I first heard about the shooting in Tucson when I received an email message from CBS. The initial report listed Representative Giffords as dead. She managed to survive, but six other people did die.

The upshot of Jared Loughner's amok run is calls from all quarters for more civility. Some folks pointed out that Giffords was featured in Palin's hit list, and that Palin's response to criticism was a metaphorical "reload." While Palin and her allies say that it's unfair to politicize this tragedy, it's now gotten expanded to a general call for civility in politics. It's not really the first time. The Coffee Party, a response to the Tea Party, has been calling for civility since its inception a year ago, but folks who're paying attention know that nastiness in politics has been in the news for a while, now, and every election cycle sees renewed calls for civility. This is an old problem.

When Jules Verne wrote Around the World in 80 Days, a story that takes place in 1872, he describes elections in the USA as being a single continuous riot. It seems that nothing has changed. We pride ourselves on our democracy, but it's never been a drawing room affair.

Jared Loughner's amok run wasn't about politics. Sure, his facebook page allegedly contained crazy talk, but so does Fox Cable News. I mean, if we locked up everyone who rants crazy, Fox Cable News would have to open a studio in an asylum.

So that I'm not just picking on Loughner, let me quickly point out that after Columbine, Harris and Klebold became the posterboy victims of bullying, or of boys who listen to deathmetal, or whatever. There wasn't a lot of discussion about sanity then, either. Someone like Ted Bundy was just a serial killer. I have no idea why cases like this are made to appear as if we're not looking at a failure of mental health. We seem to have no problem describing Ted Kaczynski as insane, maybe because the Unabomber lived as a hermit and wrote a manifesto. But are we ready to lock up all hermits who have strange political ideas?

Insanity is at least in part a political issue. The Soviet Union used to lock up dissidents as insane. Krushchev was perhaps the first Soviet official to make the abuse of psychiatry an official tool of the Soviet government, by arguing in 1959 that dissidence must be the result of insanity. By the time of perestroika and glasnost, hundreds of dissidents had been committed to asylums and subjected to compulsory treatment.

So we need a more objective way of deciding that someone needs help besides referring to their desire to see Obama's birth certificate, or their conviction that Dubya organized 9/11.

But the problem doesn't end there. While I agree that Loughner might not have gone on a rampage if he had gotten timely and effective treatment, I don't think that we actually know how to give timely and effective treatment.

Just the other day I'm sitting on the train going home, when I notice this guy talking loud up front. I think first he's just one of those people who don't know how to moderate their tone on their mobile phone, when he steps further into the car and starts randomly pointing at us passengers, telling us we're "the worst." Apparently we weren't treating him right. He ranted like that for a while, until he got off the train. His ranting probably would not have gone over to violence, even if he owned a gun. At the time I certainly wasn't worried about it. These kinds of things happen in every town, every day, and nothing bad comes of them.

Tuscon was a one in a million event. So what do we do about it?

When the Soviet Union's psychiatric institutions were being investigated by the WPA in 1989, it was found to be a maze of understaffed and over crowded "coffins" where hundreds of thousands of patients had little hope of ever receiving treatment or even getting out to return to society.

The present situation in the USA is not a lot better. The famous 1973 Rosenhan experiment demonstrated that, at least about fourty years ago, psychiatrists had little chance of being able to tell the difference between sane people and insane people. Criticism like this lead to the dismantling of psychiatric hospitals in most parts of the world that had them. Perhaps it was throwing out the baby with the bath water, but the fact remains that psychiatric diagnosis is still a controversial mine field. Look around for news on DSM-5 to see for yourself.

While most of us can agree that Loughner needed help, it's only in hindsight that it becomes clear. Since religious beliefs and political beliefs all may fall under the heading of "out of touch with reality," deciding who needs help is a touchy issue, before we even get around to asking what kind of help they need.