On how we deal with Mental Illness

One of my facebook friends sent this to me today and it shook me.

Link

In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness.

Three days before 20 year-old Adam Lanza killed his mother, then opened fire on a classroom full of Connecticut kindergartners, my 13-year old son Michael (name changed) missed his bus because he was wearing the wrong color pants.

“I can wear these pants,” he said, his tone increasingly belligerent, the black-hole pupils of his eyes swallowing the blue irises.

“They are navy blue,” I told him. “Your school’s dress code says black or khaki pants only.”

“They told me I could wear these,” he insisted. “You’re a stupid bitch. I can wear whatever pants I want to. This is America. I have rights!”

“You can’t wear whatever pants you want to,” I said, my tone affable, reasonable. “And you definitely cannot call me a stupid bitch. You’re grounded from electronics for the rest of the day. Now get in the car, and I will take you to school.”

I live with a son who is mentally ill. I love my son. But he terrifies me.

Bookmarked to come back to.

I think we have a tough time wrapping our heads around mental illness because we always attribute our mental processes, personality and habits to the Self that is untouchable and rational. So when we see someone with a mental illness, we think that it can't be helped because "that's just who they are". Or we think that, as a rational being, they can just stop thinking certain thoughts. We don't realize that our mental processes are affected by illness just like bodily processes are affected by illness.

The problem with attributing gun violence to mental illness is that from statistical analysis, there is no correlation between frequency of mental illness and the rate of gun-related deaths.

More info at The Atlantic.

It is commonly assumed that mental illness or stress levels trigger gun violence. But that's not borne out at the state level. We found no statistical association between gun deaths and mental illness or stress levels. We also found no association between gun violence and the proportion of neurotic personalities.

Images of drug-crazed gunmen are a commonplace: Guns and drug abuse are presumed to go together. But, again, that was not the case in our state-level analysis. We found no association between illegal drug use and death from gun violence at the state level.

I won't comment on her situation, as it's a miniscule snapshot of a fragment of her life. However, I will say that across the board I believe the US lacks meaningful support, reform, and compassion for people in favor of a punitive culture. Conform or be excluded. Break the rules and be stomped down, labeled as defective, and thrown into a spiraling current downward from which there is little chance of escape.

Farscry wrote:

The problem with attributing gun violence to mental illness is that from statistical analysis, there is no correlation between frequency of mental illness and the rate of gun-related deaths.

More info at The Atlantic.

It is commonly assumed that mental illness or stress levels trigger gun violence. But that's not borne out at the state level. We found no statistical association between gun deaths and mental illness or stress levels. We also found no association between gun violence and the proportion of neurotic personalities.

Images of drug-crazed gunmen are a commonplace: Guns and drug abuse are presumed to go together. But, again, that was not the case in our state-level analysis. We found no association between illegal drug use and death from gun violence at the state level.

Awesome, so we don't need to talk about either now as there is no "statistically significant" correlation...

Dr.Ghastly wrote:

Awesome, so we don't need to talk about either now as there is no "statistically significant" correlation...

I don't appreciate your disingenuous attempt to put words in my mouth just because you choose to ignore context.

This thread is very obviously a split-off from the gun control thread (even the OP's quote says, explicitly, "In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness"). I was responding to that portion of the post.

I agree that the way we treat mental illness in the US needs to be addressed. But I don't agree that it should be done instead of talking about guns, as the gist of that quote implies (and the context of the gun control discussion that generated this split-off thread).

So yes, let's talk about mental illness. We can do that without relating it to the gun control thread, because there is no statistical correlation.

Who said this conversation was taking place instead of a conversation about gun control?

clover wrote:

Who said this conversation was taking place instead of a conversation about gun control?

Farscry wrote:

This thread is very obviously a split-off from the gun control thread (even the OP's quote says, explicitly, "In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness"). I was responding to that portion of the post.

I don't know how much more clearly I can state that. Perhaps I keyed in too strongly on the sentence that read "But it’s time to talk about mental illness" instead of "It's also time to talk about mental illness."

The word "but" generally is used as shorthand for "instead of."

A Facebook poster posted wanting to talk about mental illness (and they did... relating it to their son). A goodjer quoted their post as they thought it was a good idea to talk about it, too. I see that you have some argument with the Facebook poster's choice of wording, Farscry. However, I think there's some additional intent you're adding which may not be there.

The mentally ill pretty much have 2 choices in America:

Become homeless or go to death row (likely on a wrongful conviction).

http://www.aclu.org/capital-punishme...

fangblackbone wrote:

The mentally ill pretty much have 2 choices in America:

Become homeless or go to death row (likely on a wrongful conviction).

http://www.aclu.org/capital-punishme...

Thanks to people like Thomas Szaz

Farscry wrote:
clover wrote:

Who said this conversation was taking place instead of a conversation about gun control?

Farscry wrote:

This thread is very obviously a split-off from the gun control thread (even the OP's quote says, explicitly, "In the wake of another horrific national tragedy, it’s easy to talk about guns. But it’s time to talk about mental illness"). I was responding to that portion of the post.

I don't know how much more clearly I can state that. Perhaps I keyed in too strongly on the sentence that read "But it’s time to talk about mental illness" instead of "It's also time to talk about mental illness."

The word "but" generally is used as shorthand for "instead of."

Then argue with the lady who wrote it, not the OP who found it startling and thought it worthwhile for the rest of us to read. There's some frightening things in there. Combined with the other link from fang I'm not sure how you can say she doesn't have a huge point.

Doesn't seem quite worthwhile to argue the semantics in this particular case.

I apologize, I misunderstood the purpose of the thread from the responses I'm getting.

"Mental illness" is too broad a term to apply to any particular behaviour (such as committing gun violence, for example). The majority of problems we identify as mental illness do not incite or predispose people towards violence. Of course, a few of them can under the right circumstances.

My brother suffers from paranoid schizophrenia. When left untreated it causes him to experience psychosis, a mental state that can be broadly described as 'detachment from reality'; in his case it interferes with his ability to reason and use language, leaving him in a state that sort of resembles confusion. When treated, of course, it causes depression, loss of appetite, nausea, fatigue, and a host of other problems that make it all but impossible to lead a very satisfying life.

The popular conception of "madness" is defined by Alice in Wonderland; it involves quirky affectations, speaking in rhyme, obsessive behaviour, that sort of thing. This is a naive and oddly idyllic view that largely misses the point of what's actually happening. These characters are functional, reasoning people to whom the author assigns an odd fixation to pursue and who do so in a functional, reasoning way. The reality, as I have witnessed, does sometimes involve fixations, but it's more of a shallow, unconsidered fixation, like a recurring dream. Mostly, however, it involves breakdowns in fundamental cognitive processes that result in the appearance of being partially-comatose. There aren't very many limericks about a lost hat, is what I'm saying. (Indeed, there are few words at all, and what words do come out are essentially gibberish.)

I live in Canada, and it seems to be true that criminal behaviour represents the central impetus towards treatment up here as well. That said, a number of useful social services are available to those who have been diagnosed: A bit of disability funding, more affordable public transport, some support groups and recreational programs, and of course medication. You still pretty much need to have a family support system in order to avoid homelessness and it still makes for a really difficult life.

One good piece of news is that research seems to be moving forward. For example, olanzopine is by many accounts a far better drug than haloperidol.

For what it's worth, to me it read not like she was saying not to talk about guns, but that we need to stop ignoring an equally if not more important and complicated issue.

It's not "the thing" people should be focusing on. It's another thing people should be focusing on.

*Also, before anybody posts the link to the other blog responding to the one in the OP, seriously, *really* look at the things that response says and pay attention to details. The response confuses tons of details in Long's other blog posts, including not even bothering to pay attention to which of her sons she's talking about in certain posts.

IMO the response is worthless, and reads like a response from someone who has never talked to a parent before.

So a couple of thoughts:
1) First of all, treating mental illness is difficult and expensive. A child like that described in the article linked in the OP will need substantial care - the author described how she had to change jobs just to get benefits that would help her child? What about people who aren't in a position to obtain such benefits? I don't think you can talk about dealing with Mental Illness without talking about the costs involved and the expansion of government-funded services which will be necessary to make this kind of treatment actually available to those who need it most. In light of the current political climate with regards to spending, Obamacare, etc., I wonder what can actually be done to expand services.

2) Secondly, as is also pointed out in the original article, unless a crime is committed, treatment of mental illness is self-selected. You can't force people to get help, unless they are your children. And even if a child needs help, the parents might not think so or want to get help. My sense is that a lot of people who would need psychological treatment the most would be the least likely to obtain it. Which leads to my third thought -

3) There is still a massive societal stigma when it comes to obtaining mental health care. Which means issues can get left untreated by those who think they're not a big deal, and escalate.

I heard a couple of storess from callers on the Diane Rehm show that were heartbreaking, and really shed light on how difficult this problem is to deal with. Each women had a son with an illness, Asperger's and Bipolar they loved, but frightened them in a great way.

The women with the 14-year-old with Asperger's is now divorced primarily over his care. He threatened to cut there heads off, cut their hearts out, and other threats of death. Doctors have recommended he be committed, but her husband refuses to go along with that. The real problem is, as she explained, no one wants to be responsible for tearing up a family, or even committing a child against the will of their parent. So the professional help that should take over avoids taking a side.

But I can't blame the husband completely. Once you commit someone, you've branded them for life. And there are plenty of tales of wrongly committed patients becoming damaged due to treatment. It would be a nightmare to have to make that decision for your kid.

So now he lives with his father, three hours away, and the mother and her tow daughters just have to hope that her ex has it under control.

In the second call that came in right after, a woman talked about her Bipolar son who has episodes of violence. Her issue was that when trying to call the several mental health agencies that should help, they all told her to call the police instead. But the police do to have this kind of training. But it seems like society has created a situation where they will not treat someone until they are criminally insane.

It feels easy to say what should be done after the damage. But committing a kid before is goes against the very nature of our nations's history. I don't know that there is a solution to this.

I don't think I fall into the category of "dangerous" mental illness, but... well, we'll leave the particulars out of this discussion. The short version is that even as a gainfully employed adult in full-time salaried positions, I have been unpleasantly surprised to discover how little coverage the typical health plan provides for anything related to mental health or well-being. If you can't afford some high out-of-pocket costs, you're pretty much not going to get much in the way of care.

But committing a kid before is goes against the very nature of our nations's history.

I wouldn't say that. Do you remember the Angelina Jolie film directed by Clint Eastwood called "Strangeland" I believe?
It talked about the very thing where mental illness was used by the police to incarcerate people indefinitely in asylums who didn't toe the line. Or the other movie "Girl Interrupted".

I think we have a strong history of this kind of abuse of mental illness. (sorry for the nitpick)

Interesting critique on Slate about the mom who wrote my kid is Adam Lanza. The article brings up a couple things, including the ethics of going very public with your family's problems (ie, doing talk shows rather than trying to write anonymously) and also raises questions about the mom's mental health. In her blog, she talks about how much she'd love to kill her ex husband, how much she hates being a mother, her bitter child custody battles, and the way she harshly punishes minor behavior. After reading the article, I'm not convinced her kid is out of control but rather a normal pre-teen acting out because of a crazy home life.

http://www.slate.com/blogs/xx_factor...

Farscry wrote:

The problem with attributing gun violence to mental illness is that from statistical analysis, there is no correlation between frequency of mental illness and the rate of gun-related deaths.

More info at The Atlantic.

The problem with this sort of statistical analysis is that it treats all gun violence the same, whereas we as a society are, sadly, much more selective.

A lot of gun violence is "The Wire" violence, impoverished brown people shooting impoverished brown people in the ghetto. That violence is not driven by mental health, and that violence is also not what has everyone talking about guns. But that violence accounts for a lot of the numbers in those stats - unsurprisingly, "poverty" hits the #1 correlation spot.

What everyone is talking about now isn't the daily gun violence in the ghetto, but mass shootings in the suburbs. These sorts of shootings seem to be much more strongly influenced by mental health, and whether that's true or not, it's certainly not disproven by a study that's quite likely statistically overwhelmed by inner city violence.

*Legion* wrote:

What everyone is talking about now isn't the daily gun violence in the ghetto, but mass shootings in the suburbs. These sorts of shootings seem to be much more strongly influenced by mental health, and whether that's true or not, it's certainly not disproven by a study that's quite likely statistically overwhelmed by inner city violence.

Yes, I agree that when we're talking about mass shootings, mental health is logically going to prove to be the single most significant factor for the shooters.

But that's also part of my derail that I apologized for. Only reason I didn't delete my posts is because, well, it'd make an awful lot of the early part of the thread really confusing, and plus I just generally get uncomfortable with trying to "take back" something I said when I've already caused damage with it. Gotta own my mistakes and take responsibility with genuine apologies.

On the subject of mental illness and violence:

Mental illness is not a predictor of violence
The mentally ill are significantly more likely to be victims than perpetrators of violence.

IMO the mentally ill are often wilfully or mistakenly scapegoated as the cause of violence in the community when they are disproportionately more likely to be affected by it.

source: http://www.ncbi.nlm.nih.gov/pmc/arti...

Farscry wrote:
*Legion* wrote:

What everyone is talking about now isn't the daily gun violence in the ghetto, but mass shootings in the suburbs. These sorts of shootings seem to be much more strongly influenced by mental health, and whether that's true or not, it's certainly not disproven by a study that's quite likely statistically overwhelmed by inner city violence.

Yes, I agree that when we're talking about mass shootings, mental health is logically going to prove to be the single most significant factor for the shooters.

But that's also part of my derail that I apologized for. Only reason I didn't delete my posts is because, well, it'd make an awful lot of the early part of the thread really confusing, and plus I just generally get uncomfortable with trying to "take back" something I said when I've already caused damage with it. Gotta own my mistakes and take responsibility with genuine apologies. :)

Fair enough. My apologies for adding to the derail. For a minute, I forgot that I switched from the other thread.

Maq wrote:

On the subject of mental illness and violence:

Mental illness is not a predictor of violence
The mentally ill are significantly more likely to be victims than perpetrators of violence.

IMO the mentally ill are often wilfully or mistakenly scapegoated as the cause of violence in the community when they are disproportionately more likely to be affected by it.

source: http://www.ncbi.nlm.nih.gov/pmc/arti...

Excellent point.

I think this country sorely needs a serious conversation about mental health, but I also think it's problematic that the topic inevitably comes up ONLY when someone does something violent and harmful (usually a mass shooting).

People with various degrees of mental illness are all around you. The vast, vast majority of them are not predisposed to shoot up a school. When the topic of mental health services pretty much only comes up in the media in the context of "stop horrible acts of violence", it fuels the stigma that that's all they're there for. The stigma that the mentally ill are either criminally violent or totally detached from reality, and if you're not in one of those categories you don't need any help, you just need to suck up what's wrong with you.

Gun violence causes huge amounts of damage, but how much damage does rampant, untreated depression and anxiety cause? Tons of people suffer from those issues and don't seek or get help because they're not "crazy" or dangerous and therefore feel like help for the mentally ill is not for them.

Shooting a bunch of school kids is not the acts of a normal kid acting out. Plenty of kids have terrible home lives. They don't all go ok killing sprees as a result. The shooter definitely had some sort of issues but well likely never know what. It might simply have been clinically described as ASPD though, which isn't strictly a psychosis.

Interesting critique on Slate about the mom who wrote my kid is Adam Lanza. The article brings up a couple things, including the ethics of going very public with your family's problems (ie, doing talk shows rather than trying to write anonymously) and also raises questions about the mom's mental health.

Usually I strongly do not approve of character assassination like that. However, the article was written in such a way that I could root out the unsupported assertions and was left with a few very compelling points. I had originally read some of those critiques as reaching too far on someone who is crying out for help, or going through a traumatic divorce, or in the least frustrated and at her wits end.

However, it seems both parents are a lot less than ideal, seemingly abusive and perhaps have mental issues of their own. (the dad "incarcerating" the kid for not doing chores?)

fangblackbone wrote:

However, it seems both parents are a lot less than ideal, seemingly abusive and perhaps have mental issues of their own. (the dad "incarcerating" the kid for not doing chores?)

Yeah, I can see that leading to mental and/or emotional issues with the kids over time too, unfortunately.

Farscry wrote:

The short version is that even as a gainfully employed adult in full-time salaried positions, I have been unpleasantly surprised to discover how little coverage the typical health plan provides for anything related to mental health or well-being. If you can't afford some high out-of-pocket costs, you're pretty much not going to get much in the way of care.

And that's if you have insurance.

I'm currently watching friends who are drifting down sh*t Creek without a paddle, spiraling downward into depression with precious little hope of treatment, thanks to no insurance, and nowhere near enough money to pay out-of-pocket for treatment.

The flip side of that argument is precisely why I feel stuck in my job. My wife is bipolar, and I'm simply not willing to quit my job and, for instance, start my own business, because the mental healthcare that my employer-provided insurance pays for is what's keeping our lives functional and happy.

Health care needs on my part (medication primarily) are the reason I have had to stick with treading water in the working world rather than pursuing my dream of returning to school and earning my MD (or hell, even just a PA). Even though my brief forays into returning to school earned me very complimentary remarks from my professors and the encouragement that they all regarded me as having the "right stuff" to succeed in medicine.