In my last post I complained about what I perceive to be media’s constant promotion of the crisis of the moment and what that entails. This anger was precipitated by the recent mass murder in Isla Vista Ca. by a UCSB student. But the primary cause of my anger has been the portrayal of the perpetrators of many of these cruel and murderous acts as people who are “mentally ill”. Although it is true that many horrible crimes of this nature are committed by people with mental disorders, the manner in which people with mental disorders are portrayed is mostly terribly misinformed, wildly wrong and/or wholly demeaning.

I have a few caveats which I will reveal here. First, I have a severe and persistent mental disorder. This is a clinical term but in essence it means I have a mental disorder from which there is currently no opportunity to recover. My disorder is luckily being managed with medication. Not everyone is so lucky. This circumstance makes me particularly sensitive to the stigmas and false perceptions people like me are constantly subjected to. It most certainly informs my opinions about this issue.

Second, I want to make it perfectly clear that my comments and conclusions about what is happening are in no way, let me repeat, no way, intended to downplay, deflect attention from, deny or otherwise diminish the very real causal responsibility of persons with mental disorders, in this and many other events of this type. My issue here is not that the people committing these crimes are mentally disordered. It is in the perception of mental health as a whole, of people with mental disorders and the language used in reference to both that informs my expression.

As time passes it becomes more universally accepted that mental disorders are primarily caused by physical dysfunction of the brain. This can be from traumatic brain injury, from chemical imbalances in the brain, from chemical addictions that affect certain areas of the brain, from genetic deficits, and from other factors that influence brain function. However, the cruel distortions of information about mental disorders and those who suffer with them remain alive, often strengthened by the decades of stigmas built from the passing of myths from generation to generation. We also have an unfortunate history of insensitivity regarding how these people have been treated, from having parts of their brains removed surgically to being locked in the attics of shamed families.

Many of the distorted perceptions about mentally disordered people remain with us to this day. All to often when people hear the words “mentally ill” they see a picture of a wild-eyed and violent person who sees demons that tell them to do bad things and who must be constrained and sedated. They are referred to with colorful names such as wacko and sicko and nutjob, batshit crazy and psycho. The truly unfortunate thing is that although these representations have been proven to be overwhelmingly false, the stigmatized perceptions remain strongly entrenched among a majority of the populace.

The even more truly unfortunate thing is that the media reinforces these prejudicial perceptions. Especially damaging is the consistent use of pejorative terms like maniac, lunatic, and madman etc. to refer to a person with a mental disorder. Nowhere is this more clear than in the media discussion that universally occurs when a mass murder is perpetrated by an obviously mentally disordered person. They are routinely referred to as deranged, crazy, insane and demented. The term mentally ill is thrown around haphazardly without any qualifications.

As many of these murders are committed by gunmen the inevitable debate centers on the juxtaposition of our second amendment rights versus the right of innocent people to live without being gunned down by “madmen”. Invariably the question is raised in the media that asks how many undeserving innocents need to be murdered before guns are taken away from “mentally ill” people. Panels of experts discuss how various segments of society need to recognize and act on the “warning signs” and “red flags” of mental illness. It is intimated that if we can just take care of the “problem” of mental illness that somehow magically these terrible incidents will cease. A more plausible problem in all of this is the fact that pro gun rights groups such as the NRA use this “mental health” solution as a way of deflecting scrutiny from the proliferation of guns with the capabilities of massive mayhem, and the easy access to them.

I am under no illusions that citing facts will do much to change the perceptions and judgements of many of the very people who need them to change, but I feel compelled to say something about it. Let me try to give you my take on all this without getting too emotional. And then let me offer some opinions I feel may help address the crucial social issue of the escalating frequency and severity of acts of mass violence.

1. A very small percentage of people with mental disorders are violent and represent a real threat to society. An overwhelming majority of “crazy” people present no threat of harm to anyone.

2. The people we must actually be afraid of are those who demonstrate a real potential to be a danger to themselves and others. These people represent a small percentage of the mentally disordered but comprise a large percentage of those who commit these crimes. It is less difficult to identify these people than many of us think. Mental health professionals can often recognize these tendencies, even in the young.

3. One dangerous segment of the population are those who unreasonably feel persecuted or shunned. Whatever it is that causes their suffering they cannot help but blame others. When the pain becomes too great they lash out at those they feel have wronged them. There are people who have hallucinations that tell them that some person or group of people is responsible for their misery and must be eliminated. But these people are few and far between.

4. A particularly dangerous segment of society are those with severe antisocial personality disorder, more commonly known as sociopaths. These people display little or no compassion for anyone else and are singularly concerned with fulfilling their own desires to the exclusion of everything else. They can be exceedingly dangerous in that they are very intelligent and can conceal the severity of their antisocial tendencies from scrutiny. They can plan and execute elaborate schemes and can elude law enforcement for long periods of time. They can affect any type of personality and behavior they feel will help them accomplish their ends. They normally have complete disdain for anyone who interferes with their selfish goals and have no remorse in removing them as obstacles in any way they find expedient. It is from this sliver of society that I feel many of these so-called “maniacs” come from. Yes, they are severely mentally disturbed. And yes, there desperately needs to be better ways society can identify and address the unhealthy behavior of those with these disorders, the ones who represent a true danger to society. But the remedies are not so readily simple as some would blithely offer.

What can we do?

I do not claim to have the answers but I do have some ideas. We definitely need to be better informed as a society, across the board, about the real nature of mental disorders and those affected by them. We must fight to educate our citizens, especially our youth, about the truth of these chronic disorders. When I describe my own disorder I tell people there is a part of my body that has an imbalance of substances that make me unable to properly process certain chemical reactions. This problem cannot be cured but can be managed by medications that help me live a “normal” life. Younger people usually tell me they are sad my body is broke but glad that the doctors can make it better. They could care less about which part of my body isn’t working like its supposed to. They only care that my life isn’t ruined by it. Adults invariably say “You must have Diabetes”. And Diabetes is similar to Bi-Polar Disorder in those aspects. When I tell those adults that no, it isn’t Diabetes, and they learn the truth many of them give me one of those “Come on don’t mess with me” looks. But they often get a little sheepish when they realize what I am really saying. Mental disorders are primarily chronic physical diseases, as much as Crohn’s Disease or Psoriasis. But they are just not perceived in the same way. These false perceptions must be changed. As with any cycle of misinformation and dysfunction the first cracks and eventual first breaks in the circle are the hardest to realize and are daunting. They must be changed if we are to make any progress in changing hearts and minds.

The rather large elephants, in this case, are the decisions made in the conference rooms of major news to use language that supports the misconceptions and prejudices that surround mental disorders and those who suffer them. As long as people on TV use derogatory language to define mental health and its effects it will be hard to change things. I’m not sure there is a realization that the offensive terminology used to describe people with diagnosed mental disorders is as vile and disgusting as the n word and other pejoratives. There needs to be wholesale sensitivity training for those in the media, training that extends beyond race and gender issues, and also beyond disability issues that are more prominent. If this evolution doesn’t happen the country will continue to be subjected to language that very few people question as inappropriate which perpetuates the misconceptions many Americans have about those of us with chronic mental disorders.

Even when the conversations are not about the mentally disordered, well-meaning adults in the media continue to advance their own, often poorly informed, theories about the why of this violence. They insist that stereotypes such as violent video games and films, suggestive song lyrics, and “politically correct” bans on physical punishment by educators, and the revealing of names and faces of perpetrators are to blame for these murders. While it is true there are correlations between media violence and violent behavior the percentage of youth affected is relatively small and often corresponds with other evidence of violent tendencies in these people. Also, close parental involvement in a child’s life is shown to provide a strong barrier to the deleterious effects of this kind of exposure. So, contrary to the claims of gun advocates, these factors, that are unfortunately broadly accepted, have been shown to have less of a causal relationship to violent crime than has been thought. But they sound quite good in a sound bite, repeated on news broadcasts or in syndicated columns by reporters over and over. For this reason they have found a great deal of traction with the public. Yet even the apparent validity of such proffered causes does not deflect the main focus of blame from the actions of the “lunatics”. Every time there is a mass murder by a “deranged” person the mental health care system is widely discussed, mostly featuring plenty of negativity.

I feel that if we really want to address the sad situation of cultural failure to protect our citizens we will need to venture into some very sensitive areas. As it stands now mental health professionals are only required to reveal personal information about their patients if they break a law. For example, if you tell your therapist that you were depressed because you took heroin they would be compelled to inform the authorities because the use of heroin is illegal. But if you told them you wanted to shoot your mother they would be unable to legally inform law enforcement because of the broad ranging HIPAA law, which protects our health records from being revealed if they are individually identifiable. As with many threats to people’s welfare, law enforcement can only act if a crime has been committed, and not if one is expected or imminent. At this time, in order for us to have any preemptive ability to confront the potential violent actor, the immediate family must get involved. But this raises another example of the stifling effect stigmas have in affecting our ability to help our troubled youth and young adults. Families have responded, out of shame, to the realities of mental health issues within their midst with numb inaction and denial. This familial shame may be even more difficult to overcome than societal prejudices, which are formidable in and of themselves. Also serving as an impediment to the reintroduction of involuntary hospitalization as a viable solution are HIPAA law protections for minors and adolescents over 18. Designed to protect minors from avoiding treatment out of fear of parental reprisals, the law makes it difficult for health professionals to inform families of the fact they find their children potentially dangerous.

So we are left in a position where those who can act are afraid to and those who should act cannot. Those whose job it is to help the disordered have their hands tied when it comes to warning the rest of us. The dangers in allowing mental health professionals to work together with families and law enforcement are real and substantial. The slippery slope argument here is valid. The opportunity for abuse is palpable. The rights of families to protect themselves from intrusion are clear and strong. These factors muddy the waters considerably when we try to make it easier for society to bring those with the potential to harm into the light of day. Without the surety of strong professional medical recommendations to do so, it will be difficult to legislate any effective gun control measures that are not overly broad or ineffectually narrow. And the difficulties in addressing involuntary celibacy are obvious.

It seems that some will do whatever must be done to deny their own complicity in this cancer afflicting our society. The hard fact is, like it or not, that violence is not only an accepted but is the preferred means of conflict resolution in our world. Violence is learned behavior and frankly, an American child learns a great deal about violence well before they ever touch a video game or watch a violent action film. Our young boys learn plenty about misogyny and male privilege at a very young age. When we combine the false legitimacy of violence with guns and hatred for women how can we expect anything other than what we have witnessed. I feel we must accept our own role in creating and nurturing this evil. We must. This is not an easy task. It’s difficult to accept responsibility for such abject horror. But we must.

That the parents of this young man were aware of his danger to society and took measures to provide him with professional help could not prevent his act. That the authorities had interacted with him in a way that should have raised cause for alarm did not result in a good outcome. We feel helpless. Yet we seem not quite willing to do things that help reduce the incidence of these crimes.

There must be some way to make it legal to prevent someone with the inclination to do harm from being allowed to own a firearm without them first committing a crime. Yet there must also be a way to protect that same person’s sensitive health information privacy. There must be a way to involve parents and provide them with resources and help they need to intervene on behalf of their children. At the same time an adolescent must be safe from parental abuse. There must be a way to get all of us to accept our role in making our world as violent as it is.

This is quite obviously not a simple problem and there is no simple solution. I wish I had the answer that will satisfy everyone but I do not. All I know is the continued escalation in severity and frequency of these damaging acts of violence, that tear into the very fabric of our lives, represents a much greater issue than just guns, mental health, or hatred of women. It has to do with who we are as moral beings, as stewards of our children’s civility, as responsible members of society. It certainly is not a partisan matter nor should debate on the issue center on esoteric interpretations of our constitution. Amid all the seemingly endless discussion and the knowledge of the issue’s complexity one simple truth remains.

It’s just really wrong and we need to change it.

Now.