Submitted by Charlton Stanley, guest blogger
(Otteray Scribe)
What is mental illness? It’s a hot topic in the news recently, because of proposed gun control legislation. I saw a photo yesterday of people holding up a huge sign saying, “Keep guns out of the hands of mentally ill.”
There is far more to the demonization of the mentally ill than just the firearms issue. It spills over into the Federal Aviation Administration and the Department of Transportation. It is not just guns; it is airplanes and trucks as well. This brings us to the core question of, “What is mental illness?” The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is the current handbook for classifying mental disorders. DSM-V is in the final stages of development and will be published in May 2013. That is only next month.
Which brings us back to the original question of what exactly is mental illness? In New York, a man’s home was raided, his Concealed Carry Permit revoked and guns confiscated because someone told the police he was taking an anti-anxiety medication. I have received emails in the past week from several friends about this issue. One of them is a vet, M→F transgendered. She is concerned about being able to renew her own Concealed Carry Permit (CCP). As a veteran and avid target-shooting hobbyist, she is well trained in gun safety and use. As a transgender woman, she is a target and prey according to FBI statistics. Hate crimes against LGBT people are at a 14-year high.
According to the DSM-IV-TR, “Gender Identity Disorder” is one of the mental illnesses. In the DSM-V, it is renamed “Gender Dysphoria.” While claiming it is not a mental illness, the fact that Gender Dysphoria is in the DSM-V in the first place makes it suspect in the eyes of many. Two days ago, she sent this excerpt from a local outlet:
The enforcement action started on March 29th when New York State Police asked the Erie County Clerk’s Office to pursue revoking the man’s pistol permit because he owned guns in violation of the mental health provision of New York’s newly enacted guns law called the SAFE ACT.
The allegation turned out to be untrue and his guns returned to him. As it turned out, the police, sua sponte, initiated the action. The only lawyer involved in the matter was the man’s own attorney.
Erie County Clerk Chris Jacobs said, “When the State Police called to tell us they made a mistake and had the wrong person…it became clear that the State did not do their job here, and now we all look foolish.”
Flaws in the mental health reporting provisions of the NY SAFE Act were blamed for the misunderstanding. The county clerk added, “Until the mental health provisions are fixed, these mistakes will continue to happen” (source: WKBW-TV)
The bigger issue is how come taking an anxiolytic prescribed by one’s family doctor disqualifying? It would be interesting to know just how many of those raiding officers, and their supervisors, are taking medication for anxiety, depression or sleep.
Is mild anxiety a reason to stigmatize someone, and possibly violate his or her civil rights? It gets better. The FAA Medical Examiner will not allow psychiatric medications for any class of Medical Certificate. If a psychiatric medication, it is an automatic disqualification. Several non-psychiatric medications are disqualifying as well. When Tagamet (cimetidine) was first released to treat ulcers and hyperacidity, it disqualified one from holding an FAA Medical Certificate in order to fly. I first heard about that from a friend who was an Aviation Medical Examiner at the time. He told me the FAA put Tagamet on the list because, “It acts on the central nervous system.”
What is mental illness? Some say it is anything that is in the DSM. However, as I have pointed out in court many times, the DSM is a handbook put together by a committee. Everyone has heard the old joke about what a committee produces: “An elephant is a mouse designed by a committee.”
The new DSM-V will be expanding the definition of ADHD. The definition of PTSD is supposed to be clarified in the final definition. Homosexuality was removed from the DSM-IV. If it was a mental illness, the why was it removed? The answer to that is simple. It is not a mental illness.
Let’s look at posttraumatic stress disorder (PTSD) as a single example of a single disorder. PTSD is classified as an anxiety spectrum disorder. Symptoms include feeling anxious, vivid dreams or memories of a traumatic event, and avoidance of situations that might remind one of the traumatic event. Those are called “triggers.” Some claim that only combat veterans can suffer PTSD. That is nonsense. The original trauma can be anything causing one to fear for their own life or safety, or that of others. No one knows how many Americans suffer from PTSD, but the NIMH estimates 7.7 million adults have diagnosable PTSD. That is about 3.5% of the population. 22% of Vietnam veterans returned with PTSD. My personal impression is that number is too low by a significant margin. Many people with PTSD have never been diagnosed. Why? Because they are afraid to talk to a doctor or clinical social worker.
How many rights should be taken from all those citizens and veterans, simply because they have PTSD?
When some of the most prominent mental health experts in the world cannot agree what mental illness diagnoses are, how are lawmakers, judges and law enforcement officers supposed to know? Is being transgendered a mental illness? How about homosexuality—oops, never mind, they took that out of the DSM-IV. There are many people with bipolar disorder walking around and you will never know it, especially if they are taking their medication. Should a person with well-controlled bipolar disorder be allowed to drive an 18 wheel truck, fly a light airplane, or own firearms?
It is interesting that the FAA has created a new class of aircraft, call Light Sport Aircraft” or LSA, which do not require an FAA medical certificate to fly. A light sport pilot may fly with a valid and current driver’s license. Glider pilots can exercise the privilege without a medical certificate.
This brings us to driver’s licenses. If a person, who is taking Xanax or some mild anti-depressant is not allowed to own firearms or fly a Cessna 172, why can they drive? An average automobile or pickup truck weighs almost two tons. They drive on two-lane roads at 55 or 60 mph. That means on a two-lane road, they are passing within two to four feet of each other with a closing speed of about 120 mph.
Just what is mental illness, and where is that bright line drawn for different activities and privileges of ownership? Think about it. Your physician has to give you a formal diagnosis in order to write a prescription for any medication. Almost any Primary Care Physician, especially family doctors, will tell you that a large percentage of their patients are receiving medications for diagnosed psychiatric conditions. The most common are depression and anxiety, either situational or endogenous.
Alcohol, in my opinion, is much more dangerous than any antidepressant or anxiolytic on the market. Yet, alcohol is legal in most areas. The individual is responsible for keeping their alcohol level under the legal limit, without any government official monitoring them. The rule for pilots is, “eight hours from bottle to throttle.” In other words, if you intend to fly, there should be at least eight hours between the last drink and flying. My rule was always 24 hours just to be on the safe side. Alcohol is involved in far more assaults, shootings, auto crashes, and suicides than any psychiatric medication I know of. That is because alcohol is a disinhibitor.
It is unfortunate that Congress saw fit to suppress data collection on firearms violence back in 1996. I see many pronouncements on violence related to firearms, but without real science, those pronouncements are meaningless. Last January, President Obama lifted the 17-year drought on data gathering. Some members of Congress and the NRA are demanding that the data not be used to promote or advocate any position on violence. Fine. That is the way data should be gathered—content neutral. That honors the null hypothesis approach to research. However the results of the data fall, it should be accessible to other researchers. It must not be buried.
Legislation and administrative rules that limit rights are already having negative effects on people with mental health issues. They do not get treatment, or ask their doctor for advice. Sometimes they lie. Sometimes a patient will show up, insist on paying cash, register under a John Doe alias, give a vacant lot as an address and use 888-88-8888 for a Social Security number. Most people who need mental health medications or treatment refuse to seek help. If anyone thinks that is a good thing, they are not paying attention.
As my father used to say, “Anybody with one eye and half-sense could have seen that one coming.”
HIPAA is supposed to keep your records private, but they are accessible with a court order. Alternately, any agency issuing a license or certificate can insist on the applicant signing a HIPAA complaint medical release form. Sign the form or you do not get your license. One must always beware the Law of Unintended Consequences.
Here are a few tidbits to chew upon. Please discuss. Where is that bright line?
Moreover, how is this going to benefit society by making any person who takes a medication subject to loss of firearm ownership. Surely they must realize this will absolutely deter anyone who owns firearms from then seeking out any medical support for their medical conditions. What good will become of it? People who then become increasingly despondent because they don’t trust the system and then suffer a complete breakdown in their lives since not even the most basic of medicines were not provided until a crisis happened.
This is unworkable even from just a pure medical health standpoint.
Darren,
Now we find some schools are just making stuff up to teach kids. This is just wrong, no matter what side of the argument one falls on. Lying to kids to further a political aim is unacceptable. If lying on the right wing is unacceptable, lying on the left is just as unacceptable.
If this father had not been paying attention to his kid’s homework, it would still be going on, but now the school is saying they have pulled this classroom material, all the while refusing further comment.
http://radio.foxnews.com/toddstarnes/top-stories/school-americans-dont-have-right-to-bear-arms.html
As someone who has been closely involved with such questions on the other side of the Atlantic (four years, United Kingdom Airport Operators’ Association Technical Committee; four years, UKAOA General Aviation Committee) and who still appears before the UK CAA on behalf of organizations (last appearance, Oct. 2012, Gatwick), I must heartily commend OS, Charlton Stanley, for raising these thorny issues.
His mention of the inane statement made by certain individuals that ‘only combat veterans suffer from PTSD’ is utter bilge. I took part in Operation Bushel, the Royal Air Force’s relief flights in Ethiopia at the height of the Great Famine. If I was so minded – please excuse the pun – I am certain that I could arrange for myself to be located somewhere on the anxiety disorder spectrum, despite the fact that NO combat was involved.
The questions of disclosure of metal illness, medication and past history is even more savagely adjudicated with regard to UK airspace than it is here, in the United States. The Civil Aviation Authority Form Med 160 170912, ‘Application Form For Aviation Medical Certificate’ which covers all licences from ‘Aeroplane Transport Pilot Licence’ to ‘Light Aircraft Pilot Licence’ is truly searching. Question 118 asks you to disclose if you have suffered from ‘Psychological/Psychiatric trouble of any sort’; not only that, but you are condemned by heritage, for Question 174 asks if there is a ‘family history of mental illness’, a question which would clash with directly with some of the provisions of HIPAA (Pub.L. 104–191, 110 Stat. 1936, enacted August 21,1996) in almost any U.S. court.
Further, the ‘Instruction Page’ to Med 160 170912 contains Instruction 28, which asks ‘Do you currently use any medication (full details); include any non-prescription medication’ The thought that you would have to disclose any simple cough remedy, purchased over-the-counter, is quite amazing. Does my non-disclosure of the use of menthol cough drops – which technically is a mild oral analgesic – preclude me from applying for a UK licence, or cause me to be stripped of one, up to and including an ATPL? Technically, yes.
Whatever is done to regulate licences (and I could climb into a ‘Bloop 2’ biplane, tomorrow, using my Mass. DOT Driving Licence and fly it legally), it must be both fair, and be seen to be fair, whilst still protecting the public and the pilot from the worst excesses of the regulatory system.
Tragically, whatever we do, we cannot escape the sudden act of self harm which sometimes occurs when an individual is overwhelmed by circumstances. See, the very public ‘suicide by aircraft’, which, in the early stages, involved Tower Bridge, London. The excerpt and link is from my own blog.
Sadly, perhaps the most poignant of these flights took place on 31st July, 1973, when a stockbroker’s clerk, Paul Martin, who was out on bail in respect of a fraud charge, stole a Beagle Pup, G-AXIC, from the Three Counties Aero Club at Blackbushe Airfield, Surrey. He flew through the Tower Bridge opening TWICE, and after ‘beating up’ several buildings in the City of London financial district, headed north. He later crashed the aircraft and was killed, at Derwentwater, Cumberland, in the scenic Lake District
http://shortfinals.wordpress.com/2010/11/15/a-bridge-and-a-barge/
As for the mental health issues, I predicted in December of last year that either the federal government or some state would soon move to ban firearms ownership and confiscate guns simply because a citizen was taking an anti anxiety or psychiatric medication. And, despite everyone thinking I was being unreasonable, here it is.
Just another pretext to unreasonably restrict firearms ownership.
We do NOT need a permit to exercise our rights to be exempt from unreasonable search and seizure, the right to freedom of religion, the right to due process under law, or to be subjected to any arbitrary test or standard to qualify for this right. Owning a firearm is the same protection as guaranteed by the second amendment. Just owning a firearm is not something the gov’t can just make up arbitrary rules or create second classes of citizens of who can and who cannot just based upon who the person is, not any crimes they have committed as would be the case in felons revoked from firearms ownership.
Jadog,
I wish it were that simple. Its not.
Good luck removing the stigma once it’s applied. I’m a survivor of domestic violence. During the marriage I was diagnosed with depression, anxiety, and PTSD. I was on some very powerful antidepressants and mood stabilizers. Once he left me, I was able to come off all meds. I’m not depressed. I’m rarely anxious. I was just married to an abuser who lost his concealed permit when I received a VPO against him.
Inequity is the cause of violence
Jay Haley
RWL:
As for schizophrenia. The answer to that is like most everything else. It depends. The diagnosis of schizophrenia covers a wide variety of behaviors. John F. Nash, Jr. won a Nobel Prize.
Theodore John Kaczynski, like Nash, has an earned PhD in mathematics. He killed people with bombs.
Having said that, schizophrenics tend to be unpredictable due to the illness. You would have a hard time convincing me it would be a good idea to let them have access to firearms.
Great Article OS!
(I have been waiting to see the ‘new & improved DSM V’)!
Would you (or anyone on this blog) allow a person diagnosed as schiznophrenia (mispelled) be allow to carry a weapon? There has to be a line.
Mental illness is NOT a political construct. Psychotropic medications can cause side effects that are as bad, or worse, than the illnesses they were prescribed to treat. This need not be a blanket disqualifier, though.
Tony, read this link and weep:
http://flightphysical.com/Exam-Guide/Psych/Psych-47c-Bipolar.htm
From the psychiatric section:
In other words, if you have a psychological condition, you are disqualified if you take any medication for it to keep it under control. Notice that even “Bereavement” is listed as potentially disqualifying for an FAA medical certificate.
One of the things the general (non-gun-owning) public needs to understand is that may recreational hunters and target shooters are concerned the ATF will set up medical restrictions close to, or identical to, these FAA restrictions. I used to have a poster on my office wall that said, “Just because you are paranoid does not mean they are not really out to get you.”
Richard, watch for the story I am working on to be published next weekend. Plus ça change, plus c’est la même chose.
Mental illness is a political construct. The DSM is a crock. During the Cold War, I found it interesting, and mildly humorous, when the United States complained about the Soviet practice of placing political dissidents in mental hospitals. The Soviets replied that being opposed to state control is evidence of mental illness. We are rapidly approaching the Soviet-era in this alleged land of liberty. Over and out.
OS: I think the bright line should be determined (in all cases) by testing, drugs or no drugs. Similar to a driver’s license, with a written component, practical component, and physical component (like the vision test for the driver’s license).
So I actually think “mentally ill” is a mistaken criterium; to me the question is whether the person is “mentally competent” to undertake the action for which they seek license. Can they maintain focus long enough? In a flight simulator, can they handle common problems or issues? In a timed written test (or video-administered test), do they know the proper procedures, and quickly enough to implement that knowledge in the situation described?
I think, if we choose to license an activity, then we owe the public the safety of developing an objective test and administering it, we should not take shortcuts (which using the DSM as a determinant is).
Wow…
All good questions.
Government is growing both more powerful and more intrusive. Does anybody really think that government is also getting more careful/responsible?
As a gun owner I recognize that the current situation of gun purchase/ownership needs reform. But I don’t trust that it will be done well or fairly.
So I oppose all gun law reform for fear that the gun banners will seize the opportunity to restrict my rights.
Otteray Scribe: I recognize my lack of civic mindedness and my selfishness, but as you point out so well, government has not earned our trust.
Mental illness terminology is a tool to empower the mental health care community as legitimate and worthy of respect. Further, its own addiction to Big Pharma expands their power and influence. There is no viable test for mental illness, just charlatans pushing their own empowerment, their recognition, and drugs. It is the drugs that distort and disable the victims of “mental health care.” Since drugs have become so predominant in this field we have seen the advent and escalation of mass shootings. Let us lay the blame on the perpetrators of the branding of mental illness and their predator-cronies, Big Pharma.
Very good points of interest for the mentally ill. I discussed very similar issues with my psychology students. I think there is a need for more benefits and resources to be made available to those facing emotional disturbances. Congress, and the White House should stop using Mental Health as a stepping political forum to continue passing the blame for their lack of leadership, and incompetent peformance.
Interesting article OS. I do believe that there will be a learning curve on how to handle these mental health issues, but we have to start somewhere. While I agree that a mere prescription for a specific drug should not be a reason to revoke a gun permit or to refuse a new permit request, I do agree that a reasonable waiting period to allow both sides to solve the issue would be rational. I have to take a written drivers test and a behind the wheel test, along with a specified amount of drivers ed in order to get my license to drive a car legally. If someone is refused a gun permit, they should have a quick procedure to contest the denial with appeal rights.