Gun Violence

Posted on April 27, 2013 by Ross Bishop

by Ross Bishop

Glycerne is pretty harmless stuff. But, combined with nitric and sulfuric acids it becomes an incredibly dangerous explosive – nitroglycerine. The same thing is true for the set of issues that lead to gun violence. By themselves each is tolerable, but when combined, the mixture can be absolutely devastating. Unfortunately the whole issue is being obscured by the smoke of an incredibly politicized debate, as each sub-part seeks to either escape blame or shift blame to the other parts. Anger and violence in our society are vitally important issues that desperately need to be addressed, but adding guns to the mix, as with nitroglycerine, makes the whole issue (pardon the pun) explosive. Underlying the discussion are two significant and fundamental considerations:

First and foremost, a gun is an instrument of violence. It serves no other purpose. You can use a knife to prepare your dinner, skin a goat or open a bag of Cheetos, but a gun is made for one thing – to kill.

Secondly, putting that much power into the hands of an individual is like giving them lightning in a bottle. A gun, unlike any other weapon, requires no particular skill to use, making it an incredible equalizer, and this is especially true for people who feel disenfranchised and powerless. It can make a dwarf feel like a giant.

In regard to specific considerations:

Third, guns are a guy thing. The number of women who use guns are small.

Fourth, homicides – about 6,000 a year – are tightly concentrated in poor urban minority neighborhoods. Most homicides occur between people who know each other, are doing business together (often drugs) or live together. They’re not stranger-on-stranger shootings and they are not generally home intrusions.

Homicide victims are mostly minority young men. Blacks are six times more likely than whites to be victims of a homicide. Blacks are seven times more likely to commit a homicide. The homicide rate among black victims in the United States is 18 per 100,000. For whites, the national homicide rate is 3 per 100,000.

The Baton Rouge Advocate newspaper published an analysis of 2012 murders in their city. Last year, 83 people died by homicide in Baton Rouge. Of that number, 87% were black and 87% were male. Two-thirds had been in trouble with the law before, and one-third had been in trouble with the law for drugs. The median age of the victims was 26.

The median age of the perpetrators was 22. Ninety six percent of them were black, and 90% were male. Almost two-thirds had previous arrests. One out of four had a drug record. Most of the murders took place in the poorest parts of the city.

These are populations who have been raised by violence and who turn to it for problem solving as gangs feud over territory and dominance in the illegal drug trade. An assault weapon is their tool of choice. The rates of domestic violence are also extremely high in this group. Their plight receives little attention from either politicians or the media.

Fifth, more than 38,000 Americans die by suicide every year, and more than half of them use firearms. This is six times the homicide rate. When a white man wants to commit suicide, he shoots himself. Eighty percent of those who commit suicide with guns are white males. It is likely that a gun is simply the most convenient method, but the gun’s ready availability makes it an all too easy choice. It seems that no one wants to discuss the issue of depression and the social shame associated with it for white males. Statistically, the risk of suicide goes up five-fold if there is a gun in the home.

Sixth, as a group, gun owners may have issues, they may be chauvinistic and cling to unrealistically old fashioned ideals, but the great majority of them are law abiding citizens. As a group, they feel powerless, and being amongst the most paranoid in society, are overly concerned for their personal safety. This also leads them to have issues about governmental intrusion. But, in any case, their guns will remain safely at home.

However, research has clearly shown that not only does having a firearm not protect the family, it significantly increases the risk (by 300 percent!) that someone in the family will die from a firearm homicide. A study by Boston Children’s Hospital found that tougher laws on guns does have an effect on homicide and suicide rates. States with stiffer gun laws have fewer gun-related deaths.

Many gun owners are fascinated by the development of weapons technology, and whether we like it or not, over the course of history, guns have represented humankind’s most sophisticated technological advancements. This is largely what motivates collectors.

There is a fringe element of paranoid nut cases in the gun world, but their numbers are small. However as we have seen, a powerful assault weapon with extended magazines in the hands of a single troubled individual can wreak absolute havoc, and we cannot ignore that reality.

The NRA reflects the views of the most radical gun owners. It is a knee-jerk radical conservative organization, run by the gun manufacturing industry that profits immensely from social anarchy. The organization has an investment in fostering paranoia. Its function is not to solve problems but to obstruct them and sell guns.

Seven, the typical criminal rationalized away the ideals of fairness and social justice when he was a child. The criminal doesn’t give a damn about rules or laws and sometimes even punishment. He’s angry to the point of violence and little else matters except building his reputation in the criminal community or the “hood.” He was raised in an alien culture with rules and values very different from the one you grew up in. In the world he lives in, violence not only insures survival, it is also a talisman of manhood. He was abused as a child and is willing to abuse without conscience when he is angry or to get what he wants.

Eight, although violence is typical of a few mental illnesses, violence per. se. is not. According to The American Psychiatric Association, “The vast majority of violence in our society is not perpetuated by persons with serious mental illness.” There is a small percentage of mentally ill people, and to repeat, we are not talking about large numbers here – specifically those with severe and untreated symptoms of schizophrenia with psychosis, major depression or bi-polar disorder, who are about twice as likely as the general population to be violent. People who combine schizophrenia and substance-use issues have a nine times higher risk of becoming violent. But these are small numbers even compared to the population of the mentally ill.

The real tragedy, and it’s not just about guns, is our criminal neglect of those amongst us who are troubled – mentally ill or sane but violently angry. Given proper care, many of these people could be helped and a number of mass tragedies could be avoided, but the real conundrum of this whole discussion is that it only takes one person to create terrible mayhem. About 60% of mass murders are committed by violent, mentally ill people, but we are talking about fewer than 30 people (I am setting aside homicides).

The resource commitment to identify and help these people would be substantial. We can afford to do it, but at the present time, trillion dollar B1 bombers and nuclear submarines are more important. Over the past three years, conservatives in Congress have cut $4.3 billion from the already stripped federal mental health budget and state legislatures have cut even more. Considering that violent anger is behavior that is learned and culturally passed on, it would seem sensible to do what we could to intervene in order to at least limit it’s contagious spread. Mental illness is another matter, but we could at a minimum, try to help those who are troubled.

Ninth, and possibly most important and most overlooked in the discussion to date, is the roll played in gun violence by violently angry, but otherwise sane men in homicides, mass murders and domestic violence.

The psychological profession does not consider violent behavior a mental illness. Otherwise what would we do with the military, bank robbers, drug dealers and the police? Violence is neither a diagnosis nor is it a disease, and ours remains a violent society. If you read the news, people kill each other every day by the hundreds – in Iraq, Afghanistan, New York and Chicago, and few of these people are mentally ill. A military officer who kills masses of people with a Predator drone may be many things, but he is not mentally ill. A drug dealer seeking to avenge a bad deal is little different from the sane mass shooter who seeks revenge for the abuses he feels have been done to him.

Violence driven by anger falls into two general categories, crimes of passion (largely homicides) and acts of calculated violence (revenge). The propensity for violent behavior is both detectable and treatable, but it is also so widespread through the culture, and addressing it represents a significant intrusion into civil rights, that at least today, no one with a major public platform has been willing to address it.

Forty percent of mass murders are committed by young men who are violently angry, who are calculating and delusional, but sane. If you met one, you’d think they were odd, but their behavior would not alert you to what they were planning. They can be episodic, so people who spend time with them such as parents, friends and teachers will know that something is wrong, but that can be said for many people, and trying to pick out a potential mass shooter from the millions of troubled, frustrated and disenfranchised people in society would be a daunting task, to say the least.

Unable to effectively sort out potential terrorists, the TSA searches every bag, every pair of shoes. The society would not tolerate similar gun searches at every public building, school, supermarket or movie theater. But, if we could begin to identify at least the most troubled amongst us, we could prevent some tragedies. Violently angry mass killers have been profiled by Paul Mullen, an esteemed Australian forensic psychologist:

They’re almost all male, there is one exception. They’re young. They tend to be in their 20s. They are typically social isolates. They very rarely have close friends or confidants. They almost never have an intimate relationship, although they sometimes have had brief relationships, which have usually failed.

Interestingly, they’re not like many offenders, they don’t tend to have problems with alcohol and drugs. They’re certainly not impulsive, quite the reverse. These are rather rigid, obsessional individuals who plan everything extremely carefully. And most of these massacres have been planned for days, weeks, sometimes months ahead.

The other thing about them is that they are angry and resentful at the world, they blame the world for not having recognised their qualities, for having mistreated them and misused them. Resentment is central to their personalities.

They spend their time ruminating on all those past slights and offences. And they begin to develop a hatred for the whole world.

Perhaps most important of all, these people are on a project to suicide. They go out there to die, and they go out to die literally in what they see as a blaze of glory. They are seeking a sort of personal vindication through fame or, more precisely, infamy.

So the challenge is what should we do? Because of the multi-faceted nature of the problem, there will not be one solution, but taking a number of interlocking steps can greatly help. However, there are massive political roadblocks to every reasonable solution, and we must therefore conclude that we are going to be burying many more school children and drive-by shooting victims.

The most obvious step would be to get rid of assault weapons and large capacity magazines. These things have no place in civil society and getting rid of them would greatly reduce the potential damage done by drug gangs and mass murderers.

One measure that might bear meaningful results would be to test all 14 year-old young men to profile them for potentially violent behavior or violent mental illness. Limiting their access to weapons will only be effective if there is a registry of not only potentially dangerous mentally ill people but potentially violent individuals as well. However, once we have that information, unless we are willing to provide help, denying these people legal access to weapons might slow them down, but ultimately would accomplish little. With so many weapons available, it is unrealistic to assume that procedural rules would offer more than a temporary roadblock to those who seek to do harm, whether criminals, the violently angry or those who are violently mentally ill.

It might be possible to declare weapons free zones in urban areas of high homicide and domestic violence, but enforcement and civil rights issues would present daunting challenges. But, those considerations should not preclude at least trying it.

There are several popular gun myths that need to be discounted. Chief amongst them is the idea that a gun in the home offers protection for the family. Research clearly shows that this is not the case and that having a weapon actually puts the family at a far greater risk for both fatal accidents and suicide.

Another “myth” that needs to be dispelled is that the Second Amendment to the Constitution guarantees citizens the right to own firearms. It does not, and at some point, the Supreme Court or the Congress is going to need to clarify this. The opposition to this will be historic. But, having said that, it still might be worth doing as it does send a message and does offer a certain amount of deterrence.

Related to the above, at some point in the future, America needs to mature from its dysfunctional cowboy mentality and join the rest of the civilized world and solve many of these issues by simply banning guns. The rest of the civilized world seems to get along quite nicely without its citizens killing each other by the thousands. But, in addition to enormous resistance from gun owners, America is the world’s armaments maker. We supply an inordinate portion of the world’s weaponry, and there are many jobs and literally trillions of dollars in taxes and political “contributions” seeking to prevent any limitation on the country’s weapons industry.

There Will Be More School Shootings

Posted on January 4, 2013 by Ross Bishop

by Ross Bishop

The Intersection of Social Failure

Airplanes they say, crash because of multiple systems failures. Columbine, Sandy Hook, Aurora and Virginia Tech all represent significant multiple failures in the ways we regulate weapons and in our approaches to troubled people. The sad thing is that these tragedies are only the tip of a rather large iceberg. These problems have been screaming for resolution for a long time, and as is so often the case in America, it takes a catastrophe to bring them to our attention.

Limiting the availability of assault weapons and high capacity magazines is an essential part of the solution, but it is not the total answer. There are actually five important areas that intersect to create mass shooting tragedies, and each adds an element that ultimately together leads to disaster. These areas are: the way we view and treat troubled people, the sad failure of our mental health system, restrictions in the law, the availability of assault weapons and the nature of the dysfunction that drives mass killers.

There are answers to each of these aspects. Some will be expensive and others will require changes in our way of thinking. But since most of the changes will have to come through the political process, we can expect the special interests to be busy protecting their private agendas. However, one thing is absolutely assured – unless we do something substantial and soon, we’ll be having funerals for more a lot more innocent schoolchildren.

This is a complicated matter that touches on personal privacy issues, the right to own firearms, the power of the state vs individual freedom – especially as it relates to the confinement of angry, but not mentally ill people, the limits of police power, unlawful search and seizure and of course, the right of children to go to school or the mall without the threat of being killed.

The underlying fabric to this dilemma is the way we view and treat troubled people. We shun them, we fear them. They are the pariahs of society and we treat them like they used to treat the lepers in the Old Testament. Even with our enlightened modern perspective, we still try to sweep troubled people under the rug – or into alleys and freeway underpasses. A big part of our resolving this issue will have to do with us finding compassion in our hearts for these suffering people.

When it comes to the allocation of social resources, the emotionally troubled are always at the bottom of the barrel and the first to have funding cut when money gets tight. Over the past three years, conservatives in Congress have cut $4.3 billion from the federal mental health budget.

Our present mental health system has failed for two primary reasons – a lack of funding for facilities and resources and the inability of psychology to meaningfully help troubled people.

There was a time when we had large state mental hospitals. They were truly awful places, expensive warehouses for the mentally ill that offered little prospect for patients to ever get better. It was found that smaller, community-based mental health facilities could produce some results, so Congress shut off funding for big state hospitals – and then never bothered to provide money for community based health care. Also, people didn’t want mental health clinics in their neighborhoods, so faced with tight budgets and local opposition, the politicians folded.

Troubled people were simply turned out into the street to fend for themselves. In the public brouhaha after the horrible Virginia Tech shootings, gaping holes were exposed in the state of Virginia’s mental health system. The conservative Virginia legislature, traditionally opposed to any public funding for health care, allocated $43 million toward the state’s mental health system. A year later, when the media had gone away, the same legislature cut the state’s mental health budget by $50 million.

Troubled people don’t have a political lobby. There is no one to protest when mental health budgets are slashed and resources are eliminated. Plus, as I said, mental health care is always one of the first targets of budget cutting conservatives who are concerned about the expansion of socialized medicine. Political conservatives seem to possess antipathy towards the treatment of troubled people. Psychologists are typically viewed as fuzzy thinking liberals who want to help troubled people by providing socialized medicine.

When you read expert opinions and media accounts of shooters, keep a few things in mind: Mental illness has fairly specific diagnoses. And taken as a group, mentally ill people are no more violent than you are. There are a lot of people walking around who you might call “nuts” in street vernacular, who do not fit into the defined categories of mental illness.

There is a small percentage of mentally ill people, and we are not talking about large numbers here – specifically those with severe and untreated symptoms of schizophrenia with psychosis, major depression or bi-polar disorder, who are about twice as likely to be violent. Psychiatrists have created a category of illness called Antisocial Personality Disorder, which is sort of a catch-all for antisocial behavior.

People who have schizophrenia and substance-use issues do pose an even greater risk. They have a nine times higher risk of being violent. The association is especially marked in regards to homicide. People with schizophrenia are nearly 20 times as likely to kill as people unaffected by the disease. But, these are largely individual killings. Mass shooters are rarely substance abusers. And we should carefully distinguish between typical murderers, (remembering that any murder is a horrible thing!) and the special category of mass killers, because there are important differences.

We make a serious error when we categorically label mass killers as mentally ill. Mental illness is certainly an important consideration, but the mentally ill account for less than half of all multiple victim shootings. Of the 60 most recent mass shooters, acute paranoia, delusions, and depression were rampant among them, but only 38 of them displayed signs of mental health problems (not necessarily mental illness), prior to the killings.

Actually, there are even far fewer mentally ill involved if we only consider the “big” events. The large group of shooters, and we are only talking about 60 men out of a population of 35,000,000 young men, consists of troubled people who are not technically mentally ill, but who pose a serious threat because of their towering rage. Of the three major and many smaller gun tragedies in the nation in 2012, only one of the perpetrators seems to have been mentally ill. The others were just angry, feeling that they were right and everybody else was wrong. They see other people as responsible for their problems. They externalize blame, scapegoating groups or individuals – family, co-workers, neighbors — for whatever is wrong in their lives.

Violence is neither a diagnosis nor is it a disease, and ours remains a violent society. If you read the news, people kill each other every day, by the hundreds – in Afghanistan, New York and East LA, and very few of these people are mentally ill. A military officer who kills masses of people with a Predator drone may be many things, but he is not mentally ill. A drug dealer seeking to avenge a bad drug deal is little different from the mass shooter who seeks revenge for the abuses he feels have been done to him. These killers have been profiled by Paul Mullen, an esteemed Australian forensic psychologist:

They spend their time ruminating on all those past slights and offences. And they begin to develop a hatred for the whole world.

To summarize: although direct research is somewhat limited because shooters usually commit suicide, they do operate from an almost stereotypical pattern. The shooter kills in public during the daytime, plans his offense well in advance and comes prepared with a powerful arsenal of weapons. He has no escape plan and expects to be killed during the incident. The killer is driven by strong feelings of anger and resentment, flowing from beliefs of being persecuted or grossly mistreated. He is driven by fantasies of revenge.

These killers are calculating and delusional, but most often not mentally ill. If you met one, you’d think they were odd, but their behavior would not alert you to what they were planning. They can be episodic, so people who spend time with them such as parents, friends and teachers will know that something is wrong, but that can be said for many people, and trying to pick out a potential shooter from the millions troubled, frustrated and disenfranchised people is a daunting task to say the least.

But what is a teacher or parent to do? Several of the recent crop of mass killers could easily have been helped by a residential facility, but even though their problems had been identified, there was simply no program or facility to help them, and no mechanism in place to allow them to be legally referred out for help. So the concerns of teachers, family members and even therapists fell into an abyss in the system with as we now know, tragic consequences!

Most often a teacher or parent’s only resource is to call the police, but the police can only respond to a direct, immanent, violent threat. This puts the subject, if he looses his rigid composure (which is uncommon), into a criminal justice system that is neither equipped or prepared to deal with him.

There are almost no resources to help troubled people – no housing, no supervision, no guidance, counseling or vocational training. A callous political calculation has been made that killings such as Columbine, Virginia Tech and Sandy Hook are a cheaper alternative than to create community based mental health clinics and the billions of dollars and large infrastructure that would require.

Shooters do not see themselves as troubled but rather as victims, so these angry young men vehemently resist taking medications, being confined or receiving treatment. Many of the drugs they are prescribed have truly awful side effects (including violent behavior), further complicating an already difficult situation. These men are smart but their dysfunction is likely to have already brought them up against teachers, the police and psychiatrists, and they will have learned how to play the system to avoid being confined.

The lack of community support makes the well-meaning teacher or parent who seeks help for a subject, a target for the subject’s smoldering rage. And as we have sadly seen, these men can lash out with incredibly destructive rage or in a most interesting modern twist, lawsuits! Most parents are also unwilling to see their sons as troubled because that reflects back on them as parenting failures.

A critical element in the discussion of mass shooters obviously involves guns and their accessibility. There is a group of people in our society who fear that the government might try and take away their freedoms. These are usually men who feel personally powerless. And for people who feel powerless, like a victimized shooter or an NRA member, an assault rifle can be the great equalizer.

The need of these men to defend themselves against a fantasied governmental incursion has led them to create an open market for assault style weapons that regrettably, can easily get into the wrong hands (either legally or illegally). The fear of these “Defenders of Freedom” puts the rest of us at grave risk. Eighty percent of the perpetrators of the 62 most recent mass shootings obtained their weapons legally.

Besides, home security can easily be accomplished by less aggressive weapons. And as far as protection from a governmental incursion is concerned, if you consider the premise of armed civilians going up against the might of the Army with its tanks, trained troops and helicopter gunships, the whole concept becomes pretty ridiculous. But, in one sense the NRA is right, guns are only the instruments of mayhem. But, the pivotal factor that the NRA conveniently chooses to ignore is that a rage filled person with a Bushmaster assault rifle is massively more deadly and dangerous than one without. Mass killers don’t use knives or baseball bats. Assault weapons have been perfected as instruments of death and they are incredibly effective at doing it! And that is why we must get them and high capacity magazines off the street!

The NRA, controlled and funded by gun manufacturers, purposefully and unconscionably, fuels their member’s fears, as it attempts to gain support for its private agenda, which is a society where everyone carries guns – essentially a throwback to the violent Wild West of the 1880′s.

The other aspect of the weapons discussion has to do with their sheer availability. There are over 350,000,000 guns in America and anyone who wants a gun can easily get one. You can go to any city in America and in 48 hours purchase enough guns and ammunition (including heavy weapons), to equip a small army.

America is violent country. Our homicide rates are SEVEN TIMES higher than rates in the other high-income countries. More than half of all murders are committed with guns. Our firearm homicide rates are TWENTY TIMES higher. For youths fifteen to twenty-four years old, firearm homicide rates in America are FORTY THREE TIMES higher than in other countries.(1)

Another issue in this discussion, and what has until now been a sacred cow, is the failure of psychotherapy to heal people. The simple truth is that psychotherapy and drugs just don’t work very well. But, since they have been the only game in town and they come from the esteemed medical profession, politicians give them approval because of the way the legal system esteems psychiatry, (which even amongst practicing psychotherapists is a standing joke!) The alternative is to warehouse troubled people like we do criminals – who we also don’t seem to know how to help.

Shamanism (and you must accept my bias here) has a remarkable record of helping emotionally troubled people to heal, but it is a foreign concept from “backward” tribal cultures, difficult to teach in university classrooms and is spiritually and not medically or “scientifically” based. Besides, there are relatively few really qualified shaman around. So, even though the psychotherapy car already has several flat tires, we continue to try and drive it down the road.

The law doesn’t help much in dealing with troubled people either. The courts are understandably, exceedingly touchy about confining someone against their will without a certification of mental illness. And as I said, most mass killers do not meet the the mental illness requirement. Acts of mass murder are so heinous that it is difficult to attribute them to normal people, but shooters are merely the extreme fringe of a culture that engages in deadly violence every day. In America hundreds of people are killed every single day. I don’t personally agree with the psychiatric categorizations of mental illness, but these are the rules that the law and the courts have chosen to adopt.

When a troubled person attracts attention, the police are usually called. But the only resource a police officer has is jail, and that’s only going to be for a short time. Sometimes they can pawn the troubled person off to a shelter. If a seriously troubled person comes for therapy, unless he or she represents an imminent and immediate threat to themselves or to others, the system effectively forbids the therapist from doing anything beyond counseling. Even if the subject is a ticking time bomb, unless he or she expresses an active desire to cause harm, therapists, the police, teachers, the clergy and even the courts are denied any real resource for intervention.

And when a person does present an active threat, they can only be hospitalized for 72 hours before being committed as mentally ill, if they actually happen to be so, and if there is a bed available, which these days is rare. A colleague of mine in Virginia had a potentially violent client, checked with the state and found 70 other violent people already waiting in line. By the end of the day, this violent and potentially explosive man was back on the street. The only consolation for mental health professionals is the miracle that more killings aren’t happening every day!

I would like to end by making a few suggestions. These are not complete answers, but they would go a very long way toward mitigating the current situation:

GUNS
Since an assault weapon cannot be used for hunting, and personal defense can be easily accomplished by other means, it is time that society took a stand and joined the rest of the civilized world to establish bans on assault weapons and large capacity magazines. Further, the purposefully designed loopholes in the present reporting system for weapons sales such as unregulated private and gun show sales must be closed. Unfortunately, having the government maintain a list of gun owners feeds right into the paranoia that makes NRA members want assault weapons in the first place!

IDENTIFYING POTENTIAL SHOOTERS
In a many cases, troubled people can be identified before things go bad. I have mentioned having a referral system based on observations from therapists, law enforcement officers, clergy, teachers and even family members. It would be simple to backstop these referrals with a qualified professional so that errors would be minimized.

There are tests that could help identify people who are likely to need help in the future. It would be possible to test all sixteen to twenty year olds for a host of issues. This could cull out most, but unfortunately not all, of the people likely to be future shooters.

But, there is no sense identifying these people if we are not going to provide the resources to help them. The names of people meeting critical criteria could be denied access to firearms. Civil libertarians will not like it, but under the circumstances, it would seem to be a reasonable limitation of personal freedom. Access to this list could be selectively given to parents, teachers, the clergy, therapists, the courts and law enforcement officers.

RESOURCES
There is a desperate need for community based, residential facilities for troubled people. These facilities must be sufficiently funded and staffed so that the needs of patients could be addressed and the reasonable concerns of neighbors mitigated. This would provide a badly needed resource for parents, therapists, law enforcement officers, the clergy, the courts and educators who, with some changes in the law, could refer out troubled people with protection from retribution and lawsuits. This represents a very large expenditure, probably the equivalent cost of an aircraft carrier or a few nuclear missiles.

PSYCHOTHERAPY
Psychotherapy has emphasized cognitive behavioral health for years. Cognitions and behaviors are measurable, observable. And to some extent, altering thoughts and behaviors does help MANAGE emotional issues. But in only rare cases does it HEAL them. This leaves open room for relapse when the person is subjected to challenging circumstances.

There are other healing methods like shamanism that have an established history of providing exactly the healing that troubled shooters require. These approaches can reach the cause of the underlying problems and address them. It is time to begin looking into some of these alternate approaches.

THE LAW
Confining someone against their will who is not mentally ill and who already feels victimized by the world is going to pose a nightmare for the courts and legislators. Where do you draw the line? What about errors in diagnosis? And there will be some. This matter is subjective and emotionally loaded, presenting land mines for the legal system.
As I said, this is a complex issue with many moving parts.

Solutions will require changes in the concerns some politicians have about socialized medicine and our present legal prohibitions around personal privacy. Creating community based mental health clinics will be expensive. But most importantly, what needs to change are the views, fear and ostracism we hold towards troubled people.We need to find our compassion for them. Societies do not die in a cataclysm, that is only the final event in a series of unresolved social issues that cause the social fabric to decay. To delay, to not provide care for the many troubled people who live amongst us, is to only invite more school shootings, and the painful thing about that is what it says about a society that is unwilling to respond to the cries of its neediest people. Perhaps the Mayans were right after all.

(1) To clarify Mullen’s point: Interviews tell us that mass shooters are not exactly loners. They do not seek isolation, and have “friends,” but their social experience is marked by a history of struggling to connect. They experience rejection by their peers or they draw back from potential friendships, assuming they’ll be rejected if they try. They believe they are perceived as unimportant and insignificant. Many mass shooters, rather than wanting to be alone, end up that way because they cannot maintain a connection.

(2) (http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/WhitePaper102512_CGPR.pdf)

People With Mental Problems

Posted on December 15, 2012 by Ross Bishop

America’s Invisible Walking Wounded

By Ross Bishop

As the nation expresses its shock and grief over another school shooting, another group of people, although terribly saddened, will tell you that they are not surprised. Actually they are relieved that this sort of thing does not happen more often.

The people that I am referring to are the country’s psychotherapists. Therapists are acutely aware that a part of society is walking around, an invisible ticking time bomb, waiting to explode. The therapeutic community is the front line in dealing with the problem and they know the level of care for troubled people in America today is simply awful. They have pleaded for years with politicians to make changes in the level of public support for the mentally troubled, and they have been repeatedly rebuffed.

Every therapist will tell you about shaking their head after a session with a certain client, knowing there is no other help and praying that this person wouldn’t hurt someone or themselves before their next session. Until the client picks up a gun and becomes an identifiable threat, there are few resources available to deal with a potentially explosive situation. Waiting to intervene with the police until a threat is identifiable, as we saw at Virginia Tech, is simply way too late. And it is the wrong kind of intervention, anyway. And for every potentially violent person we see, there are many more out there walking the streets who refuse treatment. And for every potentially violent person, there are 1,000 more who pose no particular threat, but are greatly in need of care. We are not providing that care.

The issue presents a number of difficult challenges; I will try and shed some light on some of the problems:

The perennial issue is funding. In 1963 during the Kennedy administration, the nation moved from the tradition of custodial hospital care to a system of community based care. The idea was to get people out of expensive physician-run hospitals and manage their care on an outpatient basis. The hospitals weren’t producing results and many chronically mentally ill people could exist in the world with the right kind of support and supervision. It’s a good and workable system, when properly funded. But the government has never properly funded the concept. It did what it often does, pass a grandstanding idea and then hold back the funding. Can you say “Medicare?” Can you say “No Child Left Behind?” Can you say “body armor?”

Care for mental illness is also one of the first places that axe-wielding politicians look during budget crises. If you cut subsidies for drug companies, farmers or military contractors, their special interest groups raise a ruckus. The mentally ill have no constituency. They are easy targets. In 1970 there were 200 in-patient mental health beds per 100,000 population in the country. Today that number is less than 25. Yet the population of mentally ill people grows daily. The result is that we have a woefully inadequate, fragmented, ad hoc system that puts mentally ill people through incredible hurdles to receive at best a marginal level of care, if any at all.

In any given year, 5% to 7% of the adult population experiences a serious mental illness. If you want to find them, go to a freeway underpass. Thirty to fifty percent of the homeless in the country are mental patients. Funding for mental health care comprises 8 percent of all health care spending, without counting the cost of freeway overpasses and alleyways for housing. A former Surgeon General estimates that 20 percent of the U.S. population has a diagnosable mental disorder.We are not helping these people; we are just turning them out into the street. I could give you a lot of statistics, but the bottom line is that we are doing an abysmal job. A country that can spend $25 billion on a Navy aircraft carrier attack group and $3 billion on a single Air Force bomber and $2 billion a week on a war in Iraq, should be able to provide adequate care for its mentally ill.

Most of the private agencies that help troubled people would collapse without the support of the volunteers that carry the system on their backs. And these groups would disappear without donations from the public. A professionally trained mental health staff is a rare commodity in their world.

Public resources are pitiful. There simply is little there. Social Services Caseworkers manage hundreds and hundreds of cases, under incredible stress and get paid maybe $25,000 a year. The position has an annual turnover rate of 40% in some states. A Psychiatric Social Worker with a master’s degree, who does individual and group counseling, will make between $35,000 and $50,000 a year. Business MBA’s start out today at $92,360.

Most mentally troubled people have little money. Their lives are difficult and they cannot hold down jobs. They have no insurance. There is little publicly funded therapy. The therapeutic profession provides many thousands of hours of gratis consultation to troubled people every year. Many of these patients wait until their problems become critical and then go to the hospital emergency room where they know they will not be refused help. They will then stiff the doctors and the hospital for the cost of their care. It’s a lousy system and it makes physicians angry with poor people.

I write about troubled people as a group, but “they” are not easily identifiable. We start out with the great mass of people in the center and then as we move toward the fringes, we find people who do not conform to the norm. Some of these people we describe as “mentally ill.” The few who are way out on the fringe are identifiable, but what about all the many others who exist in the gray areas? Where you draw the line is a difficult judgment call, even for experienced professionals.

Complicating the assessment is that it is very difficult to know what a mentally troubled person will do. The extreme cases are obvious, but they are the minority. You can take two similarly troubled people and it will extremely difficult to predict how each is going to respond. If therapists had accurate predictors, they would have solved the problem long ago.

For various reasons many of these people will resist voluntarily seeking help. Some are delusional, most of them disconnect from reality in some way or other. Many of them are incapable of assessing their own situation or the risk they pose to themselves or to others. Many of them do not see themselves as a threat or simply do not care. Some of these people are decidedly anti-social and are angry at the world. They react violently even to the idea that they are troubled. If you tried to incarcerate every potentially troublesome person, the task would be monumental. Psychotropic drugs have terrible side effects and many troubled people resist taking drugs for a host of other reasons. And I haven’t even mentioned the related drug and alcohol addiction problems. But, we can help these people, and we can certainly do a much better job than we are today.

Adding complications to an already difficult situation, there are important legal concerns. Even though they are troubled, these people have rights. Our society bends over backward to be certain that a person is not deprived of their rights through error or malice. There is important precedent here. If you consider the abuses of civil rights by the Nazis, the former Soviet Union and today’s Communist China, you have vivid examples of how individual rights need to be carefully protected, lest they be abused for political ends. And if you consider the surveillance of civil rights leaders and liberals by the FBI during J. Edgar Hoover’s tenure, (and heaven only knows what’s going on today under the guise of homeland security!) you begin to realize how fragile these freedoms can be.

What if the decision to incarcerate someone, is wrong? As I said, in many cases it is a very difficult call to make in the first place. And, some mentally ill people are very angry and delusional and have pursued health care professionals physically as well as through the courts. It’s a way to get back at the world they are violently angry at. When there is little legal protection for professionals, they are pressured to not expose themselves to physical harm or to lawsuits. Another problem is that psychiatrists – the people that the courts rely on for diagnoses – are in well trained in medicine, but generally not well trained in psychology.

As a result of the legal and economic considerations, public agencies have adopted the “imminent threat” standard. The imminent threat policy means that only when an individual has expressed a specific intention to harm themselves or others that public agencies can intervene – if someone is available. The policy frankly is both a cop-out and a legitimate response to the lack of funding. It limits the public system’s legal exposure and saves a great deal of taxpayer money.

Once in custody, a person who has been identified as a threat can be detained, usually for no longer than 72 hours. Then, if a psychiatrist determines that incarceration should continue, a hearing is held and a judge can then decide to give control of the person over to the state. It’s a big hammer. Arrested for violent behavior, once a person in the justice system a few states do provide good mental health care.

If a troubled person has fallen off the edge and desperately needs care, unless he or she poses an imminent threat, they get sent to the freeway underpass or back to their room to live in hell. There is no reward in the system for taking a risk on a patient (some do anyway) and there is legal risk. The publicly employed people I know would run the legal risks if they had resources to address the problem. They don’t. If a troubled person gets help it will be either from someone bending the rules, the generosity of an individual therapist or some privately funded organization. This person may be able to get a free bed and a meal, but they will not likely to get the care they need.

The tragic thing is if the patient freezes and dies in some alley or takes their own life, no one will notice, almost no one will care. These people are our lost and silent 51st state. Los Angeles hospitals have dumped their indigent patients on skid row for years, and only recently was this reported.

Young people present a special set of mental health issues. Primary care providers report seeing an increasing number of children and youth with mental health problems, 9% is a commonly used figure. That is higher than the average population. And, there is great difficulty in finding available clinicians to take these cases. We just do not have enough people trained in dealing with adolescent issues. And, frankly for the pittance they are paid, I don’t blame them. Studies consistently show that children with untreated mental disorders are at a higher risk for dropping out of school, committing violence and criminal acts, drug abuse, and suicide.

Just to give you an idea of how bad the situation is, some therapists, undoubtedly in contravention of everything they believe in, have recommended to parents with abusive schizophrenic or bipolar children, that they literally kick the kids out of the house (make them homeless) so that the kids will get arrested, become a part of the criminal justice system, and thereby receive the care that they cannot presently get from social services. It’s that bad out there. How would you fell as a parent, faced with that kind of choice?

School shootings are terrible and painful events. We have had Columbine, Nickel Mines, Santee and now Virginia Tech, (a massacre at Port Huron, Michigan was prevented) and a host of smaller incidents. Did you know that there have been 34 similar school shootings in North America? I am not including every school homicide here – we’ve had 9,000 of those.

An additional dynamic we are beginning to recognize is that with adolescent boys, a synergy can occur from their relationship that gives rise to a “third,” extremely destructive, combined persona. Neither of the boys in the Columbine shootings for example, fit the profile of a school shooter. But together they formed a grotesque, two-headed killing machine that did.

What should we do? Here are a few ideas.

A. Provide a middle step to incarceration. Provide the level of community-based mental health care funding that was originally conceived in community based mental health care (and has never been funded). Set up properly funded mental health centers with real counseling support and a trained professional staff in every community in the country. In addition to voluntary services, require that people referred to the centers (see below) participate. Pay public therapists and staff people a decent wage so that you get first-rate professionals dealing with society’s most troubled citizens.

B. Expand and properly fund the concept of supervised community housing for troubled people.

C. Pay private therapists to provide help for people who need it. Do not bury them in paperwork for doing so. Give therapists the power to refer people to community mental health facilities (“A” above). Require that referred patients attend. Remove the legal onus from therapists for errors of judgment regarding these referrals. Give licensed therapists permission to prescribe medications.

D. Fund non-church related organizations such as the Salvation Army to provide beds for homeless people and counseling assistance.

E. Recertify therapists every three years by boards of their peers.

F. Put some real teeth into gun control laws – especially as it applies to mentally troubled people. Create a national registry of felons, drug dealers and the potentially violent mentally ill who would be prohibited from purchasing or owning guns.

G. Establish T.A.T. (Threat Assessment Teams) in every school and college in the country to identify and funnel help to troubled students. Give teachers and college professors the right to refer students to the mental health centers (“A” above). Provide legal protection for them from lawsuits for such referrals. Return to teachers the right to discipline students for dysfunctional behavior without the fear of being sued by parents.

H. Provide meaningful training for first responders to help them better deal with mentally troubled people.

Will this solve all of the problems identified above? In a word, no, but we can definitely reduce the number of them. I do not believe that it is possible to completely eliminate outbreaks of violence. But, both his teachers and fellow students had repeatedly identified Cho Seung-Hui as a potential problem. Sadly, there was no mechanism to both help him and to protect the community. The system failed miserably to do anything meaningful about a clearly troubled young man, and I will guarantee you that his behavior was identifiable long before recent events. Someone could have caught him, if we had a net. We can most certainly do a great deal better than we have. It would also be a big step towards becoming the kind of compassionate society that we say we would like to have. It is going to cost a lot of money, but I wonder, what is it costing us today in ways that we do not realize?

The question my friends is, what are we willing to do about it?

Ross Bishop

"Wisdom is not gained by knowing the answer; it is gained through the experience of the journey."

Tag Archives: mental illness

Gun Violence

People With Mental Problems