You are being fooled about mental illness
It's not illness
It's not dysfunction
It's not biological
It's not medical
It's not chemical
It. Is. Meaningful.
"What are we doing?" These are the words repeated over and over again yesterday by Senator Chris Murphy in an excoriation of his colleagues on the floor of the U.S. Senate. He was urging them to take action towards better gun safety and background checks in the hopes of preventing the horrible tragedies like the one we just experienced in Uvalde, Texas, where 19 school children and 2 teachers were killed by an 18-year-old with an assault rifle. Yet, as important as Senator Murphy's challenge is, I fear this opportunity will go unfulfilled, once again, just as many others have gone since that fateful day in 1999 in Columbine, Colorado.
The debate on this issue isn't over whether guns kill people or people kill people - both do. It is about what things in our world precipitate gun violence like this and what things are we willing to do to reduce this characteristically American phenomenon. Neither is this a matter of good vs. evil, identifying those at fault, or being able to tell the difference between the bad guys and the good guys. And, focusing our efforts at how to "take down" the bad guy once the shooting starts is merely reactionary and short-sighted, only giving us a smug sense of justice, yet leaving the problem untouched while we wait for the next mass shooting. So what do we do?
All too often the debate centers on mental illness and how we need "better mental health care" as a solution. But this is wildly off target.
Whether or not someone has been diagnosed with mental illness, or even if they were never diagnosed but meet the clinical diagnostic criteria for a mental disorder, has no impact on their propensity for violent acts like this. The common belief that it does merely reflects a gross misunderstanding. The science is clear about that. The science is also clear that a few basic factors increase one's risk of committing such acts:
1) being male;
2) being younger;
3) being unempathetic, remorseless, and callous;
4) having committed prior acts of violence, especially starting in youth;
5) having easy access to weapons, especially lethal ones like guns;
6) having poor social support;
7) feeling paranoid, persecuted, and mistreated, and;
8) using alcohol and drugs to cope with distress.
You'll notice that a mental disorder is not one of these. You might think that #7 is about mental disorder, but it is not. Those things (feeling paranoid, persecuted, and mistreated) do not fulfill diagnostic criteria. Many people feel those things without ever having been thought of as mentally disordered or having been diagnosed as such. In fact, many of us have felt that way at some point, and likely at many points, in our lives.
Nevertheless, as with previous tragedies like the one in Uvalde, mental illness is sure to be targeted and then a simplistic "better mental health care" will be proposed as the answer, as well as background checks to disallow the "mentally ill" from buying guns. Such a strategy will not address the people who have the risk factors listed above. But, there will still be a false sense of comfort addressing the problem as the hype dies down and other events in our life crowd out the realization that 21 people have just been massacred.
To make matters worse, psychiatric interventions typically imposed on people thought to be "mentally ill" would include psychiatric drugs, which ironically is one of the risk factors above (#8 - See the film "Prescripticide"). At present, there are 30 commonly prescribed psychiatric drugs that are well-known to increase the risk of violent behavior by those taking them.
The people subjected to these interventions would also feel paranoid, persecuted, and mistreated in the process (risk #7), especially if they are committed to a hospital against their will, are forced to take the drugs, and are prohibited from owning guns. All these things together are likely to increase the chances they become socially disconnected from others (risk #6). Therefore, this form of intervention will have the opposite effect of actually increasing the risk of these violent acts in this wrong-headed strategy of reducing the risk.
What are we doing?
From the very inception of the medical model of mental distress, psychiatry (and I include all other mental health professions) has put itself on a path to destruction by painting itself into a corner where it must admit it is not a medical profession unto itself.
Psychiatry started out as the application of medical science to discover medical causes of and treatments for distressing experiences and behaviors. For over two centuries though, it has failed to discover any such causes. Yet, this failed campaign continues in vain. It is bad enough that this is the present state of the profession - seeking a fantasy - but there's a more damning issue that is becoming clearer and clearer. If psychiatry ever did find those elusive bits of brain or body physiology that cause human distress, it would no longer be psychiatry!
This is because all medical specialities, except psychiatry, have a bodily organ or system as its focus. Pathology within that organ or system becomes that specialty's target of assessment and care. Psychiatry has no such system or focus because all are already taken by those other specialties. If faulty brain chemistry or dysfunctional neural circuits cause mental distress, that is handled by neurology, not psychiatry. If endocrine flaws cause mental distress, that is endocrinology, not psychiatry. If nutritional deficiencies cause mental distress, that is nutritional science, not psychiatry. If genetic anomalies cause mental distress, that is handled by genetics, not psychiatry. In all those cases, the problem is not "mental" illness. It is straightforward illness.
The best (and an important) role for psychiatry to play is in helping to identify what bodily pathology is likely causing mental distress and wayward conduct, and then to hand it over to the specialty that deals with that bodily system. When no pathology can be found or reasonably theorized, it is not an illness or medical matter. Still, thousands of mental health professionals ignore this consulting role for psychiatry and march on, seeking fantastical anomalies in people and doling out even more fantastical cures.
Calling a problem "mental" illness obscures the real cause and solution.
Let me begin this new blog by revealing a secret that is hiding in plain sight: The conventional mental health industry isn't about health and illness. Instead, the industry has bastardized the reputation of the medical professions in order to disguise a morality crusade. Its purpose has always been to control unwanted and distressing people. Nowhere in the process do we find actual treatment of an illness. What we find are moral judgments about the appropriateness of behaviors, thoughts, and feelings, and methods to stop them using physical, chemical, electrical, or persuasive means. This is not medicine. It is crowd control. For this reason, many professionals within that system have abandoned its medical model and try to help others in a humane and compassionate way. These professionals can be very helpful, but only if they remember the goal is to assist to the extent and in the way that person wants assistance.