Where were the killers, the mass-murderers?  In Tucson, in Aurora, in Newtown.  Where were the killers’ family members, class-mates, friends and neighbors?  Were they residing in Denial, looking the other way, ignoring the specter of mental illness in my family, among my friends, my neighbors?  Such is the stigma, the cloud of fear, ignorance and denial that surrounds mental illness in this allegedly civilized country of ours.  As a mental health worker and a person whose own family was afflicted by mental illness, I understand the painful dilemma surrounding mental health diagnoses and treatments.

I am not implying that family members and others surrounding the shooters were to blame for the deaths of so many innocents.  Of course not.  Those mass killings and the ones which may be coming are part of a complex social issue involving many causes.  Inadequate gun laws and poor access to mental health services are just two slices in the pie chart of shameful culpability.  Here is how I apportion the causes and here are my recommendations.

Culture of violence, 30%.   Films, video games and TV shows that glorify killing are pervasive and ubiquitous, presenting blood and gore as entertainment.  They offer multiple excuses to justify atrocities and allow participants to enjoy the (virtual) thrill of slaughtering victims: “it’s war time and they’re the enemy…they’re zombies…they’re evil aliens from another world…they’re vampires.”  The purveyors of this stuff are the vampires.  Boycott them.  Supervise your children to shield them from such assaults on their innocent humanity.  Those forms of “entertainment,” unfed by your dollars, will shrink like a leech deprived of blood.

Inadequate gun laws 30%.    We love our guns, here in the United States.  Many people hunt with guns, not just for pleasure but for subsistence.  My own son owns a gun that probably saved his life on one occasion.  And yes, we need to be prepared to defend ourselves from internal and external threats to our freedom.  But can you at least begin to see that we are afflicted with a National paranoia, a pervasive fear of extinction, and that we use guns to assuage that sick fear?  Ironic, perhaps, in that our country was founded on gun violence and aggression justified by the claim of “Manifest Destiny.”  Consider the recent evidence of guilt and fear induced paranoia:  in what other country in the world would an upper-middle class woman, secure, educated, who lived in a peaceful little town among friends, own pistols and assault rifles and take her mentally/emotionally disturbed son on target practice jaunts?  To me, that is almost as shocking as what happened because of it.  Who was it who said, “We have met the enemy and it is us”?  Support sweeping changes to gun laws.  On the day of the 2-year anniversary of the January 8 shooting of Congresswoman Gabby Giffords and others here in Tucson, I signed another petition demanding change.

Mental Health Issues 30%.   This is the toughest issue to confront, both collectively and individually, and the most complex, but our focus here is very narrow:  mental health and violence.  Statistics show (sorry I can’t cite specifics right now) that the vast majority of crimes are not committed by the mentally ill; and the vast majority of the mentally ill do not commit crimes.  The best predictor of violence by any person is a history of violent behavior.  But the Tucson and Newtown shooters had no previous history of violence and only the Aurora shooter (as far as we know) had been diagnosed with a mental illness.  Then how can we predict and thus prevent violent behavior by the mentally ill?  We must look for indicators of mental illness and potential violence in those near to us, and take action when needed.  A few profiles that may suggest future violence:  males in their 20s, those with paranoid schizophrenia with a history of violence, those with sociopath personality disorder with a history of violent, abusive or coercive behavior, and those with bipolar disorder in a manic phase.  Another potentially dangerous condition is depression in men, which on rare occasions manifests as a smoldering anger that flares into violence.   We must not ignore the fact that the vast majority of mass killers are male.  Is this surprising in a culture of male superiority and dominance that feeds the male ego and can render such things as loss of a wife or girl-friend or loss of a job as excuse for rage and vengeance?   Teach our men and boys that violence is the act of a helpless, impotent person, and going out “in a blaze of glory” is a disgustingly misnamed act that is not only desperate but cowardly.

 

In the end, recognizing when someone is “just not right” mentally/emotionally is the easy part.  Taking action is the hard part.  Living with or around a person who exists in a different reality and is sure there is nothing wrong with him or her can be excruciating.  A family member of one of my clients once told me, “Living with a crazy person is making me crazy!”

If you know someone who is obviously disturbed and refuses to get treatment, the State of Arizona (and, I believe, most states) provides for what is called a Petition for Involuntary Evaluation.  This allows mental health workers to go to the person’s location and conduct a mental status exam, even if the assistance of the police is required.  If the person is deemed a potential danger to self or others, they can be hospitalized for 72 hours, which allows time for two psychiatrists and other mental health workers to evaluate their condition.  If found in need of treatment, they can be hospitalized longer and required by law to receive treatment.  There are adequate safeguards in the law to prevent this from being used maliciously or inappropriately, to protect the rights of those who are mentally ill as well as those who are not.  I believe it is the responsibility of every family member and yes, every citizen, to know such details about mental health law in their area, and to act on it when necessary.

Unfortunately, even when an ill person enters treatment, he or she doesn’t always stay with it.  The major flaw in the country’s mental health laws and their delivery, in my opinion, is the inability of professionals to adequately force medication compliance on those who have been court-ordered for treatment, even those who have demonstrated or threatened violence.  Change mental health law to enable professionals to force medication compliance on those who have been diagnosed with a serious mental illness and present a significant threat to others.

 

The last slice in my pie chart of causation and responsibility is:  Individual and Collective Moral Values 10%.  What can one say here?  What about the Quakers among us, who abhor violence and refuse to participate, even during war time?  What about the Christian Commandment “Thou Shalt Not Kill?”  What about those of the Baha’i Faith, whose founder told his followers not to resist their tormentors because it is better to be killed than to kill?  We human beings are endowed with a penchant for violence and with an equally strong penchant for empathy, kindness and compassion.  These opposing capabilities remind us of the story about the two beasts within our breasts that are locked in a struggle for dominance.  Which one wins?  The one we feed.  Let’s feed the one within us that embodies our intellect, our compassion, and our humanity.