Two Takes on Depression

Treating the very condition you live with––A clinician's dual perspective

Why I Feel Sympathy for the Devil

The intersection of gun violence and mental illness

I have mental illness. It’s taken hours of talk therapy, months of finding the right dosage and timing of medication, and years of work to learn how to live successfully with it. I’ve redefined how I think and feel, and learned what kinds of people and experiences to limit or allow in my life. Now in my 50’s, I’ve come to know the textures of my own mental illness and the wisdom that comes from living within its boundaries. But I wasn’t always so wise. There was a time when my mental illness overwhelmed me. A long ago era that my thoughts became muddled and foggy, and my depression devolved into despair. Where my judgment became distorted to the point that I was rage-filled and violent – splintered from the weight of soul crushing emotional pain. Where, at age 19, I held a pistol in my hand, ready to pull the trigger.

When news breaks of a mass shooting, the tragedy grips me with both horror and sadness. Like many, I’m initially shocked by the terror of it all, feeling anguish for those who were killed or wounded, and for the bystanders caught in the trauma’s wake. I grieve for the first responders, the families and friends whose lives will be forever changed, and the traumatic reactions that will reverberate in the community for years to come. When the information rolls in about the gunman and his connection to mental illness, I prepare myself for what comes next, for it’s not the temperature the collective majority will be feeling. It’s not a fevered pitch for gun control, the death penalty, for laws to be changed or names to be blamed. I feel empathy for the gunman. A sorrowful compassion. A melancholy that comes from a knowing first-hand experience how one’s mind has left reality not by choice, but by circumstance. I mourn that his illness wasn’t seen. That it wasn’t detected. That signals were missed, or that communications were lost in translation. I can’t help but wonder if the clarity of his mind returns, how he’ll accept the realization of what he’s done.

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There are certain kinds of mental illness that infect the mind like a virus attacks the body. It weakens defenses, cripples resolve, and leaves one vulnerable to corrosive thoughts. Studies note that there are certain ages (late teens and early twenties) and particular kinds of symptom onset (depression, psychotic breaks) that raise the risk for violence. At 19, I was at that age – and my break with reality aligned with a first-time symptom onset. My violent act was self-directed though, with suicidal thinking taking hold of my once reasonable mind. But I had the luck of others hearing my pleas for help, the good fortune of medical intervention and the support of family and friends that prevented the unthinkable from occurring.

Predicting violence is not an exact science, but access to lethal means significantly raises the risk. It’s been nearly 45 years since The Gun Control Act of 1968 defined mental health disqualification for owning a firearm as “adjudicated mental defectives and any person who had been committed to a mental institution.”

Dated and antiquated, the procedures, programs and amended legislature like The Brady Handgun Violence Prevention Act of 1993, Threat Assessment Teams on Campus and The National Instant Criminal System Improvement Act of 2008 have been vital and important changes. Well intended and passionately supported, they still show us; however, that loopholes and technicalities still exist.While there are no easy fixes to this situation, it’s clear that we need to be better readied when mental illness knocks, raps loudly or roars through the door. We need to work harder to identify at-risk children and adults, and remind healthcare professionals not only of their Duty to Warn responsibilities, but the need to go above and beyond one’s comfort zone in the name of public safety. I am reminded of the notion of the Bystander Effect, where believing someone else will take care of a concerning issue creates a diffusion of responsibility. In the end, no one “calls it in” and chaos swirls. Just ask Kitty Genovese who was murdered in front of 38 people, none of whom made any attempt to get her help.

We cannot continue to be a “good enough” society by just doing the bare minimum. The coordination of medical, health, academic and legal information between and across local, state and federal agencies for at-risk individuals is deplorable – with lapses and oversights being caught only after deadly acts occur. Bipartisan government, The National Rifle Association, State and Federal regulatory agencies, and public and private gun sellers must find more realistic ways to protect those who cannot, or should not, have access to firearms. This not about a fundamental right to bear arms, it is something even greater – an obligation to our own humanity to help those who cannot help themselves.

And finally, we need to balance the myths of mental illness with realistic truths about diseases of the mind. Research shows that most people who live with mental illness are not violent towards others – and are more likely to hurt themselves. But the truth is that a small percentage of individuals with certain kinds of psychotic disorders can be violent. Communicated responsibly and accurately, these facts could foster greater ways to identify, treat and follow at-risk children and adults – and help to address stigma and dilute ignorance about mental illness.

Until then, I will always feel sympathy for the devil.

 

Dr. Deborah Serani, author of the award winning ”Living with Depression” by Rowman and Littlefield, is a go-to expert on the subject of depression.

 

 

 

 

 

Deborah Serani, Psy.D., is a psychologist and psychoanalyst who lives with depression and specializes in its diagnosis and treatment.

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