Bipolar 2 From Inside and Out

Posts tagged ‘funding’

Murder and Mental Illness

Murder is associated in the public mind with brain illnesses, particularly schizophrenia, bipolar disorder, and PTSD. David Hogg, anti-gun activist and mass shooting survivor has a lot to say about the topic: “If you believe it’s mental illness, call your reps and ask that they fund mental h[ealth] programs in our schools and communities. I don’t agree it’s mental illness that causes these shootings But we do need more funding for mental health programs to reduce the growing rate of suicide.”

Hogg has said that systemic poverty, race, and hatred are bigger motivators of mass shootings than mental illness. He also notes, “I do think it’s important to note the shooter at my high school had tons of mental health stuff. From my understanding, … there were school psychologists, there were therapists, there were all these different things involved. And I don’t think one more therapist would have made the difference for him. We need to put our politics aside, and get something done.”

The assassination attempt on former President Trump has stirred up the debate again. The assumption that mental illness is the cause of public acts of violence persists. The usual suspects include bullying, psychotropic medication, and social isolation. There have also been a lot of conspiracy theories and blame tossed around. It was Democrats. It was a “false flag” operation. It was staged. It was a foreign plot. The injury was minor. The injury almost took his life. (There may well be more I haven’t heard.)

I fully expect the mental illness hue and cry to start. In fact, it’s already begun. There have been reports that Thomas Crooks sought information on major depressive disorder and was bullied at school. (He was 20 years old when he fired at Trump. Apparently, he committed no violence while at school.) I stress that these are not facts. They have only been reported in the media and tempered by the term “allegedly.”

Personally, I don’t accept such reports at face value. Media reports in the aftermath of a shooting have so often turned out to be unwarranted, misguided, or premature. I prefer to wait for more reliable, less heated reporting that comes from official sources who have actual knowledge of the situation.

I will say that major depressive disorder is a disorder that leads to violence against oneself rather than others. Even if the Crooks did have it (not proven), it seems unlikely that it was a factor in the incident. Depression more often results in suicidal ideation or attempted or completed suicide than in homicide. That he might have been seeking “suicide by cop” is even more unsupported so far and probably unknowable.

It may be true that Crooks had a mental illness, but we don’t know that yet—if we ever will—and there are other possible explanations for his actions, including garden-variety hatred, violent extremism, and political motivation.

What I do think we know is that mental illness will once again be assumed to be the cause by both the public at large and the media. They may even find some psychological “experts” who never met Crooks and never treated him to expound on his diagnosis or motivation in media interviews. That’s usually the course these things follow. Lilliana Mason, a political scientist at Johns Hopkins University, said today, “It sounds like he was relatively isolated and troubled, sad and looking for attention.”

I also firmly believe that this incident will make no difference whatsoever in the debate on gun control. And if mental illness is the cause, it will be acknowledged as a Bad Thing but will not result in any initiative that would provide funding for better care of those with SMI. A massive tut-tut and a hearty shrug are about all I expect.

I’d love to be proved wrong.

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Mental Health

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Mental-Illness-and-Drug-Abuse

One thing I’ve noticed about all the political rhetoric about plans to deal with mental illness is that they always lump it in with drug abuse. Like the two were the same thing. Like the solutions are the same. Like the causes are the same. Like the two are somehow related.

It’s true that many people with mental illness have substance abuse issues. And lots of drug abusers also have mental disorders. But people with varicose veins also have acid reflux. That doesn’t mean they’re related.

Of course there are similarities. Drug abuse seems to be controlled by the pleasure or addiction centers of the brain. And mental illness has to do with a malfunctioning brain. But just because the same organ is affected doesn’t mean the causes – or the treatments – are related. The causes and treatments for the lung ailments cystic fibrosis and asthma are not the same.

The various conditions that we call mental illness may be centered in the brain, but we’re a long way from knowing exactly where. Serotonin receptors? Maybe. Other neurotransmitters? Possibly. Drug treatment seems to work by trial and error, at least in my experience. Every time I’ve asked a psychiatrist how a psychotropic medication works, the answer is invariably “We don’t know.”

Treating drug abuse with other drugs is counterintuitive. Besides, it largely doesn’t work. Antabuse merely makes alcoholics so sick when they drink that they prefer to remain sober. Narcan can pull an opioid abuser back from an overdose, but it does nothing to prevent the next one. And methadone has its problems as well, especially since it’s an opioid too.

Many people break the chains of alcohol or drug addiction with the help of 12-step groups. Such groups have no effect on serious mental illness. Even therapy groups have limited results with people who suffer from psychiatric brain disorders. Support groups can help some of them cope with the problems associated with mental illness, such as loneliness, frustration, fear, and, well, lack of support. But healing is a hard thing to come by, and seldom is found in a circle of people with similar severe psychiatric conditions.

Part of the 12-step approach to addictions is surrender to a Higher Power – not technically the Judeo-Christian God, but the functional equivalent for most. God has not proven to be a reliable cure for mental illness, though of course prayer can help sufferers deal with their suffering and find comfort amid their troubles.

So why do politicians make the assumption that what will be good for one condition will be equally effective for the others? That funding directed at mental health problems and drug abuse can be used for the same types of treatments and treatment centers? Admittedly, politicians are not generally well educated about either mental illness or drug addiction. That’s why they have advisors, who should be able to explain the differences and the nuances to them. And that’s why there are organizations with members who have studied the problems – or who struggle with the conditions themselves – who can inform those who control the pursestrings as well as the general public about what is needed.

It’s convenient to want to deal with mental illness and drug addiction in the same way. Treatment centers, hospital beds, and halfway houses may play a part in dealing with both problems. But hospital beds for detoxing, for example, are different from hospital beds needed for those with serious mental illnesses such as schizophrenia or psychosis, which may necessitate a long, difficult stay.

This is not the place to discuss involuntary commitment or AOT (assisted outpatient treatment, also called “outpatient commitment,” a form of involuntary treatment in the community) for severe mental illness, except to say that involuntary commitment is not an option applied to drug abusers, however much the conditions are conflated. They are complicated issues, and ones that I am not qualified to speak to.

But until we can convince people, and especially those who pull the political strings, that alcoholism, drug abuse, and mental illness are separate subjects that need different kinds of attention and support, we won’t make sufficient progress on either problem.

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Mental Health

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