Wednesday, January 9, 2013

The Newtown Tragedy and "Getting Help"

I've had some strong reactions to media coverage of the tragic school shootings in Newtown, Conn. For the first few days, I was outraged that, yet again, "mental illness" was being trotted out as the only possible explanation for senseless, sociopathic violence. As I read more about the shooter, Adam Lanza, it became harder to convince myself that he hadn't been mentally ill-- certainly paranoid, probably depressed, definitely something beyond the mild autism with which he'd been diagnosed. I still wish the public didn't assume from one extreme example that people with mental illness are inherently violent and dangerous, but that stigma has been going strong for decades now and I've settled in for the long haul.

I had a second strong reaction during the brief talk of creating a national database of everyone who's ever been diagnosed with any mental illness, putatively to keep those people from buying guns. Never mind that diagnoses are far from an exact science, can change over time, and are frequently given only because health insurance demands them. What is most outrageous is the potential for such a database to be leaked, shared, and used to justify all kinds of discrimination. Thankfully the Orwellian implications of this concept struck enough people that it was soon dropped from public discourse.

What I'm left with, now that our relentless news cycle has pushed past Newtown, is a sort of sad bemusement at the brief concern Americans had for our broken mental-health system, the brief interest in what kind of "help" might or might not have been available to Adam Lanza.

The fact that millions of people now have zero access to community mental healthcare-- in Chicago, in Illinois, and across the country-- is clearly not as compelling as one wild-eyed assassin. The fact that psych patients in crisis now wait in ERs for days on end, because there are not enough inpatient beds even for the privately insured, just doesn't have the salacious wow-factor required for news coverage. (I bet a lot of people would say "wow" if they could hear what individual human beings endure when there is literally no mental healthcare to be found. Right now that is the dubious privilege of people on the front lines, like me.)

The system is tragically underfunded and fragmented, and playing up public fears of the rare sociopathic mass-murderer is never going to change that. Why? Because it is just another version of the belief that people with mental illness are fearsome, loathsome, undeserving "others" whose suffering is less important (and more their own fault) than that of proper, right-minded citizens who just fall into misfortune. As long as this belief persists, politicians will continue to pick at the scrawny carcass of the mental-health budget as a way of "balancing the budget." Funds that could be shifted and applied to mental healthcare will remain locked away for ideological reasons-- though legislators generally remain unconscious of their own ideology.

I am so grateful to Erasing the Distance for educating people on a much larger scale than I'm capable of. I believe and I pray that as more people learn the truth about mental illness, compassion will grow and eventually, public policy will change for the better. Busting stigma and correcting misinformation (such as the notion that mental illness equals violence) is the only way to turn the tides. I'm in it for the long haul, and glad to have ETD by my side.

Finally, I'd like to explore another issue that emerged from the Newtown tragedy-- namely, the belief that Adam Lanza's shooting spree could have been prevented if he'd had a mental-health intervention. "Somebody should have done something" was the refrain du jour, a sentiment designed to help us cope with our grief, horror, and lack of control. Unfortunately, this sentiment isn't grounded in reality.

The fact is that mental-health treatment cannot be forced on someone who does not want it. There are rare exceptions; the courts can mandate long-term medication or other treatment for those who cannot take care of their basic physical needs or who commit crimes related to their mental illness. The standard for forced treatment is intentionally high in order to protect people's civil liberties. Someone who is perceived as eccentric, unkempt, offensive, antisocial, or "off" nonetheless has a right to be that way, as long as they do not endanger themselves or others. Adam Lanza couldn't have been forcibly treated or institutionalized, and it's probable that he would not have sought treatment because he was intent on carrying out his plan.

But what about people who do accept treatment, who keep appointments and take their medications? Aren't they, at least, guaranteed to get better?

The fact is that even with treatment, many people continue to struggle. About one-third of people with mental illness don't respond to any medications. Others simply can't tolerate side effects like weight gain, tremors, and sexual dysfunction. Individual and group therapy are useful tools, but they too have their limitations. People vary in their level of insight about their illness, and their willingness to talk about it. Those who have experienced trauma, have deep-seated phobias, or abuse substances may take years to get to the point where they can confront these issues. And people with psychotic symptoms like hallucinations and delusions cannot be "talked out of them."

But what if someone is hospitalized? Doesn't that get their recovery on the fast track? Well, in the best of all worlds, hospitalization can be a good start. Because hospitalization is so expensive for insurance companies, patients seldom stay more than one to two weeks. The purpose of hospitalization is to stabilize acute symptoms so that the person can transition to outpatient care. But even in the hospital, people can refuse certain treatments unless they are an immediate danger to self or others.

I really feel for families and friends who are desperate for loved ones to get well. I also feel for people who are disturbed by seeing mentally ill people on the streets, and want them to "get help." But recovery can be a slow journey on a bumpy road. It's still very much worth it. And once we as a nation take our focus off the extraordinarily disturbing Adam Lanza and place it on the millions of people suffering in our own towns and cities, people just like us, recovery will be possible for all who want it.



Lisa Sniderman, LCSW received her M.S.W. from the University of Chicago in 2003 and has been a licensed clinical social worker since 2005. She is a past member of ETD's Mental Health Advisory Board and one of our storytellers. Click here to check out Lisa's posts.

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