Blinded By Anguish

Yesterday, a terrible tragedy was brought upon Newtown, Connecticut, by a mentally-unstable individual. His targets were primarily very young children. His weapons of choice were guns.

Almost immediately, there were some who — in the words of one blogger whose writings I regularly follow — “seize[d] the opportunity to use tragedy to further [their] own agenda.” Or, to put it more charitably, “though blinded by anguish are speaking out on what they see as a terrible problem that, if solved, would prevent tragedies such as that wrought upon Newtown.”

In any event, since there are those who stridently seek a solution, but in their anguish-induced blindness propose a faux-solution of taking guns away from everyone instead of identifying and treating the mentally-ill, I see no reason not to respond.

Being blinded by anguish, people frequently do not see things clearly. Most people reading this — those who believe they already know the right answer and don’t have any desire to consider another viewpoint — will stop reading about now: the problem is not guns. In fact, one potential solution to the problem might be “more guns.”

The real problem — the recognition of which could lead to a real solution — is that the United States long ago made the treatment of mental illness a non-priority. In fact, the idea of providing treatment for the mentally ill has become anathema, unless the mentally-ill individual, or someone who loves them, has the resources to pay for it themselves, privately, without bothering taxpayers.

(click here to view)

Nick Anderson Houston Chronicle Jan 12, 2011 EditorialCartoonists.com

If I read the embedded editorial cartoon above correctly, even smart people get things bass-ackwards. (I read the cartoon as being more a complaint about the ease with which one can obtain a gun than about the difficulty of obtaining mental health care.)

As taxpayers, we have no problem supporting a police state — we’re even more accepting of what is, in essence, a military-style lockdown of our nation (again, paid for by taxpayers) filled with TSA agents, checkpoints, and ubiquitous SWAT-style militarized police — but we’ll be damned if we’re going to pay for providing treatment for the mentally ill. Even more are we against the idea of humane hospitals for keeping the more-dangerous mentally ill away from the rest of us until and unless they appear to be no longer a danger.

Instead, we will wait until those mentally ill cause some kind of a problem. Then we will mourn. We may kill them, if they haven’t already killed themselves. Or we might finally sequester them where they can’t hurt anyone else, but in a jail or prison, without treatment, where we will torture them instead of providing care.

But not because it’s cheaper. Prisons themselves might be cheaper than hospitals, especially if you ignore overtime costs and supermax prisons which disproportionately contain and create mentally-ill prisoners. But the side effect of closing mental health hospitals has actually increased costs, some of which is based on the fact that large numbers of the imprisoned mentally ill, with proper treatment, would not need to be locked away — either in prison or a hospital.

Around about the 1960s, however, we reverted to the pre-19th-century approach to handling the mentally ill. Our society turned its back on providing treatment for the mentally-ill, turning instead to prisons and jails, which are not built for the task.

Bernard Harcourt put it succinctly, in this 2007 New York Times article:

Over the past 40 years, the United States dismantled a colossal mental health complex and rebuilt — bed by bed — an enormous prison.

The result is that today, as Judge Kevin Burke has pointed out,

More Americans receive mental-health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City, and Cook County Jail in Illinois.

This is inhumane. One Human Rights Watch report, quoted in “Imprisoning People with Mental Illness” (which I also linked above when talking about treatment helping to avoid imprisonment) noted:

Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories.

Frequently, the prisoners end up in isolation units. “In the most extreme cases, conditions are truly horrific,” the report stated, adding:

Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. … Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.

Proper and appropriate mental health treatment would not only be more humane, it would reduce costs.

This is especially true for people who do not appear “on the surface” to be mentally ill. (I base this “do not appear” statement on the fact that the linked paper is about an employer-provided health care plan from which increased mental health services were provided. I make the assumption that at least some, if not all, of the people receiving the health care were employees of that employer, and thus were at least stable enough to keep jobs.)

But when we closed the hospitals, we also pretty much cut funding to all outpatient services — in Fresno, where I practice law, a number of programs have been limited, or shut down — with the result that more mentally ill people either end up in prison, or wreak havoc in both large and small ways within the communities where they continue to live, often on the streets. And, of course, they still periodically need to be hospitalized because their ordinary health care needs are not being met.

Aside from the funding issues, with fewer medical students choosing psychiatry as a specialty, things can only get worse.

Unless we properly recognize that this — and not the lack of gun control — is the problem. Yeah, I know. Twenty babies were killed yesterday! I get it. Meanwhile, an estimated thirty-nine-to-fifty percent of households in the United States have at least one gun.

Meanwhile, between thirty- and forty-thousand people die in automobile accidents every year. More than twenty of them were babies.

Yeah, I know what you’re thinking: “cars are necessary; guns are not.” Even though I disagree with this, let’s pretend for a minute that this is a good way to rationalize elimination of gun ownership in the United States.

Motorcycles. Certainly not necessary when we have cars. Fatalities around 4,000 to 5,000 per year in the United States lately. Possibly not so many “babies,” but I have seen children on the backs of motorcycles.

So what about peanut butter? Peanut butter is not necessary to anyone’s diet. Yet it kills an estimated 100 to 125 people per year. And the majority of Americans oppose banning it in our schools, where I’m willing to bet we have more than twenty babies.

How about alcohol? Unnecessary. Linked to 75,000 deaths per year. Those familiar with history will remember the success of the ban on alcohol sales in the United States.

I could go on, but I think you get the point. Hell, even toilet paper can kill, although, at least arguably, toilet paper is necessary.

I am not, by the way, attempting to diminish the deaths of the children by this constant reference to “babies.” I use that word for two reasons. For one, these children were so young as to be considered babies. My office manager has a child in the age range of the children who were killed. I’ve spent a lot of time around her and — perhaps like many other childless people — when I first heard about Newtown, my first thought was of her. And don’t think that just because of what I’m writing here that that did not affect me: I read “breaking news” stories all day and watched Diane Sawyer, and Scott Pelley, all night with tears streaming down my face. The second reason is that everyone who’s been arguing about this on social media is using the phrase “babies.” Babies are the most fragile of our citizens, and I can imagine nothing worse than the senseless murder of such a large number of them in one very horrific event such as this.

But the fact is that — relative to the number of guns in the United States — the number of homicides committed with guns, whether of babies or anyone else, is quite small. And, in fact, of homicides committed each year in the United States, only sixty percent are committed with guns; forty percent are committed without guns. Banning guns is not going to stop homicides. It won’t even stop mass murderers.

The facts are there for anyone who isn’t blinded by anguish: the best way to stop mass murderers is by improving America’s mental health system.