The criterion of involuntary committal is that a person present an immediate danger to self or others. (The precise language varies from state to state in the U.S., but in no state does it meaningfully stray from this concept.) The person must be actively suicidal, actively homicidal, or actively psychotic in a manner that presents a danger to self or others (such as walking into traffic, picking fights, or living in a filthy environment and not eating). There is no room for vagueness, there is little room for suspicions, and there is no room for considering what might happen — professional observations of the person’s current state are the only thing that matters. Involuntary committal is, legally speaking, the same as imprisonment and must only occur and be maintained through due process of law. All of this exists to prevent extensive historical abuses of involuntary committal.

As long as the criteria are met, a person may be held in a psychiatric facility against will. (Much higher legal standards apply for the administration of medications against will.) The patient’s status is reevaluated periodically before a probate court (the period varying from jurisdiction to jurisdiction), and when the probate court finds that the criteria for involuntary committal are no longer met the patient must be reclassified as a voluntary patient and permitted to leave under the terms set by state law — and that is the end of the matter, unless the facility chooses to appeal the decision, an extraordinary step that is rarely successful. This is not a decision on the part of the psychiatrists, except inasmuch as they make their professional opinion known to the court. (There are ways to spin a marginal case to keep a patient inside, but it’s ethically sketchy and the case in which a psychiatrist has both a reason and a need to do so is a rare one.)

Some patients are accomplished at “faking good” — that is, they manipulatively conceal their illness and sing the right song to get themselves sprung. Some of them, especially those who have been through a round or two, have become quite wise to both the legal and psychiatric systems and can make a very good go of gaming them. Psychiatrists are usually intelligent and experienced, but they are still human and can sometimes have the wool pulled over their eyes. Other patients turn things around quickly in the controlled environment of an inpatient unit, and genuinely look very good, but lose it when they get back outside — a mental-health slang term for these is “boomerangs”.

Sadly, what happens sometimes is that a person who has once been involuntarily hospitalised may resolve to do whatever it takes not to be put inside again — including masking feelings and bottling up rage, knowing that expressing what’s going on may be a ticket back inside. The efforts to avoid being committed again may actually worsen a person’s mental state.

As for Cho, I don’t know anything about his psychiatric history. I’d be quite interested to know how ABC News obtained a document pertaining to a person’s psychiatric admission — unless a temporary detention order is a public record under VA law, which seems doubtful. That aside, the report clearly states that the box for danger to others was not checked. All that proves is that he did not show signs of danger to others at the time. Sixteen days is more than enough time for the manifestations of a person’s mental illness to change radically, to say nothing of sixteen months. Paranoid schizophrenia, for example — I don’t know if that was his issue, but he was in the prime age range for manifesting it — can progress very rapidly and feature sudden psychotic breaks. So can the bipolar disorders. The fact of his hospitalisation over a year previous does not by itself indicate “they should have known” — that’s an expression af a common and ignorant stereotype of mental illness.

He kills 32 people, and you needed to see a video to determine he was angry?

For this particular subset of crimes I disagree. It is fueled by rage yes, but a large component of the rage is a feeling of helplessness and anger about how ignored they are, and the media reaction helps play into elaborate fantasies about lasting glory — not much unlike the visions of heaven “martyrs” hold to carry out their acts. I think focusing on the killer also has the unintended side effect of making the victims seem like an abstract concept and that could help desensitize future killers.

Obviously something that is planned and premeditated to this extent is far different than most murder/suicides (which in my view are triggered by a psychotic break). There were warning signs, but the sad fact is that they weren’t appreciably different (except for the stalking and legal pronouncement which I agree was poorly handled and he should maybe have been forcibly detained until mental professionals cleared) from tens of thousands of other kids; kids that are at danger of being ostracized and made even worse.

Plus the reactions to all these tragedies are hardly about introspection but are about rationalization (about why “we” are different or that next time “we” can prevent it) and stigmatization. I think it’d be more helpful to bring in the people that had (or still have) these thoughts and discuss about how they use positive things in their life to find meaning and what their struggle means about human nature and “manag[ing] the anger.”

What a simplistic way to decide this. So is the fear that airing Cho’s materials will encourage copycats. Let’s see, if someone is already ready to die and wants to take a bunch of people with him in his rage, I wonder how a little thought about publicity will change the equation. This is not an attention-seeking act. It is an act of expressing rage. Let people see that.

There are so many ways that people are mischaracterizing what makes someone commit mass murder/suicide that I think everyone needs more information about this, not less. It is not incomprehensible. Whatever else one calls it, it is human nature, a nature many people need to understand better to manage the anger in themselves as well as in others.

The fact is that people like this are inexplicable, save they are ‘sick bastards.’ The diff is filigrees of bile and insanity. Who is worse- a political killer like OBL, a sex deviant like Gacy or Bundy, a racist killer like McVeigh or the DC Snipers, or plain old loons like these Postal spree killers.

There is little to understand save that they are deviant. Brian Williams is certainly not the mannekin to explain such fine degrees of diff anyway, nor is a dolt like Oprah, for in the end all they say is he was a ‘troubled’ youth.

Great! What expertise and observational skills.

While I find it understandable for people to want to find some answer to this, Cho’s actions speak for themselves. This was planned and executed by one man, who is singularly responsible. The lack of warnings or lock downs, the near misses in Cho’s treatment are all features, but he is still the one who pulled the triggers.

I’m sure that somebody at NBC is counting themselves very lucky, as every news outfit has to throw up the peacock on every image and sound bite. The networks will do what they do and we can choose to turn them off or on. And if there is a copycat out there, whatever crime he commits will be his fault and his fault alone.