State of Denial: Wishful Thinking vs. Common Sense

In last month’s post about untreated mental illness, I wondered how long it would be before the next predictable tragedy happened.  Now we have the answer:  two weeks.

John Zawahri, mass shooting, Santa Monica shooting

John Zawahri

We don’t yet know the reason why John Zawahri put on body armor, then picked up several guns and a lot of ammunition to go on a shooting rampage in Santa Monica, CA.  He might have been a home-grown terrorist but terrorists don’t typically start out by killing their own family members.  That behavior is more often found in the severely mentally ill who have become dangerous to themselves and others.   One law enforcement source said of Zawahri that, “he had suffered mental health issues and was hospitalized a few years ago after allegedly talking about harming someone.”

That happened on Thursday of last week.  The next day, an article by Gary Fields appeared in The Wall Street journal entitled, “Families of Violent Patients: ‘We’re Locked Out’ of Care.”  It focuses on the dilemma of parents who want to help their mentally ill children but are prevented from doing so once those children reach adulthood.  Those families, who know the young people best, and who have the strongest motivation for doing anything they can to help, are held at arm’s length by privacy restrictions in the Health Insurance Portability and Accountability Act (HIPAA).   In Pennsylvania, the age of majority is set at 14, so an eighth grader is considered an adult.

Voluntary Treatment

In reading about the mentally ill, I see assertions from mental health experts that treatment and commitment should be voluntary.  In @WSJ, Mr. Fields quotes Ira Burnim of the Bazelton Center for Mental Health, an advocacy group in Washington D.C.   “Mr. Burnim argues for a system of ‘assertive community treatment’ in which therapists work with patients to help them build the habits needed to stick to their therapy.”  Mr. Burnim thinks it’s essential for everything to be done voluntarily, “which means the patients buy into the treatment plan.”

An article in the June issue of @MotherJonesby Mac McClelland entitled, “Schizophrenic. Killer. My Cousin,” repeats this theme.  Ms. McClelland quotes Cindy Gyori, executive director of Hyde Street Community Services, a mental-health center in San Francisco.  Ms. Gyori thinks that mentally ill people “should be able to do whatever they choose until they’re a danger—just like non-mentally ill people.  She finds involuntary treatment laws “stupid,” even though studies show that they “decrease the rates of violence and hospitalization and incarceration among severely mentally ill patients.”

To me, this approach is the triumph of wishful thinking—and the denial of stark reality—over simple common sense.  The National Association of Mental Illness defines the condition thusly, “Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.”

Just Two Questions

As a layperson, I have two questions:

Brain Mapping, brain function, brain physiology

Brain Mapping

Question #1:  How does anyone, even a psychiatrist or other mental-health professional, know when a mentally-ill person becomes a danger?  No psychiatric tests exist to tell us this.  While we can map the physiological brain and tell what parts of it are active, we can’t decipher the thought processes going on inside it.  In the body we can check cholesterol levels, sugar levels, or blood pressure to determine when they are dangerously high.  But there is no way to tell precisely when the voices a schizophrenic hears have flipped from saying benign things to telling a young man he needs to kill.

Question #2:  How can a person who is demented, delusional or irrational make logical and rational decisions about his or her own treatment?  Mr. Burnim expects deranged patients to buy into a treatment plan and develop regular habits for treatment, even though by definition they have a diminished capacity to do so.  Ms. Gyori thinks that mentally-ill people can make rational choices despite the fact that their thinking is disrupted.  Mental illness means that they are not necessarily rational or in control of their thought processes.

grieving man, mass shooting, predictable tragedy

Predictable Tragedy

These attitudes on the part of lawmakers and mental-health professionals are the height of denial and innocent people are paying the price for it.  Loving families, the first line of support for the mentally ill, cannot get information about their child’s condition, treatment, medication, or status.  Without authorization, they cannot even pick up their child’s medications.  Given the severely reduced funding and lack of resources for the mentally ill in the United States, this makes no sense at all.

A National State of Denial

As I said last month, we are in a national state of denial.  We don’t want to admit that friends, neighbors, co-workers, business leaders, or family members might have mental problems.  We don’t want to pay for the resources to treat the ones who clearly do.  We don’t want to admit that mentally-ill people can’t be relied on to make good choices about their own treatment.  And we don’t allow families to step in and help to keep their own kids on medication or a treatment plan. 

Does this make any sense?  This week we can ask that question of the victims’ families in Santa Monica, just as we might have asked it of grieving families in Newtown CT, Aurora CO, and Tucson AZ.  Where will we ask it when the next predictable tragedy happens?