Lindsay Lohan was arrested, again—this time for allegedly punching a woman in the face at 4 a.m. today, inside a Manhattan nightclub. She was also charged Thursday with giving false information to police about a motor vehicle accident during June, resisting an officer and reckless driving.
She is currently on probation for a 2011 theft (a necklace). Her other recent problems have included being party to a domestic dispute with her mother and being involved in a hotel brawl in her hotel room with a male visitor. She has a history of a Driving Under the Influence arrest and a history of violating the terms of that probation. Perhaps even worse (only half-kidding), she made friends with actor Charlie Sheen, who famously told the American public, including millions of teenagers, that using 8 grams of cocaine in a night couldn’t hurt him because he’s too tough.
I have never met with or treated Lindsay Lohan (although I have spoken about her informally with her father Michael) and would not be in a position to diagnose her.
However, given a different person behaving as Ms. Lohan seems to have been behaving, the facts speak for themselves: That person is unable to make safe decisions. And when a person, famous or not, demonstrates an inability or unwillingness to take control of his or her life in a way that would give a reasonable individual assurance that no terrible harm will come to her (or someone else), and when a law is also broken, it is time for the court to trigger an aggressive psychiatric protocol.
By an “aggressive psychiatric protocol” I mean invoking not just a stay in jail for weeks or a few months, but a very lengthy period of probation—perhaps a decade—during which the person is compelled by law (in order to remain free) to submit to random drug screens, to wear an ankle bracelet that can sense and transmit blood alcohol levels to the police (devices that do exist), to surrender her license, to agree to twice-weekly psychotherapy and any psychiatric medication agreed upon by two independent psychiatrists and to be placed on monthly injections of Vivitrol (a medicine that decreases the likelihood of alcohol and opiate intoxication and cravings). Any deviation from the “aggressive psychiatric protocol” would lead to probation being revoked, and the remainder of the term being served in jail.
As troubled as Ms. Lohan may be, after all, there just isn’t an illness known that would compel her to go clubbing, nor compel her to (as happened) play possum with the prior rules of her earlier probation (which included attending substance abuse treatment on a designated schedule). Helping her stay alive and get to the bottom of her troubles can’t wait for moments of insight triggered by short stays in community jails. That goal can only have a reasonable chance of success when the potentially great synergy between the judicial and psychiatric systems is deployed.
The Lohan case points out, in fact, the missed opportunities in courtrooms all over America to use psychiatry to greater effect, in order to help people not repeatedly break the law. I would venture that sentencing a large percentage of first time violent offenders (their choice, in order to avoid prison), for instance, to enforced psychiatric care, ankle bracelets of the kind I mentioned and random drug testing would cut recidivism rates (the rate at which convicts reoffend) by 50 percent, saving many billions of dollars.
Lindsay could—and some might say, should—be a public test case.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.