In the wake of another soul shredding national tragedy, we are talking about mental illness. I am glad we are talking about mental illness. We need to talk about mental illness. Some of us have been approaching this issue for our entire lifetimes and there are many, many organizations devoted expressly to advocacy on behalf of the mentally ill. It is a great time to join these well researched, well established organizations who refuse to give up researching and lobbying and educating on these very complex and painful issues. It would be a miracle to have an entire nation join this trying battle, however, I am personally pleading with you, as a person who has a great emotional stake in this issue, to approach this with some humility, some cursory soul-searching and a great deal of research into the facts.
I’m going to make it simple for you honor this request. Please consider a few specific points I’ve laid out here before you respond to a national tragedy by trying to address the national crisis of mental illness. I will attempt to heavily cite them as appropriate.
1) With substance abuse removed as a factor, the mentally ill are not more violent than everyone else. Substance abuse by itself is correlated with violence in those with and without mental illnesses.
What does that mean? Well, it means that the mentally ill are about 20 times less likely than a person without mental illness to have committed any particular heinous act of violence. The great majority of violence presents in the mentally healthy and it is wrong, both factually and morally, to assume that mental illness culturally engenders violence, unless you mean the violent abuses which the mentally ill are statistically far more likely to receive.
What does that mean? It means that the prevailing notion that “if we can only corral the mentally ill into the hospital pharmacy and have people waiting to treat them, by force if necessary, the problem will largely evaporate” is false. The successes may seem to have some limited promise for psychosis (there are no approved pharmacological treatments for personality disorders), but it is extremely limited when compared to placebo. The problem is not generally that these pesky sick people refuse to stay healthy and stop taking their meds. The reason for cessation is usually that the meds aren’t working in the first place.
For every circumstance you can call to mind where an society has granted unquestioning supremacy and authority to one party (caucasians over POC, husband over wife, employer over employee, parent over child, heterosexual over GLBT, arm of government over dissident, well-to-do over poor), involuntary commitment has been used exhaustively, and continues to be used, as a supplementary tool to oppress, silence and abuse the already vulnerable when the primary tools do not prove adequate. Short involuntary commitment, when competence comes into play, can also save lives, but clearly, standards to prevent abuses are either ineffective or, more often, simply unaddressed by policy despite a major, pressing issue. Addressing the treatment of the unwilling is a complicated, perilous thing. Treatment of the willing does not generally apply to mass shooters.
What this means is that forceful psychiatric interventions, by and large, have almost no burden of proof, because they simply cannot meet it, even in good faith. We would not allow a person to be incarcerated for something they were suspected to want to do in the future, but all the same rights can be taken away from a person who is mentally ill, or who is perceived as mentally ill, on the flimsiest, unsubstantiated supposition of future guilt.
5) Everyone should look in deep their hearts before they speak an opinion on this issue and ask themselves whether their goal is to contain the mentally ill at a safe distance, out of fear of an out of control society, or truly to help the vulnerable and sick, whether that helps anyone else or not.
The former goal is rooted in bigotry and ablism and the latter is honest advocacy. They are simply antithetical, but I have seen over and over again, the former acting as though it is the latter. The first step when you approach any major social issue should always be to listen. You cannot be an advocate if you are unfamiliar with the people for whom you advocate. You must become acquainted with their needs, circumstances and desires— specifically those of the people afflicted with mental illness. Not their families. Not their friends. Not their partners. Not their churches. Their own needs, circumstances and desires. We must, as a society, take responsibility for the overwhelming majority of the violent who are mentally healthy and look at what causes correlate with violence in that demographic. Addressing those causes will likely reduce violence in the mentally ill as well.