Sunday, December 16, 2012

Please Don't Make Assumptions


Like many, I have been drenched in sadness this weekend.  In honor of ClinkShrink's wisdom that media coverage of  tragedies leads to more such atrocities, I will talk in generalities.

When a public tragedy happens, it gives us reason to relate it to the issues we naturally advocate for.  I am no exception, and I've been posting articles on my own Facebook page in support of gun control.  I especially like this article by Nicholas Kristof, "Do We Have The Courage to Change This?"

Mass shootings bring up the issues of gun control, adequate treatment of the mentally ill, and the combination of the two, as President Obama has put it, oh so in-eloquently, “Enforce the laws we’ve already got.  Make sure we are keeping the guns out of the hands of criminals… Those who are mentally ill."  And finally, there are what I'll call the Out-in-Left Field assumptions.

Let me take it systematically:

The Out in Left Field Assumptions:
It seems to me that sometimes people are quick to make assumptions, to fill in the blanks using their own stories.  On Friday, someone I follow on Twitter posted that the perpetrator's mother (at that point, thought to be a school teacher), was probably bullied at school and the son was doing her "dirty work."  I was floored at the assumptions that were made there, with no evidence whatsoever, and I no longer follow that person's tweets.

The Problem is The Mentally Ill People and the Care They Are or Are Not Getting:

On a blog called The Anarchist Soccer Mom, a woman posted about her own son's problems. Her 13-year-old is violent, unpredictable, and sometimes dangerous.  He has been hospitalized and she's had to hide sharp objects and call the police.  Treatment with many medications has not helped, and she's been told by a social worker that unless he gets into the legal system -- presumably by her pressing charges--  little more can be done (note that this is a child who is in treatment, not an adult refusing care) and she finds that answer inadequate (it is).  I don't know enough to comment on the quality of her son's care and whether or not there is more that could be done if only the resources were available --she does say she has health insurance.  But what troubled me is that the Huffington Post reprinted it with a title asserting that she is the shooter's mom, naming the gunman in the most recent tragedy.  I understand that she worries terribly that her child could do something awful and that she is frustrated by the inadequacy of a system that has been unable to help her child, but so far, we don't know that the shooter in question was anything like her son.  We've heard he was smart, quiet, withdrawn, and may have had a diagnosis on the autism spectrum.  So far, we've heard nothing about violence or hospitalizations.  And since I'm asking people not to make assumptions, I will tell you that I am making the assumption that the Huffington Post renamed her piece with a provocative title.

As of this writing, we know little about the mental health history, or care, that the most recent gunman requested or received, and we have reason to believe that his family may have had resources to obtain care for him.  In other instances, shooters have been in active treatment, or have had a history of a single, or a few, visits to student mental health centers, sometimes in the remote past.  In retrospect, on any case with a mass shooting of strangers, it's obvious that the mental health care rendered was insufficient, but whether there is something that can learned to prevent future such events remains unclear.  These shooters tend to be male and isolated -- that would be a lot of people to round up in preventative measures.  While I certainly believe that our mental health services are inadequate, we aren't hearing that shooters were people trying desperately to access care but were unable to do so. Sometimes they are people that a mental health professional or an educational institution was concerned about.  And while some gunmen have sought treatment at some point and then fallen through the cracks, it's not always clear that having laws that would make it easier to commit someone would make a difference, or that we want to become a society where people can be forced into treatment because they fit a profile.    Nevertheless, Newser linked to the Huffington Post anarchist soccer mom's Huffington Post title with the statement,"It's time for a meaningful, nation-wide conversation about mental health. That's the only way our nation can ever truly heal."

Yes, we need better mental health care.  And I do think that if we had a kinder and gentler system of involuntary treatment that didn't upset and traumatize people, then there might be a lower threshold to getting help for people, but I'm not sure that would prevent all these tragedies. It's one way we can begin the process of healing, but it's not the only way.  Do we ever really heal from something like this?

Keep the Guns Away from the Mentally Ill

On Pete Earley's website, he talks about how troubling it is when a mentally ill person commits a heinous crime because it further stigmatizes his son who is not violent, but has suffered from a psychiatric condition.  I'll let you read his post, because I'm not sure I'll do it justice.

Unfortunately,  Mr. Obama, I'm not sure how one goes about keeping arms away from the mentally ill.  I'm not even sure who those mentally ill are, given that a gazillion people take psychotropic medications and door-to-door surveys show that over half of all people suffer from a psychiatric disorder at some point in their lives.  It seems that disturbed people sometimes obtain guns legally because they aren't ill enough to be identified by the system (for example, if they haven't been hospitalized or criminally charged), or they are related to someone who has legal guns and they use those.  And people who are well can buy guns and then later become mentally ill, if you think it's an issue of "those people," think again.

It sounds good -- obviously suicidal or homicidal people shouldn't have guns -- but I don't know how it translates into something useful in terms of legislation.

Gun Control

Okay, you can fly a plane into a building, knife multiple people in China, blow up a federal building with fertilizer, or jump off a bridge.  We are never going to prevent all murders and suicides, but gun possession allows for a level of lethality that isn't seen in such numbers when people have impulsive violent moments, have had a little too much to drink, or leave their guns where children can play with them, or disturbed people can take them.  We probably can't round up every young man who is isolated and distressed, but we probably can question everyone who purchases large amounts of ammunition, or make it illegal to own high-velocity weapons. 

 Dr. Erik Roskes, a forensic psychiatrist, notes about the astounding number of gun deaths,"Those victims far outnumber the victims in Connecticut, Colorado, etc on an annual basis, and many would not be dead were it not for easy access to handguns. Many more people die due to impulsive shootings than due to the planned acts of the perpetrators of the mass tragedies - yet because they happen one at a time, there are no headlines.  It is not too soon - it is never too soon - to rethink our antisocial national approach to weaponry."  

I don't know if we'll find out what happened last week, whether this tragedy was planned or impulsive, the result of anger or psychosis, illness or evil, or whether this, or other similar tragedies,  are preventable in a society that values the right to bear arms and the right to refuse psychiatric treatment in the absence of stated imminent dangerousness.  Making assumptions is not helpful.

Finally 

~Yes, we need better access to mental health care, whether or not such care helps prevent tragic, senseless acts that effect many people or one person.
~Perhaps we want to re-think our threshold for involuntary treatments, but that certainly will not capture every potential mass murderer.  If we do so, we want a system where accessing treatment is fast, easy, non-stigmatizing, humane, and respectful.
~We need to re-evaluate our gun laws, now. 

I'll go back to my sadness now.