Thursday, September 19, 2013

Guns, Again (--another broken record shrink rapper)

Apparently,  if the shooter is dead, I can talk about it (a little).  I don't know any facts except what I've seen in the paper, and I've interviewed absolutely no one, so I'm not going to say much, but I am going to use what I've read to write a post on the on-going issue of the role of mental illness and gun control.

Per today's New York Times:

But several senators, like Senator Richard Blumenthal, Democrat of Connecticut, who has pushed for tougher gun laws since last year’s elementary school massacre in Newtown, Conn., see mental health policy as a way forward.
Mental health is really the key to unlocking this issue,” Mr. Blumenthal said. “I’ve become more and more convinced that we should establish the mental health issue as our common ground.”

  So you know, I have read approximately eight news articles, mostly in the New York Times, a couple in the Wall Street Journal, and I listened to the transcript of the interview with Dr. Ritchie and Dr. Torrey on PBS.  And ClinkShrink already wrote about this in Speaking Ill of the Dead, because she's a broken record.

Here are the "facts" I have seen reported.  Note that some of these "facts" are conflicting:
--the shooter went to the VA ERs twice in the past month and got medicine for insomnia.  He was reported not to be suicidal, depressed, or anxious, and was given Trazodone, an antidepressant used for sleep. Trazodone is not an SSRI, and I say that because there have been questions about whether SSRI's can cause violent or suicidal thoughts.
--he had a "decades long history of mental health problems" with no clarification as to what that meant or consisted of.
--the VA has no history that he ever sought mental health treatment
--on August 7th, he was in Rhode Island and called the police because he was paranoid that people were following him and there was something to do with microwaves.  (Sounds psychotic, but the psychosis is due to what? No clue but possibilities might include ?schizophrenia, ?delusional disorder, ?DTs, ?bad drug trip, ?mania, ?brain tumor, ?malingering, ?psychotic depression, ?neurosyphillis, ?hypothyroidism aka myxedema madness --I have no clue, though Dr. E. Fuller Torrey calls this "classic paranoid schizophrenia" and he may be smarter than me.).  
--The police faxed a report to his employer
--The police did not fax a report to his employer .
--The police did not take him to the ER (that we know of).
--Nothing has been said (that I saw) about any offer to take him for a psychiatric evaluation, so we don't know if he 'refused' care that day or any other day.
--His father said he had PTSD from being a first responder on 9/11
--There is no record that he was a first responder
--There has been no mention of psychiatric hospitalizations
--He had VA benefits and access to care and was actively employed and working, rehired by a prior employer this summer and had a security clearance.  To me, this implies that his work for that employer during the previous stint was satisfactory.
--His discharge from the military was honorable.
--His discharge from the military was not dis-honorable.

So with regard to mental health issues being the key to gun control, I ask:
--What's the line?  You hear a voice and everyone's head is wired such that the voice goes directly to a databank so that your guns are removed and a magical shute pops up to wisk you to a state hospital bed?
-- You tell a doctor you are having trouble sleeping and you can no longer own a gun? This would be a huge help in either keeping guns from people or cutting down on sleeping pill prescriptions.  And it would be fun to watch the drug companies go bonkers.
--Everyone who sees a therapist is exempted from owning a gun?  Or just people who see psychiatrists?  What about people who get psychotropic medications from their family doctors?  Or do we weed people out by their psychiatric diagnoses?  Or specific symptoms?  And how do gun-limiting databanks and law enforcement agencies discover those symptoms or diagnoses?  Insurance forms?  Mandatory reporting by therapists?  What about self-pay patients?  Perhaps we should require anyone with psychiatric symptoms to self-report to a database?

With regard to looking at behavior, instead of imprecise labels like "the mentally ill," I've seen the following reported (again, just what I saw in the press):
--two weapons violations for discharging a gun, no convictions.
--the shooter reportedly claimed he had an anger-induced blackout (not an official diagnosis) as an explanation for firing shots
--two days in jail for a bar fight 
Legal records are not confidential, so it might be much easier to ban people with a history of criminal impulsive behaviors from owning guns and cast a wider net.  

When someone has committed a tragic, senseless crime and has complained, ever, of a psychiatric symptom, it's easy to say mental illness is the common denominator and that's where we should target our gun control.    If you shoot strangers, we don't understand that behavior (at least I don't), so we say someone is severely mentally ill, and in retrospect, they may well have been.   But until that time, it may not have been obvious that they were dangerous and the question is how big a net should we drop?  Mental health professionals  see people every day with psychiatric symptoms, insomnia, violent thoughts, and sometimes psychotic symptoms.  It is so easy to see the 'red flags' in hindsight, but so many people have these symptoms who never go on to hurt anyone, that our predictive powers are sometimes limited.  I certainly think there should be a mechanism to report someone who a therapist is clearly concerned about as being at high risk for violent behavior, and in our state, there is a mechanism to get someone in the hospital, but not to keep them from owning or purchasing a gun.  I think we need to base such gun control on actions -- people who've been violent or people who have had suicide attempts serious enough to require medical admission, or those with stated intent.

Finally, at this point, we don't know for sure that mental illness was the motive for this action and maybe we should wait to hear if anything indicates that it was before jumping to that conclusion.