Scapegoating Persons Labelled Mentally Ill: The Politics of Marginalization

Scapegoating is an ancient human practice that probably dates from the time the first human beings decided to circle their huts — what we fondly term the dawn of civilization. When things got tense in the compound, penalties got handed out to one or more individuals or families, those usually at the low end of the pole, the politically powerless or vulnerable. It beat killing one another and rending the social fabric, that thin veneer of civilization.

Americans, despite our vaunted exceptionalism — or maybe consequent to it — have been aces at the practice and have always had a long list of candidates. First, there were native Americans, particularly after the Civil War, when the last politically viable Indian nations were wiped out. If not for them and Custer’s Last Stand, armed hostilities between North and South over Reconstruction might have re-commenced.

Next have been African-Americans, particularly African-American men, from the time of Emancipation, through the Civil Rights era, up to the present. They’ve either been lynched, slapped into prison or left with no work to support their families. I believe close to 25% of all black men in this country are unemployed.

And we’ve always had the poor, made notorious by Reagan as welfare queens and now popularly known as “the takers.” Marginalized folks, rendered extraneous to the political and economic life of the country, their membership in the larger society sacrificed to allow domestic denial of painful realities.

I could go on — suffragists and women’s libbers; gays; Muslims; illegal immigrants. The list has evolved and grown since 9/11, but I’ll stop with the most recent candidates for marginalization, those persons presumed to be mentally ill and excluded from Joe Biden’s list of “… law-abiding responsible Americans [who have the right to] bear arms…” How ironic that folks who are more likely to be victims than perpetrators of violent crimes will now occupy a prominent place in the Federal gun background check data bank.

How foolhardy to think that the bureaucratic measures taken in New York’s SAFE Act — the Secure Ammunition and Firearms Enforcement Act — will prevent those folks at risk to harm themselves or others from doing so. Clinicians, legally bound to report their patients’ innermost thoughts and feelings, will find themselves compromised and tongue-tied. Those of their patients with well-honed survival instincts will simply keep their mouths shut.

Politicians, on the State and Federal level, can now congratulate themselves on actually enacting legislation, no matter how purposeless, rather than languishing in partisan impotence. But who will address the violence at the root of the violence, of the mass murders of innocent persons all across the country? Who will confront the NRA and its sanctimonious notions of popular revolution embodied, its adherents contend, in their sanctified second amendment? Who will confront the American Psychiatric Association and its insistence that psychoactive medications, no matter their toxicity to those prescribed them, are the treatment remedies of choice? And who will confront the Federal Government, which has dragged the country through two pointless and deadly wars, been responsible for the deaths of hundreds of thousands of Iraqis and Afghanis, and left millions of its own citizens unemployed, homeless and desperate?

In short, who will challenge the current trajectory of the American Empire? Ever since Newtown, I’ve been reading every blog post and newspaper article that discusses gun violence. The self-righteous media have been lambasting the NRA and appear to have it on the run; but to borrow a bit of Mark Twainian irony, the reports of its death are greatly exaggerated.

More than half of what I read links violence to persons believed to be mentally ill. After all, Seung-Hui Cho, the Virginia Tech shooter, was certified by a Virginia judge to meet criteria for in-patient psychiatric admission. James Holmes, the Aurora Cineplex shooter, certainly looked bizarre in his Batman armor and orange Joker hair; and Jared Loughner, Gabbie Gifford’s shooter in Tucson, is still considered, two years later, to be incompetent or too crazy to stand trial. Adam Lanza remains a mystery, but the contention that mass murderers are deranged has been made to appear quite credible.

Many articles and posts disputed this mental illness–violence causal connection. My favorite data set was offered up by Michael Friedman, a social worker who teaches at Columbia’s School of Social Work in NYC. Specifically, “stranger homicides” in the U.S., including mass murders, occur at a rate of 140 persons per 14 million population. To quote Friedman, “multiple or single murders of strangers by people with psychotic conditions … take place at a rate of 1 person per 14 million population.”

In short, folks presumed to have serious mental illnesses kill people they do not know at a rate 140 times less than individuals without a mental illness diagnosis. Pretty hefty disparity. More importantly, to quote Walkup and Rubin in their recent article in the New England Journal of Medicine, “…When violence is committed by a mentally ill person, it usually occurs in reaction to an interpersonal provocation and is often charged with emotion. Only rarely do mentally ill people engage in dispassionate, planned, predatory violence toward others. In school shootings, there has been evidence of both a strong emotional component – feelings of anger and alienation – and extended and detailed planning that went undetected or unaddressed…”

This was one of the few articles that didn’t reduce persons labeled as mentally ill to abstractions; it also conformed to my own experience in the public mental health system, particularly when I served as director, for more than 17 years, of one of the largest case management programs in NYC. We served several thousand persons during that period of time, all with diagnoses of serious mental illness and all veterans of the system. None committed a murder or a serious crime armed with a gun while I was director and none have since I retired almost three years ago.

Actually, less than a handful of our clients had a gun; and if any had ready access to a gun it was because another family member owned one. They simply couldn’t afford to own one. The acts of violence that they did commit invariably involved disputes with domestic partners, family members or friends over money or drugs, and were usually fueled by intoxicants. Weapons of choice were fists or a club of some kind. But such acts were rare.

The median age of those we worked with was 44 and they were well socialized into the mental health system and its culture of social control. A handful of those with prior criminal histories, compiled when they were younger men and women, had been convicted of homicide, manslaughter and armed robbery. Again, such crimes were rare; and the two or three of our clients who had actually killed someone returned to the community from prison chastened.

As one of our parolee clients told me, prison had given him the chance, for the very first time in his life, to reflect on what he had done and the life he had led before his murder conviction. His goals, when he returned home, were to complete his parole, and work and earn an honest living so he could reunite with and support his son. All of which he had done by the time we discharged him from the program. During my almost forty year tenure in the public mental health system, I never encountered anyone remotely resembling the mass murderers I referenced above.

As I wrote in one of my previous blog posts about Aurora, individuals who kill on this scale rarely seek mental health treatment, and those few that do never allow themselves to be adequately engaged in treatment. Consequently, I found the gun control measures that were put forward in actual and proposed legislation absurd and impractical in the extreme. If they serve any purpose it’s to allow politicians, the general public and many system stakeholders to delude themselves that the causes of the violence have been identified and are being addressed.

First, gun control has been reflexively paired with social control initiatives aimed at persons caught up in the public mental health system. Despite arguments and statistics advanced by advocates and clinicians that there is no causal link between presumed mental illness and violence, the politicians and those many individuals who fear and – I can’t say it any other way – hate and despise folks who’ve been labeled as mentally ill, have proceeded to stereotype an entire class of individuals numbering in the millions as inherently violent.

NY’s SAFE Law and Obama’s legislative proposals, both of which will probably serve as models for many states, will oblige clinicians, providers and system bureaucrats to identify all system clients who have suicidal or homicidal thoughts. These individuals will most likely be listed on the FBI’s gun data bank, formally known as NICS – the National Instant Criminal Background Check System. They will join the system clients already there, viz., any person who’s ever been involuntarily admitted to a psychiatric hospital regardless of the reason for or circumstances surrounding the hospitalization.

New Federal regulations will oblige those states that have been lax in reporting their involuntarily committed patients to the FBI data bank to now diligently do so. Obligatory reporting of any person with a mental illness diagnosis presumed to be dangerous to self or others has now moved front and center as a strategy of social control and gun violence prevention. In NYS, it is integral to SAFE, the State’s new gun control law, and can now be seen as coupled with Kendra’s Law, the State’s outpatient commitment law, recently extended until 2017, as companion gun control measures.

Psychiatric survivors have been outraged at what they term “psychiatric profiling.” Even as I write this, a coalition of organizations – spearheaded by Tina Minkowitz’s Repeal Mental Health Laws (RMHL; www.repealmentalhealthlaws.org) and Jim Gottstein’s Law Project for Psychiatric Rights and Occupy Psychiatry (http://psychrights.org) — is planning their challenge to what they’ve defined as an abrogation of their civil rights. They’ve adopted as a symbol of protest the inverted black triangle that persons designated as mentally ill were obliged to wear in Nazi concentration camps. To avoid conflation with that defamed identity badge, they’ve added the slogan “Stop Psychiatric Profiling”, to run horizontally across the face of the triangle. I share their outrage and I plan to wear the protest badge.

(Please note the image is in PDF format. Just click on it and copy and paste it wherever it might be seen and impact viewers. If you encounter difficulty downloading, contact me via e-mail or, better yet, link to the websites listed above.)

Second, and to focus on the actual gun control measures being promoted, bans on assault weapons and large-cartridge magazines, and more restrictive gun registration requirements, as contained in the SAFE Law and in the President’s Plan, appear to be commonsensical approaches to the problem of too many damned guns in the country – one for every inhabitant and 40% of all non-military guns in the world. California’s proposed law to register sales of ammunition can be similarly described.

Unfortunately, the great majority of gun-related crimes are committed with unregistered guns, which comprise 40% of all guns in the U.S. If you do the arithmetic – 300 million X 40% — that’s 120 million unregistered and illegal guns. Most of the other loopholes that currently exist – unregistered gun sales at gun shows – will probably continue to exist. That’s when you’ll see how undead the NRA really is. One can’t help conclude that all the foregoing is smoke and mirrors to cover the failure of state and Federal governments to gain the trust and support of ordinary citizens, the persons who purchase guns, legally or not, to stop the legal and illegal gun-running in the country.

The third level of unreality, which follows directly from the foregoing, is all the hoo-ha over “improved access to treatment”, as if the latter will somehow remedy the political failures of government to address the violence that saturates the country. Interestingly, I’ve yet to see “treatment” fully spelled out, so I can only assume that politicians and providers are referring to TAU, “treatment as usual.” Today, across the country, TAU means medication, monitoring of behavior, and more medication.

As persons labeled with serious mental illnesses have been reduced to abstractions, so, too, has the treatment that’s supposed to help them. Little attention is paid to the virtual absence of psychotherapy for those who might want it. No attention is paid to the multiple toxicities of prescribed psychoactive medications. No concern is voiced, save by a relative handful of survivors and advocates, over the civil rights and privacy violations of those caught up in the public mental health system. Actually, it matters little, since those subjected to TAU and its consequences are not regarded as persons with citizenship rights. To sum up, the unresolved issues at hand are political not clinical in nature:

• The NRA constitutes one of the greatest barriers to change and to effective gun control. It is a violent organization, that attracts many members with its often overt message that concerned citizens have a civic obligation to overthrow unjust governments. Accordingly, while there may no longer be a need to have armed state militias, the NRA promotes the presumption of a need for an armed and aroused citizenry. Which citizenry heeded the presumed threat to their gun rights and literally bought every weapon available for sale in gun shops across the country as the Biden Committee began hearing testimony in Washington. A convenient truth which its self-deluded adherents ignore – here again they can thank the “mentally ill” – is that the NRA fronts for the gun manufacturing industry, which has financed the NRA’s lobbying activities for the past twenty years and which has made a helluvalot of money since Newtown. When will our armed citizenry figure out who the real enemy is? Was Pogo right?

• The American Psychiatric Association functions in an analogous manner, fronting for the multi-billion dollar pharmaceutical industry. It, too, should be considered a violent organization, promoting the use by millions of trusting individuals of psychoactive medications, all of which – no exceptions – have been shown to have harmful side effects. Much has been written about these phenomena – read Whitaker, Breggin and Healy, among others – so I will forego repeating it. The APA does not admit to this, nor has it developed protocols to minimize or eliminate altogether the risks these medications represent. And it won’t anytime soon. It, too, appears to reduce its members’ patients to 15-minute, insurance-reimbursable, units of time. Several colleagues and I are on the verge of launching a boycott of the new DSM-5, which represents a $25 million investment by the APA; which is why the cost of the new tome, for which the APA is already taking advance orders, will be $199. We hope we can put a sizable dent in those sales. After all, it’s the US of A and money talks.

• Little is said in the mainstream media about the U.S. as the world’s imperial power. Our dirty little secret. Ronald Reagan referred to the U.S. as “the shining city on the hill.” Hilary Clinton, in her recent appearance before Congress to explain away the Benghazi disaster, referred to “the one indispensable country.” The favorite euphemism for empire is, of course, “U.S. Exceptionalism,” which implies a country of freedom and justice, an example for the world to emulate. I’ll spare you a political diatribe and instead encourage you to watch Oliver Stone’s epic documentary, “The Untold History of the United States,” recently aired over several weeks on Showtime. I’d describe it – pardon the melodramatics – as gut-wrenching. See it! (Or read the companion book.) It lays out a chilling perspective of the U.S. and the role it plays in an increasingly contentious world.

• Lastly, and the purpose of this post, folks presumed to be mentally ill or crazy have been scapegoated by Western societies ever since the ships of fools of Medieval times began floating up and down Europe’s rivers. In this country, the first large mental hospitals that were opened in the mid-1800’s represented a perversion of the “moral treatment” that was initially offered to native-born Americans, usually of English descent. When the Irish arrived in the aftermath of the potato famine in Ireland of the 1840’s, those who came to NYC and found themselves overwhelmed by the Five Points slum in lower Manhattan, were quickly hustled off to the new state hospitals on Long Island and upstate New York. No thought was given to their miserable living conditions until Jacob Riis took his scandalous photos of a new wave of immigrants at the end of the century.

Today’s psychiatric survivors and those still involved in a presumably benevolent public mental health system must feel themselves totally betrayed. Hopes of recovery for those still in treatment and of the attainment of full civil rights for those who have pried themselves loose from the system appear to have been wiped away by senseless murders in which they had no part. So easy to ascribe blame to a segment of society that, despite its rather large size, is relatively unorganized and politically powerless.

It’s important to remember that folks who have been involved in the public mental health system have only had a promise and, as it turns out, a flimsy guarantee of civil rights since the mid-1960’s, or for about as long as African-Americans have been guaranteed the right to vote. There’s an unhappy congruence in both groups’ struggles for personal and communal freedom, and a long, long history of abuse and of scapegoating by a powerful and often cruel ruling class. Neither group has ever surrendered.

It seems appropriate, then, to close by borrowing from an address by Martin Luther King made to psychologists several months before his death 45 years ago and entitled “We Need Creative Maladjustment”: “… The policymakers of [our] society have caused the darkness; they create discrimination; they structured slums; and they perpetuate unemployment, ignorance and poverty. It is incontestable and deplorable that [persons presumed to be seriously mentally ill] have committed [these horrible] crimes, but they are derivative crimes. They are born of the greater crimes of [our] society.. We must never adjust ourselves to the… self-defeating effects of … violence … It is no longer a choice between violence and nonviolence, it is either nonviolence or nonexistence … I have not lost hope.” As always, mourn for those who have been killed, but organize. Remember, we are all prisoners of hope. And, one

Final exhortation – BOYCOTT THE DSM-5!

References:

Baumann, A.E., “Stigmatization, Social Distance and Exclusion Because of Mental Illness: The Individual With Mental Illness As a ‘Stranger’,” International Review of Psychiatry, April, 2007, Vol. 19, #2, 131-5

Biden, J., “Now is the Time,” http://www.whitehouse.gov/now-is-the-time, January 16, 2013

Brennan, Allison, “Obama’s Gun Violence Measures: Would They Work,” CNN, January 16, 2013

Breggin, P., Cohen, D., Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications, Perseus Books, 2007, rev.

El-Ghobashy, T., “Law’s Mental Health Provision Draws Ire,” Wall Street Journal, January 16, 2013 Foucault, M., Madness and Civilization: A History of Insanity in the Age of Reason, Vintage Books, New York 1988

Frances, A., “Price Gouging: Why Will DSM-5 Cost $199 a Copy?,” DSM-5 In Distress, http://www.psychologytoday.com/blog/dsm5-in-distress/201301/price-gouging, January 23, 2013

Franklin, K., “Martin Luther King to Psychologists: We Need Creative Maladjustment,” http://www.psychologytoday.com/node/53556, January 17, 2013

Friedman, M., “Mass Murder: Is There a Mental Health Issue?,” Huffington Post, January 17, 2013

Girard. R., The Scapegoat, Johns Hopkins U. Press, Baltimore, 1989

Healy, D., Pharmageddon, U. of California Press, Berkeley & Los Angeles, 2012

Mayors Against Illegal Guns, “Fatal Gaps,” November, 2011 http://www.mayorsagainstillegalguns.org/downloads/pdf/maig_mimeo_revb.pdf NYAPRS

Enews, “Cuomo, Legislature Reach Gun Control Agreement That Expands Kendra’s Law But Doesn’t Make It Permanent,” January 15, 2013

Office of the Press Secretary, The White House, “Now Is the Time: The President’s Plan to Protect Our Children and Our Communities By Reducing Gun Violence,” January 16, 2013

Quarmby, K., Scapegoat: Why We Are Failing Disabled People, Portobello Books, 2011

Riis, J., “Jacob Riis’s New York,” Photo Museum of the City of New York, Slide Show,The New York Times, 2008, http://www,nytimes.com/slideshow/2008/02/27/nyregion Stone, O.,

Kuznick, P., The Untold History of the United States, Gallery Books, N.Y. 2012

Stuart, H., Arboleda-Flores, J., “Community Attitudes Towards People with Schizophrenia,” Canadian Journal of Psychiatry, Vol. 46, #3, pp. 245-52, April, 2001

Walker, I., Read, J., “The Differential Effectiveness of Psychosocial and Biogenetic Causal Explanations in Reducing Negative Attitudes Toward ‘Mental Illness’,” Interpersonal and Biological Processes, Vol, 65, # 4, 313-325, 2002

Walkup, J.T., Rubin, D.H., “Social Withdrawal and Violence – Newtown, Connecticut,” New England Journal of Medicine, December 26, 2012

Walshe, Shushannah, “New York Passes Nation’s Toughest Gun-Control Law,” ABC News, January 15, 2013

Wessler, S.F., “What Obama’s Gun Plan Means for Mental Health Care,” Colorlines, January 17, 2013, http://colorlines.com/archives/2013/01/

Whitaker, R., Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown Publishing, N.Y., 2011

Wintemute, G.J., “Tragedy’s Legacy,” The New England Journal of Medicine, January 2, 2013