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View Diary: Stop Blaming Newtown Tragedy On Mental Illness (301 comments)

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    •  Japan, in fact, has one of the lowest crime rates (45+ / 0-)

      and the lowest gun violence rate, IIRC. And the amount of truly effed up video games, anime and manga that start there and never leave there while still being wildly popular is quite high. While Japan, the Americas and Europe all make a lot of games that have disturbing content for at least somewhat artistic purposes, Japan runs a monopoly on the "there isn't any artistic defense for this" by a loooooooong shot.

      They do have suicide problems, but those are for entirely unrelated reasons.

    •  Not the disease, but perhaps a symptom (6+ / 0-)

      Americans worship violence and death.  Next to sex it's our favorite entertainment.  

    •  Brit, I just want to mention that all of the (0+ / 0-)

      conditions mentioned by Long at the beginning of your article are in the diagnostic and statistical manual (DSM) for mental disorders.  They all have diagnostic and insurance codes.

      Cats are better than therapy, and I'm a therapist.

      by Smoh on Wed Dec 19, 2012 at 07:17:17 AM PST

      [ Parent ]

      •  Autism is not a mental illness (9+ / 0-)'s a learning disability. The other two new disorders are reputedly in DSM-V, but it hasn't been published yet

        The Fall of the House of Murdoch -with Eric Lewis and all the latest Leveson evidence out now!

        by Brit on Wed Dec 19, 2012 at 07:21:07 AM PST

        [ Parent ]

        •  I don't believe Autism was Adam Lanza's problem (14+ / 0-)

          that lead to his violence.

          I do believe he had other psychotic mental disorders.

          We'll have to wait and find out to see.

          Jared Loughner was not diagnosed with schizophrenia until after he was in prison custody and spent a few months on antipsychotics, at which point he recognized what he had done and felt remorse, accepted his guilty verdict.

          Now, they say he developed it in the eleventh grade, but it went unrecognized.

          Adam Lanza may have had Aspergers. From reports, I'm sure he must have. But he may have had other co-morbidities that could explain what happened.

          The pattern of U.S. mass murderers seems to be that these are primarily men in their late teens to early twenties: this is when schizophrenia, and the psychosis which accompanies it, and the violence which accompanies that, first is seen.

          We have no means in place whatsoever in our society if someone near us is, as an adult, displaying signs with a break with reality. Trying to get people help is, because of U.S. laws as well as social stigmas and a hands-off attitude which has been around for several decades due to the deplorable condition of mental health facilities, largely impossible.

          It is incontrovertable that early treatment for schizophrenia has a better prognosis.

          Also, I find the U.S. and the U.K. to have relatively incomparable views about mental health. The U.S. in general has fairly anomolous views because we are such a partisan nation that we can't seem to examine mental health concerns without using the lens of a partisan "don't tread on me" personal rights based Right or a "freedom for all and the right to be who you are above all" based Left.

          I categorically do think the Newtown Tragedy was partially a product of a brewing and mistreated mental health situation that could have been stopped. That doesn't mean I don't think that guns were the vehicle of the tragedy and shouldn't be addressed as well. But I do think that the driver of that vehicle, so to speak, should have received earlier intervention of some sort. And I do believe that the facts will bear this out in time because they will follow the same patterns that other mass murderers have shown.

          The Aspergers part is a simple red herring for a much different mental disorder.

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          by mahakali overdrive on Wed Dec 19, 2012 at 08:22:46 AM PST

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          •  we may not agree often but you are... (6+ / 0-)

            right on here MO. thanks for that comment.

            a lot of times mental illnesses go undiagnosed because either the family and friends don't know what to look for or the stigma is shaming to them.

            not to mention that in this country, health care is expensive and many ins plans - if one is lucky enough to have it - have appt amount limits as well as higher copays.

            what this country needs in addition to a gun discussion is a mental health care discussion. we need to be better educated about it and we need to actively fight the stigma.

            the Aspergers and autism statements many in the media ran with is a red herring, and they ran with it, imo, because even the media isn't educated about mental illness.

            fighting the stigma includes backing folks away from a correlation that all folks with mental illnesses are to be feared. mental illnesses aren't a one size fits all, and in this country they go ignored, untreated, and wildly misunderstood.

            for the author to say to stop blaming the tragedy on mental illness is just as bad as those who are saying it was Aspergers or autism. perhaps instead of blaming anything right now we should be more introspective instead of racing for one diagnosis.

            anyway, great comment MO.

            A) "The administration should be worried about the level of despair here." ~Markos Moulitsas at NN12 B) "Stoking the base’s enthusiasm is part of a campaign’s job, whether or not it thinks it should have to do it." ~Michelle Goldberg

            by poligirl on Wed Dec 19, 2012 at 09:02:41 AM PST

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            •  Thank you, and I agree with your post as well (4+ / 0-)

              I have thought a lot about this, and I feel like if we don't address the issue in full, we could see more people without treatment. I do want to talk about the gun laws we have: clearly I feel these are flawed. I also want to talk about mental illness. I'd like to see it destigmatized because until it is, it will not be properly treated. My particular concern here tends to be schizophrenia, which took my uncle's life and which afflicted his father as well. I am also understandably concerned about other forms of mental illness which predispose people toward violence. That includes violence toward themselves, incidentally. Asperger's is not one of these disorders which I'm referring to: here, I mean primarily thought disorders which can have a wide variety of causes. These are particular issues which are not adequately treated and which are profoundly stigmatized.

              That's due to a simple, factual lack of information and media hyperbole. So education campaigns here could be useful.

              We need to talk about what we can do to fix our problems with America's glaring absence of mental health assistance and aforementioned public education.

              And we need to talk about our nation's gun availability issues and where these are lacking as well; I believe that's a place that the most energy is really focused right now, at least in terms of the national dialogue. Or maybe that's just what it looks like from my reality bubble.

              I'd add that we also need to deal with our antiquated drug laws which clearly didn't factor into the violence at Sandy Hook, but which are another major part of why the U.S. is a violent nation.

              And I'd add that we need a demilitarized police force.

              There's no pat answer. There needs to be careful analysis to avoid losing the window of opportunity for meaningful reforms with the widest impact.

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              by mahakali overdrive on Wed Dec 19, 2012 at 09:18:29 AM PST

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            •  I'd forgotten the delectable... (3+ / 0-)
              Recommended by:
              mahakali overdrive, boriquasi, rubyr

              ...personalised nature of comments on Kos.  

              for the author to say to stop blaming the tragedy on mental illness is just as bad as those who are saying it was Aspergers or autism.
              This is ridiculous and unnecessary as the title of a Priceman diary - an attempt at petty spite at the expense of actually reading up or caring about the issue. I'm not going to engage with people here who are just looking to insult on such an important subject. Consider yourself ignored

              The Fall of the House of Murdoch -with Eric Lewis and all the latest Leveson evidence out now!

              by Brit on Wed Dec 19, 2012 at 09:28:17 AM PST

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              •  frankly, i don't care who the author... (2+ / 0-)
                Recommended by:
                priceman, LaEscapee

                happens to be, i have a problem with the gist of the diary.

                this doesn't have anything to do with personality conflicts here at Dkos; for me it has to do with an issue that is a very important one to me that i have lots and lots of experience with in my extended family as well as with a couple close friends.

                put another way, even if priceman had written this diary, i would have made the same comment. further proof of this not being about Dkos personalities is my agreement with MO, and we don't agree on much, but this is too important an issue to sully with personal personality conflicts.

                if you don't like my criticism of the diary, address that instead of dismissing it wholesale simply because you took it personally. the issue is too important for pettiness.

                A) "The administration should be worried about the level of despair here." ~Markos Moulitsas at NN12 B) "Stoking the base’s enthusiasm is part of a campaign’s job, whether or not it thinks it should have to do it." ~Michelle Goldberg

                by poligirl on Wed Dec 19, 2012 at 10:12:36 AM PST

                [ Parent ]

              •  Didn't see that part of the comment (1+ / 0-)
                Recommended by:

                Rushing -- no glasses -- everyone talking to me in this room. Sorry. That's not appropriate; I agree.

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                by mahakali overdrive on Wed Dec 19, 2012 at 11:43:25 AM PST

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                •  I think I'm just a bit shocked to see... (1+ / 0-)
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         an essay which clearly argues against the stigmatisation of those who have mental health problems, could somehow be construed in the converse

                  The Fall of the House of Murdoch -with Eric Lewis and all the latest Leveson evidence out now!

                  by Brit on Wed Dec 19, 2012 at 12:02:46 PM PST

                  [ Parent ]

                •  so you guys took that personally? (2+ / 0-)
                  Recommended by:
                  priceman, LaEscapee

                  geez. no wonder nothing gets done on mental illness.

                  it was a criticism of the diary. the author wrote the diary. and i do think it's just as bad, not because of who the author is, but because of a lot of the content.

                  you guys have got to be able to separate personality conflicts from actual debate and discussion. apparently i was the only one here who could.

                  sorry to disturb. hope no one ever has to go through the stuff my extended family as well as a couple friends have gone though. it's too important an issue. that's why i put personality conflict aside. why can't you guys?

                  A) "The administration should be worried about the level of despair here." ~Markos Moulitsas at NN12 B) "Stoking the base’s enthusiasm is part of a campaign’s job, whether or not it thinks it should have to do it." ~Michelle Goldberg

                  by poligirl on Wed Dec 19, 2012 at 12:04:25 PM PST

                  [ Parent ]

          •  At this point we're speculating about Lanza's... (2+ / 0-)
            Recommended by:
            mahakali overdrive, rubyr

            ...diagnosis and you're missing my point.

            There is a slightly elevated risk of violence during psychosis, but what is different about Newtown is not America's healthcare services (spending per capita on mental health comparable to Britain) but the access to assault weapons.

            That doesn't mean more shouldn't be spent on mental health, but the professionals I spoke to while writing this piece were appalled by the trite diagnoses and misunderstanding of the likelihood of violence among those with mental illness.

            To confuse these two issues at the moment is to stigmatise those with mental health problems, and deflect away from the glaring immediate cause of the scale of the Newtown massacre

            The Fall of the House of Murdoch -with Eric Lewis and all the latest Leveson evidence out now!

            by Brit on Wed Dec 19, 2012 at 09:25:45 AM PST

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            •  I see your point here (1+ / 0-)
              Recommended by:

              but I have very strong views on mental health in the U.S., first and foremost, and I am going to take this a step further and state expressly that it's not right to use the broad header of "mental health" in this case because that does lead to a stigma. Fault the DSM for this or the Psychiatric industry, but for whatever reason, thought disorders -- including organic thought disorders -- which create disorganized or delusional thinking are lumped in with garden variety issues like generalized anxiety or seasonal depression. I think this is because the United States has stopped attending to a very specific set of psychiatric conditions which require more than just a Prozac prescription and a "see you in six weeks."

              Frankly, the U.S. is terrified of in-patient care for people with thought disorders, and given the gross history of abuse of these facilities and the failure of the 1963 Act to remedy these clinics as was originally meant to happen, followed by Reagan's economic gutting of these services entirely in the 80's, we are not in a good place.

              We have no psychiatric emergency services to speak of. We have a prison system which responds to 911 calls for emergency psych services, three day involuntary holds for anyone who meets a slender set of criterion in decaying facilities which are archaic, and people with psychosis are essentially left without a safety net.

              Now, combine that with a country with lax gun laws.

              And with stigmas against mental illness in general.

              There's a "hand's off" approach. Which is unethical. In Ms. Lanza's case with her son, she could afford to place him into a private facility, but she could not have done so without his consent, which apparently she was legally seeking or had already obtained. I want more on that.

              There's no question about why we have mass murders at the rate that we do. Here, we can look to historical data: undertreated, misdiagnosed, or ignored psychotic-type thought-disorders + mental health social stigma + ease of gun access + societies which value personal freedoms above all else = mass murderers. Something like that. You can move down the line basically from Manson to Klebold and Harris to Loughner to look at this. For whatever reason, I've always found it of interest.

              Granted, these are the outliers. The mass of gun violence occurs in the context of domestic disputes, burgleries, or are drug related. The first two could be disputed to not be premeditated, by and large, and committed by sane people. The latter is probably in a class of its own. The latter two are often interrelated. As I've not a clue how to stop domestic disputes or other interpersonal homicides like those which are "gang related" or happen during bar brawls, those which happen when so-and-so-caught-so-and-so-sleeping-with-so-and-so, I am not able to comment on these. But mass murders, psychosis-related violence, and drug-related violence each have their own sets of answers which would go a long way toward solving them, and guns are only one aspect of each of these. They are, to be clear, an aspect. Ignoring the full spectrum of the problem is deleterious because it really is negligent to do that when these issues are largely preventable.

              It is the outliers which gain the most media attention though, and which often involve the most brutal cases, like killing twenty children in cold blood.

              Stigma only occurs if the media perpetuates this without a counternarrative. While trying to offer mental health solutions, one ought to also support mental health destigmatization efforts AND explain the glaring difference between a kid with Asperger's and someone with a fulminant psychotic breakdown. The public is capable of understanding the difference. Most people are a little mentally ill or know someone who is these days ;) But most people don't know what a break with reality looks like as readily. And it sure doesn't look like it should be treated with a little SSRI.

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              by mahakali overdrive on Wed Dec 19, 2012 at 11:22:13 AM PST

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              •  I also have very strong views on mental health (2+ / 0-)
                Recommended by:
                mahakali overdrive, rubyr

                I spent my adolescence living on the grounds of a psychiatric institution where my mother was the resident social worker. I've know many people with variants of mental illness and personality disorder.

                Like most health care services, there's clearly no doubt that the US needs more accessible mental healthcare. But that is, with all due respect, a distraction from the issue I'm focusing on here.

                To put it bluntly; If mental illness were the key factor in multiple gun homicides, other countries would regularly experience similar acts of carnage. But they don’t.

                The Fall of the House of Murdoch -with Eric Lewis and all the latest Leveson evidence out now!

                by Brit on Wed Dec 19, 2012 at 11:46:09 AM PST

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          •  It's important to recognise IMO (1+ / 0-)
            Recommended by:

            (not that you aren't) that while mental illness is an important factor in some cases of violent behaviour, it's not as though there is an answer out there that the US (or any other country) simply isn't implementing.

            If "addressing mental health issues" was possible, I expect most societies would do it in a heart-beat.

            But, sadly, psychosis is often very resistant to treatment.  And I'd be very unhappy about any society that proactively restricted the liberty of people on the basis of what they might do, on other than very egregious grounds.  Most countries' as mental health laws do allow for compulsory confinement under compelling circumstances, but even that is contentious.  And in any case, statistically,  psychosis is far more likely to render you vulnerable to violence than lead you to perpetrate it.

            So my own (UK biased) position is that it really does come back to opportunity - the availability of the tools of mass slaughter.  There are too many guns in America.  As a result, people who are bent on slaughter are far more likely to find it possible to act on their disordered impulses.  Plus, I suspect that the very frequency of mass shootings in the US itself feeds into the content of those impulses.  Mass shootings are on the regular menu of violence for the deranged imagination in the US, where they remain a la carte elsewhere.


            •  Screening in vulnerable populations (2+ / 0-)
              Recommended by:
              Oldestsonofasailor, Brit

              is one answer which NAMI has proposed.

              Destigmatizing mental illness all around is another.

              Providing resources for society to have on hand if someone they know is psychotic which doesn't involve the prison system or the police.

              Of course psychosis is resistant to treatment. Compliance is one issue. Side effects another. Diagnosis another. And then just a lack of response. I have seen this firsthand. It's less likely to be treatable if a casual approach is taken to treating it.

              I don't have a strong opinion of the UK's mental health (and other medical) services much more than I do the US's. I find both lacking, each in different ways.

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              by mahakali overdrive on Wed Dec 19, 2012 at 11:35:09 AM PST

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              •  But what do you do (0+ / 0-)

                with the results of the screen?

                And yes, compliance is one issue, side effects another, and diagnosis another.  But even someone takes their medication, and finds the side effects tolerable, and the diagnosis is such that the treatment does in fact reduce the symptoms, many patients continue to experience symptoms, including those that are reduced by the medication, and others that simply are not touched by it.

                In other words, we do not have good treatments yet for serious mental illness, even when what we do have is taken and tolerated.  That's only partly the fault of mental health services - it's also simply a reflection of the state of psychiatric neuroscience.

                I hope we are making progress, but there's a long way to go.


                •  The earlier the treatment, the less likely (1+ / 0-)
                  Recommended by:

                  complications ensue.


                  Research into the early course of schizophrenia has identified a prepsychotic prodromal stage (mean duration: 4.8 years) and a psychotic prephase (mean duration: 1.3 years). Comparisons of individually matched samples have demonstrated prodromal symptoms common to schizophrenia and moderate to severe depression. It is not until positive symptoms emerge that psychosis and mood disorders become distinguishable from each other. In both disorders the prodromal stage early produces functional impairment and related social consequences. Hence, early intervention is of great public health relevance. This intervention is targeted at manifest symptoms and not at the underlying, still unknown disease process. Cognitive-behavioural therapy at the prepsychotic prodromal stage seems to favourably influence the short-term illness course. In the psychotic prephase, a combination with low-dose antipsychotics seems to have some efficacy. The aim of early recognition by the instruments discussed in this paper is to permit the identification of the largest possible proportion of at-risk persons as early as possible and their referral to appropriate treatment.


                  NAMI, the National Alliance for the Mentally Ill (a patient advocacy group), advocates early screening for mental health issues as well:

                  They feel it could help destigmatize mental illness and lead to better outcomes for patients and society.


                  Liz Downey is the Executive Director of the National Alliance on Mental Health, or NAMI, a grassroots effort by families to offer services. She says the stigma associated with the disease is the biggest hurdle to overcome.

                  "That's why we don't have the money, it's the stigma. Until you are personally affected by it, you're not going to see a big change," says Downey.

                  ...She proposes children receive mental assessments every year at school just as they get physicals.

                  "We don't want schools diagnosing, but we want to make sure we're covering all the bases," says Downey.


                  "We don't have it today because of the funding," says Downey.

                  Returning to schizophrenia (which is only one of several disorders which can cause problems with psychosis, of course; others could be organic as well)...


                  It was reported by Yale University today that there is more evidence that "Detecting and treating schizophrenia rapidly, following the onset of a first psychotic episode, improves the patients' response to treatment, according to a study by a Yale researcher.


                  "It looks like the longer the period of time before treatment, the worse off the patients are not only when they come into treatment, but how they respond to treatment," McGlashan said.


                  "All factors being equal, early detection efforts will bring people into treatment at lower symptom levels," McGlashan said. "Patients who began treatment earlier tended to be younger, less symptomatic, and more responsive to treatment."

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                  by mahakali overdrive on Wed Dec 19, 2012 at 02:31:53 PM PST

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                  •  Yes indeed (1+ / 0-)
                    Recommended by:
                    mahakali overdrive

                    but none of that means we have it licked, unfortunately, even if early detection screens were optimal.

                    Effect sizes for interventions, even early, remain depressingly small, apart from control of positive symptoms (hallucinations and delusions) by antipsychotic medication, which can be substantial, but even so is rarely complete.

                    But I agree that early detection is important.

        •  There isn't a really clear distinction (1+ / 0-)
          Recommended by:

          between the two.

          Both schizophrenia and autism are developmental disorders.  And not all mental conditions are either illnesses or learning disabilities - they may rather be unusual ways of perceiving the world.   Sometimes that way of perceiving the world gets in the way of interacting with the world effectively, and sometimes it leads to real harm and distress.

          My own heuristic is to regard a condition as an illness if it directly causes distress ("dis-ease") and not if it doesn't.  

          But by that heuristic, both autism and psychosis may sometimes count as illnesses, and both sometimes may not!  But certainly psychosis tends to be the more distress-causing.

      •  The problem with the DSM (2+ / 0-)
        Recommended by:
        Brit, mahakali overdrive

        is that categorizing mental illness, learning disorders and personality disorders is so very difficult.  Half the time it is comparing apples to oranges.  Some DSM diagnoses parallel specific disease processes - schizophrenia, bipolar disorder, etc... Others show a clear link between environment and brain chemistry and function, such as PTSD.  Others describe "hardwiring" problems like autism spectrum disorders.  

        The really difficult ones to get a handle on in terms of etiology, role of environment, and whether there is even actually some disease process are personality disorders, and they are the ones that are most germane to this conversation.  There's some evidence that lack of empathy and extreme anger management problems are inherent and good parenting can only mitigate but not reverse these sorts of personality disorders.  There's other evidence that abuse and neglect can lead to them. It's the lack of empathy and the disregulation of anger, combined with access to guns, that leads to these incidents.  So it is in part a mental health problem, but the discussion needs to be a lot more nuanced than it is.

        Bipolar, schizophrenic and other mentally ill persons are usually non-violent (except in the most tragic situation when a mentally ill person experiences delusional paranoia).  Autism-spectrum individuals are no more likely to be violent than the general population.  But people can have more than one diagnosis.  Can a person with an autism-spectrum disorder also have a personality disorder, a basic lack of empathy and an inability to regulate anger?  Perhaps, but the two problems may have unrelated causes even in the same individual.  We can't dismiss this discussion of mental illness and weaponry as irrelevant, we just need to be very careful with the terms we use, understand that the vast majority of the mentally ill present no risk, and avoid painting with a broad brush especially when it comes to developmental disabilities like autism spectrum disorders.

        “If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin.” Charles Darwin

        by ivorybill on Wed Dec 19, 2012 at 09:22:37 AM PST

        [ Parent ]

    •  Also, I agree with your comment. (3+ / 0-)
      Recommended by:
      Brit, ConfusedSkyes, DoctorWho

      It all comes down to wrong and simplistic cries of "it's the video games", "it's mental health", etc.  guess what?  It's guns and an underlying piece of American culture that demands we be allowed to be cowboys.

      Cats are better than therapy, and I'm a therapist.

      by Smoh on Wed Dec 19, 2012 at 07:19:46 AM PST

      [ Parent ]

    •  Because there is no correlation. (2+ / 0-)
      Recommended by:
      scilicet, Brit

      "blame video games" is a standard NRA talking point, and it's just as much crap as their other talking points.

      "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

      by nosleep4u on Wed Dec 19, 2012 at 08:25:02 AM PST

      [ Parent ]

    •  The data says you're right: (3+ / 0-)
      Recommended by:
      Mistral Wind, Brit, scilicet

      As Ars Technica reports, there is actually a negative correlation between video game consumption and gun-related violence.

      You can tell Monopoly is an old game because there's a luxury tax and rich people can go to jail.

      by Simian on Wed Dec 19, 2012 at 08:46:51 AM PST

      [ Parent ]

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