Mental Health Care, Mass Murder, and So On

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.

13 Responses to “Mental Health Care, Mass Murder, and So On”

  1. Greg says:

    Dan,

    Thanks for this. I agree wholeheartedly. And thanks for expanding your sympathies to include the shooter. Anyone capable of committing such an act was very sick indeed, and as you said, you can feel sympathy for him while not excusing his actions. I’m an alumnus of Virginia Tech, and I always felt that the outpouring of sympathy following the shootings there should also have spared a little for the shooter. He was clearly a tortured individual who had suffered terribly for many years in a prison constructed of his own mind.

    The “othering” of those responsible for these shootings is dangerous. It’s a sop to our need to feel that such acts can only be committed by evil people. By comforting us that no one WE know could be capable of such acts (false) it blinds us to the true causes of this violence, offering a simple, pat answer to an infinitely complicated question. The shooters are people too, desperately sick people in desperate need of help. If he’d gotten it, he and all the others would be alive today.

  2. Robin Weeks says:

    Brava, Dan. I recently attended a lunch where the local Mental Health Court judge made very similar points about the stigma of mental health disorders –they’re just as genetic and treatable as diabetes (for example), but heaven help the person who steps up to treat their mental problems responsibly: our society would rather everyone be quiet about their mental problems. Rob is a very necessary voice from a very dark void.

    As a defense attorney, I’ve represented many individuals in mental commitment hearings. The standards are as you describe: they must be gravely mentally ill (unable to care for themselves) and/or mentally ill and likely to injure themselves or others. If Rob wasn’t inclined to seek help on his own, no way could we force it on him–despite his wonderfully revealing blog post–until he did something violent.

    Especially considering that the stigma means that most people are NOT inclined to tell their loved ones that they’ve been having violent thoughts, the fact that mentally ill persons are increasingly acting on these influences is on all our heads. Until we get the word out that we can and will treat mental disorders–and treat the sufferers with kindness and understanding instead of ostracism and fear–we can’t promise anyone that this will stop.

  3. Very well said, Dan. Before my first husband took his life (we believe he was bipolar), we sought help through the V.A. They asked if he wanted to kill himself at that moment. Well, he didn’t want to at that moment, but it was a recurring problem. They said they were sorry but they couldn’t help him then. So, in the next down cycle, he killed himself.

    Medications can do a lot, but if you’re already not functioning well and having a difficult time holding a job or don’t have a job that has medical insurance, you can’t afford the meds. One of my bipolar kids who doesn’t have insurance would need to come up with $400 a month just for the meds. And that’s assuming they’re the right ones, because the doctors have to mess with them some to get the right ones and the right doses. And the doctors aren’t cheap either.

    They used to just lock the mentally ill into asylums. Now it seems it’s more like to be prisons.

  4. Karen Evans says:

    My family has been dealing with varying degrees of depression for several generations now. It is so frustrating when talking to medical professionals, they only want to throw pills at the situation. In my case, and that of my daughter, we are trying to find coping strategies with less medication, because so far, the pills haven’t worked. This is not always an option for some disorders.

    I agree with you completely that there needs to be a change. And the only way things will change is if we do whatever we can individually until it becomes a movement. This situation needs more compassion and understanding. I am committed to doing my best not to judge others, but to try and help.

  5. j4k says:

    The Stigma of mental illness led me to avoid counselors and medication for some depression i dealt with for a good part of a decade.

    Finally got some help, things are much better…

    Just reminds me i need to stock pile my meds before teh zombie apocalypse

  6. HamletMonkey83262 says:

    Very well said. I agree with you on this. I think one difficulty for persons with mental illness results from the fact in today’s world, any admission of a problem, or a request for help, can have legal and other ramifications down the road. Someone who realizes they don’t have as much control in or of their own mind as they want to might find the prospect of giving up some external control of their own lives to be very frightening. Combine that with stigma and the possiblity that this could be used against them legally or in seeking employment and other opportunities, it can then be understandable that persons struggling with these issues avoid help and try to keep the problem hidden. In my own life, I have seen people try to offer what help they can, which does help, but the options do need to increase, as well as how consequences for seeking help are handled.

  7. I totally hear you, Dan. The mental health care system definitely does need some improvement.

    On the other hand, I think everyone can take steps to help those around them. People who experience depressions would be largely benefited by having people who take the initiative to befriend them and interact with them.

  8. Amber Argyle says:

    I started to comment, and it became so long I just wrote my own blog post: http://amberargyle.blogspot.com/2012/12/guns-media-and-mental-illness.html

  9. Jay s says:

    The majority of mentally ill people in this country are poor, and do not receive or have access to mental health care. This being so, it would stand to reason that the majority of poor, mentally ill people would be committing the majority of mass murders (Sandy Hook, Colorado Movie shooting, other school shootings) but they are not.

    Who is committing Sandy hook type mass murders? It’s The mentally ill who can afford, or have access, and are already getting treatment from the psychiatric profession and most likely treated with medications.

    The real questions should be; what were the drugs Adam Lanza and James Holmes, were either on or withdrawing from, or had taken in the past? Can we really say for sure that these drugs caused no brain damage? Can we say for sure what was the effect on brain chemistry? There are alot of warning signs and a list of side effects that go with these drugs to indicate we don’t know what the hell they really do.

    It takes a mind bending drug to commit such a horrific mind bending act such as Sandy Hook, and the Colorado Movie shooting. If we don’t understand these acts maybe it’s because we don’t fully understand how the drugs these mentally ill people take, work.

    Be careful what you wish for regarding an expansion of mental health care, especially as treatment is given today. I’m not sure psychiatry is ready. After all, Today you are playing with fire when you use those powerful mind altering drugs currently prescribed per best practices by a psychiatric profession that truly does not understand fully the consequences of so much of these powerful brain chemistry altering drugs they prescribe. Do they cause brain damage? What is the effect on brain chemistry? Do they alter the brain permanently? Why are there so many side effects? Why do they cause people to sometimes be violent? What else are these drugs doing to the body?

    People with mental illnesses need to see psychologists, not psychiatrist. I believe some people turn into monsters when they take psychiatric drugs.

  10. SeekingPlumb says:

    This is so bang on! I wish this post could be given to someone, somewhere who can make things happen on a large scale. I try to educate those I meet, but it feels like a drop in a leaky bucket. :P

  11. big sis says:

    jay s – be careful in making such statements. I would have to completely disagree – I know many well-off people who suffer from mental illness – mental illness knows no boundaries and to say it is mostly just the poor shows your ignorance on the subject.

  12. A R Vapor says:

    Dan, thank you so much for addressing this issue! You have voiced a concern that I was too afraid to speak about out loud: everyone keeps talking about gun violence and how the law needs to be stricter with their use, but no one is talking about helping young people like Adam Lanza! Everyone keeps saying he was just a bad person and things like that, but he had a mental disorder, and most everyone is afraid to even say it. I’m glad there ARE people that are brave enough to talk about this issue because it’s a serious one. Since this summer, my brother has been in and out of jail because of his schizophrenia and depression, and we’re trying to get him help, but it’s too difficult…My mother was always afraid of the possibility, but I’ve known he needed help for a long time, and finally, we’re just now trying to get it to him. I hope it all works out. And I’m glad you have decided to address it here!

  13. Lacey Taylor says:

    Hello Dan, it’s do strange to have stumbled across your words here today. I went through Columbine as a young person. When they started taking away lockers. I posted a comment on my own Facebook that is very similar to yours here. I attend college full time. I can honestly say that there are times I’m scared to go to school. security could be tighter on campus, but that to me is irrelevant. Schools should have advocates that work with a limited amount of students. Checking in so to speak with their progress and emotional well being. The problem with mental illness is that ask of these people who are not suffering, label those who are as “evil” or pretend it doesn’t exist entirely. The more a person suffering sees this, the less likely they are to get help. That makes the problem worse. An above statement says that no one knows how the antipsycotics work? Trust me, they do. I’m not going to sit here and explain it. I wish we did have a better mental health care system. It would save more lives than a background check. People just want simple answers. Sometimes the answers are not so simple.

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