This post is not like any other post I’ve written.
I feel the need to respond to the Tucson AZ chapter of an ongoing American tragedy. I’ve been waiting for my feelings and thoughts to settle down a bit before I responded because I needed some time to think through what happened and put it into a context that makes sense to me. It’s very hard to do since much of what is being discussed in the media about it doesn’t make too much sense to me.
Not to belittle the traumatic and senseless loss of life from yet another mass murder by an untreated severely mentally ill person, but the predictable 24/7 media carousel that horrific events such as these generate is disgusting and intolerable.
The issues surrounding the killing spree that are thrown out to us from our many screens, if we choose to watch or listen, focus mostly on all the sources of blame for the tragedy: the hateful political climate, right wingers, left wingers, schools, parents, guns, public apathy, inadequate involuntary commitment and treatment laws, among others.
Hidden in there somewhere is an American tragedy affecting millions of us, but seemingly few want to acknowledge. The public’s ignorance about mental illness in general, how violence is associated with mental illness specifically, and the shame and stigma associated with mental illness and mental health treatment—directly contributes to the lack of appropriate treatment that would lower the likelihood for many vulnerable mentally ill people to commit these crimes.
This tragedy goes ignored, so unfortunately attacks like the one in Tucson occur on a fairly regular basis in the United States in a variety of public, private, and corporate settings and across varying political climates throughout our country’s history.
A commentary I read by Paul Heroux in the Philadelphia Inquirer this week helped put the tragedy in perspective for me. He verbalizes what I see as a blazing red neon warning sign, but what few people fail to recognize as a constant in these tragedies when he says “How much we know about mental illness can tell us how prepared we are to deal with [such attacks]”. We’re never prepared because the issues of mental illness and its treatment are virtually ignored by those in control to make changes.
He also discusses the recent issue of the Harvard Mental Health Letter (HMHL) that reviews the various factors that contribute to violent behavior in the mentally ill. According to the HMHL, those with schizophrenia or bipolar disorder are three to four times more likely to be violent if they also have a substance abuse problem. In addition to substance abuse, Heroux explains, “genetic and environmental factors, such as poverty and early exposure to violence, have also been found to be partly responsible for violent behavior”.
Since substance abuse is a trigger for violence in the mentally ill, research cited by the HMHL suggests, “adequate treatment of mental illness and substance abuse may reduce violence”. It also recommends long-term interventions including a variety of treatment approaches including cognitive-behavioral therapy, conflict management and drug and alcohol treatment.
Events like Tucson are especially painful for those like myself who provide treatment and counseling for the tens of millions of Americans with mental illness and drug and alcohol problems. The woefully inadequate resources and thoroughly broken system within which we try to work to take care of these people is often overwhelming and disheartening.
I’m actually a fan of the principle of managed care, which can be an effective tool for managing healthcare costs. In the United States today however, managed care is a euphemism for a system designed to ignore, neglect and abandon people with the chronic illnesses of schizophrenia, depression, and addiction.
Sadly, the trend is towards eliminating and restricting care. For the past several years, I’ve seen more and more people in my practice whose employers no longer choose to pay for health insurance that includes mental heath care. The people with more serious mental health issues will fall through the cracks, creating more Tucsons.
I’ve written elsewhere on my PARC blog about the need to continually educate and inform people about what mental health problems are and what treatment is, in order to help lower the ignorance quotient that keeps the stigma barriers so high. I’m hopeful that maybe this time (or the next time?) the powers that be will start to address the power of stigma that fuels the tragedy to continue.