Constitutional Law, Science, Uncategorized

What is mental illness? Where is the bright line drawn?

Submitted by Charlton Stanley, guest blogger
(Otteray Scribe)

Image 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?

412 thoughts on “What is mental illness? Where is the bright line drawn?”

  1. Off Topic:

    U.S. Tortured Detainees And Top Officials Are Responsible: Report
    By Luke Johnson
    Posted: 04/16/2013
    http://www.huffingtonpost.com/2013/04/16/torture-report_n_3092775.html

    Excerpt:
    The torture report discarded the euphemism of “enhanced interrogation techniques” and said that U.S. forces engaged in torture. By examining court cases of torture and cases by the United States against other countries, the authors concluded that “The United States may not declare a nation guilty of engaging in torture and then exempt itself from being so labeled for similar if not identical conduct.”

    The report rejected the contention that torture resulted from of a “few bad apples,” as Bush said following the release of sickening photos showing American soldiers abusing prisoners at Abu Ghraib in Iraq. The authors cited two decisions as key to this conclusion: Bush’s declaration that the Geneva Conventions did not apply to detainees in Afghanistan and the Guantanamo Bay detention center, and his authorization to allow the CIA to use brutal techniques against some detainees. The report also cited comments by Vice President Dick Cheney that the U.S. must work on “the dark side” and other similar comments leading to the perception that such practices would be tolerated.

    The investigation concluded further that there was no evidence that torture produced any significant information, much of the information provided was unreliable, and it did not lead to the capture Osama Bin Laden. The authors clarified that classified evidence may exist to show that such practices worked, but the U.S. government has thus far declined to release it.

    *****

    Our country terrorizes people in other countries with its drone strikes.

  2. LeeJ,

    If they can get ahead of the blaming….hey why not….after all….most of the folks that watch faux news….can’t remember why….. but they know they should…..

  3. Bob,

    Good to see you….I agree with you agreeing with OS….. Fear….what motives you….. Guess it could be a good government campaign…..or is that propaganda…

  6. OS: “One can grieve for the dead and wounded, and console the survivors without crouching in fear. Fear is what terrorists want, and appears to be what many politicians want so they can pass further restrictive laws that erode rights. Catch people in the middle of mind-numbing shock and politicians have an easy sell.”

    Amen.

  7. AY:

    it is sickening but we accept 200, 300 people dying in a plane crash and we dont use it as a device to expand government and further limit our rights.

    If we had changed the regimes in Saudi Arabia and Iran we would not have this problem today. But since the Bush family is in bed with the royal family what are you going to do?

  8. Gene H:

    “One thing is for sure though: the sacrificial lamb being offered up is civil rights in the name of “homeland security”.”

    you are right on point. It is really sickening how this has been going on these past 12 years. And people dont seem to even care, pass the NDAA-ho hum, expand wire tapping-yawn.

    It is disgusting. I am sick of these fools who think DHS is some magical security blanket and the Patriot Act is patriotic and will protect us.

    Good save us from people who will use this to expand their power. Apparently King is one of them. What a moron.

  9. Gene,

    That is why I have not commented before now on this…..Its heart sicking…..So, they say they have a suspect of interest….. I was reading different news articles and I’m still aghast…. labeling someone just because they can…..

  10. AY,

    No chatter, no credible threats, no claims yet, low explosive primitive devices? This may be “domestic anarchy” already. I noticed this morning that CNN had that weasel Peter King on blabbering about the “value of the DHS” and how “now is not the time to cut their budget”. And yet, oddly enough, there are no “truthers” popping up for this attack. Maybe they haven’t had time to put it together, but something like this? Makes far more sense both tactically and strategically as a false flag then something like Newtown. I’m not claiming conspiracy. Just noticing the media and public responses to date. As to what went down, like any investigation, the proof is in the eating of the pudding.

    Evil abounds. It’s not confined to either the civilian or government sectors. One thing is for sure though: the sacrificial lamb being offered up is civil rights in the name of “homeland security”.

    Franklin was right.

    Domestic, foreign, false flag or no, the fear created by this sort of event will be ginned up to justify further building the police state by those with a vested interest in either consolidating and expanding state power and/or monetary interests in supplies and support services.

  11. I am sorry for all of the things people do stupid that harm others…… I am trying to make sense of these so called “terrorist” that we have not only inside of these borders but the ones we entrust to keep US safe…. The US is involved in so many so called “Just Wars or Conflicts”….. that its just a matter of time before not only do enemy combatdants come ashore to the US but the citizens become so disenfranchised with the way the government is run that anarchy becomes the norm…..

    May the family and loved ones be comforted in this drastic deed….by one we don’t know yet…..

  13. People of prominence who get a half hour on tevlevision every night with ten minutes off for commercials, who do commerciansl as part of the news, and the commercials are for cancer products, can be the greatest announcers of the news who ever lived. But they sold out to cancer causing tobacco profiteers and promoted smoking to young children. So Ed and Walter were great guys and all but they abused the public trust. I will watch someone with a conscience like Amy Goodman on Link TV. And this gets us to the brightline of the bipolars of the world. Many hyperactive people are hyperactive because of the intake of certain items such as sugar, tobacco, meth, cocaine, and itchinBay wives. Doctors who treat their illness do not address the addictions and only get them addicted to some drug sold by Big Pharma.

  14. The Bright Line. I knew a guy who was locked up in a mental hospital for years. He got mad at a so called doctor and punched him. The doctor was just in country from some place where English is not even the second language. They had him diagnosing mental patients. Well the prosecutor saw fit to prosecute the patient for the assault. The state wanted him to plead n.g.r.i. (not guilty by reason of insanity). The guy was smarter than the average bear. He took his chances with the jury and got convicted. But they only gave him a year. He did that with not so crazy people in the penitentiary and got released for time off for good behavior. Had he done the n.g.r.i. apCray he would still be locked up with the loonies until he got better. Had he not puched out the doctor who sprech nein he would still be locked up with the looneys. I would say that this was a bright move for a guy on the bright line. He may have been a bit bipolar or whatever but he saw a ticket to ride and took it. When he got his green card the doc became an opthamologist and looks into eyes all day and does not have to discern whether they are looney or not.

  15. BarkinDog
    Please don’t derail the discussion. This is not about smoking, and frankly, the fact Murrow smoked had nothing at all to do with his skills as a reporter. I have no use for tobacco either, but that is OT.

  16. Otterayscribe: I liked Ed Murrow on tv. But one thing. Its a big thing. He smoked on TV during his show and encouraged children to thus copy his fine example of adulthood. He got paid for it. Walter Cronkite was worse: Winston Tastes Good, Like a Cigarette Should. He was told to say that on the air. He makes a joke in his Memoirs of the time that he corrected the grammar and got chastised. It would have been better had his granma corrected his ethics.The good ol days of news on television had some good points but you basically had a thirty minute news show punctuated by ten minutes of commercials. Now we have news 24/7 and overall, with C-Span and the like, its better. And the kids are not told to smoke. Millions will live longer.

  17. Malisha,
    Data should be gathered, free of any kind of agenda. We see that all the time now, where data are skewed based on point of view. Content neutral. Just gather the numbers. There are lots of statisticians and researchers who have been unable to get the numbers needed so real analysis can be done. My point is, don’t interfere with the data gathering by telling the CDC and DOJ what they can look at and what they can’t.

  18. 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.

    Wait a minute, wait a minute: “demanding that the data not be used to promote or advocate any position on violence”?

    Somebody in this country in this day and age is demanding that data NOT be used to promote or advocate any position?

    That’s not possible! OS, tell me I read that wrong. Tell me I misunderstood; tell me anything. Don’t tell me that is actually happening.

    How is that “fine”? Isn’t that religious orthodoxy itself? Certainly it cannot be government! It cannot be freedom of speech — it cannot even be freedom of thought!

    Evidence … must not be used … to promote or advocate any position …

    Scotty, you can beam me up now.

  20. For an object lesson on the proper way to respond to any terror act, look a the way Londoners behaved during the blitz. The nightly bombing raids on London took their toll, but the Brits, with their usual aplomb, went about their business.

    Look at photographs and newsreel movies of Londoners going about their business during the blitz. I can remember Edward R. Murrow broadcasting from rooftops and the steps of public buildings as the bombs fell. People went calmly and quietly to underground shelters as the bombs began to fall. As soon as the all clear sounded, they went back about their business. London had it right. I hope Boston does too.

    It is a sad thing when our government leaders try to sell panic in order to pass new laws like the despicable Patriot Act. Want to hear how it should be done? Listen to this one minute clip of Edward R. Murrow broadcasting on the radio live as another air raid began. The double-deck buses were still running, as the bombers were coming over. This is a man, and a people, our own government leaders could emulate, but probably won’t.

    I posted the brief clip of Edward R. Murrow’s voice to share this man with those too young to remember. Strong, vibrant, confident–and calm. Broadcasting out in the open; not the slightest hint of fear, even though he knew one of those bombs might have his name on it. He always broadcast from rooftops and from the steps of public buildings as the bombs rained down.

    http://www.youtube.com/watch?feature=player_embedded&v=6KLQxtDOkZA

    Compare Mr. Murrow with some of those “journalists” broadcasting live from the middle east during both Gulf wars. Diving for cover, hands shaking as they tried to put on gas masks.

    Someone once said of Murrow, that when Armageddon comes, Edward R. Murrow will be the play-by-play announcer.

    I feel old. I remember being glued in front of the radio, listening to him. After the introduction, his memorable voice would come on, “This is London……”

    In the background, you could hear the sirens, anti-aircraft guns firing, and bombs exploding. If they were low enough, the engines of the German bombers could be heard droning overhead. In the middle of all that, the best newsman who ever lived told what was happening. all the while reassuring the whole world that no matter what, London, and the British people would go on.

    Then I think about the BS of those color coded alerts, and the breathless panic of “news” talking heads as they clutched their pearls while looking for a fainting couch.

    One can grieve for the dead and wounded, and console the survivors without crouching in fear. Fear is what terrorists want, and appears to be what many politicians want so they can pass further restrictive laws that erode rights. Catch people in the middle of mind-numbing shock and politicians have an easy sell.

    1. “Fear is what terrorists want, and appears to be what many politicians want so they can pass further restrictive laws that erode rights. Catch people in the middle of mind-numbing shock and politicians have an easy sell.”

      OS,

      Well said and we can already see examples in the coverage of this tragedy. By the way although I never heard Murrow broadcast from England, I heard enough of him starting with McCarthy, to list him as someone I revere.

    2. To Otteray Scribe,

      Dear Charlton, thank you for those extremely kind words regarding the broadcasts of Edward R Murrow during the London Blitz of 1940/1941. I think it safe to say that there WAS panic at this time – but it lay, squarely with the politicians. Making 3 million (yes, MILLION) cardboard coffins, in anticipation of civilan deaths was quite amazing. Having the United States Ambassador describe (with some relish) how Herr Hitler would shortly be in London did not go down too well, I can assure you.

      Murrow brought broadcasting genius to play, as well as personal courage. His broadcasts lead to a small congregation in South Dakota church deciding to sponsor a British family. This meant that my parents and my then infant brother found themselves bombarded, not with bombs courtesy of the Luftwaffe, but with food and clothing parcels from an older farming couple – and to my acquiring a set of American Godparents, when I arrived! It also set in train a sequence of events which could be said to have caused my immigration to these shores more than 12 years ago.

      Edward R Murrow did many things in his lifetime, but increasing the number of naturalized United States Citizens by one would have been a surprize to him, I think.

      Once again, thank you OS.

Comments are closed.