyingly negligent parents. There’s a lot of that going around.  

Here the “element of omission” takes center stage. Are the Crumbleys psychotic? Is Ethan psychotic? What is “psychotic”? How do we identify psychosis, and what do we do about it when we think we’ve seen it at work? Is this case an example of “shared psychosis,” in which some of the victims do not show clinical symptoms? What are the responsibilities—and the risks—of intervening in the actions of one who might be in a psychotic state?

These are old, wearying questions. They have been charged with fresh urgency by the bloody Oxford affair. Or should have been. After days of online searching, I have not been able to find an indication that any of the Crumbleys has received psychiatric diagnosis. I’ve found nothing but the most glancing speculation that serious mental illness—genetically inherited brain disease—was present in any of these people. And I certainly have found no serious, informed discussion about this possibility. And so the Crumbley story remains a missed opportunity at least as a “teachable moment,” a broad, ongoing national discussion on the nature of this beast. And on the policies—judicial/legal, educational, budgetary, and ethical—that scream out for rapid and thoroughgoing reform.

I am going to offer an example of policy dysfunction that I published in my previous blog. It was articulated by D.J. Jaffee, a disciple of the pioneering E. Fuller Torrey, who founded the invaluable Treatment Advocacy Center. Shortly before his death last year, Jaffe restated an observation he’d made many times in his talks and writings. It bears strongly on the Crumbley case:

“The law says we can’t do anything until after the psychotic victim becomes dangerous to self or others. As ludicrous as it sounds, the law requires dangerous behavior rather than prevents it.”

I cannot say whether Ethan Crumbley or his parents are mentally ill. A competent psychiatrist should and must make that call. I will say that telltale signs are blinking red.

There are Ethan’s notebook jottings, noticed by teachers: “The thoughts won’t stop. Help me,” and “Blood everywhere,” and “my life is useless,” and “the world is dead.” There are his sketches depicting a bullet and a bullet-riddled body.

There is the now-infamous message texted by Jennifer Crumbley to her son the day before he shot up Oxford High School, after a teacher told her that Ethan was searching for ammunition online in class: “LOL I’m not mad at you. You have to learn not to get caught.” And of course there is the fact of James buying that hideous weapon for his young son in the first place.

And there is the widely accepted thesis that if the rare onset of schizophrenia is going to occur, it typically occurs in mid-adolescence, Ethan’s period of life. This is the stage in which the prefrontal cortex is pruning itself of outworn synapses and generating new ones. If a genetic disorder produces over-pruning, an oversupply of normally essential chemicals such as dopamine can rush in and produce an imbalance that permanently damages the brain. (No thesis is yet seen as conclusive in the study of this affliction.)

The social effects of serious mental illness spread out in a widening cone from the victim through the family, the community, our schools, our political life, and the health of the nation. Mass shootings continue to be rare, but the debilitating dread of mass shootings is nearly pandemic. The cumulative costs are as under-appreciated by the populace as the nature of the disease itself. Ignorance, apathy, and fear continue to rule.

I have called in the past for creation of a federal cabinet-level department that would unify, critique, and extend policymaking in all these problem areas as well as others. Foundational reform of our disgraceful jails and prison systems, de facto catch-basins for the insane, for instance. Solitary confinement, that turns sane prisoners into madpeople and the mad into vegetables, must be abolished.

D.J. Jaffe disagreed with me about this. He felt that such a department would only add another layer of bureaucracy.

All right. Let’s add another layer of bureaucracy.

Mental-health reform is borne on the backs, overwhelmingly, of women: mothers of victims, mostly. Their advocacy work in the past twenty years alone has been heroic and sporadically effective. But these “secular nuns”—the phrase just came to me—are largely worn out and disillusioned. They carry on, but we must not depend on them to keep doing the trench-work that the problem demands. Our advocates need reinforcement—collective national reinforcement. Society must be made safe from our Ethan Crumbleys. Yet we must not let things rest at primitive blame and punishment. Humanity and moral justice call us to protect the mentally ill and to reclaim them if we can. This would be the most honorable means of protecting ourselves, and reclaiming our own souls.