Mental Health


Editorial Comment: This article was written the day after the Uvalde, Texas school shooting. It is merely my attempt to discuss this terrifying societal problem about which I have strong personal feelings. It is not meant to anger anyone or diminish their opinion. Since Uvalde, we have had numerous other incidents, most recently in Highland Park, Illinois. The long, sordid mental health history of the Highland Park shooter further strengthens the opinion shared in this essay, and should be remembered as one man’s professional position.

Uvalde, Sandy Hook, Columbine, Tucson, Buffalo, Waukesha, and on and on. Mass murders occur all too often in the United States. Each incident is unique, but the outcome is always the same—families experience the tragic loss of loved ones and politicians make emphatic pronouncements, but nothing ever changes. Nothing!

There are several constants that exist in nearly all of these tragedies: the perpetrator gave advance warning of his intentions, bullied and threatened other people, posted hateful messages or threats on social media, grew up in a broken or dysfunctional family, and had a history of mental illness. As we recently saw with the Uvalde shooter, a detailed, chilling, and rambling manifesto gave obvious warning of his intent. 

While it’s true most school shooters used a firearm to accomplish mass murder, their weapon did not fire itself. Regardless of whether the weapon was a hand gun, shot gun, rifle, or a “weapon of war,” someone had to take that firearm in their hands, aim it, and fire. Guns represent potential energy—it lies dormant/inactive until that energy is activated by the hands and thoughts of a human being. Until it is used by someone with evil intentions, it is only an object with powerful, dynamic potential. 

The purpose of this article is, first, to state how poorly mental health professionals identify, call out, and treat individuals who indicate they mean harm. I feel they are largely responsible for allowing the current state of unrest in American society. Second, to show how these same mental health professionals are reluctant to impose restrictions on those who threaten harm for fear of retribution. Third, to demonstrate how the entire mental health establishment is to blame for the blasé manner in which they regard those people who outwardly express contempt for society and harm for others. This laissez-faire attitude has resulted in many preventable disasters. Why is it so difficult to isolate people who make overt threats? Why can’t someone who threatens another be questioned about their intentions and be challenged, or even temporarily detained? It’s because the person will cry harassment, discrimination, or denial of their rights, and a civil rights lawyer will bring more harm to the accuser than is ever experienced by the accused. 

Mental health diagnoses have undergone a liberalizing in the past 15 years. Situations that used to be classed as anti-social behavior and demanded a stern, disciplined, and punitive response—mental health hospitalization or incarceration—are now termed aberrant personality disorders. Instead of isolation or incarceration, treatment is directed at trying to understand the behavior and rehabilitating the offender.

The American Psychiatric Association is the organization that governs psychiatrists in the U.S. It is their “labor union.” It’s purpose is to “improve research into all aspects of mental illness, including causes, prevention, and treatment of all psychiatric disorders. To improve psychiatric education and training, and to promote optimal conditions for career and practice satisfaction.” They also compile and publish the Bible of mental illness, the DSM-5. That stands for Diagnostic and Statistical Manual of Mental Disease, the 5th edition. It is the reference manual to which psychiatrists refer to classify patients by diagnosis and treatment. The “5” designates this as the 5th revision completed in 2013. In its 1142 pages, every conceivable mental health disorder is explained and classified. 

This is essentially a manual of mental disorders. If the psychiatrist is uncertain where to classify a patient’s mental illness, the DSM can clarify that uncertainty. They refer to it and use it all the time. In 2013, the DSM-4 (4th edition) was revised and became DSM-5. Mental health professionals tend to be permissive and non-judgemental, which influences their decisions on dogma. So the DSM-5 saw some drastic philosophical changes. Diagnoses that had been classed as anti-social behavior had been re-classed as personality disorders. In other words, the APA “decriminalized” many previously-considered “crimes against one’s fellow man,” and diminished the seriousness of the situation. They seemed to have a less strict interpretation of aberrant behavior and a more dismissive attitude toward punitive restriction. For example, “Psychopathic personality has always been a contentious concept…(it is now called) personality disorder with predominantly asocial or sociopathic manifestations. It means there is a specific category of people inherently committed to antisocial behavior.” By renaming it, the negative stigma was removed, making it appear that behavior wasn’t as big a deal as was previously thought. Attitudes toward serious mental disorders have changed. 

My years in practice were fraught with battles with psychiatrists. Getting them to see a patient was very difficult. There was always an excuse why they couldn’t see them. If they did see them, it was only once then they passed them on to a psychologist for counseling. This was

frequently a waste of time.

Now that mentally ill people inhabit tents and lean-tos on the streets of major cities, and not rooms in state mental hospitals, as long as they defecate and urinate in public, as long as they harass and frighten regular citizens, and as long as the real dangerous individual behavior is dismissed, we will continue to have tragic mass murders. In years past, people with severe mental problems were institutionalized and not allowed to live as they do today. Civil libertarians felt forced residence at a state hospital was denying people of their individual rights; never mind these folks were unable to cope in society. We can’t restrict their freedom of expression and individuality so we’ll let them live on the street instead! This approach is tragic, pathetic, and significantly more harmful to them than being confined to a state-supported mental facility. Hospitalization is the humane thing to do. It improves their physical and mental health and protects innocent children and adults from harm. Two things are accomplished: the anti-social patient is removed from a society in which he cannot cope, and any lethal weapon he/she might possess cannot be an instrument of mass murder. Craziness like Uvalde, Sandy Hook, etc. would then be far less likely.

Dr. G’s Opinion: I’m not a gun owner, and guns scare me to death. I don’t like them and have no desire to have one. However, I would never deny a law-abiding American citizen the right to own a gun(s). It’s guaranteed by the constitution. Millions of people love hunting and skeet shooting, but they aren’t the problem. The emphasis in mass shooting is misplaced; it’s on the car (gun), not the driver (shooter). Instead, it should be on the shooter, the mentally unstable person who makes overt threats that are dismissed or de-emphasized by mental health professionals. It’s unrealistic to think we can eliminate mass shootings altogether, but if mental health professionals respond appropriately to the threatening messages patients send, a  significant reduction can be seen. 

References: Editorial: DSM-5.1 Acta Psychiatr Scand 2016; 134:187-188.

Am Psych Assoc. “The Organization of DSM-5”

Blackburn R. “On Moral Judgements and Personality Disorders” Brit J Psychiatr 2018 Jan 2; 153(4):505-512.

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