Thursday, January 13, 2011

Revise Civil Commitment Laws II

Revise Civil Commitment Laws II

A few days ago I presented the educated assumption that the man who shot and killed six people and wounded Congresswoman Giffords along with 12 others, was suffering from Paranoid Schizophrenia. I reviewed the deinstitutionalizing/community mental health initiative of the early 1960′s and also the change in our civil commitment laws that made it almost impossible to get psychiatric and psychological help to those who are in psychotic states and who refuse to seek or accept help for their condition.

Many facts are now available that were not then. Professionals interviewed on the media have tentatively diagnosed his condition as paranoid psychosis. Neighbors had seen symptoms of psychosis in this young man for a long time, high school classmates and friends reported his increasing symptoms of psychosis, college classmates and a math professor reported their fear of this man in their class. The students feared he would bring a gun to class and the professor was afraid to turn his back to do math problems on the blackboard for fear that the actively psychotic person might shoot him in the back. These fears were present despite the fact that no one reported ever seeing him bring a gun to class. Also, the man’s disturbed and and forboding ramblings were publicly posted on the internet.

This tragedy could have been, and should have been, avoided.

Once again, America has hog-tied itself with our laws and we see the inhumane outcomes of our attempts to be humane. It is a sad truth that mental patients were once locked away and many were never released. It is a happy truth that, with the discovery of antipsychotic medications, many were able to benefit and lead more normal lives. It is a sad truth that a large proportion of hundreds of thousands of mental patients who were once released from hospitals did not get medications, or refused to take them, or were ones for whom the medications did not work very well. A great many of these former mental patients joined the legions of our mentally ill homeless and those in our prisons.

So I ask, what is humane about this outcome for nonviolent psychotic? And what is humane about America allowing an obviously dangerous paranoid psychotic to wander freely amongst our citizens who were fearfully trying to get help for this individual, while our mental health systems and our legal systems were unable to provide the help and protection needed? So now a man is a mass murderer who likely never would have hurt anyone. All of thishappened because of his untreated paranoid psychosis. So now a congresswoman has been brain damaged, twelve more have been wounded and nine other citizens have been killed.

In response, our government predictably swings into frenetic and futile action. It proposes that we limit the capacity of firearm magazines (use two guns, or poison, or several knives and a sword). It proposes that we limit the zone around a public official in which citizens may possess a gun to 1000 feet. What does it matter? How would such a law be enforced and how likely is the law to control the behavior of a dedicated sane assassin or someone in a murderous psychotic rage? Finally, the grand absurdity emerges among these lesser ones: it was Sara Palin, Fox News, Rush Limbaugh, etc., who need to be silenced!

No, dear friends, what really needs to happen is a revision of our civil commitment laws.

Although murderous attacks by paranoid psychotics can never be prevented 100% of the time, the probability of it happening again can be cut dramatically, if we will only behave rationally.

It is essential that our licensed doctoral level mental health care providers (psychiatrists and Ph.D. clinical psychologists) once again be given the authority to commit actively psychotic citizens, who refuse help, to mental health care facilities. This new commitment procedure can be much more humane than the previous ones. The new commitment procedure would be for evaluation and medication assistance (remember medication for psychosis was once unavailable). The first goals of this intervention would be to quell the ongoing psychotic episode, educate the patient as to their particular mental disease, and teach them how to effectively cope with it through medication and stress management. The final goal of this commitment would be discharge the patient as soon as possible with mandatory supportive follow-up.

It should be understood that such a treatment approach would need to be refined through outcome analyses and further revisions, to the point that it reflects our best efforts to protect the rights of all citizens concerned, including the patient under treatment.

V. Thomas Mawhinney, Ph.D. 1/13/11

P.S. You will note that I have omitted the paranoid psychotic murderer’s name. I did so because that person did not do the killing. Rather, it was a dangerous mental disease (paranoid schizophrenia) that America allowed to wander freely amongst its citizens that did the killing.

To those who ask: What about individual freedom? I will ask: What about the individual freedoms of those students and the professor terrified in the classroom? What about the freedoms of the professionals who were called to help, but who were restricted from providing help? What about the individual freedoms of those killed and injured by a paranoid schizophrenic’s murderous attack? What about the individual freedoms of all of the victims?

The list of victims includes the paranoid schizophrenic who did the shooting, those who were killed and injured, and all of their friends and relatives and the rest of us who have been traumatized by this and similar tragedies.

Some say that this suffering is “the cost of freedom”. I say it is the cost of our own cultural design mistake, and a loss of freedom which must now be repaired.

No comments:

Post a Comment