Mental Health - The New Boogie Man!

I have contemplated writing and then not writing about this.  To some extent may be I am desensitized, since Dec 2012 when a bunch of elementary school kids went to school to never go home again.  Part of me really went numb that day because it hit so close to home.  As a mother of two very young children living in today's America, my drive from work to school that day was very hazy because I couldn't see through my windshield and it wasn't even raining.  

The pain is very palpable and I remember breaking down inside my car outside their school just thinking about, how I am about to go hug my children and am going to take them home safe and sound, while somewhere in rural America many parents just like myself won't get to do that.  If you are a parent you know what strings that pulls.  You also know what I am referring to because it has happened multiple times after NewTown around schools, malls, temples and college campuses across America.  At the same time the outrage on FaceBook and social media has gradually just dwindled with each incidence after NewTown.  May be people are just numb or may be this is the new way of living in America.  I tend to think losing elementary school children has really just numbed us, especially because they have just died in vain and nothing has changed.  

Memorial day weekend this year, familiar bangs went off in Santa Barbara, again followed by TV and Media coverage, analysis of what went wrong and why and who and when?  Missed opportunity and what nots.  

But the fact of the matter is that there still is no answer for the father who lost his 20 year old because he was in the wrong place at the wrong time.  Because in today's America you cannot be just going about your daily business, without taking the risk of being in a bullet's way.  

And as always focus has gone to mental health.  People talk with conviction because he was seeing a therapist.   Like that is a certain criteria for dx of mental illness.  A NY Times article says it all and is basically the epitome of what the gun control debate has essentially now become.  It starts from mental illness assumptions, to the role of medications in inciting violence without any regard for the possibility of considering that some people, inherently are capable of committing mass crimes just because they want to and can do so easily, given the ease of access to multiple legally bought firearms and arsenal of bullets and rounds.  

Are we really that naive? Am I saying that psychotic/mentally ill people can’t be violent? Of course not.  But I am absolutely going to oppose the definitive "mental illness causality" so to speak.  An acutely psychotic patient for the most part is not sitting around and planning a NewTown, Aurora or Santa Barbara style murder.  There is months of planning, preparation, and vendetta in those plans.  If you have treated even 5 schizophrenic or psychotic patients, you will know that their biggest targets are mostly themselves or people they already know.  Less than 1% of violent crimes are committed by SMI and even less by firearms.  

It is simply irresponsible to punt the blame on mental health or medications and ignoring the fact that antisocial and pathologically narcissistic human beings do exist and are incapable of feeling remorse or regret, in their rage and anger.  By far these mass murderers have willingly chosen to become monsters and have planned and executed their vendetta successfully. Yet we refuse to address the issue of anyone being able to buy multiple weapons and 400+ rounds without being tracked.  Cough syrup purchase is tracked (for good reason) but go ahead and buy arsenal and post You Tube videos, your second amendment protects you.  

I am not saying that a mentally ill mind is not unwell, au contraire it is very unwell.  In fact so unwell that these people can't take care of basic daily life.  Hence the admission criteria "unable to care for self" along with other admission criteria does exist for psychotic patients.

People throw examples of Boston or OKC, while neither of these incidents were carried by psychiatric patients. So while there are incidents carried by other weapons of destruction but to that effect, we do have tracking on simple fertilizer too and really how many people have committed mass devastation using bombs and this regularly?  

The grandiosity SB murderer exhibited is not because he was mentally ill, say psychotic (actively psychotic patients don't have those well-kempt appearances) but there is no room left to consider possibility of his personality, with his sense of entitlement that everyone owed him something because “look at me” and that he saw nothing wrong with his way of thinking.  Or that he is a loner with a twisted disturbed way of thinking who is angry, full of rage and vengeful and is incapable of containing his anger and rage.  

The is no attempt to distinguish disturbed minds from ill minds and at the very core of this debate that needs to be distinguished.  Most disturbed angry people don’t seek treatment nor do they believe they need it and that in itself doesn't make them psychiatric candidates.  They might very well be far off the center of what is socially productive but that alone doesn't justify lumping them with mentally ill individuals because it ignores the basic idea of neutrality and objectivity and essentially allows society to dust off hands from accepting gaping holes in social responsibility towards the common good.   

That takes me to the medication conundrum that is in this mix.  The fact that there are side effects on labels and that they will happen in certain % of people, doesn't trump the fact that for millions of people on these medications for proper indication, do not have those side effects and have their symptoms well under control.  So whether FDA has crossed all the Is and dotted all the Ts doesn't mean that the data supports the warnings.  Hence they are warnings, not contraindications.

I do not deny SE and warnings because I prescribe these drugs but I really do not think that not treating ill people is an option and any warning takes precedence over benefits of treatment, when empirical and final data on harm is open to question at best.  For the most part, regardless of what and why something was prescribed, in majority of these cases these people were not even taking the medication.  My basic point still remains, are we really just so sure that all of these people are just mentally ill?

There is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness. (Fazal 2006)

I quote from the NY Times what I cannot say any better: 

"All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force."

As a provider I am just frustrated with how comfortable as a country we are, with just not doing anything but going after a small group of individuals, who are already not well served anyways.  

Simply focusing on mental health and medications, for something of this magnitude will not solve this problem but really only stigmatize the treatment even more. 
  

How long can we hide behind this boogie man to avoid addressing the real problem of our inability to fight the real fight?