The Invisibility of Mental Illness

A mentally ill man walked into a movie theater with three guns and a tear gas canister.

  • “Ban all the guns!” I hear people say
  • “No, give EVERYONE a gun so someone can shoot him!” I hear others say.

A mentally ill man walked into a movie theater with three guns and a tear canister.

  • “We should restrict the sale of tear gas!” some have said
  • “Tear gas was part of the Founding Fathers’ vision for America!” others haven’t actually said.

A mentally ill man walked into a movie theater with three guns and a tear gas canister.

Why is this a debate about gun control instead of mental health services?

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12 thoughts on “The Invisibility of Mental Illness

  1. For one thing, notwithstanding the inexplicable shooting, there’s nothing to indicate the guy is mentally ill. This contrasts with Jared Loughner, where it was apparent immediately. Spiteful isn’t a mental illness. Yes, there should be far more far money and attention given to mental illness anyway, but let’s not jump to any conclusions about this crime. Mohammed Atta and Kleibold and Harris weren’t mentally ill either. They show the rank heinousness of an act isn’t in itself the results of a psychiatric condition. .

    • Well, I’ll retract this: he was mentally ill, that much has now come out. So, now the discussion is fair. Treatment of mental illness should be better funded and there should and must be better education about it. I’ll add, that becomes especially important when the mentally ill can arm themselves with ease.

  2. “Why is this debate about gun control instead of mental health services?” It’s clear that the two should be inextricably linked to an extent far greater than it is at present. That is the issue here. What is the mental health screening process involved in obtaining a gun license? Why are people not flagged when they buy, say, 6000 rounds of ammunition? Holmes’ mother clearly knew he had issues, as her first response to his arrest was, “You have the right person.” It’s not an either/or issue, it’s both, gun control AND mental health. I would like to know what is involved in the screening process for mental health. No, we don’t know his diagnosis yet, but clearly, had they dug a little deeper into his mental status, this tragedy could have been averted. Pyschotic disorders are not as uncommon as people think, with a prevalence roughly equivalent to that of autism. Schizophrenia alone accounts for 1 in 160. I’m not surprised this tragedy happened, I’m just surprised it doesn’t happen more often.

  3. And quite honestly, I’m seeing much more emphasis on why he was so easily able to purchase an assault rifle and a 100 round magazine so easily. Those were banned until 2004. Even Bloomberg, a big gun control guy, is talking explicitly about the assault rifles and the magazine.

    You will never catch everyone before they snap or act on their delusion. But I see no reason why we need to allow assault rifles and 100 round magazines to be purchased with ease.

    Take a look at this article from Mother Jones, It lists all of the shootings that used high capacity magazines. I for the life of me cannot understand why these should be legal. http://www.motherjones.com/mojo/2011/01/10-mass-shootings-high-capacity-gun-clips

    We don’t talk about the mental illness, as ManFromFred said, because there is nothing to talk about here. To do so, is just making things up.

    And full disclosure. I’m a gun owner, but like to consider myself a reasonable one. I’m no longer a member of the NRA because of their propensity to argue everything with a straw man. “They are coming for our guns!”

  4. Manfromfred, in this case there are actually some indications of him suffering from some kind of psychosis (see for example the comments of the owner of a shooting range whom the shooter contacted repeatedly before the incident: http://www.nytimes.com/2012/07/23/us/online-ammunition-sales-highlighted-by-aurora-shootings.html). But I agree with you in that you do not need to be mentally ill to do something like this. Ideology (including religion) has proven to be more than enough, and having a personality disorder (e.g. being a sociopath) is not the same than having a mental disease (e.g. severe schizophrenia or depression).

    However, I am with Angie here and really happy of somebody finally mentioning the issue. First and foremost, to make things clear only a minuscule fraction of mentally ill people is dangerous or violent. But if you have a large enough portion of mental patients going untreated, you will get the occasional tragedy for sure. And that tragedy will only add to the thousands of individual ones of the mentally ill people who preventably and unnecessarily live miserable lives for not getting adequate medical treatment. I worked at a mental health institution in a European country for a while and it is difficult to convey the difference that medical treatment makes in the life of a mental health patient. It is simply the difference between indescribable suffering and hardship, and a normal, productive and fulfilling life.

    I also think that mental health is the best demonstration of the need for a public universal health system, similar to those in *all* the remaining developed countries. A mentally ill person is the epitome of someone from whom we cannot ask exclusively personal responsibility to get her own health insurance (we are not just talking about the homeless person rambling in that street corner, but also the responsible working relative who cannot leave the patient unsupervised and must buy medicines during the whole life of the patient). Thus the private sector paradigm breaks when we are talking about these patients.

    Secondly, mental patients also exemplify why healthcare is not a merely individual interest, but one affecting the whole community. Leaving moral issues aside (if we do not take care of our sick – if we are not taken care of when we are sick, – who by definition cannot take care of themselves, what is the meaning of community and the point of organizing in institutions at all? But that would be a different debate), when my neighbors’ kid has schizophrenia, it is also my problem and in my own interest that he receives adequate treatment. Another example would be vaccinations and contagious diseases. Sure, I can pay my insurance so that my family gets the vaccines and treated if they catch some form of hepatitis, but it is much better for me if everybody gets the vaccines and are promptly treated before you have an outbreak. Not to mention that, even for those of us with it, health insurance in the US is rather pretend: If you do not have full coverage, you do not really have health insurance. If insured people often get broke when they have a serious disease, you are just paying to avoid bankruptcy from more menial diseases, like a broken leg. And on the way you are making healthcare more expensive for people who cannot afford insured. That’s not how healthcare works in any of the remaining 25 OECD countries.

    Bottom line: I wholeheartedly agree with you, Angie, and cannot understand why, even when the discussion on gun control is also important, the debate never touches these issues when a tragedy like this strikes. Sorry about the exceedingly long post, but this is a subject that really troubles me…

    • On disability from a mental illness myself, yes, the issue concerns me, too. I almost ended up homeless due to it, and still might end up that way in the long run, despite being under treatment.

      However, this guy’s actions seem deliberate, thorough and well-planned, not something delusional psychotics are generally able to maintain over long periods. Their thinking is just too disorganized. Plus, he had no history of mental illness and was able to fly through a background check. Usually with extreme psychotic breaks you can see some hint in hindsight.

      Now, he was close to the peak age for the onset of schizophrenia and bipolar illness, and his mother knew something when she immediately told authorities they had the right guy. However, he was at least rational enough to not talk to police and get a lawyer. That’s not impulsive behavior under stress, something that you’d expect from a psychotic. Moreover, he voluntarily turned himself in and told police his apartment was booby trapped. That shows some degree of afterthought or remorse, perhaps after his point was made, whatever it was. Remember Jared Loughner’s mugshot, his demented grin? No regrets there. No, that usually follows much later.

      He’s highly intelligent and a diligent student, but suddenly, methodically, he began to prepare for this attack four months ago. The obvious question is, what happened then? Unless he starts talking or put something down in writing, I’m afraid we may never know.

      • You make very good points. However, I think that the incoherent ramblings are a very strong clue. On the other hand, I do not think that all psychotic patients have their ability to plan impaired. In any case, we will see as the investigation goes on and we learn more details. Although you are right: we will probably never understand it completely.

        In relation to Angie’s post, David Brooks does mention the subject in an opinion post in today’s NYT: http://www.nytimes.com/2012/07/24/opinion/brooks-more-treatment-programs.html?ref=opinion

        A pretty weak voice in what appears to be a desert, but something is something.

  5. I have the benefit of making this comment after a week and two days after this event. What’s fascinating is how many people, bloggers and commenters jump to conclusions before even a week has passed. A. mental illness seemed likely the following Monday at his arraignment, and B. by Friday we learn that the guy was getting mental health services. So, the question of access to high powered weaponry should still be on the table.

      • Maybe we are reading different things in it, Angie, but I do not see it to contain anything stigmatizing. As I see it, the author is describing a real situation of which many people are not aware. She is using direct narrative for the most part. Note how she does not get into interpretations after describing each of the small episodes. She just describes them. But she is also aware and very explicit about how she is influenced by a subjective component: she is scared of her child and she feels impotent to help him on her own. As I understand it, the piece is about her ability to meet her responsibilities on her own, not about placing any blame or evil on her child’s side.

        I do not think that the message is the mental health patients are dangerous (again, she does not discuss or give any opinion on that part of the article, but just describes specific events without further comment), but rather and very explicitly that both them and their families need professional help, and in the US we are using the penal system as a substitute for proper healthcare.

        If I am pretty passionate about the subject is because I met many people in that situation when I worked at a mental health institution: they simply do not know how to deal with a mentally ill relative, and they are in permanent agony about it. In the rare cases when the patient shows aggressive behaviors, they can get to be truly terrified, as is the case with this person. But in most cases it is their inability to figure out a way of stopping or mitigating the excruciating suffering of their loved one. I have been with people going through very difficult moments. Terminally ill or handicapped relatives, traumatic deaths and all types of personal tragedies (I have that type of job). But I have never witnessed such devastating pain as the one experienced by the families of some mental health patients.

        At the healthcare facility where I worked (in western Europe), most of these patients were treated as outpatients expending most of the day at the facility. The whole treatment was covered by their insurance in the public health system. They did not just get drugs, but received therapy and participated in constant activities, while the effects of the medication were closely monitored.

        And it worked. Mental health medication can work amazingly well, allowing patients to live completely normal and fulfilling lives, but has a huge component of trial and error. Once you find the right medication for a patient (and, in many cases, trained and treated the family), they can go on with their lives and do not need that extra care anymore. But in young people who have just developed the symptoms, it takes a while to find the right medication. So it is extremely important to monitor how they react to the different drugs. Therapy also works wonders with young patients. They need to learn how to deal with their disease and, more often than not, heal old wounds not only in them, but also in their families (the head psychiatrist used to say that most times you needed to treat the family in order to treat the patient). So the average age of the patients was pretty low: most of them were in their early or mid twenties, in the process of learning and finding the right treatment for them.

        The head psychologist there had worked a lot with kids (the subject of her dissertation was early schizophrenia), and she always said that, unlike in adults, psychotherapy does work with severely ill kids, and it is very rewarding working with them because you do get many of them actually cured (i.e. they do not just become chronic patients who can still carry a perfectly normal life, but many kids can actually get their health completely restored, and carry on without medication).

        Bottom line: I think that the main point of the author is that she did not get that kind of help, and cannot imagine how she could get it. I think that the point is relevant in the case of Newtown as the mother of the shooter clearly handled the situation very poorly, and she is getting bitter criticism, after paying with her life for it. But few people have raised the question of how much help and advice did she get to do things differently. Sure, she had insurance and the kid apparently visited several doctors, just as the author’s kid (I am sick of the argument of “oh, he had actually been to a doctor, so healthcare was not part of the problem”). But is that proper healthcare and enough for these cases? If you have read some of my past posts you probably know already that part of my beef is that the healthcare problem in the US is not just about coverage. People who are snug and happy criticizing things like the Affordable Care Act, and claiming that the free market is the best solution because they have insurance, are not aware of how awful and deficient is healthcare in the US compared to other countries.

        What I read in her article is that (1) private insurance in the US is providing very costly and far from appropriate solutions; and (2) what tragedies like Newtown’s demonstrate that it is not just on her own interest that her child receives proper care, but on all of us as a society. She also makes a very cogent argument of we being already paying for it through the penal system, which is not just an inappropriate, but a completely immoral solution.

        Then I probably missed many important points and mishaps with the paper, and you may very likely be right about it having more negative than positive connotations. Plus I ended writing another ridiculously long post. Sorry about that…

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