If you read one thing today, make it this piece in Gawker

I’ve been struggling with how to respond to last week’s tragedy in Connecticut. On a personal note, I’ve been giving my first grader a number of extra hugs.

A friend and colleague just emailed me to ask if I was going to blog about it. On a gun policy level, I just don’t know how to respond. I don’t feel qualified. I look at a picture of the weapon he used, and I’m horrified to think why anyone would feel a need to own one. I live in Indiana. I have many friends who hunt and own rifles. I have many friends who own handguns. I get why they want them. I don’t know why anyone who is not actively in the military needs to own a gun like the one used in Newtown.

I know I don’t want to turn schools into armed fortresses. The costs of that seem too high, as well.

But this tragedy is also the product of a mental health issue. I can talk about that.

There’s a piece up at Gawker, by Liza Long, that is absolutely worth your time. She has a mentally ill son, and her story is unbelievably compelling:

I live with a son who is mentally ill. I love my son. But he terrifies me.

A few weeks ago, Michael pulled a knife and threatened to kill me and then himself after I asked him to return his overdue library books. His 7- and 9-year-old siblings knew the safety plan—they ran to the car and locked the doors before I even asked them to. I managed to get the knife from Michael, then methodically collected all the sharp objects in the house into a single Tupperware container that now travels with me. Through it all, he continued to scream insults at me and threaten to kill or hurt me.

That conflict ended with three burly police officers and a paramedic wrestling my son onto a gurney for an expensive ambulance ride to the local emergency room. The mental hospital didn’t have any beds that day, and Michael calmed down nicely in the ER, so they sent us home with a prescription for Zyprexa and a follow-up visit with a local pediatric psychiatrist.

We still don’t know what’s wrong with Michael. Autism spectrum, ADHD, Oppositional Defiant or Intermittent Explosive Disorder have all been tossed around at various meetings with probation officers and social workers and counselors and teachers and school administrators. He’s been on a slew of antipsychotic and mood-altering pharmaceuticals, a Russian novel of behavioral plans. Nothing seems to work.

My greatest frustration in clinic is that for so many issues, there’s nothing I can do. I’ve seen cases like these. They make you despair. They’re part of the reason I can’t practice clinical medicine full time. I need to fix the system first.

Please read the whole thing. I know it’s hard, and I know many of you will have difficulty with it. But we need to see what’s at stake and how bad things can get. This is real. This happens. We ignore it not only at the peril of mentally ill children and their families, but at our own as well.

UPDATE: I’m not trying to say this cases like this are terribly common. Ms. Long’s case is extreme. But getting kids into mental health services, no matter what the issue, is an unbelievable difficult, if not impossible task. It’s reasonably easy to get a homicidal or suicidal kid admitted to the hospital when they’re actively describing intent. Short of that, there’s often little we can do.


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