It’s going to happen again with the same reaction by the media. Maybe we will wake up tomorrow morning and see the report in our morning newspaper; maybe we will hear about it from a coworker at lunchtime; or it will be the lead story of the evening news. Mass murder. Mentally Ill Man. The words will be slung together and dished out to a public which has been bred to believe that mental illness and violence are strongly correlated. Politicians, doctors, family members, and activists will devise plans to cope with the problem. It happened with the Virginia Tech shootings, it happened with the recent Germanwings crash. Autism, bipolar disorder, depression, and schizophrenia have all been implicated at one time or another. The mentally ill cannot be trusted, goes the drumbeat. Schizophrenics and bipolars are killers.
Statistics show that about 3% of the mentally ill are violent. We are ten times more likely to be the victims of violent crime than perpetrators. Yet when we are portrayed on television or the movies, sixty percent of the depictions commit crimes, especially violence. So coupled with the way news outlets spin stories about mass murder, the general public believes that we are ax murderers and serial killers.
Some reformers use this fear to drive some very specific agendas, namely destruction of our rights to privacy, forced medication, and the resurrection of mental hospitals. The objective is to control the mentally ill. They might argue that this is the best we can get in a society with our values, but that is a weak defense of some very problematic and questionable policy changes.
Let’s take the first: A bill proposed by Representative Tim Murphy, a former therapist, would erode our HIPAA privacy. Caregivers — those family members who pay for our treatment — would be able to join us when we visit the psychiatrist and have access to our records. This sounds harmless on the surface, but advocates for Murphy’s Law ignore why we are entitled to that privacy in the first place. What if our caregivers are abusing us? Psychiatrists are required by law to report such incidents in many states. The presence of the abuser might well prevent a mentally ill victim from confiding in his psychiatrist. Or, if they found out that the patient had been telling the psychiatrist, they might well end the revealing patient-doctor relationship. NAMI for years told its members that there was no relationship between child abuse and mental illness; recent studies have reported otherwise, however. Emotional abuse is supposed to be especially damaging.
Susan Sheehan’s Is There No Place on Earth for Me? tells the story of one “Sylvia Frumkin” who went in and out of mental hospitals back in the early eighties. What impresses the reader is that not only were conditions in mental hospitals bad, but when Sylvia went home, she was tormented by her family. Round the spiral she went until she was back inside. These family members are the people to who Murphy’s Law will hand over the patient files. Given the newly understood connection between mental illness and abuse, one must ask how many victims of incest, family violence, and emotional abuse will find themselves unable to escape the people who horrendously overstimulated them in the first place? That Murphy and his minions brush this off as insignificant is troubling. Murphy’s Law contains no protections against this kind of abuse. The old, discredited notion that the family is always right — pushed by the public’s fear of those of us who live with mental illness — drives this bill, which they feel must be enacted despite the costs to the individual.
Actual cases of people who are violent in episode are rare when compared to the perpetrators of crime at large, but they do exist. I know of a few individuals who absolutely need to take their meds because of their brutal tendencies in mania. Medication helps most of these, but not all because homicidal thoughts are complex patterns that have many causes beyond mental illness. The violent among us often have normal siblings who are violent, too. So is the cause really mental illness? Many of us have thought aggressive thoughts but done nothing to realize them just as the thought of suicide passes through our brains from time to time without action on our parts. Psychiatrists have a hard time telling which of us are going to follow through and which of us are just spouting. So when do we forcibly medicate? The case of a woman in a demonic mania who hit her mother with a baseball bat seems clear enough, but do we also force those who have merely professed to their therapists and psychiatrists to take meds even though statistics show they won’t act on it? The extremists who are motivated by the massacres perpetrated by Seung-Hui Cho and Andreas Lubitz — to name two — say yes.
What do I think the real effect of this would be? An erosion of the doctor-patient relationship is the chief victim. Who would tell his doctor that such phantoms were hectoring him? I speak from personal experience when I say that imagining beating or killing anyone frightens the hell out of you. You don’t want to carry things through as much as you want to stop the thinking. Suicide is a bigger risk than homicide in these instances. My psychiatrist trusts me and I have not let her down. Neither of us would want the State coming in to supervise my treatment because of a symptom that probably will not manifest itself in the world. Do I deserve the extra pain of being a certified pariah and thought criminal because of my disease? Do the actions of a few (a handful out of millions) justify these Orwellian steps?
The simplest, most complete, and reasonable answer is No.
Reviving mental institutions is another idea that the media-frightened propose. The best of proponents believe that these are the best way to deal with the problem of homelessness and jails crowded with the poor mentally ill. They believe — beyond all reason and experience — that somehow these will be better places than jails, that they will be administered wisely and judiciously. But talk about what protections need to be in place to protect the patients and they will deny that there can be any problems along this line or dodge the subject entirely.
The 1963 Community Mental Health Act aimed to free patients who didn’t need to spend the rest of their lives in mental hospitals. The Act is one of America’s most noble failures, not because it was structurally flawed, but because it was never carried through. The closure of hundreds of antiquated and barbaric institutions was a good result, but the local support centers funded by NIH grants never materialized because of poor funding. Lithium, I like to tell people, let us go home and live full lives as members of the community — as long as we kept our mouths shut — but once we were there, all kinds of economic discouragements arose and some of us found ourselves on the streets. People commit crimes so that they will get the medications they need for their illness. Does this call for mental hospitals? No, it demands that we realize all the promises of the CMHA. You just can’t go cheap on these solutions.
These proposals all have one thing in common: they depend on stigma. I saw one of the leaders in the movement to adopt Murphy’s Law suggest to a group of activists that maybe we should stop talking about stigma entirely! He reasoned that African Americans don’t talk about it (hey, what is racism?), that it detracts from our real objectives. Stopping the discussion about stigma, of course, has several implications. First, it wrests control of the mental health advocacy movement away from patients — the ones who know better than anyone else what it is like to live with a mental illness — and their concerns. Second, it obscures the actual connections between mental illness and crime. We get to leave that job — completely unquestioned — to the mainstream media which, as we know, has done such a bang-up job reporting the truth. Third, we make the mentally ill into unemployable victims who even if properly medicated cannot find a job. So where are they to go? Gee, how about reopening mental hospitals where we can turn them into slave labor and permanent recipients of the public dole? While we are at it, let’s privatize it! Fourth, stigma creates uncomfortable work environments. How are we supposed to feel when we go to the water cooler and our coworkers are talking about how people like us should be locked up? Who would dare speak up? Who needs that stress? Fifth, it gives the impression that there nothing is to be done except drastic measures. I’ve mentioned a few above. Cop shootings are another dimension. Not only do they do it, but as in the case of the cops who beat a Fullerton schizophrenic man to death, they get away with it because juries have been brainwashed to believe that the mere fact that someone is mentally ill makes them a danger that can only be dealt with by the use of extreme force. Sixth, it puts the blame for violence on the shoulders of the mentally ill when the overwhelming number of crimes are committed by people who are not mentally ill! Studies show, as I mentioned, that the unafflicted siblings of violent schizophrenics are just as dangerous! This points to a family dynamic rather than mental illness. And everyone knows how the NRA has disingenuously scapegoated us to blind the American public to the dangers of unregulated guns. I am sure my readers can come up with other things that can, do, and will happen if stigma is not challenged.
Patients and caregivers do have some common agendas. We both want to see care given to those who aren’t getting it. We want to end the use of jails as alternative mental hospitals. We want decent health insurance benefits for those living with mental illness. But the proposals I have enumerated all stress control where I stress empowerment. Murphy’s Law does absolutely nothing except move some bureaucracies around, strong arm states into creating forced treatment programs, and erode HIPAA rights. Our emphasis mustn’t be on “families in crisis” but on people in crisis — the ones who are actually sick. The proposed bill is a lazy approach to mental health that does nothing to give the homeless access to health care, debt-free education, jobs, housing, or comprehensive health insurance that doesn’t disappear when they lose their jobs and their savings. The proposed law will do nothing to get people off the streets or take care of those who are most severely stricken. It is a worthless, political bill; and it disturbs me that so many mental health activists have been duped into supporting it.
The hockey mask prevents the public from seeing our true faces. Instead of joining the throng when a spectacular crime is reported, we need to speak up about stigma and the ineffectiveness of the services we are offered every day of our lives. We can’t stand by and let our state and federal governments go cheap because they don’t think our votes are worth courting. 2.2 million Americans live with bipolar disorder alone. That’s a voting bloc that can turn a close election if we unite. We are our own best poster children. Talk about your life and its hardships. That is the true way to reform.
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