When I went on tour with THE HOLLOW CITY this summer, a book about schizophrenia, I started each signing and event with my personal feelings on the current state of mental illness care and treatment in the US. I won’t repeat the whole speech here, but I’ll give you the short version: it sucks. Mental illness in American culture is stigmatized, poorly diagnosed, and inadequately treated. This needs to change.
Caveat: In this blog post I’ll be talking primarily about dangerous mental conditions, and I want to say up front that it is not my intention to stigmatize mental illness further. The vast majority of mental disorders are not inherently violent, and the people who suffer from them need help, not fear or mistrust. Statistically speaking, everyone reading this post has at least one person with a mental disorder in their immediate family–it is a part of our lives that we need to embrace and study and deal with instead of sweeping under the rug. That said, some mental conditions, when untreated, do result in violence and danger, and we need to deal with those in the same open-minded, positive way.
A person in prison is five times more likely to be mentally ill than someone on the outside. This suggests one of two things: first, that people with mental illness find it difficult to live within the standard template of American society and end up breaking rules and laws. This is true, in the sense that we have built a society designed for people whose brains work in a certain way, with very little wiggle room for anyone else, and very little help offered to those who don’t fit the mold. Second, it suggests that people in prison are more likely to be diagnosed with a mental illness now that someone is paying close attention to them. This is also true, and suggests a further, much more important point: diagnosing and treating mental illness before it becomes a problem will help to keep these people out of prison in the first place. It will help them feel comfortable in, and function productively in, the society at large.
The most damning part of this situation is that it’s not accidental. Most mental illnesses, properly dealt with, won’t require legal intervention at all, but the dangerous ones will–and the treatment process for dangerous mental disorders in America literally relies on the prison system as a standard step in the procedure. Countless parents and spouses and children, trying to get a dangerously unstable loved one the treatment they need, are told the same thing: “we can’t do anything until he or she commits a crime.” Worried that your father might be sliding into violent dementia or psychosis? If he refuses treatment–and he will, because denying the problem is one of the common symptoms of dementia and psychosis–then there’s nothing you can do until he actually becomes violent and hurts somebody, at which point it might very well be too late. Worried that your spouse is becoming dangerously erratic and paranoid? Worried that your child might take his own life? My family dealt with a loved one (whom I will not identify) a few years ago who had become clinically depressed and suicidal, to the point where he needed constant care, but he literally could not get it–we had to wait until he tried to kill himself, hope that he failed, and THEN we could get him help. In our case we never had to go that far because his depression developed into an eating disorder, and we were able to get him committed to the hospital for malnutrition. But not every family has that luxury, and even then, we were only able to get him the help he needed when his life had been physically threatened. All of the mental threats, all of the underlying causes, were completely meaningless from a legal standpoint.
On one hand, you can see where the law is coming from: our legal system stands proudly on the principle that we are innocent until proven guilty, which expands into the principle that we can only be convicted of crimes we’ve actually committed, not crimes we think about committing. The same people who won’t throw you in jail just for talking about killing your boss also won’t throw you in a treatment facility just for talking about killing yourself. This system works for crime because it gives us the freedom to choose, and then holds us accountable for our choices; this doesn’t work for mental illness because mental illnesses very specifically attack–and often destroy–your ability to make informed choices. We’ve created a system that refuses to deal with the more dangerous facets of mental illness until they’ve already caused problems, when we should be focused on trying to prevent those problems in the first place. Worse still, once those problems have been caused, the people who caused them are more likely to be lost in the criminal and prison system than to receive any of the counseling and treatment they need. For a country that calls itself the greatest nation on Earth, that’s a pretty damning spot on our collective conscience.
My brother has been struggling with mental illness for a few years now, and wrote a very powerful piece in reaction to the Sandy Hook shootings that you should all read. It’s important to point out that Adam Lanza, the shooter in the Sandy Hook incident, did not have (at the time of this writing) a publicly announced mental disorder, but the signs are clear that he probably had clinical depression at the very least. Testimonials from his father and his school counselor show a long history, of joyless, friendless, lifeless life. We can talk about gun control all we want, and that’s definitely a conversation that needs to happen, but banning guns wouldn’t have prevented this massacre anymore than access to guns caused it. Guns certainly made the massacre more effective and deadly, but they didn’t cause it; it was caused by a severely disturbed mind who had nowhere to go and no one to help him, who made a very bad decision that could have been avoided with the right care and attention. My heart breaks for the children and teachers who died, and for all of their families and friends, but it also breaks for Adam.
I might be losing some of you here, because nobody wants to sympathize with a man who murders children, but I can’t help it. The more we learn about his life, the more tragic he becomes–and no, this does not excuse his choices. I’m not trying to excuse him, I’m trying to understand him, and why he did what he did, and figure out how similar events can be prevented in the future. America has a mass murder about every six months, on average, which makes this one horrific and shocking but, sadly, right on schedule. Sometime in the next five to eight months we will have another. Tightening our security standards for gun ownership might help reduce the body count of future massacres, but it won’t stop them from happening; without semiautomatic weapons close at hand, Adam Lanza might not have moved on to the school, but he most likely still would have killed his mother and himself. We should not consider that an acceptable alternative.
If we want to stop this kind of thing we need to look at the root causes–not just at the weapons or the decisions to use them but the people who make those decisions in the first place. We need mental health care to be available, accessible, and unstigmatized, so that Adam’s school counselor has some resources to work with the next time he identifies a teen with obvious pain and trauma. We need somewhere people can go when they know they have a problem, and we need some way of dealing effectively with people who refuse treatment even though everyone around them can tell they have a problem. We need some way for people like my brother–a successful, well-intentioned family man who recognizes his problem and does everything he can to treat it–to be able to afford the treatments that help him and every one of us live normal, happy, healthy lives.
Do we really want to call ourselves the greatest country on Earth? Then let’s start acting like it. Support mental health care. Support people with mental illnesses. Spread the word, share your love, open your hearts. Find someone struggling and help them. We can do this.