Mental Health - The New Old Boogie Man Part 3 & Counting

Here we go again.  two more shootings this weekend, more loss of life and more empty promises.  I don't know why I keep writing these posts because it's so futile to look back to 2012, 2014 and realize that what I wrote then, can verbatim be applied to each subsequent post and to this one and will probably continue.  So I won't repeat.   

I said here "United States doesn't have a monopoly on mental illness but it seems like we definitely are the worst in using mental illness as a scapegoat.  Please help me understand what sort of unique "mental illness" is so prevalent in this country that we have over 30,000 firearm deaths every year and more mass shootings than any other developed country in the world?"  My stance hasn't changed and the common denominator of gun access is still true.  

My hope lost it's light when kindergartners died in this country and nothing changed.  I remember my heart exploding with pain and despair driving to pick my children from daycare on that day.  No rain was falling from the sky but my windshield was clouded.  There are very few instances in my life, where the pain is etched so deep in my heart, that years later I still vividly feel it.  This is one of those.  

As a psychiatrist, I am a master at necessary ambivalence but sending my children to school every day, thinking of my children moving on to high school, college, being in theaters, malls, grocery stores, places of worship and trying to grow up in general, is more than just necessary ambivalence.  I now realize that all of us are just daily taking the risk knowingly because we can't just be locked in our homes.  This isn't ambivalence anymore, it's learned helplessness.  I can no longer just hush my nagging head.  It gets worst when I hear politicians talk about mental health, God and thoughts and prayers, every single time.  It doesn't do anything for my anguish when the words continue to sound hollow and the feeling of everyone being sitting ducks, doesn't abate.  

Every shooting is the "worst one in US history" since the last one.  Every shooting happens where "we never thought" it would happen here and it's beyond my cognitive reserve to make sense of the repeated De Ja Vu.  

Whatever these politicians think the reason for over 200 mass shootings and over 1100 Americans being hurt since the beginning of this year is, I am done worrying about those reasons/justifications.  Whatever boogieman it takes for them to not feel like they are betraying their sponsors, I don't care anymore.  For these people, facts don't matter, numbers don't change selfish agendas, and the cowardice is astounding.  

Our children are braver than the politicians, as they suffer through active shooter drills and get repeatedly traumatized, but continue to go to school.  But I don't want their bravery to be an excuse for the political cowardice and inaction.  I am disgusted by the continued defamation of psychiatric patients, despite research showing that this is simply not why US has a mass gun violence problem.  But at this point, I don't care.  If the political will to do anything is only going to be mustered on the backs of our children and our patients, it won't be the first time that the real victims of this epidemic will provide a hand out to the begging politicians.  

So I am begging this country's powers to be......DO SOMETHING.  PLEASE!!!!  

Please feel free to stand upon our children's shoulders, our patient's illness BUT DO SOMETHING.  But stop forcing Americans to continue digging graves for their children, wives, fathers, mothers, husbands and neighbors because you are unable to call out evil for what it is, as you stomp on the fresh graves and spew your hollow talking points.  

When will this end?  

Mental Health - The new Boogie Man Part 2

Here we go again.  I have lost count of how many times I have written posts like this.  Exhibit 1, Exhibit 2,  and Exhibit 3 . 
Before I start, let me clear the ground for anyone who would want to jump on me, curse me, threaten me and/or call me names.
 - Mass shootings by people with serious mental illness account for < 1% of annual gun related homicides. (1)
- Patients with serious mental illness count for 3% of violent crimes and even less in gun related violence. (1)
- This Epidemiological Research brings to light complex nature of violence and negates the absurdity of "Mental illness" talking point as a cause and effect, simplistic concept in context of the rampant gun violence problem in the United States.(2)
- According to The National Safety Council's report on the leading causes of death in the United States listed are: 1/370 people under the category of assault with a gun, death by a mass shooting 1/15,325, and accidental death with a gun 1/6904.  All these numbers are higher than the chance of dying by an attack from a foreign terrorist and dying by being in a tornado or cataclysmic storms. (3),(4)
I can keep citing and trust me, I have done my research but I am not the one who needs convincing that guns ARE the problem.
Since the start of the year 2018 multiple gun related incidents have happened across the United States in various schools.  Whether you want to quote the numbers with or without counting the number of children dead or not, is up to you.  Take your pick.  How many is too many? What is your threshold?  What are you comfortable with? Please feel free to pick a number.
But I refuse to play this game anymore.  In May 2014, I wrote this blog post that I would now call, De ja Vu after the Santa Barbara shooting.  Since then, every time a shooting has happened, I have gone back and read it.
How many times I have felt that things are finally turning around? ZERO. And how many times I have felt that we are sinking down, deeper and deeper in this hole....100% of the time.
I am sick and tired of thoughts and prayers, because they don't bring back the dead children but only pander to the sold out, cowardly, selfish politics of our country.
I am refusing to be the next casualty of the economics of the gun industry's bottom line.
I do not want to hear another person telling me that guns don't kill.....because THEY DO.  They are weapons made to KILL and to be used by willing humans, to do exactly what they were made to do.
I am not going to give up my right as a human being, as a mother and as a citizen of this country, to have my children go to school in the morning and to have the 100% expectation of them coming home in the afternoon, like they are supposed to.   Or do you want to tell me that the right to bear arms, is somehow more important than a parent's right to not to have to bury a child, after being sprayed with bullets?
I refuse to be labelled as part of the problem because the sold out politicians have decided to trample on the mentally ill and point the finger, as they simultaneously take money from the gun manufacturers through the NRA, while they slash funding for mental health, public education, safety nets and refuse to do anything about enforcing the gun laws.

The two knee jerk responses; mentally ill and/or over medicated, need to STOP!!!!
Which direction do we go as providers? Because don't we full well know that there are millions of people with particularly violent ways of thinking, that has nothing to do with chronic mental illness and they don't come knocking on our doors to get help with changing their way of thinking?
We are losing our voice in this because the talking points are shaping the public perspective in our direction by lumping every angry, unhappy, disturbed and at times racially motivated individual as "mentally ill"?  Before we know it, this will solely be a mental health problem.
It is our job as physicians, parents and mental health providers to speak up and point out that lumping every disturbed, psychopathic, angry, and criminal person, as a mentally ill patient, actually completely bars congress from doing anything at all.  It's a cowardly cover for the incompetence of our political will.
Why do our patients have to suffer even more, when statistically we know that SMI patients are most dangerous to themselves and to those who intimately take care of them, (when acutely sick) and not just random students or mall goers?
Why do we have to keep making amends with every new shooting, only to repeat the heartache until the next "biggest mass shooting in U.S history"?   Isn't every shooting bigger than the last one?
Why do we not talk about the trauma our first responders are subjected to every shooting, when they witness the carnage of these lethal weapons, used by a "law abiding citizen" who legally bought the gun/guns. tactical gear, magazines?
Why do we keep allowing the peripheral trauma to spread from these weapons to our every day life?
Why do I have to be okay with my young children being terrified of active shooter drills and that this is the norm in their education? Why don't we talk about the generation of traumatized children, who are growing up in this culture of people's right to own such weapons? Why do we keep giving up on their right to live their lives and hopes and dreams of future olympians, doctors, scientist, ballet dancers, cops, teachers?

United States doesn't have a monopoly on mental illness but it seems like we definitely are the worst in using mental illness as an scapegoat.  Please help me understand what sort of unique "mental illness" is so prevalent in this country that we have over 30,000 firearm deaths every year and more mass shootings than any other developed country in the world?

I am sorry but you may need to take a vacation from hunting a deer with an AR-15 and use the good old fashioned hunting rifle along with your hunting skills, because we need to figure this out...NOW!!!
As a psychiatrist who treats SMI patients, I refuse to simply take this excuse that somehow the United States has a more seriously mentally ill population than the rest of the world, and by association, hand off the entire responsibility of the mass massacre culture onto my most vulnerable patients. I will not be an accomplice in making our children a walking target of this epidemic of inaction.  This is not on my profession to fix.  This is not on our children to fix, but this is on us to say ENOUGH!!!

I am here to say, mental illness is NOT evil and EVIL is not mental ILLNESS.  Is that loud and clear enough for us to move on to the actual problem????
When will we be ready?????
When will be the time?????
When will we choose our children?????
When do we start saying and voting #NOTME #NOTMYCHILD ?

1- Gun Violence and Mental Health - APA 2016
2- Swanson, J. W., McGinty, E. E., Fazel, S., & Mays, V. M. (2015). Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Annals of Epidemiology, 25(5), 366–376. http://doi.org/10.1016/j.annepidem.2014.03.004
3- Causes of Death in USA
4- http://www.nsc.org/learn/safety-knowledge/Pages/injury-facts-chart.aspx

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?