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We're all in this together
By lindamuralidharan on 2013-03-29 04:16:07
I was deeply moved and interested some time back when my sister blogger Lyn wrote about her being diagnosed with
Asperger's syndrome. It is never easy for responsible people to self-disclose even though so many of us have symptoms of
some kind of mental or emotional dysfunction, and I dare say all of us have a close friend or often a relative who
experiences difficulties of this nature. Some are disabled by their condition to the point that they cannot be completely self-
supporting financially. Others have learned the coping mechanisms necessary to keep their symptoms at bay and may be
employed in a variety of fields. I not only admire Lyn's willingness to share something so personal but I am also happy that
she has the coping skills to be a caring, competent, responsible adult in the face of limitations that can be very difficult to
overcome. I am concermed about how we define our terms and the temptation to label people in much the same way as Lyn
is concerned. I have been particularly concerned since the Newtown shootings and our national need to establish
background checks as a prerequisite for purchasing a gun legally. I was reminded of this acute problem when Gabby
Gifford's husband, Mark Kelly, made a video of his going through a background check process. The point of the video was
to show that law abiding people will easily pass this test, and he read out the few questions he needed to answer. There were
questions about domestic violence charges and about felony convictions. So far, so good. The worrisome question was the
one that asked if he had ever been adjudicated to be mentally defective. What in the world does this mean? I suppose it has
some reference to different processes and terms used in different states. In the states where I have worked and lived I have
never known a client of mine or a friend of mine to have that "diagnosis" or descriptive term attached to their treatment or
criminal charges. I have worked with people who were at least at some moment in time a danger to themselves or others. I
have known and worked with people whose symptoms were severe. Some had poor impulse control and/or anger issues.
Some were delusional. Some were clinically depressed and at risk for suicide or other acts that could put themselves or
others in danger. Some hallucinated....either from a chronic mental illness or from abuse of hallucinogenic drugs. Some
remained chronically dysfunctional. Some accepted good mental health treatment (and/or substance abuse treatment) and
learned to utilize coping skills that increased their ability to function. Some may live peacefully in the community but are
still seriously impaired in function while others now hold full time jobs, participate in healthy family lives, and contribute
much to their respective communities. A common pattern for some people is that they experience severe symptoms that
involve the possibility of their lashing out violently or engaging in dangerous acts like walking out into heavy traffic.
Somehow they find themselves at a psychiatric unit that convinces them to take medications that are somewhat useful...none
are actual cures.... As their minds clear over a matter of days or weeks, many get back on track to the extent that they are no
longer a danger. They may experience severe symptoms again in the future and then return to the hospital or clinic and start
the process anew. Usually problems are most disruptive to their own lives or to society when they are not taking a
particular medication but it is also true that life style lapses can cause trouble. Sufficient food, rest, and coping strategies
that involve stress reduction and maintenance of good social relationships can be key also. I object to the idea that we might
label such persons based on experiences they have in a moment frozen in time but are not the experiences or behaviors that
define the whole person. We could be depriving some people of their civil, Constitutional rights. We might agree that an
"unstable" person who is prone to violence ought not to be allowed to legally own a gun. But is every person using Prozac
for diagnosed depression going to be called mentally ill in the sense she or he will be denied the right to gun ownership?
(And today I heard an advocate for background checks use the term "adjudicated mentally ill"....again I have never heard of.
Psychiatrists and other licensed mental health personnel diagnose people not courts insofar as I know.) Defective? Well, I
am defective. I have gone to treatment for some issues that interfered with my having a happy life. I have never been
hospitalized nor have I been charged with a crime, but I do suffer from mild to moderate depression. So, compared to an
issue free and symptom free lifetime , I have defects. I am also poorly coordinated. So, compared to the rest of my athletic
and well coordinated family members I am also defective in that regard. It distresses me greatly to think that some category
of people are going to be labeled "defective". I am very concerned that we will miss the boat in trying to identify people
who go through some stage in their lives where poor treatment or no treatment of symptoms of dysfunction that could lead
to violent acting out puts other people at great risk. While there is no easy way to do this, the effort needs to be directed
toward identifying warning signs of impending crisis and not on labeling....."bi-polar", "depressed", "autistic",
"psychopath", "schizophrenic", "PTSD"...none of these will say who will become violent at any one point in time.
Diagnosing is an imprecise and incomplete process in terms of defining a whole person or in terms of predicting future
behavior or even, in too many cases, in terms of determining the best treatment for any given individual. My hope is that we
will really learn some things from this debate. We are trying to hold institutions more accountable. Several people at
Virginia Tech identified the shooter, as a person to be alarmed about before the massacre. How do we get institutions to
communicate concerns appropriately to the applicable authorities and how do we get ill individuals to enter treatment? How
do we get more civilians... not just staff and treatment professionals...to recognize the symptoms that require immediate
attention? It's a little hard at times to distinguish the process...chicken created egg or egg created chicken. In the case of
Giffords' shooter, the neighbors said he was pretty much isolated at home as a child, wasn't let out much to play with other
kids and the family seemed polite but somewhat isolated themselves. Now the father and mother say they were very
worried about their son's behavior in the time frame just prior to the shooting. But they sought no help. If people have a
teenager or young adult who is acting strangely, who can't or won't follow a college schedule or work at an income
producing job, the family does need to do something. And in another case, I expect that the young man who shot so many in
the Colorado theater had had some symptoms for many years. But the family likely was busy making sure they continued
to believe in themselves as a model family...dad was a high achiever in the scientific world and the mom and kids were
pillars of the church going and achieving youth set. In our fast paced, striving life today we often are not tuned in to our
loved ones when we need to be. We often dismiss them when they need to express some pain or worry and call them weak
and tell them to "man up" and stop whining. If this young man had increasing symptoms ... he seems to have been very
interested in other people's experience of delusions or hallucinations...and they interfered with his studies...he may not in
this context have been able to admit to his parents that he needed a break from studies. He may have felt shame that he
was failing. Intense shame in these situations can trigger intense rage. This man may have many symptoms that constitute
what we call schizophrenia. And if someone had noticed or been listening some years earlier when the symptoms were
milder, the right treatment might have helped him reduce or avoid the build up of symptoms. My hope is that background
checks will look for behavior patterns and not the mechanical labeling or convictions of individuals. My hope is that friends
and family and teachers and therapists will be sensitive to individuals who are suffering so much that they want the whole
world to suffer with them. And who find life so unbearable they seem to hope the police will actually take them out. And
then act on these concerns. Do we have resources in place to respond if my hopes are fulfilled? And will each one of us be
willing to reach out when we feel overwhelmed, feel the world closing in on us , and get the courage to be honest with
ourselves and others? We are all in this together. Any one of us could be victim or perpetrator. Any one of us could be
passive bystanders or active searchers for solutions. I want guns available to serve the Constitution and to "live and let live"
with regard to those civilians who have a peaceful use for them. I want the appropriate weaponry used at the appropriate
times by law enforcement personnel. I also want limits that make it clear guns are the tools of last resort when sport is not
involved. Therefore I support an assault weapons ban, limits on magazine capacity, and background checks that do not
threaten anyone's civil rights and that are enforceable..at least to a reasonable extent.
