Mood Swings

A psychiatrist surveys the mind and the wider world

Suicide by Homicide: Accepting the Reality of Mental Illness

Outpatient involuntary treatment needs to be considered.

A mentally ill young male kills innocents. He had struggled with – fill in the blank mental illness (autism, depression, bipolar disorder, schizophrenia) – and did not receive treatment, or did not agree to treatment, or did not respond to treatment. He and his family tried to get help, but failed, and eventually his family gave up. The young man became a loner, living quietly on the margins of society, until, one day, he had enough and decided to kill himself.

There is the phenomenon of suicide-by-cop; there can also be suicide-by-homicide.  The young man decided to kill himself by killing others, thereby ensuring that police would kill him, and, if not, he could always kill himself at the end. It might be in a movie theater, or a subway station, or at a mall where a politician would speak.  it might even be in an innocent elementary school.

He had access to guns, yes, but it was an insane mind that pulled the triggers, a mind, often, with a treatable disease. Not infrequently, we know the disease, we know how to treat it, we have the treatments. It is sometimes the case that it is not lack of knowledge which leads to tragedy; it is the inability to implement what we know.

This is not a problem of ignorance; it's a problem of will. 

And the blame for not being able to implement what we know lays with us, with many members of our liberal American society, who will defend to the death their personal liberties, their civil rights. One cannot force outpatient treatment for mental illness in most states. Many will even deny that these mental illnesses are “real.” The blogs, including many on this Psychology Today website, are full of critics of psychiatry and drugs and the pharmaceutical industry and the medical profession. It’s all made up, they say. These are “socially constructed” illnesses, whereby the psychiatric profession can exert its power-hunger and the pharmaceutical industry will profit. 

If these are fictional conditions, then some very real innocent lives have been lost because of those fictions.

We must finally put aside all the discrimination against mental illnesses, which reaches the point of denying their existence, and admit what any civilized, educated society would do: these are real illnesses, often characterized by the refusal of those who have them to accept treatment. Sometimes, society has rights which overrule extreme individual civil liberties. Besides strict gun laws, we need more laws allowing for outpatient commitment to treatment for severe mental illnesses like schizophrenia or bipolar disorder.

This doesnt mean that we can cure all mental illnesses easily and that all of our treatments are just fine. But we can treat some illnesses, and we can manage to control some extreme behaviors. I have known many persons with bipolar disorder or schizophrenia, who could have had at least moderate benefit from treatments, but who refused to accept those treatments.  And their parents could not force adult children to be treated. And judges could not change the laws.  

Extreme tragedies are rare, but small tragedies happen on a daily basis, because of insufficient legal ability to treat some of our most treatable mental illnesses in the outpatient setting.

We don't need to lock people up; we just need to give parents of adults with mental illnesses more legal tools to try to get their children treatment. 

Such interventions may not have prevented this tragedy, or they might have; we cannot know. But I think it is highly probable that in a society with very strict access to guns, and with much wider ability to treat mental illness in the community, such tragedies would be much less common than they are in these United States. 

The radical libertarian right will hate it, but so will the radical left, who can’t accept the idea of mental illnesses being real rather than social fictions. And many liberals, who have no problem with forcing people to pay money in higher taxes, will refuse to force people to get their diseases treated.

When both extremes oppose an idea, it tends to be right. 

 

 

 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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