NPR: “Gun Violence And Mental Health Laws”

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On NPR’s Morning Edition, Lauren Silverman debunks the assumption that mass shooters are usually ‘mentally ill,’ and that mental health policy can substitute for gun control legislation. “We need more funding for treatment of people with ‘mental illness’ in this country,” Dr. Paul Appelbaum, a psychiatrist and director of the division of law, ethics, and psychiatry at Columbia University, says. “But to argue for that funding on false grounds — namely to try and persuade the public that it will protect them [to] have more mental health clinics — in the long run can only backfire.”

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69 COMMENTS

  1. The psychiatrists are always asking for more funding, even now that more money is spent on “mental illness” medical care, than all other medical care. But somehow the fact the psych drugs cause akathisia, which can result in violent behavior, is never mentioned. The mainstream media is so filled with propaganda it’s shameful.

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    • With respect, addiction by itself is not considered to be a mental illness. If it were, then an alcoholic with no other diagnosis could receive state funding, sit at home, watch Netflix and drink himself to death.

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  4. Funding requests are always made under false grounds.

    The problem with Applebaum’s argument is that you’ve got the TAC and others going after “untreated mental illness”. Violent crime is attributed to “untreated mental illness”.

    Community mental health care, so-called, developed from forced treatment. The “mental health” enforcers are scrambling after people who are non-compliant, who reject or resist treatment.

    I do think it is good he points towards the criminal matters that precipitate violence. Violence is a criminal matter. The case in this argument involves the Texas Tower shooter, Charles Whitman, who, after one session it seems, dropped out of therapy.

    The argument has been made that community care is cheaper than institutional care, and in the main it is true, but if the “mental illness” rate goes up substantially, this argument loses some of its steam. Given enough new people labeled “disabled”, out in the community, and subsidized by the tax-payer, the cost goes up with them as well.

    More money for mental health treatment certainly isn’t an adequate way to address the many social problems that often precipitate intervention.

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    • Community care is cheaper because it does nothing to help anyone, why are you against proper funding from the taxpayer to the poor who are more likely to be mentally ill from poverty, and in turn violent?

      Yes many poor don’t commit crimes, but the vast majority of violent crimes come from the poor who are more likely to be mentally ill due to poverty.

      It’s really common sense, and your community care theory doesn’t hold up much weight and sounds like a way to leave people on the streets suffering with mental illness

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      • As I see it all treatment, including community care, descends from forced treatment. Once you stop locking up people against their will and wishes, and treating people who don’t want to be treated, what do you have? Unfortunately, as people have been sold a bill of goods, too much.

        Should we ever stop treating people by force, then the question becomes how do we cut back on the numbers of people in treatment. My point? They wouldn’t be there if forced treatment wasn’t there first. Tolerance, after all, is not a form of mental health treatment, and costs a whole lot less.

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          • I agree that treatment is often damaging (for various reasons, not all of them physical) and that such damage can lead to poverty. However, I think it’s important to note that mental illness ALL BY ITSELF very often leads to poverty. I have some ideas where the money should go but I consider myself a disgruntled psychiatric survivor, not a policy maker.

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          • And your “job creation” does nothing to help the street person without access to a shower, clean clothes, decent food, printer for his resume, bank account, home address, etc., etc., etc., etc., etc., etc., etc.

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          • Frank B., let’s get serious. There was a homeless guy outside of Tim Horton’s the other day. He was, quite frankly, fucked up. How would the abolition of mental health legislation actually help this person? I gave him a couple bucks. What did you do?

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      • Is social control always a bad thing?

        I’m as opposed to forced psychiatry as the next idealist but what tangible alternative is there?

        Every alternative I have so far seen mooted on closer examination rejects the most difficult and complex cases. Especially when they are poor.

        You read a lot on here about people finding their liberation in things like yoga and meditation. Now how many yoga and meditation groups are going to welcome someone in the depths of a so-called schizophrenic psychosis, and there not arise issues around ongoing membership?

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        • I like your sensible thoughts and no, social control isn’t always a bad thing. With respect to the rest of your post, and at the risk of being severely flamed, I offer my suggestions:

          1. abolish coerced community care
          2. vastly increase the number of in-patient beds
          3. reserve involuntary treatment for rare & extraordinary circumstances (will expand on this later, if you wish)
          4. watch the hospitals fill up naturally

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          • Believe me, in the face of the most truculent and complex individuals, it’s a big ask for everyone to be nice and kind at all times without some form of sedation going on. But I appreciate you don’t seem to be against that, as any on here would.

            There has never been a true asylum of the kind you allude to. As lovely as it sounds. And I’ve never actually seen any realistic proposal for such a place. Which is something that concerns me. Because without a vision, what can there ever be?

            And before you can even have the vision, you need the people.

            But like I say, the most complex and truculent people are the very people that a true asylum should be designed around. And yet, time and time over, these are the people that get tossed aside and abandoned.

            I agree with you that there should be a humane approach to people with the most complex needs. And yes the basics should at least be in place, and often are.

            But ultimately the people of alternative approach don’t seem to be equipped to deal with the most truclent and complex people. They generally wash their hands of them. The schemes and initiatives and places of support and recovery generally want rid of them too, soon enough.

            And so it generally follows that the only people willing to stand in and help are the psychiatrists. Or, just as often, no-one.

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          • I largely agree with you. To be frank, our collective inability to address the tough issues head on is why the anti-psychiatry movement is a laughingstock. Our wonderful website here at Mad in America with all our wonderful contributors is almost never cited. It is not taken seriously. We are not taken seriously. We are not getting anywhere. Nobody has ever heard of us. Mention Robert Whitaker, Bonnie Burstow, Irit Shimrat, Laura Delano and so, so, so many others and people will just stare at you.

            Joel Hassman is a smart, albeit abrasive, psychiatrist who tried this same tough talk here and got first ridiculed and then banned. He wrote about the experience on his own website. I now expect that I will be banned. I am feeling upset and think I’ll pack it in for the night. Thanks for the discussion. I enjoyed it.

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          • One last thought. You mentioned sedation. Yes, it is sometimes required. Sometimes lots and lots and lots of it is required. Trust me. Open up Riverview again, offer three square meals and as many snooze berries as you want and the place will be packed before you know it. Fuck, I’d live there!

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          • 1. Abolish non-consensual coercive treatment. One version of that, coercive treatment, are these either federal benefit or community treatment blackmail deals. They should be kaput.

            2. As an advocate I once met put it, “If you give them more beds they will fill them.” I say we need fewer beds. It’s called, deinstitutalization.

            3. Outlaw involuntary treatment. (See point no. 1.)

            4. Hospitals don’t fill up naturally, especially when you are talking fill up with people who have nothing physically wrong with them. People who are desperate, and looking for an answer, sometimes look for that answer in a hospital emergency room. The answer, by the way, is never found in the hospital emergency room, and going there only complicates matters.

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        • Additionally there are the egoic types. These people go around touting themselves (touting themselves) as examples of recovery in action.

          But is touting oneself as a recovered person, recovery in action, or something else?

          And if that is what everyone must do, how long until the pyramid collapses?

          Who is actually equipped to deal with the truculent? Even mainstream services dispense with some of the most aggressive and troublesome ASAP.

          I have seen nothing but airy-fairyness when it comes to these core groups, who are, after all, the most at need, and generally, the most neglected.

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          • I haven’t seen anything that is actually equipped to humanely and skillfully help people with the most complex problems and the most challenging behaviours; no one wants them on their hands and if they do get saddled with them, are keen to be rid of them ASAP.

            All the alternatives seem to be for people with needs that do not cross over a certain threshold of good taste. The only people willing in any way to engage with this core group are often psychiatrists. I’m not saying I agree with their approach, but no-one else seems much willing to even draw near. And then there are that group of people like psychiatrists like to brand as borderline. Which is basically not a diagnosis but a warning to other professionals. And the core group there too, are denied help. And much of that again is because no-one seems equipped to help them, beyond, it would seem, offering them drugs, or, more usually, offering them to the Fates (ie. Death).

            Before anyone pipes in, yes I know, there are many, many people labeled with the same conditions but who did and do not display that core level of truculence, complexity and difficulty, who can say write convincing narratives about how yoga, meditation and organic sultanas saved their life. But I’m trying to keep this realistic.

            Who has the alternative?

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          • Well, reading between the lines, “almost-entirely voluntary” means, not voluntary for the most complex and truculent cases. Which would represent no change for the core group of people with psychotic conditions I made mention of.

            Hospital admissions and medication aren’t really suited to helping that core complex truculent group of people labeled borderline, so how would you help them?

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          • I’m not exactly sure we’re talking about the same group of people. I myself have been diagnosed with borderline personality disorder from time to time but I doubt very much if you saw me walking down the street you’d think “complex and truculent.”

            To be blunt, are we referring to the freaks and ghouls I see in the waiting room of my “assisted” outpatient treatment community clinic? If so, could we just refer to them as “street people”? Would that offend anybody?

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          • What I was asking was who has an alternative for the most complex cases. You’ve offered no alternative for those with psychotic conditions who are the most challenging and truculent. Beyond keeping things as they are. ie. forced treatment, homelessness or suicide. Or some combination of all three.

            I also asked what should be done with the most complex and truculent of those that come to be labeled with borderline. I think I may have hit a nerve. It’s not intended. There is a core complex and truculent group that receive that label. You don’t identify as one of them. That’s fine, I’m speaking generally. What would you propose as an alternative for this group? Given that in Europe at least they tend to be denied any substantive help.

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          • “It is my belief that many, many troubled people would be happier in hospital, provided that they were free to leave at any time.”

            That may or may not be true. I was wondering if there might be an alternative to hospital? That is reverting to the choice of one thing or nothing.

            I don’t mean to burden you with these questions on a personal level. I don’t think anyone has yet come up with a sensible alternative. So psychiatry is kind of winning the core argument in many ways.

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          • RR, I’m mystified. We seem to be talking at cross purposes. Rest assured you have not touched a nerve. Yes, I know – we’re talking about the sickest of the sickest. And for them, too, I think hospitals are a fantastic option.

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          • The sad fact is that there are hapless people among us who, for one reason or another, cannot take care of themselves and simply must not be abandoned. It is our duty to house them, to feed them and to provide them with the best quality of life that we can.

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          • In my part of the world, we used to have https://en.wikipedia.org/wiki/Riverview_Hospital_(Coquitlam)

            It was a hell hole. I was imprisoned there in 1988 and briefly in 2009. Now it’s been closed. The ex-patients were dumped into the street, without support, without medication, without funds. Most of them ended up here https://en.wikipedia.org/wiki/Downtown_Eastside This is a worse hell hole. It is a drug-infested slum of single room occupancy hotels. People literally die on the streets.

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          • Sounds good to me. If there’s nothing wrong with you, then why the fuck are you receiving disability benefits? I receive $900 a month from the Canada Pension Plan. I would much prefer to work full-time but that is just not possible with my bipolar disorder. Deal with it.

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    • Good for you for finding what works for you. Here’s my treatment plan:

      Nozinan p.r.n.
      Risperdal p.r.n.
      Reduced work week to 20 hours
      Advanced Directive in place with doctor and parents.

      The irony of it is that I BEG for treatment but am denied. I was at the Fernwood Inn in Victoria, BC yesterday afternoon and I was in TERRIBLE shape. I told the bartender and the waitress and they were very cool with it, just making sure I had what I needed (which happened to be lots of water, a pen and paper, a single cigarette, a ride to Oak Bay Avenue).

      Phone calls were made to: Victoria City Police Department, the Pandora Assertive Community Treatment, and also to my employer. So guess what happened????

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      • Yet, I’m afraid to go outside now because I’m all wired with too much caffeine and email correspondence. I owe my employer four hours of work today. I emailed my supervisor to confirm that I would be in AT SOME POINT before 1:00 this afternoon. Fine. It’s now 7:07 a.m. Maybe I could get a little more sleep, listen to a little music, make myself a protein-filled breakfast.

        You guys have your hearts in the right place but you’re going about this all wrong. I’ve been dealing with this since 2002. Here’s what I know:

        – if you don’t act crazy, the police won’t beat you
        – they beat you because they are afraid of you
        – mentally ill people can be violent. That’s just a fact. I’m a middle-aged, well-behaved 50 year white female living in Oak Bay. I have a criminal record that includes ASSAULT. Because the hospital wouldn’t take me in when I and everybody around me knew that I desperately needed medical treatment.
        – I didn’t get help until I got into the criminal justice system. Don’t let that happen to you. Be proactive and set up a plan

        Fuck, you guys piss me off sometimes. It’s nothing personal. It’s just your impotent rage at those nasty psychiatrists and those evil police officers isn’t going to get you any traction. Crank it up a notch. We’re at the start of a revolution.

        What the fuck is a crazy person supposed to do? I’ve made my decision. You’ll have to read about on Hassman’s blog. Best wishes.

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  6. NPR as a major liberal media bastion should be expected to tilt to the “gun control” side of the false set of choices regarding what causes “senseless” violence, i.e. “mental illness” vs. the existence of guns (even though guns existed long before 1961 and this didn’t happen).

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      • At least I think that’s the year the piece says Whitman committed the murders, which they present as the beginning of a new era.

        Though there have been many murders over the years deemed attributable to “mental illness,” using the logic that the greater the depravity of the murder the more “mentally ill” the killer is, hence less responsible for the act.

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        • Thanks. I’m not familiar with this particular incident. I am very, very conflicted on the insanity defence issue. I speak as someone with a criminal record which I believe is unjustified on the basis of my state of mind at the time. By way of example, do you really think that calling 9-1-1 repeatedly to report that wild pigs are roaming ought to warrant a conviction of criminal harrassment? Ought throwing a lukewarm cup of coffee at a psych nurse warrant a conviction of simple assault? I don’t but our legal system did. Make of that what you will. Don’t want want to fight with you, oldhead. I like your style.

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    • I was being a little tongue-in-cheek, I am unqualified to “judge” anyone in that sense anyway.

      As to the insanity defense, I’m against it in principle; however I believe one’s state of mind should be considered as an extenuating circumstance in some cases. But it’s still more a matter of “guilt” and “innocence” than “sickness” and “health.”

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      • Yes, I’ve considered that too. In a sense, the insanity defence will always exist, regardless of what is enshrined in law. My example is the man who comes home to find his wife in bed with another man and shoots both his wife and her lover. The killer’s understandably jealous rage isn’t a ticket to walk but certainly impacts sentencing.

        But, back to my sad case … what do you think should have happened?

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          • Oldhead, my friend … I KNEW what would happen at the time. I was just too crazy to ACT on what I KNEW. You know, for a supposedly crazy person, you’re not terribly empathetic.

            I was throwing the contents of my apartment out the window. I turned over my fridge, threw my photographs, screamed, burned food, got drunk, embarrassed myself on the internet, wasted police resources, scared the shit out of my parents, destroyed my marriage, alienated my friends. I KNEW that I would be evicted yet I was truly powerless to stop. Psychotic manic happens. Get over it right now or you’re off my team. I say this with the greatest of respect for your point of view.

            May I offer the following, in the spirit of solidarity: Szasz was an idealist. He was a libertarian. He was an academic. He was famous. He was smart. He was revered. And he was an ASSHOLE.

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