• 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.


    • I have such mixed emotions about this piece. It is in several ways deeply irresponsible–not least in releasing a picture of the child. Other serious questions have been raised about the piece, as well. Yet it bears witness to one parent’s dilemma in a way that demands to be read.

      • I hear everything you’re saying. There are issues with the way it’s presented. But I think the raw power should not be ignored. If there was a way to anonymize it, I’d be all for that.

    • I think the reason why people think they need an assault type weapon stems from the militia and Ted Nugent people who throw around rhetoric about needing to defend yourself against the government. I see this meme repeatedly in comments on blogs and newspaper articles and it seems to stem from adding a line from the Declaration of Independence into the 2nd Amendment and reading it as if it said a well-regulated militia is necessary to preserve freedom by overthrowing an unjust government, the right to have military grade weaponry shall not be infringed.

      • Daily Kos writes: “I served three years in the U.S. Army. I’ve fired bigger guns than the gun fetishists would ever dream of firing—from a .45, to an M-16, to an M-60, to an M-203 grenade launcher, to a .50 caliber, to … one of these:” The picture can be seen at http://www.dailykos.com/story/2012/12/17/1170940/-Some-thoughts-on-the-coming-gun-debate

        Unless “the militia and Ted Nugent people” start developing or acquiring nuclear weapons, they are always going to be overpowered by a government which spends more on war than the next several dozen countries combined. Their justification for the purchase of firearms is as irrational as the idea that raising the Medicare eligibility age will reduce health care costs or that reducing tax rates results in higher taxes to the government.

    • There also seems to be some inkling on the internet that all is not quite as it seems. The previous posts on this blog don’t hint at anything like this, and if anything make the mother seem like the one with issues. What is truth? I have no idea.

    • My problem with the piece is that we have no idea what the CT shooter’s diagnosis was, or if indeed there ever was a diagnosis. So we have no idea whether Ms. Long’s experience is anything at all like what Lanza’s mother was going through. Yes, Ms. Long’s situation is heartbreaking. But tying it to the Newtown shooting shootings just isn’t warranted based on what we know and more importantly what we don’t know.

      • It is in the sense that I’ve read any number of pieces blaming the parent[s]. I think there’s little information to warrant THAT.

    • I read the piece, and it is a good one.

      The main issue I am grappling with is that she seems to be suggesting we expand involuntary commitment laws to enable society to confine and treat individuals with severely disruptive, violent tendencies (readers new to the field of mental illness need to remember that most people with mental illness are not violent).

      Let’s assume we can successfully identify our target group and achieve relatively high compliance with commitment. Let’s assume it’s a highly supervised program (could be 24h residential or day care only).

      Assuming you can get to that, here are the problems I see:

      1. Very, very expensive. We will need numerous aides/paraprofessionals, and I imagine the staffing ratio will be much lower than in traditional residential long term care settings. There will have to be a bunch of psychologists and psychiatrists on board.

      2. Do we even know how to treat these individuals?

      3. Individuals with these conditions may be beyond the patience of most humans to successfully supervise. Constant disruption, threats of violence … we have a lot of issues with abuse in nursing facilities and institutions for those with developmental disabilities. Part of the problem is challenging behavior on the part of the residents. Successfully caring for those populations is already stretching our capabilities. Successfully supervising for individuals with mental illnesses like these may be beyond the ability of most humans – and that’s even before can we successfully treat them for their conditions (whatever those are).

      I hate to come across like I’m saying we are $*&^ed, but maybe we are.

      • Nice summation of the problems with these kids. One of my fellow docs has a kid with attachment disorder. Her stories sound like the ones Ms Long cites. It has been expensive to try to treat, and nothing much seems to be working very well.


    • i don’t think it has been proven that adam lanza is mentally ill

      • To me, by definition someone who is capable of doing what he did is not mentally well. I don’t say that in a “he’s mentally ill so it is not his fault” way, but rather I’m saying that healthy well adjusted individuals simply don’t behave that way and we need a system to identify people with those types of disturbances and either help them or restrain them.