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?
OS,
Excellent article!
First, I”m neither a pilot nor a doctor. Although my father was both. He was a senior FAA medical examiner and I often helped him with his paperwork for Oklahoma City. While I agree with your thesis about the ambiguity per the definition of mental illness, I don’t think grouping the FAA medical requirements (especially for class I certificates) with licensing procedures for handguns and automobiles is a fair comparison.
With class I certificates, you’re not only talking about pilots responsible for the lives of their passengers. If you put yourself in the shoes of those folks in Oklahoma City, responsible for the ultimate evaluation of all those pilots, wouldn’t you also err on the side of caution per evaluating the mass of pilots; while allowing for individual consideration via appeal?
On another topic, as a fellow gun owner and reasonable man, how did you feel about the idea pushing for gun legislation while emotions were running high from Sandy Hook? As in let’s strike now while we can abuse the informal fallacy of ‘appeal to emotion’ to fulfill our political agenda. In doing so, proponents of more gun control were able to conceal the fact that the proximate cause of the fatalities at Sandy Hook was the murderer’s choice of targeting victims that posed the least threat of resisting being killed rather than the choice of gun he used. Rather than face the fact that a person set on shooting kids in an elementary school has chosen a task as easy as shooting fish in a barrel, people somehow argue that he couldn’t have done it without the ‘assault weapon.’ When the truth is, he could have done the same thing with four handguns without reloading.
So logic dictates that the focus should be on the perp, rather than the tool employed. Which brings us back to mental illness; where do we draw the line; and can we ever implement a system capable of predicting and preventing such tragedies as the one at Sandy Hook.
I have no idea where that line should be drawn. But I do know that we should not curtail civil liberties by treating freak occurrences as routine events; especially while shamelessly employing informal fallacies of logic to do so.
“Does anyone think former Congressman Anthony Weiner…
should clear a mental health screening to buy a gun?” Alen Gottlieb
The ‘can of worms’ here is disturbingly similar to zero tolerance & mandatory sentencing….
inotherwords, Common sense & fair adjudication, not enough time or money for that
OS,
While in college I read that book…. You are correct in that the profilers in that case were eerily correct…. That’s one if the reasons I like Criminal Minds…. They use from what I recall some of the techniques…
Bi-polar is nutcase by another name and is another name for schizophrenia. The name is an assault on two bears whom I know at the zoo and they dont appreciate the word association and have asked WordPress to censure the postulation of Bi and polar with a hyphen. Bi-polar can be treated in its two phases of hyperactive and depression. But never the twain shall meet if diet is employed to address the hyperactive child at an early age. Diet and bike riding. For those of you who want drugs for all the ills you then simply do what the ads tell you five million times a day on television and “Ask Your Doctor”. If you are hyper, walk your dog and if you are depressed, walk your dog and give him/her a hug. Big pharma is bad Kharma.
Bruce,
Adolph clearly had a personality disorder. Whether he was “crazy” in the sense of having a psychosis has been debated. Dr. Walter C. Langer, of the
Office of Strategic Services (OSS), was ordered to do a psychological profile of Hitler. With 20-20 hindsight, we can see that Langer and his team was eerily accurate. Langer’s project was given the code name of “The Nizkor Project.”
Here is a complete transcript of the Nizkor project results. There are links to photocopies of the original typewritten documents.
http://www.nizkor.org/hweb/people/h/hitler-adolf/oss-papers/text/profile-index.html
OS,
Thanks for the link to the Hitleranalysis of which I wasn’t aware.That alone as they say was worth the price of admission.
It is a myth that people suddenly snap. Every case of interpersonal violence I ever worked on, the perpetrator has been working up to it, sometimes for years. There are warning signs if one knows what to look for. Sometimes the victim is selected at random, and sometimes targeted.
That is excluding accidents of course. But even in the case of many accidents, we have all heard the expression, “He (or she) is just an accident looking for a place to happen. The warning signs are there for all to see.
Was Adolph Hitler mentally ill? a lot of Nazis didn’t think so. He also confiscated all the guns from the local population. A person can be considered sane one day and be pushed over the edge the next like Christopher Dorner. This has to do with gun control and if someone wants a gun that person is going to get it, so taking everyones gun from them is only going to make them more vunerable, but if everyone had a gun people would be safer. Back In the wild west when most packed a firearm the murder rate was a lot lower per capata than it is today.
BarkinDog,
Wrong, and not at all amusing. Neither is Artie’s recommendations that we can fix mental illness with chiropractic, or those who suggest mediation, or changing diet.
This may come as a shock to some here, but conservative Fox News columnist Charles Krauthammer is a former psychiatrist. Medical degree from Harvard, and did his psychiatric residency at Massachusetts General Hospital. In his last year of psychiatric residency, Dr. Krauthammer was Chief Resident in Psychiatry. During his time at Mass General, he specialized in studying bipolar disorder. By careful observation, he discovered a form of mania separate from bipolar disorder, called “secondary mania.” He has published a number of scholarly papers on bipolar disorder, and is still considered a leading expert on the subject, despite the fact he left the practice of medicine for politics in the late 1970s.
Bipolar disorder is as real as a broken leg or an acute myocardial infarction. Chiropractic, dog walking, meditation or healthy diet will fix neither of those things either. A healthy lifestyle is desirable, including eating healthy, getting exercise and de-stressing, but as the old saying goes, when you are up to your a$$ in alligators, draining the swamp is the last thing on your mind.
Darren, I thought I was the only person who liked the flick, Brazil!
lottakatz,
What you, Nick and many others are riffing on, is a perfect example of how the Overton Window works. Joe Overton understood that government moves ideas incrementally from totally unacceptable to business as usual. The stages of the Overton Window are:
– Unthinkable
– Radical
– Acceptable
– Sensible
– Popular
– Policy
LK, when any constitutional right is infringed, no matter which Amendment it comes from, First, Second, Fifth, etc. If we are not vigilant for even those rights with which one might disagree; and the Second is a perfect example, the path is then set for further erosion.
Think in terms of what happens where there is a small leak in a levee along the Mississippi river. A trickle becomes a torrent, and as the levee is eaten away by erosion, the torrent becomes a flood. Once that happens, the barrier to protect the lower wetlands is useless and might as well be there for decorative purposes only. We see that happening today.
I went past a church yesterday which had a huge banner with red lettering across the front of the church: “PUT PRAYER BACK IN SCHOOLS”
That is a 1A issue, and I’m pretty sure none of the Constitutional lawyers who frequent this site, as well as non-lawyers, would tolerate implementing that for a moment. Current attacks on the Second Amendment are not much different. The fourth, Fifth, Sixth and Eighth Amendments are under attack as well, and we damn well better start paying attention. Even to those with whom we don’t agree.
There is an old Arab parable which speaks directly to the matter:
The story of the camel getting his nose into the tent.
BarkinDog, bipolar disorder is real. You’ve either never seen anyone is the throws of mania and rapid cycling or, as I suspect, you’re bipolar and unmedicated.
Gene H.
Good points, the problem revolves around the law itself, doesn’t it?
Our system demands specific “charges”, laws are struck down all the time for being too vague. The authoritarians have had a field day for the last 50 yrs defining things as a means of controlling the masses. The other problem is our Congress and State Legislatures abdicated their responsibility to actually create the law itself, they’ve relinquished that duty to the various “regulatory agencies”, whom now have police powers where regulations become defacto law.
The NYS SAFE ACT I believe could be struck down on this point alone, the vague and arbitrary term of “mental illness”. Am I mentally ill if I distrust government? Am I mentally ill if I support the Constitution as it’s written? Am I mentally ill if petition for redress?
I’m not sure I agree with bifurcation of mental illness between “socially competent” and “a danger to self or others”, when it comes to our rights, shouldn’t the only standard be “a danger to self and others”? Is the person, no matter what arbitrary label some doctor may apply to them, a danger to themselves or others. Shouldn’t the State (generic) be required to prove this in a court of law before a right is denied?
If the goal of all these “regulations” are to “protect society” then society, through it’s agents, must prove someone is a threat, right?
“Bi-Polar” is a construct which came about when the Renardians were out of control and diagnosing lower echelon DSM folks with schizophrenia, and wrongly. To keep a suburban male on the job the DSM folks created the “bi-polar” disorder thing. It gives one a better entre to society and keeps one from being socially foreclosed. Hyper activity is real. Depression is real. Some folks do go from one to the other. Some are hyper-depressed.
Eagleton was the type who was given the bipolar label. His depression was treated with shock treatment. That was rather radical. No one needs shock treatment. No one needs lobotomy. Hyperactivity needs diet and sometimes drugs. Depression needs change of scenary, possibly divorce wifeypoo, and diet and sometimes drugs.
Stay away from psychologists. Stay away from the Renardian doctors. Freud is a fraud with a wierd beard.
This dog was a lawyer for mental patients for many years in a prior life as a human.
Every humanoid needs a dog. If you dont like dogs I bet you really dont like doctors. We dogs dont treat, we assuage and consul. If you are hyper, go jog with a dog. If you are depressed, job and then walk with the dog. Have an ice cream cone in the park and if there is an itchBay waiting at home to give you apCray, think about divorce.
Completely OT OT OT OT:
I just ran across this cruising around the interwebs and it’s a nifty story about a milestone in aviation that I thought our pilots here might enjoy. I have never heard of this kind of thing and found it fascinating.
Tiny plane kept aloft for months in Arizona skies
http://www.azcentral.com/news/articles/20130414yuma-flight-record.html
Chuck wrote:
“A middle-level bureaucrat has no power to make things happen, but they do have the power to obstruct. So that’s what they do.”
~+~
That is at the heart of the problem and it describes a bureaucracy completely.
If a bureaucracy could somehow morph into a living being, it would certainly resemble the movie “Brazil” One of the most telling parts of the movie was where Robert DeNiro’s character was swallowed up in a vortex of paperwork. In my view that scene was either the work of pure genius, or someone writing strictly from the perspective of 30 years of cynacism from having worked in one.
Gene,
Society may be moving forward, but regulatory agencies seem to be going the other way. The late Dr. Joe Matarazzo wrote a long article for The American Psychologist, the primary journal for the American Psychological Association. That was several years before he became President of APA, and was more than familiar with regulatory boards of all kinds. He dealt with many of them over his long career. To sum it up, he observed that licensing and certification agencies became more and more strict and bureaucratic the longer they existed.
As for me, been there and done that. Dr. Dwight Allen, former Dean of the College of Education at UMass-Amherst, told me something interesting. He said that everyone has a need to feel empowered. A middle-level bureaucrat has no power to make things happen, but they do have the power to obstruct. So that’s what they do.
As you know, in 2011 my wife of 55 years passed away only five months after my 17y/o grandson died of cancer. According to the FAA, bereavement s a a reportable condition, which concerns them enough to make me jump through hoops to renew my pilot’s license. Last time my two-year renewal came up, they only renewed me for 13 months, and said at the end of that time they needed more tests. About six or seven thousand dollars worth, and on my dime, not theirs.
I may write a future story about Bob Hoover and his experiences with the FAA medical office.
Great article, Chuck.
On the issue of a bright line, I don’t think a bright line criteria is always applicable. There are exceptions where such a criteria is required from a pragmatic standpoint. For example (and as you well know), the legal criteria for sanity to plead an insanity defense is “does the party know their actions are right or wrong?” This goes directly to mitigation of the mens rea component of the charge and from a legal standpoint, too much resolution into detail can simply muddy the waters to the point that proceedings grind to a halt. That is one area where a bright line makes sense. In almost all other areas, I think one must look at mental illness in a birfucated manner. First, is the person a danger to themselves and/or others? This does not always mean the same thing as “is the person violent?” although it can. Second, is the person socially and/or technically functional? By that, I think the socially functional aspect is fairly self-explanatory but by technical functionality I mean basically “is the person not prone to delusions of any sort and otherwise competent to engage in an activity?”
The truly horrible thing is the stigmatization that goes with mental illness. And that’s a social problem at its core. For the purposes of public safety and justice, we can define the problem(s) mental illness can create in a structural and detached manner revolving around present or potential dangers as aided by trained and qualified mental health care professionals such as yourself. The social stigma part of it? I’m not sure how to address that other than education and exposure. Mental illness is certainly stigmatized today, but that stigma is not as strong as was say 30 years ago before people became somewhat more educated to the issues and conditions. Most everyone has a “crazy aunt or uncle” but back in the day the stigma was so much stronger than it is now, families often didn’t even talk about it. Now? Even though stigma still exists, it is less so because the unspoken problem with “Uncle Bob” is now “Uncle Bob has PTSD”.
As a criteria used by the state though through agents who are not trained psychological professionals or not relying upon professional diagnosis in licensing and other ministerial actions of state, it’s entirely inappropriate. We aren’t talking about the narrow use at bar when professionals are relied upon to demonstrate competence or incompetence to stand trial. We’re talking about clerks practicing medicine without license. I don’t that that is appropriate when insurance companies do it and I sure as hell don’t think it’s appropriate when some governmental clerk makes that call.
OS: The link says, These personality problems relate to [snip] disregard or antagonism toward authority, especially rules and regulations.
Man am I in trouble. But … I don’t care, because I disregard authority.
Nick, when another right is being eroded as little as the 2nd and I whine at such an disproportional level by all means, have at it. 🙂 I recall when we had an assault weapons ban and when roads didn’t have police check-points for drunk driving- before the courts said driving on taxpayer built roads was a privilege, stop and frisk wasn’t ubiquitous in a city, or that every communication you sent or received wasn’t fair game to be sucked up by an internal security agency. And you probably do also. Lotta’ rights been circumscribed and at a far less intrusive level that the regulations being prescribed for gun owners. C’mon man, get a grip.
Lottakatz, don’t you think that if we had stood up and said no when the first rights were being eroded away things would be different?
The line in the sand for me, even as a non-gun owner, is the RKBA. Mutually assured destruction against tyranny.
Could any government withstand the assault of 300 million firearms, fully-loaded and pointed right at them?
Let’s hope this brinkmanship ends before we destroy it all.
Fascinating article.
I have actually lived inside some of the subjects you guys are discussing here.
I am a physician, in a very conservative southern state.
I also happen to have bipolar disorder.
Trust me, it’s not a “political construct”. I wish it were.
Having lived with it, and had it nearly destroy my life, it’s not an abstract concept. It’s something I deal with on a daily basis. While it’s no picnic,it can be controlled and dealt with, just like any other illness, diabetes, hypertension or whatever.
Unfortunately, society doesn’t deal with it like any other illness.
There’s a lot of talk about treating the mentally ill with respect and humanity, it doesn’t really happen that way.
Not even in the healing profession.
The Federation of State Medical Boards, and the national association of Physician Health programs both have recommendations that doctors who are diagnosed with my disorder be monitored for from 2 to 5 years for possible problems.
However… my state’s board has advised me that I will be monitored for my entire career. Apparently, EVERYONE in our state must be monitored forever and ever, amen. There is no appeal and there is no option, aside from leaving the state.
Now, understand, I have never had ANY sort of disciplinary action or sanctions against me by any licensing body, hospital medical executive committee, peer review organization or specialty board. I hold an appointment as a clinical professor of medicine at our local medical school, and am the head of my department at the hospital.
It makes no difference.
The board has informed me that there is ‘just too much uncertainty’ surrounding the diagnosis of bipolar disorder to allow me to practice without being monitored for the rest of my career.
Physicians who are caught abusing drugs or alcohol are typically monitored for two to five years, and then cut loose with an admonition to not do it again. In spite of the fact that addiction specialists say that addiction is a lifelong diagnosis, it’s ok to let them self-police.
Those of us with a ‘mental illness’ cannot, apparently, be trusted to do the same thing.
Wait.
It gets better!
I am a pilot. I learned to fly when I was 16.
Well…I used to be a pilot.
As was noted above, the FAA says that because I have been diagnosed as being bipolar, I can no longer fly.
I am now grounded for the rest of my life. I flew for years, and was pretty good at it. I flew in the service.
Now, the government says because I have been diagnosed with this, I am automatically grounded. The government fears that I may suddenly snap or something, and fly my plane into a building, or a crowd, or something, I suppose.
Now…my granddad took me out and taught me to shoot a Prince Albert can with a .22 rifle when I was six years old. I’ve loved to shoot ever since. I am not much of a hunter. I don’t really enjoy shooting living creatures, but I love some target shooting and go to the range whenever I get a chance. I also have guns in the house that I would use to defend my home and family, should that ever be necessary.
The problem here, is that having seen how the government has dealt with my mental illness in every other aspect of my life, I have no doubt that they will handle the issue of mental illness and firearms just as well as they have every other time they have interacted with me.
Which is to say, piss-poorly.
After everything I have been through, I have NO trouble visualizing a visit from the BATF.
There’ll be a knock on the door, and the guy will say: “Doctor, from our records, we see that you have a .45 automatic, a 45/410 revolver, and a Remington 870 shotgun. I am afraid that, in the judgement of the government, there is just too much uncertainty surrounding your diagnosis, and they have decided there is just too much risk to allow you to keep your guns…”
So, could some of these helpful people from the government please explain to me why on earth would someone with a mental illness WANT to seek treatment, when it means that you suddenly become a second class citizen the second you disclose the fact that you have a disease?
Registered Lunatic,
Thanks for your heartfelt posting. However, your horrific dealings with political bureaucrats (licensing, etc.) proves my point that mental illness is something defined by government agencies and, as such, is, and always will be, a “political construct”. Just sayin’. Over and out.