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. Now the President, along with 2 US Senators, have received letters containing a harmful chemical. Betcha’ $100 that it is related to the Boston Bombing!

  2. Anonymously Yours said

    Leej,
    You never know….Do I think that this government is capable of manipulating someone to do something like this…..Yes…..

    I am hoping it is some “nut” not a fair word who did this on his/her own to fulfill their own agenda.
    I hate to think the gov’t is (has been) acting like a magician, distracting us while they manipulate to have it come out the way they want is abhorrent to me, and yet…more and more I am coming to the (very sad) conclusion that there is way too much distracting and hiding of information.

  3. I would run the cherry bomb kids list and the redneck mothers list on the NSA computer and then narrow it down to New England. A suburb of Boston is the homebase of the culprit. I am thinking he is a loner. Backpacker. Most students these days are backpackers. But below age 40 and older than 28. Nearsighted. Took the subway. Rode a bus. Stashed the pressure cookers a day or so in advance. Lit the fuse a mnute or so before they went off. Look in the videos for some one age 30 smloking and going away from the bomb but out where he can see the finish line when it goes off.

  4. If I was running the investigation I would do the Goodwill Search on the NSA computer and run down all the pressure cookers. The fact that the bombs were placed at the finish line, and off track, suggests homegrown terrorist. A foreigner would have stopped the race in its tracks, so to speak. Another clue which suggests homegrown and cornfed are the ball bearings used in the bombs. Kids in America use ball bearings with their slingshots. These are sold in hobby shops with slingshots. When kids gravitate from cherry bombs and M-80s into making their own bombs, they employ that which is at hand. The pressure cooker is rustin away under the workbench. The gun powder is removed from shotgun shells. The ball bearings are from the sling shot stash. The time fuse is a cigarette atop a cherry bomb fuse which goes into the gunpowder down in the center of the pressure cooker. It dont take a nutcase, a rocket scientist or an Arab to put two and two together. Amatuer bomber went pro. No prosac involved
    You heard it from me.

  5. I hope that the Marathon Bomber was not a nutcase. It will unlease an avalanch of nutcases telling us how to diagnose, define, catagorize, treat and contain nutcases. These guys come with beards and smoke pipes if they are of the psychologist genre and drive fancy cars and live in suburbs funded by Big Pharma if they are of the MD persuation and prescribed drugs for everything that dont ail ya. Mental hospitals will come back into vogue. The DSM is about to have its fifth edition and will usher in an Arab Spring.

    Some bottom line things need to be put in perspective. Who is responsible for what they’re doing? Who made them what they are? If they are not responsible because of some large degree of nutcase then why punish?
    There is a song which puts this into perspective. It was written by Jerry Jeff Walker and is set in his home parts. This is not posted for humor.

    [music]
    Its up against the wall Redneck Mothers
    Mothers who have raised the son so well..
    He’s 34 and drinkin in honky tonks..
    kickin hippies asses and raisin hell.

    He sure do like, that Falstaff beer..
    Likes to chase it down with that malt liquor…

    etc

    So, in the aftermath of the Marathon Bomber, I say its time to straighten out parents who nurture and raise these creatures If the Marathon Bomber turns out to be a home grown version, and the pressure cooker suggests that he is, then Jerry Jeff Walker will not be far off base. And this is a Bright Line.

  7. Bron,
    Other than visual, pressure cookers have a hermetic seal. If the outside is cleaned with something to neutralize any remaining “tell” odor, there literally is nothing for even the best dog to detect.

    If the government starts requiring pressure cookers to have serial numbers, that horse is already gone too. One can find them at antique stores, yard sales, and online auctions. I just checked eBay and found 4,679 active listings.

  9. What Bron said. I believe DHS and other agencies are afraid if they publish stuff like this, they will somehow give the bad guys ideas. Never mind that the bad guys also know how to use the Internet, or have books.

    Here is what security expert Bruce Schneier had to say on his blog this morning. Note especially the link to, “This is pitiful.”

    http://www.schneier.com/blog/archives/2013/04/initial_thought.html

    1. OS,

      Thanks for the Bruce Schneir article. He puts this in its proper context and explains the truth of the matter and how the fear from these incidents is used.
      In this post 9/11 era we forget that the Oklahoma City Bombing, which killed 168 senselessly, was committed by domestic terrorists. Yet in the years that have followed there have been few concerted efforts to deal with these terrorists which are home grown. My cynicism is that there was little profit to be had in dealing with these groups and some benefit to the powers that be. With 9/11 there was profit to be made on many fronts and so we have spent more than $3 trillion by using the fear of the American people to make certain wealthy entities even richer.

  10. DHS knew about these things as early as 2004. I never heard of them being used this way.

    Why doesnt DHS share this type of info instead of just saying report any suspicious package? If I saw a pressure cooker on a corner on Sunday April 14, I would have thought it was someone’s sunday dinner gone missing.

    These people at DHS are mostly dopes, they have 600 million eyes and they dont use them. I am beginning to think the government hasnt stopped any terrorists, there just havent been any.

  11. http://gawker.com/5994791/here-is-video-of-a-pressure+cooker-bomb-exploding-and-here-is-who-knows-how-to-build-them

    In mid-2010, the Department of Homeland Security put out a circular, classified “For Official Use Only,” warning of their potential use in domestic attacks:

    Rudimentary improvised explosive devices (IEDs) using pressure cookers to contain the initiator, switch, and explosive charge (typically ammonium nitrate or RDX) frequently have been used in Afghanistan, India, Nepal, and Pakistan. Pressure cookers are common in these countries, and their presence probably would not seem out of place or suspicious to passersby or authorities. Because they are less common in the United States, the presence of a pressure cooker in an unusual location such as a building lobby or busy street corner should be treated as suspicious.

  13. Until now, a pressure cooker was a harmless looking device that looked like something Aunt DoeDoe just picked up at Goodwill. Whereas, a pipe bomb looked like a pipe bomb. So, the Marathon Bombers could have walked that pressure cooker under the arm and no one was the wiser. For humanity’s sake Goodwill should stop selling them.

    Getting back on the topic of the brightline of mental illness, and tie it into the bombing, there are a lot of bright folks out there who make bombs who are not nuts. They are Fourth of July run amok. All this yak on the media about whether they are terrorists or not is mush. A nut who wants to bomb the local school is a terrorist of sorts. He is definitely homegrown. A foreign guy who comes in from Saudia Arabia to take down the Twin Towers is an International Terrorist. A jerk like Justin Bieber who leaves his monkey at an airport in Europe is a nutcase. The guy who shot Reagan was supposedly a nutcase. Lots of these guys could not plead and win a defense of not guilty by reason of insantiy. The guys who hijacked the planes and flew them into the Twin Towers knew that they were killing themselves and others. They might have had a rush before the plane hit but that does not make them bi polar, paranoid schizophrenic or manic depressive. They were “Game On” to the political rap of their pals in al Qaeda.

    The brightline of the politics of this bombing is illustrated by that Congressman from New York who speaks turdy turd and a turd, last name King. He wants to end immigration as we know it. Irish looking guy if my guess is right. He should watch the movie Blazing Saddles. That is the scene where the town decided to let the freedmen into town as citizens just after the civil war with the hope they would fight off some bandits. The one guy said ya but said: But Not The Irish! I think that Congressman King has shown the brightline today on this topic about immigration. We definitely should bar the Irish from coming here anymore. If he is not Irish then I apoligize. Time will tell whether the Marathon Bombers were foreigners, whether they were mentally ill and whether they got their pressure cookers from Goodwill. I gotta get back to my half blind guy who is listening to CNN on what is usually my time to watch Animal Planet.

  15. lottakatz, You’re thinking using logic. The others using logic are using their logic to drum up the emotions of the sheeple to the benefit of themselves or their money masters. You’re bucking the party line of letting emotions rule.

    Actually, I’m more fearful of the police state than guns (handguns more than others) or bombers (except those delivered by drones).

  17. Bron, RWL,
    From an engineering standpoint, a pressure cooker makes as much or more sense than a pipe. First of all, it is a large cylinder, which allows a shaped charge to be installed, much like a Claymore mine. Second, it is designed as a pressure containment vessel. That means a few fractions of a second longer delay before it ruptures. I just did a few rough numbers on the back of an envelope, and assuming basic black powder was used, it had time to build pressure up to somewhere close to 100,000 psi. Even with a relatively low power explosive, the pressure is magnified. Here is a pressure curve chart for black powder. This is not in a closed pressure vessel, but in the chamber of a rifle. The pressure peaks between 50 and 60K psi, and that is with the bullet leaving the barrel. That can easily double in a closed pressure vessel such as a pressure cooker. So, when the authorities talk about a “low pressure” explosive, low is a relative term. In order to do maximum damage, they only needed a thirty to fifty yard blast zone to cut the runners to pieces.

    http://www.frfrogspad.com/pressure.gif

    This is not rocket science…..um…..never mind.

    A brief instructional video. note the convex side of the Claymore is the business end. About the same radius curve as a pressure cooker.

  18. Bron: Your dog might know more human talk than he lets on. One thing that we fail at is when something really exciting gets mentioned. For example, “Lets take BarkinDog by McDonalds and get him the special with the burger, fries and kid toy.” Or: “Betty is coming into town with SuzieQ.”
    SusieQ happens to be his favorite Poodle that he has porked. Or say you drive by McDonalds and do not pull into the drive up. Or you go to the bank and the teller does not send the dog biscuit out that wind pipe device with the receipt for the deposit. He knows what she is saying when she says through the microphone that a treat is coming out. He barks.

    I bet that your dog gives you quite a bit of solace when you are depressed over something and that your spirits rise when you go for the dog walk with him.

  19. Bettykath, I was thinking this evening that Lanza killed 26 people , 20 of them children, in less than 5 minutes. If you add up murders/wounding with guns v. these “terrorist” attacks, guns win in sheer numbers. I hope you’re not right about the focus being taken off of gun control. It looks like the House is planning on weakening an already weak bill.

    And before I’m chided over apples and oranges or the fallacy of an argument from emotion (yea, mea culpa) I’m just going on the amount of carnage. Do citizens have more to fear from terrorists or other Americans with guns?

  20. BarkinDog:

    no worries. My old dog is deaf and half blind, I am his seeing eye human. And translate the spoken word into sign language for him. It is pretty easy because he only knows come, go, down and sit all using a flat hand. No, I dont hit him with it.

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