Posted by: thealienist | April 23, 2013

I’m Back – and Wondering About the Past Year

I’m sorry for the prolonged absence, but I have been busy at school, in practice, and with my family.  For those who occasionally stop by, thanks.  I hope to post more regularly from now on.

It seems to me that more issues of mental illness have been coming up in the news lately.  We had the Aurora cinema shooting, the Sandy Hook school shooting, and the Boston bombing.  We have the gun control debates.  In each of these, and in numerous other reports, conversation has turned to the issue of mental illness and public safety.  The argument seems to be that “if only we (society) had known that these people were mentally ill, we could have prevented this.”  Does anyone else see a problem with this?

We should be very careful when we weigh the benefits of patient confidentiality vs. public safety.  Here are a few questions I think we need to address as we consider new policies for public safety:

1.  Who are the dangerously mentally ill?  Research shows that most of the mentally ill are more likely to be a victim of violence than a perpetrator of violence.  While there are some mentally ill who show in increased risk of violent behavior, I wonder which group would be bigger — the violent mentally ill, or the violent non-mentally ill?  I’m sure there is some information out there about this…I’ll have to look it up.

2.  How are we going to identify the violently mentally ill?  Are there specific illnesses that predispose one to violence?  Is the risk large enough to restrict the rights of citizens based solely on a diagnosis?  How many non-violent citizens will have their freedoms abridged simply because they sought treatment for a mental health issue?  Mental health professions have proven themselves to be mediocre predictors of violence, at best.  Non-mental health providers are unlikely to be any better.  Whose testimony will be used to limit an individual’s rights in our country?  Behavior predicts behavior, thus one of the best predictors of violence is a history of violence — not mental illness.  We already have laws against felons possessing firearms.

3.  Will the mentally ill get treatment if it carries the risk of losing their rights?  We might make the problem worse by motivating individuals not to seek help since it would increase the cost of treatment (not only time, money, and effort, but freedom).

4.  Are we using the term “mentally ill” simply to label people we desire to control?  I do not believe that this happens very much in the United States, but it has happened elsewhere and (if we are not careful) could happen here.  One of the main dangers of this approach is that finding someone guilty of a crime means that I can punish him for a limited time, but labeling someone “ill” means that I can “care for him” until he gets better.  If the diagnosis is not valid, if the “care” entails coercion and restriction of rights, and if society reserves the right to judge when one is “better,” then it is better to simply responsible and be punished rather than to be “ill” and be “treated.”

5.  Are we using the “mentally ill” as a way of disavowing our own violent impulses?  It is disturbing to think that we all have aggressive desires from time to time.  It is anxiety provoking to know that elements of our society can suddenly become violent.  We calm ourselves by saying that it was not “us” who did the aggression, it was “the mentally ill” or “the criminals” or “the terrorists.”  We exclude them from our mental community and assure ourselves that we will be safe if only the outsiders are excluded or controlled.  Thus, we fantasize about how guns in our hands will protect us from guns in their hands.  We also try to think of ways that we can keep them out of our country.

I am not saying that there are no answers to or cogent arguments to be made for or against the questions above.  I believe that thoughtful people can discuss these issues and strive to improve public safety.  I simply do not believe that burden of public safety should be borne on the back of the mentally ill.

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