It’s 11:00am Friday, January 9th at our Fort Lauderdale Florida addiction and mental health treatment center and we have just dropped off a discharged patient at the airport to fly home. The short 15-minute drive to Fort Lauderdale International airport is an easy one for us. Our patient would make it safely home, but less than two hours later shots would ring out in baggage claim in yet another horrible act of gun violence in this country. Sadly, this horrific tragedy was preventable in numerous ways if the appropriate actions were taken and effective treatment was provided.
The shootings that occurred at the Fort Lauderdale Airport impacted our staff and patients on an even deeper level than prior mass tragedies. Not only was it close to home, but the shooter is alleged to have had a significant history of trauma and mental illness. Without proper treatment, serious and acute stage mental illness can easily result in harm to oneself or others. Having practiced in the field of addiction and mental health for twenty years, I know what psychosis looks and sounds like. When an individual is in a severe psychotic state, he or she is no longer open to reason or any type of rational thought process. The United States is simply not doing enough to make guns less accessible to those suffering from mental illness. Even more critically, we are certainly not doing enough to make treatment accessible to those suffering from mental illness or addiction.
The alleged shooter, Esteban Santiago, is reported to have served in the Iraq war. His family related that upon his return, and having witnessed a bomb exploding amongst fellow soldiers, he was never the same. It has been reported that he sought help in November by notifying the FBI in Anchorage of his troubled thought processes and homicidal ideations. He was psychiatrically hospitalized for just a few days, during which his gun was held. Unfortunately, he was released much too soon and his gun was returned. Far too often we hospitalize individuals with severe psychiatric illness during the acute phase only to be discharged with little to no follow-up care. Mental health difficulties simply do not remediate in a few days. Most mental health difficulties involve chronic symptoms that must be stabilized, treated, and then managed for a lifetime in order to maintain healthy functional behavior.
Based upon what has been related through the media and his family, there are a couple potential diagnoses that the shooter could have been suffering from. Taking into account his military experiences, Posttraumatic stress disorder (PTSD) is one possible diagnosis he could have been suffering from. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this is a condition in which an individual has been exposed to actual or threatened death, serious injury, or violence. Intrusive symptoms such as memories, dreams, and flashbacks where the individual feels and acts as if he or she is still experiencing the traumatic event are common. Internal or external triggers can cause intense psychological distress and impairments in mood and thought processes.
PTSD could also be accompanied by depersonalization in which ongoing or recurrent feelings of detachment from reality and one’s sense of self occur. Additionally, derealization can occur, causing ongoing and recurrent feelings as if the world around the individual is distorted, unreal, or dreamlike. PTSD could be diagnosed in addition to other mental health illnesses.
Schizophrenia spectrum or some other psychotic disorder could also be a potential diagnosis based upon reports in the media. According to the DSM-5, these are diagnoses that involve symptoms in five domains that include delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms. Males experiencing mental health disorders in this domain most commonly present with a first break in their early to mid 20’s. As Esteban Santiago was a young man when he entered and discharged from the military and is currently twenty-six years of age, mental health difficulties other than PTSD certainly could have emerged that were either triggered by his military experiences or could be unrelated. Without the proper diagnosis, treatment, and anti-psychotic medication, a person suffering from some form of Schizophrenia or psychotic disorder will likely continue to experience increasingly bizarre thoughts, auditory or visual hallucinations, incoherent or illogical speech, and much more. An individual experiencing untreated psychosis could experience command hallucinations in which one believes their mind is controlled and directed by familiar or unfamiliar voices telling them to take action.
While we do not yet have sufficient information to make an accurate diagnosis, it is clear that it takes a very ill and cognitively disorganized individual to commit such a heinous act. It is clear that he believed something was wrong and attempted to seek help. It is clear that we allowed him to check a gun at the airport and took no further steps to understand the hands it was being returned to. Mental illness in itself is certainly not a crime, but without proper steps to make treatment less stigmatizing, resources more accessible, and improve gun control, I fear we will continue to see horrible events such as this repeat themselves. When treated appropriately, most mental illness has a good prognosis and does not lead to violence. We need to take further steps to prioritize mental health treatment as much as we do physical disorders. Gun laws in the United States should take into account that access to weapons is a major risk factor when accompanied by severe untreated symptoms of mental illness. In an attempt to avoid limiting freedom for the masses, lawmakers are missing the big picture and will be unable to effect positive change.