JUDY WOODRUFF: Monday's shooting raises questions about how someone like Aaron Alexis is screened and allowed access to a U.S. military base, and whether his past should have raised alarm in the screening process.
Dr. Elspeth Cameron Ritchie had a 24-year career in the Army as a psychiatrist. And Dr. E. Fuller Torrey is a psychiatry professor at the Uniformed Services University of the Health Sciences.
And we welcome both of you to the NewsHour.
Dr. Ritchie, to you first.
What have you heard both just now in the interview with the reporter, Ernesto Londono, and with what you have been reading today that raises questions in your mind about who Aaron Alexis was?
DR. ELSPETH CAMERON RITCHIE, former Army psychiatrist: There is a lot that raises questions in my mind.
First, though, I want to send out my condolences to the family members of the deceased and to the friends and colleagues of those who died, because they're really important, to keep them in our thoughts.
In terms, though, of this gentleman's mental state, when you look back, there's red flags all over the place. There's a problem he had when he was in the Navy. There's these episodes. There's the hearing voices pieces. And you would say, how did this person ever get a security clearance?
Having said that, what I have seen often is in retrospect you can look back and see the problems, but at the time, people were not putting that information together. I seriously doubt the people who granted the security clearance knew that he was hearing voices. What I do wonder, though, it sounds like his behavior was pretty bizarre, and you wonder why nobody picked it up earlier.
JUDY WOODRUFF: Dr. Torrey, what about you? What are you hearing and reading about him that causes concern?
DR. E. FULLER TORREY, Treatment Advocacy Center: Judy, it sounds to me -- obviously, I haven't examined him -- but all the information that's now out there, it sounds like a fairly typical case of paranoid schizophrenia, relatively late onset.
Paranoid schizophrenia often begins a little later than other forms of schizophrenia. He clearly thought people were following him. He thought people were use machines to cause vibrations in his body. This is a brain disease. It's a brain disease like Parkinson's disease or Alzheimer's disease.
Somewhere, something went wrong with his brain in his 20s, and now you're looking at symptoms of the disease, one of which is acting out, in this case killing people. And in his mind, he was doing it based on delusions.
My guess is that he was terminated by the Navy, more or less, discharged on. He probably thinks the Navy were doing all of these things that he's experiencing in his mind, and he was going to get back at them. And so this episode makes no sense to us, but to him it made perfect sense.
JUDY WOODRUFF: Right. And we're still looking for more information that would confirm your theory.
Dr. Ritchie, what about his -- the fact that just -- the Veterans Administration, there's a report that they were treating him. Now, that has not been confirmed. What would the normal procedure be? If someone who is a retired Navy reservist has clearance to work on a Navy base, is being seen -- if he's being seen by the Veterans Administration, what obligation would a health care provider have to share that information with someone else, to flag it?
ELSPETH CAMERON RITCHIE: There's always a tension between preserving medical confidentiality and a duty to warn.
I don't know that the VA had any information about him being dangerous, but if they did, they would do a risk assessment and say, how much of a danger is this person? Actually, psychiatrists do this all the time. And you want to encourage people to seek treatment, so they need to feel that that information is confidential.
On the other hand, if there's an identified threat, it's called Tarasoff. We reserve to it that way. Then we have a duty to warn the intended victim. And I don't know, again, who knew what when.
JUDY WOODRUFF: Dr. Torrey, what about a couple very clear questions raised out of this? How did he get the security clearance to be working for a Defense Department subcontractor, this company he was working for through Hewlett-Packard? I mean, how are we to understand something like that?
E. FULLER TORREY: Well, two or three things.
First of all, it's important to emphasize, Judy, that most people with schizophrenia don't become violent. It's only a small been who are not being treated who become violent. In terms of -- we put everything together now, and you say this guy was potentially dangerous. He had a brain disease. He had alcohol abuse. Apparently, he had episodes of violence.
But nobody had that information. Dr. Ritchie is quite right. Nobody had that information to put together, and so that -- also people with paranoid schizophrenia actually can look pretty good in an interview. And so it's difficult. This is a man who didn't know he was sick. He had what we call anosognosia, where he has no awareness of his illness. He would have been hard to treat.
JUDY WOODRUFF: We also know, Dr. Ritchie, that his father has told reporters that Aaron Alexis was among the first-responders on 9/11, that he lived in New York, he worked at a community college close to the Twin Towers. Could something like that -- and his father said to reporters that he had some sort of post-traumatic stress illness.
ELSPETH CAMERON RITCHIE: He could have had some symptoms, but I want to make really clear that PTSD, post-traumatic stress disorder, doesn't cause people to hear voices.
People may have some jumpiness, some hypervigilance, but the kind of paranoid delusions that Dr. Torrey mentioned are not consistent with PTSD.
GWEN IFILL: Dr. Torrey, did you want to...
E. FULLER TORREY: No, I strongly agree with that. I think there was any PTSD here, it was a very minor issue on it.
This fellow had a brain disease that we call schizophrenia, almost certainly, on it. The question is why he wasn't being treated. We don't have enough information to know that. If he had been treated, we probably wouldn't be seeing this.
ELSPETH CAMERON RITCHIE: But we do know that schizophrenics often have no insight into their disease, as you mentioned. So it's likely that treatment was offered and he said, no thanks, I don't need this.
JUDY WOODRUFF: I want to ask both of you just very quickly in the little time we have, this is not the first time we have been having this conversation about someone with a mental or emotional illness involved in a mass shooting in this country.
What kinds of questions should we be asking as a country after this sort of an episode, Dr. Torrey?
E. FULLER TORREY: We're seeing more of those, Judy. This is increasing in incidence. This is because we have a total breakdown of the public mental health treatment system.
And I just happened to have published a book coming out called "American Psychosis" which gives the whole history of this. You're looking at the breakdown over the last half-century where we have released everyone from the hospital, but we don't provide treatment in the community for them. That's why we're having people in jail who are mentally ill. That's why we're having homeless mentally ill.
And that's why we're having increasing episodes of violence.
JUDY WOODRUFF: What would you add?
ELSPETH CAMERON RITCHIE: I would add we also have to look at our gun laws, the fact that somebody with mental illness could go purchase a gun that day and use it.
And we have had this conversation so many times over these last few years Connecticut, with Aurora, with Fort Hood. We have to stand up and say, we need to have a comprehensive intelligence approach to how people can obtain guns.
JUDY WOODRUFF: And we know that he -- believe that he purchased a gun legally in the state of Virginia the day before the shooting.
We're going to leave it there, but we thank both of you for being with us.
Dr. Elspeth Ritchie, Dr. Fuller Torrey, thank you.
E. FULLER TORREY: Thank you.