Saturday, June 8, 2013

Gun Violence and Mental Health

It took public relations genius to make a handful of white schizophrenics the face of American gun violence. And to blame it on the NRA.

Give credit to those who used the massacres at Tucson, Aurora and Newtown to obscure the issue of who is really committing gun violence in America.

New York Mayor Michael Bloomberg has launched a crusade for stricter gun laws, so that all of America can have restrictive gun laws, like his city does..

How’s that working out?

Glad you asked. In New York City last weekend 25 people were shot in 48 hours. 6 people were killed.

Those of us who believe that the gun violence committed by paranoid schizophrenics can best be controlled by committing and treating such patients involuntarily have had their voices drowned out by the drumbeat against the NRA.

The people who wrote the laws allowing paranoid schizophrenics to control their own treatment bear the greatest responsibility for what these poor souls do with their “freedom.”

Given the way mental illness is classified schizophrenics and other psychotics are thrown into the same class as people who are depressed and anxious. Psychiatrists know well that when they are dealing with psychotics they are dealing with a completely different illness, yet the laws do not recognize that individuals suffering from a brain disease cannot exercise judgment about their condition or treatment.

Amazingly, those who are willing to allow schizophrenics run wild insist that they are trying to ensure that these patients willingly get treatment. They are worried that the stigma on mental illness is causing them to turn away from treatment.

In a long and compelling article about the problems families confront when trying to get help for their violent, schizophrenic children, the Wall Street Journal quotes Ira Burnim, a man who runs a foundation that supposedly defends the human rights of psychotics:

Advocates for the mentally ill disagree on how to reconcile the tension between patient rights and public safety. Confidentiality is vital to ensure patients seek treatment, says Ira Burnim of the David L. Bazelon Center for Mental Health Law, a Washington, D.C., advocacy group.

"The current system discourages patients" from seeking care because of the stigma of mental illness, says Mr. Burnim. He argues for a system of "assertive community treatment," in which therapists actively work with patients to help them build the habits needed to stick to their therapy. "The key is everything is done voluntarily, which means the patients buy into the treatment plan," he said.

This is absurd. Given a free choice, most paranoid schizophrenics will refuse treatment because they do not want it. They are afraid that medication will silence their voices and make it more difficult to sustain their delusions. The last thing they are worried about is the stigma attached to mental illness.

To think otherwise is to reveal a profound ignorance about psychosis. You cannot expect voluntary compliance from patients who have no willpower.

When the voice of God tells you to open fire or to jump off the building, you are not thinking about a stigma. You are not thinking about anything: you are obeying the command.

Many psychotics, as the Journal reports, commit horrific crimes. Do you really believe that James Holmes and Adam Lanza were worrying about social stigmas when they opened fire? Did they care about being ostracized by polite society?

Another set of laws makes it impossible for physicians to discuss a patient’s case with the patient’s parents. In the state of Pennsylvania the child gains the right to privacy when he is 14.

The Journal recounts the case of a paranoid schizophrenic named Matthew Milam. I quote it at length because it offers a picture of sides of the debate that no one ever mentions.

Surely, it is true that science has made significant advances in discovering medication to treat schizophrenia. And yet, when you allow the patient the choice of whether or not he is going to take his medication, it does not much matter how effective the medication is. 

Second, most discussions of mental health care assume that qualified and credentialed medical professionals are all doing a great job. After all, doesn’t the credentialing process guarantee it?

In the case of Matthew Milam some psychiatrists knew what was happening. Some did not get it. Those who were empowered to release the young man from a treatment facility were apparently oblivious to the reality of his condition:

 Milam, a businessman in Harahan, La., said his son grappled with mental illness from adolescence. Diagnosed as paranoid and schizophrenic, Matthew Milam, 24, once cut his own throat. Another time he dug a grave for himself in the backyard.

In October 2011 he was admitted to an Ochsner Health System facility in New Orleans and discharged eight days later—over the protests of his father, who assembled signed affidavits attesting to his son's behavior. Matthew Milam's longtime psychiatrist, Milton Anderson, who worked at the same facility, had written in reports that the young man was "a very high risk for suicide or other bad outcomes."

Pat Milam says he hand-delivered the documents to the doctors. "I didn't want them to say, 'We didn't understand you thought he was that dangerous,' " he said.

Citing HIPAA, the staff wouldn't discuss his son's treatment, Pat Milam said.

What Mr. Milam didn't know: Professionals at the facility had noted "several days of escalating homicidal and suicidal ideation." One nurse noted that Matthew Milam had "a suicide plan." The notations were in documents Mr. Milam by law couldn't access.

Nevertheless, doctors concluded Matthew was improving and could be discharged. According to treatment records later released to the family, the young man said he wasn't suicidal. Doctors thought he would stick to his treatment, Mr. Milam said.

The family brought him home. On Oct. 21, Pat Milam said his son offered to fix him eggs for breakfast, then went to his room. When his mother looked in on him, he was sitting in the closet. Pat Milam was about to call the police when he heard the explosion.

According to police reports, the young man had attached a shotgun shell to a 12-inch piece of steel pipe. He put it in his mouth and lighted a fuse attached to the shell through small holes he drilled.


Bob said...

I agree, and have excerpted your post here:

Stuart Schneiderman said...

Thank you, Bob.