Dec 17, 2012

Political correctness in the mental health community is killing people

Those of us who work around mental health, and particularly those of us in the recovery community, must stop whistling in the wind about risk of violence.

The one thing I trust on the Treatment Advocacy Center website is the list of murders committed by people with mental illness. Whatever we may believe about the TAC’s proposed response to this issue, it is time for the mental health recovery community to acknowledge that the list is there, and that dozens of names from shopping malls and schools were added to the list last week.

Yes, I know that people with mental illness are much more likely to be victims, not perpetrators of violence. Yes, I know that it’s important not to fuel stigma. So what. Anti-stigma’s political correctness is murder blindness. It is not compatible with anybody’s safety.

Violence denial does its own damage. It undermines the credibility of the recovery movement. It threatens the very notion of people with mental illness living in regular neighborhoods. It brings out today’s version of peasants with pitchforks, the NIMBY people who agitate against safe housing in our communities.

Recovery involves more than feeling vaguely better about our lives. As we reconstruct our lives, we must confront our real risks, including risk of violence.

I believe that the mental health recovery movement has a responsibility to build the public’s capacity to understand the violence in our society. After all, we are the mad. We own the stories of our lives, including our first-hand experience of the process of breaking down. What lessons can we teach about what it takes to interrupt our path when we are at our worst?

Messaging that gets violence right

It does not take much to get the connection between recovery and risk of violence right. Here’s what I write about recovery in my book Defying Mental Illness.
Recovery is a process of building a person's capacity, empowering the person to overcome the effects of the illness. Every person has a range of talents and abilities, a variety of vulnerabilities, a certain capacity to withstand stress, and a certain risk of causing harm when something goes wrong.
Ask four questions to help build recovery.
-- What helps you make the most of your talents?
-- How can you reduce the areas where you are vulnerable?
-- How can you improve your ability to cope with stress?
-- How can you deal with the risk of something going wrong?
The answers will inform critical choices about treatment, medication, overall health, career, housing, and family relationships.
Here’s another excerpt about crisis and violence.
We usually encounter two types of violence in civilian life: instrumental violence and expressive violence. Instrumental violence is used to gain control over others. This is the violence of robbery and terrorism. Instrumental violence that is fueled by delusional thinking can be as well planned as a bank heist. The other type of violence, expressive violence, is the failure of self-control. People break down and strike out. Anger and frustration builds up to a violent outburst. For people with mental illness, handling the internally generated background noise of their symptoms is difficult enough. Stress and conflict make the internal noise level worse. The "fight or flight" response kicks in. But people usually do control their behavior, even at this point.
Most people with mental illness never become violent. People with severe mental illness but no substance abuse and no prior violence have a very low probability of becoming violent. But risk factors add up. The risk of violence increases if the person has more than one psychiatric disorder. The higher the number of co-occurring psychiatric disorders, the greater the risk of violence. The combination of substance abuse and major mental illness is more volatile. Another key predictor of future violence is past violence. Risk skyrockets after someone commits their first act of violence. For example, nearly a third of people with schizophrenia also abuse alcohol or drugs, and are, statistically speaking, twice as likely as the average person to become violent. If such a person commits a violent act, their likelihood of future violence doubles yet again.
Dangerousness involves reckoning with four factors: magnitude, likelihood, imminence, and frequency. Courts weigh these factors to determine if the facts justify involuntary treatment…
In community settings, people with paranoid delusions are more violent than people in other mental illness categories. Their violence is well-planned, aligned with their delusion, and aimed at individuals or institutions. These individuals are likely to commit the most serious crimes because they can gain access to weapons, stay relatively well-connected to reality, and maintain an ability to plan. There are many other patterns of violence connected to mental illness symptoms. People with depression can react to despair by striking out at other people. Parents may kill their children prior to a suicide, especially mothers of young children. Because everyone's experience of mental illness is so different, it is entirely appropriate to ask treatment providers what risk patterns to look out for. Everyone has a stake in safety. Talking about risk does not make violence happen.
Effective long-term crisis prevention for most people with mental illness means controlling the internal noise level by managing symptoms, plus controlling the stress factors within the environment, plus building self-management skills. As the person builds impulse control and self-manages symptoms, the risk of violent action goes down.

1 comment:

Anonymous said...

Very thoughtful. Thanks for it.