Since President Trump linked mass shootings to “mental illness,” organized psychiatry and psychology have been decrying any association between the two. What struck me about the responses was that instead of saying, “Sure they’re mentally ill, but what must change is the American glamorization of violent redemption and the American attitude toward guns,” spokespeople instead claimed that mass shooters are not mentally ill at all. When Red Sox fans hate the Yankees, that’s culture; if a Red Sox fan shot up the Yankee clubhouse, you can bet on mental illness.
Part of the problem, as I blogged here, is that there are three kinds of mental illness—poor psychological integration, nonconformity to cultural expectations of behavior, and brain disease—and people are rarely clear which one they mean. People with brain diseases like schizophrenia may be no more prone to violence than other people, but mass shootings, as I blogged here, are very often associated with paranoid functioning (one particular kind of poor psychological integration that blames malevolent forces for one’s own failures), and mass shootings are a violation of American social norms (although they may conform to the norms of a subculture such as white supremacy).
The larger problem in discussing the mental illness label is the impossible task psychology and psychiatry have set for themselves. They want to treat nearly everyone, and they want to do it without offending anyone, partly because mentally ill people are unfairly discriminated against, but partly because the surest path to treating nearly everyone is to avoid offending them. Far from analogizing mental illness to physical disease these days, which itself has problems, they seem currently to be analogizing mental illnesses to dental caries: nearly everyone has them, there is no stigma, it doesn’t make you worse at relating to others, and everyone should be treated regularly. Flossing, which is clearly beneficial, is a daily habit only for 30% of Americans, while psychiatric drugs, many of which apparently don’t work, are taken daily by about 20% of Americans. I imagine it’s hard to raise money for flossing commercials when its profit margin is so narrow.
The proper answer to unfair discrimination against people with mental illnesses is to delineate fair discrimination (such as not letting erratic people fly planes) rather than to abolish all discriminating judgments. A key to doing that is to distinguish what people with various conditions can and cannot do, and another key is to distinguish who can take steps to fix a problem (usually the patient) from who, if anyone, is to blame for it.
This may sound to some like victim-blaming, because one of my agendas is to help mentally ill people get better, which means I don’t accept them as they are. I don’t think oncologists are accused (yet) of victim-blaming for telling us not to smoke, but I’m pretty sure some doctors are accused of victim-blaming for telling us to lose weight. The treatment for social anxiety, for one example, is to socialize (often in collaboration with a therapist), endure the anxiety, and discover that whatever you’re afraid of either doesn’t happen or isn’t that bad. Instead, many people would rather take a pill or stay home under the covers and get angry when you tell them they should get out more. The best way to get money out of such people is to tell them they don’t have to change, that they can take a pill or come to a therapist and receive “validation.”
Marsha Linehan described one of the main problems in treating borderline personalities, namely, that they need to change but they experience any effort to change them as a rejection of who they are. She created a “dialectic” between these two stances, but now many people are claiming they don’t want even a dialectic, they want to be told that the world should accept them as they are. One way to coddle people who behave disadvantageously toward themselves or others is to tell them that they are nothing like the bad people on the news, which generates these claims that the bad people are not mentally ill. It also seems that some people have gone so far in the direction of insisting that mentally ill people deserve our sympathy (instead of, deserve our efforts to help them get better) that they cannot imagine using that label to describe someone unsympathetic.
The upshot is that organized psychology and psychiatry are so committed to telling you that your bad behavior is not your fault that you are left with nothing you can do about it except to passively undergo drug treatment, passively undergo manualized therapy, and hand over your money (or better yet, your insurance card: why should you have to work to pay for treatment?). Research shows clearly that collaboration is the key to successful therapy, but that’s true only if success is defined as getting better. If success is defined as not being as upset as previously about how you behave and getting support for attacking people who don’t accept you as you are, then passivity will work.
“Victim” has gone from a technical term (one of the characters in a criminal episode) to a term of pity to a term of superiority (“no one has suffered as I have”) to a term of inferiority (because it implies that the person has some adversity to face, in a culture that claims you shouldn’t have to face adversity). Parents will be accused of victim blaming if they teach their daughters to drink safely and stay fit. “Mental illness” is on the same journey. It is currently widely used as a term of superiority (“let me teach you how to talk about my mental illness”) but it won’t be long before it is rejected outright and replaced with “misunderstood.”
Mass shooters are mentally ill in the psychological sense, and that means there is something wrong with the way they make sense of the world, other people, and themselves. There’s something wrong with us, too, but not the same thing, if we are chronically late or chronically put things off or get irrationally nervous or treat ourselves abusively. That’s not an insult; it’s an invitation to change for the better.