This essay was first published in Newsday. A 17-year-old who had no issues growing up begins to be annoyed by everything: lights in the bathroom, the sound of water running. He has trouble sleeping. He begins self-medicating, turning to drugs or drinking to quiet the anxiety he feels. He also wants to silence the voice in his head that is telling him to throw rocks at anyone who tries to get him to come down from the roof of his home.
This boy is eventually diagnosed with schizophrenia, but only after he has had multiple episodes, according to a story told by Sen. Lamar Alexander (R-Tenn.) at a hearing on mental health reform. Experts say it takes one to two years, typically, after teens' first episode of psychosis for them to be diagnosed and helped. The longer they go on unstable, the worse their illness gets.
When it returns to session next week, Congress is scheduled to take up mental health care reform, an issue touched off by the shootings at Sandy Hook Elementary School and other recent mass murders.
There are many good proposals. One bill from Sen. Mark Begich (D-Alaska) would train law enforcement and school officials in "first aid" for mental illness - how to detect problems early and intervene effectively. The Obama administration is also working on a public awareness campaign.
But there are off-point ideas too. One of them is broad funding of community mental health clinics - a bipartisan bill introduced by Sen. Debbie Stabenow (D-Mich.).
It's not bad to promote better access to and affordability of mental health services. But, if we want to prevent massacres, let's be more direct. Let's shrug off the fear of stigmatizing one group, shed the political correctness, and admit to ourselves that untreated psychosis is a crisis among mostly young men.
These are the facts: Adam Lanza, 20, attacked a school in Newtown, Conn.; James Holmes, 24, shot up a Colorado movie theater; Jared Loughner, 22, opened fire in a Tucson supermarket; Seung-Hui Cho, 23, killed 32 at Virginia Tech.
There are two current political distractions to talking plainly about the causes of mass shootings. One comes courtesy of the National Rifle Association, which is trying to turn the national conversation away from gun control. David Keene, NRA president, has repeatedly called for Americans to "fix the mental health system." Yet NRA opponents are so virulent that they seemingly refuse to agree with the NRA about anything, even this commonsense goal.
The other distraction is from advocates for the mentally ill. They seem to believe that if we admit that some mentally ill people are violent, then we are painting all as violent. This intonation surfaces after every mass murder: People with mental illness are much more likely to be the victims of violent crimes than they are to be the perpetrators.
Fine. Let's agree to this and get down to solving the problem.
At a congressional hearing in January, Dr. Thomas Insel, director of mental health at the National Institutes of Health, talked about why mental illness is difficult to diagnose. There are no blood tests, and it's often a disease that starts young.
"When we talk about mental illness, we're talking about illnesses that begin early in life," Insel said. "It requires a different mindset about how do you detect, how do you intervene, and how do you make sure that you can make a difference."
Before treatment, people are at a 15-fold greater risk of becoming violent than after treatment, Insel told the congressional committee. There's hope in that statistic. It means that treatment can work, he said, and people can recover.
Like treatments for cancer and heart disease, cures are most effective when the illness is caught early. Allowing people to suffer for years with paranoia and hallucinations is cruel. To catch this killer, let's be honest enough with ourselves to look at young men.