Zelophehad’s Daughters

Aurora Shooting-We need to talk about better identification and treatment for mental illness

Posted by Beatrice

Although this post is a bit off topic for a Mormon/feminist blog, I feel that it is important enough to discuss that I am including it here.  As most people are likely aware, on July 20th a 24-year-old man came through the exit door of a movie theater in Aurora, Colorado and opened fire on the audience.  Twelve people have been confirmed dead from the shooting, and 58 people were injured.  Most of the news articles that I have seen covering the event have focused on issues of gun-control and security.  While these are certainly important topics to discuss, I have been surprised that there has not been more discussion about improving mental health in our country.  It is important to note that a discussion of mental health does not presuppose that we excuse the atrocious behavior of the shooter.  Rather that by improving the identification and treatment of mental health in our country we would be reducing the overall risk of such tragedies occurring in the first place.

An additional piece of news that has surprised me was the statement made by President Obama in Fort Meyers, Florida after the event.  As part of a his statement he said, “Such violence, such evil is senseless; it’s beyond reason.”  While I appreciate his intent, I find this statement problematic primarily because it implies that there is no way we can understand why individuals act in a very violent way.  As a psychologist, my response is that although it is very, very hard for us to understand these acts of extreme violence, I think that it is important that we do everything we can to understand why these events occur and what we can do to prevent them.  This can be accomplished through research about the causes of mental illness as well as studies that look at the effectiveness of different treatments.  Even though I recognize that Pres. Obama was responding to the tragedy with very short notice, I wish that he would have taken the opportunity to talk about the importance of improving overall mental health in our country.  Once again, these kind of statements must be made carefully in order to avoid excusing the behavior or sympathizing too much with the perpetrator.  However, I feel that it was a missed opportunity to reduce some of the stigma around general mental health issues and raise awareness about how the mental health system could be improved overall.

In the spirit of raising awareness, I wanted to  address some common misconceptions about mental health issues.

1-We tend to lump people into strict categories of “normal” people and people with mental health problems.  However, this type of thinking does not accurately represent the variation within the human population.  When we look at any mental health issue, such as propensity toward depression, everyone fits somewhere along a wide spectrum of functioning.  Thus, at one extreme are people who rarely struggle with depression while at the other extreme are people whose depression so debilitating it significantly hampers their ability to function in everyday life.  However the important thing to note is that most people will be somewhere in the middle of that spectrum and that their position in that spectrum can fluctuate throughout their life.  Although there are specific diagnostic criteria for identifying someone with depression, mental health professionals recognize that cut-off points are somewhat arbitrary.  Thus, drawing a cut-off point on the spectrum and stating that everyone to the left of the line “has” depression while everyone to the right of line doesn’t “have” depression may not be a useful way to think about mental illness.

2-Related to the first point is that the stigma around mental health illness can often prevent people from seeking professional help when they would benefit from it.  If we think of the world in these strict categories (those who have mental health issues and those who do not), people are reluctant to do things that would put themselves in the “mental health issues” category.  So they may feel that if they go to a therapist, take medication, etc. then they are placing themselves in a category that they don’t want to be in.  However, many people don’t realize that mental health problems are fairly common.  Most people are going to suffer from some form of depression, anxiety, or other mental health problem during their lifespan.  We need to normalize mental health issues and help people realize that it is a common part of life that most people deal with.  Almost everyone goes to the doctor and we see this as a normal part of being a responsible adult.  We need to do the same for mental health.

3-Because events like the Aurora shooting get a lot of press, we often assume that people with mental health issues are commonly dangerous or violent.  However, a vast majority of people with mental health issues are not dangerous or violent.  Most people fall in the middle of the spectrum discussed earlier with very few people at the extremes of the spectrum.  I do think that is important to seek to understand the behavior of people at the extremes.  Why are these people so violent?  What factors contributed to this behavior?  I can’t state this too many times, but the purpose here is not to excuse the behavior, but take measures to reduce the likelihood of this behavior occurring in the future.  When discussing this issue with a friend, he was firm in his belief that because the violence in Aurora was premeditated, it could not be a mental health issue.  In his mind, people with mental illnesses are incapable of the level of planning that went into the violent act of the shooter.  I am not sure where he got this idea from, but it was difficult to convince him that some people with mental health issues are capable of this level of preplanning.   I firmly believe that knowledge is power and gaining better knowledge about mental health will contribute to a better understanding of how to prevent these violent acts.  As I stated before, I disagree with Pres. Obama’s statement that  “Such violence, such evil is senseless; it’s beyond reason.”  We need to do everything we can to understand the reasons so we can reduce the violence.

What do you think?  What are common stigmas or misconceptions about mental health problems?  How can we reduce the stigma around mental health in ourselves and people around us?

26 Responses to “Aurora Shooting-We need to talk about better identification and treatment for mental illness”

  1. 1.

    When discussing the shame around seeking help I think of the latest thing on the Real Housewives of New Jersey. Teresa and her brother have a horrible, horrible relationship. But when talking about counseling her entire deal was “I don’t have a problem, my brother does. So I’m going to therapy to help him deal with his problem.”

    For some reason the idea of sitting down with a third party and discuss the difficulties you’re having is highly stigmatize even on television when one would think due to the ample usage of the Bishop as that third party (however misguided that may be) members of the church would be the most understanding in seeking help.

  2. 2.

    Thank you so much for this post. As someone who suffers from mental health problems, I so appreciate this post. I agree that there needs to be LESS stigma attached to mental illness. Part of being whole and well includes mental health, not just physical health, and we need to be able and willing to accept and openly discuss that.

    A man I know recently committed suicide. He has struggled with depression off and on for years and, though I don’t know the details surrounding his death, I suspect his mental health contributed to the suicide. My husband and I were talking about his death, and he (my husband) commented that he just can’t understand how someone would end their life, especially when they are right in their prime. This man was in his early 40s when he took his life. My response to my husband was that, yes, I understand that you can’t fathom someone feeling there was no other choice but to take their own life. But as someone who has BEEN in that place before, as someone who has seriously planned and contemplated my own death, I can say that I know what that kind of pain feels like. And the only reason I am still here to tell you about it is that I was able to reach out and find the help I needed. It felt hopeless. At times it still does. But medication and therapy have saved my life, quite literally.

    I was one of those people who didn’t “believe” in therapy because it meant I was “broken”. I was raised to believe seeing a therapist meant you were crazy. But I am here to say that finding help for my mental illnesses has been the best thing I’ve done for myself, ever.

    If you feel depressed, anxious, whatever – there is help. There are places you can go and people who want to help you. It breaks my heart to think that maybe, if it wasn’t so taboo to have a mental illness, my friend wouldn’t have taken his own life, and his wife and daughters would not be mourning him right now. Maybe I would be able to hear his wit and see his face again.

    Please know that mental illness is real, and it is very debilitating for some people. You may not see it; some people are experts at hiding how they truly feel or what is going on in their minds. But it is real. We need to talk about it and make it an acceptable part of caring for ourselves to address mental health issues.

  3. 3.

    Thanks for the post! I am a lurker and don’t comment often. I have a few thoughts. My husband is an I/O Psychologist and has commented on how hard it is to predict violent/unethical behavior. Right now the assessments that are available are not very successful at predicting such behavior. Even with behaviors such as stealing from an employer..it’s just difficult to predict…let alone mass murder. We’ve talked about this a lot in light of what happened in Aurora.
    Also, we actually new someone that was involved in a murder suicide in Idaho. Unfortunately, it was the murderer we knew. He was a Human Factors Psychology professor at the University of Idaho and killed a grad student there. My husband was actually a grad student in the I/O Program at ODU while this man was a grad student in the Human Factors program. Anyway, this individual had a history of depression issues, however, it was still a shock when we heard that he murdered someone and then killed himself. Looking back there were red flags, but even amongst professionals it seems those flags were only recognized after the fact.
    I also have a brother with schizo-affective disorder and have witnessed how difficult it is to advocate for help. We just do not have the structure in place to adequately meet the needs of families in this area.

  4. 4.

    Lots of typos and bad grammar! Apologies!

  5. 5.

    why do we need to label guys like this “crazy” or somehow having “mental issues”? Can we not accept that normal people do evil things? This guy has been meticulously planning this for some time. What’s the difference between a guy like this, and some guy working for the military to create an even more destructive weapon? The military worker also works quite meticulously to ensure that the latest bomb can pierce even more people’s bodies. Is that not crazy?

  6. 6.

    Dan,

    I think you bring up a good point. How do we define mental health issues? Within psychology, someone is thought to have a mental health problem if they fall in one or more of the following categories.

    1-Deviance-Behaviors, thoughts, or emotions that deviate from societies norms and values.
    2-Dysfunction-Behaviors, thoughts, or emotions that seriously interfere with daily functioning.
    3-Distress-Behaviors, thoughts, or emotions that cause significant personal distress.
    4-Danger-Behaviors, thoughts, or emotions that indicate potential danger to themselves or others.

    With regards to the example you bring up, the Aurora shooter is deviating from societies norms and values while someone in the military is not. Although it is morally a difficult issue, as a society we generally accept and sanction violence if we feel that it is protecting our country. However, the boundaries of the four categories I mentioned are fuzzy (when do you label someone as being deviant or not?).

    I think a larger point though, is that regardless of whether we label the Aurora shooter as someone with a mental health issue, or label him as a normal person doing evil things, we still need to work to understand why he did what he did. We still need to work towards understanding so we can reduce the chances of this happening in our society.

  7. 7.

    I have been very open about my struggles with mental illness in my ward, in hopes of empowering others who might be suffering silently. I feel a sense of despair of ever getting through to those who don’t suffer, however. Even my husband, who has gone through the refiner’s fire with me, doesn’t quite understand. Although he’s become terribly sensitive and kind about it. The only way to erase the stigma is openness.

    “Fixing” us—–I believe, in the long run, many of us are on our own. Much of the root of my own disease lies in physical maladies, combined with family of origin sickness. I suppose I’ll spend the rest of my life dealing with it.

    The system in Utah is hopelessly antiquated.

    I have had one thought per the Aurora shooting, though. While I truly agonize for his family, his mother, I wonder why, if she was so certain he was going to commit a horrific act of violence, didn’t she act? I don’t blame her for her son’s choices. But she knew it was him as soon as she heard about the tragedy, before the authorities came to her house.

    I also realize it’s very very hard to force a mentally ill loved one into treatment and it’s equally hard to get authorities to listen when one is alarmed. I suspect it’s possible that if she had called the police in Aurora, they’d have spoken to him and he’d have charmed them with lies.

    I still wonder why.

  8. 8.

    Thinking about this issue more, I realize that when we tend to say some has mental health problems, or label someone as “crazy” we usually are focusing on the fact that they are not thinking logically or rationally. Thus, perhaps my friend thought that the level of preplanning indicated that the individual was thinking logically, and thus did not have a mental health problem.

    While faulty thinking can certainly be an indication of a mental health problem, it is not a necessary prerequisite. Mental health issues can also include faulty emotions (such as an extreme lack of compassion for other people) or faulty behaviors (such as a level of violence). So by definition, people who act in an “evil” way have mental health difficulties.

    One concern I have with labeling people as “evil” is that we assume that nothing can be done to prevent the behavior or improve the functioning of the individual. Of course, free choice is a difficult and complicated issue when discussing mental health issues. However, we need to be careful to not make the assumption that nothing can be done to prevent these situations.

  9. 9.

    I’m not sure that this approach to the problem is any less simplistic than the gun/guncontrol debate (a debate we are not having anymore). What about the influences of our culture which glorifies violence and tells our young people that violence is an acceptable way to deal with people or things we don’t like? Witness some of the signs and beliefs of tea party members. What about the breakdown in sense of community and community values? I don’t disagree that spotting aberrant behavior and being able to do something about it would be an enormous help, but we must look at much more in the long run.

  10. 10.

    Good point, Ken. One part of psychopathology (the study of mental health issues) that I didn’t mention in the post is the effect of sociocultural influences on behavior. While not all therapists or psychologists will incorporate this approach, it is certainly part of the psychopathology umbrella. So, on the individual level, you would be looking at how the broader culture influenced someone’s thoughts/emotions/behavior. However, I think you bring up a good point that we need to also look beyond the individual and think about how these cultural forces are impacting broader society. I would argue that this broader perspective is still part of the question about mental health (and by mental health, I mean the mental well-being of everyone in the society), but just taken from a broader lens.

  11. 11.

    I, like annegb, am open to my ward, friends, and family about taking anti-depressants. I do this because depression is a factor in everything in my life and bringing it out in the open seems to relieve the touchiness, at least for me!

    I am not as open at work because of the risk of discrimination or the perception that I am not able to complete my job duties. However, I view depression as an illness, and I have no qualms about taking sick days for self-care. I have even taken a sick leave from work to treat my depression. Just like someone who needs time off work to recover from pneumonia or has an episode related to diabetes, I respond to and monitor my depression.

    Regarding the Aurora shooting, here is an interesting article about his mother:

    http://www.theatlanticwire.com/business/2012/07/abc-news-long-speed-controversy-reporting-james-holmes/54921/

  12. 12.

    Interestingly enough NAMI has been working to raise awareness about mental illness for the purpose of education along with reversing stigmatization. A recent survey found that while the public is now more aware and to some degree understanding the stigma still remains.

    There are two things I would like to address. First we are all mentally ill to some degree. While this might be true of depression it is not true of all conditions. Bipolar disorder and schizophrenia in all its forms are not behavioral disorders. They have a physical cause. There needs to be much more research tone to discover the factors involved in these diseases of the brain. I only mention this because I think it is important that everyone understand that there is not a one size fits all solution. We do know that treatment works when it includes family support, medication, and therapy.

    Secondly there is next to nothing that can be done to identify and treat anyone over the age of eighteen for anything they don’t want to be treated for. Even when parents or friends notice that something is wrong the most they can do is gently encourage their loved one to seek help. These serious mental illnesses go undiagnosed and untreated until a person does something illegal. Then the justice system takes care of it. That is why there are so many mentally ill persons in jail. That and the dearth of hospital beds in nearly every state in the union.

    I commend you for bringing this topic up. It is hugely important and it is being ignored. It is unfortunate that it doesn’t actually bring lawmakers to strengthen the laws in favor of prevention by early treatment. That is the place to start.

  13. 13.

    Great points, YvonneS. I am glad that you brought up that there are multiple causes of mental illnesses. You bring up another point as well. Some mental illnesses (like depression) are fairly common, while others are much more rare.

    I am also glad that you brought up that it is difficult to get treatment for adults who resist or refuse treatment. Hopefully further research will identify methods that are more effective at preventing mental health problems from escalating as well as identifying more effective methods to convince people with mental illnesses to receive help. One benefit o more accurate and public information about mental health is that family members will know more effective ways to approach someone about getting help.

  14. 14.

    I’m with Dan. You leave out the possibilty that he has chosen evil.

    Some men just want to see the world burn.

  15. 15.

    Kramer,

    It is a common misconception that if we say that someone has a mental health issue then we presuppose that they do not have control over their choices. There are a wide variety of mental health issues that are caused by a wide variety of factors. Thus, some mental health issues are related to being disconnected from reality and not understanding how one’s choices are affecting others. However, and this is really important, other people with mental health issues have a greater level of control over their choices and know the likely consequences of that behavior. Additionally, some people’s mental health is made much worse by factors beyond their control while some people’s mental health is made much worse by their own actions and choices. By very definition someone who “wants to watch the world burn” (desiring this level of chaos and violence) has poor mental health.

    The main points are that 1-We need to gain a better understanding of the causes and treatments of mental health problems and 2-Someone who choses aberrant behavior could potentially benefit from professional counseling if they were willing to receive such counseling.

  16. 16.

    Thanks for this important post, Beatrice. Forgive me if I veer too far away from your point, but your essential argument about how people are not either “good” or “evil” reminded me of a class on Holocaust Studies that I took during my undergrad. Among our assignments were two books that sought answers to the question of how and why the Nazis were able to deteriorate into committing such inhuman, evil acts so quickly: Stanley Milgram’s Obedience to Authority (1974) and Christopher Browning’s Ordinary Men (1992).

    The first book was a write-up of Milgram’s famous psychological experiments, in which he put subjects in a position to believe that they were administering electric shocks of increasing voltage to other people:

    http://en.wikipedia.org/wiki/Milgram_experiment

    His conclusions were that most people – even “good” people – are easily cowed by those whom they perceive to be in authority; they will do “bad” things – even if those things are against their own personal moral compass – if they are pressured enough. Browning’s book, a historical work, found that a Polish police battalion of “ordinary men” – husbands and fathers – were willing to engage in the mass murder of their Jewish neighbors, even when the Nazis told them they didn’t have to participate, and even when they knew for certain that they would experience no negative repercussions for refusing (it was not a kill-or-be-killed situation).

    Both of these books were really disturbing to me, because their conclusions indicated that there is not some big fundamental difference between people who commit deeply evil acts and those who don’t; the biggest difference is situational.

    (Significantly, not everyone was willing to participate in the Milgram experiments, including, for example, a young German woman who refused no matter how much they pressured her. She stated specifically that she did not want to make the same mistakes that her people had made a generation earlier during the Holocaust. So if we accept our own propensity for evil, we may indeed be able to learn from history.)

    I realize that you are talking specifically about mental health here, but it sounds like this is another facet of the same thing, or a similar dynamic: we tend to think that we would never do something evil, and that only “crazy” or “evil” people do evil things. When we acknowledge that we all have the capacity for evil, or for “craziness,” we may be more able to think critically about our choices, as well as more wiling to speak out when we see problems around us.

  17. 17.

    Galdralag,

    I think your points fit right into this discussion. It is understandable that we would want to distance ourselves from people who commit horrible acts of violence (and engage in other immoral behavior). We do this by thinking of these people as being “other” in that their motivations are tied to their evil nature and their acts are “incomprehensible.” The examples that your bring up we so surprising to people because they saw that there was less space between themselves and people they wanted to categorize as “other”. We are all human and are all somewhere on the spectrum of functioning. One of the key things I learned about psychology is that studying people who are not functioning well helps us to better understand people who are functioning well and visa versa. We shouldn’t approach the study of human beings as if we are studying two completely different categories of people.

  18. 18.

    Galdralag: The Milgram experiments were a tad bit more nuanced (things aren’t as bad as they seem if you look more at some details… but other things make things seem even worse).

    For a good and really entertaining run-down of those nuances, you should listen to the beginning of the Radiolab “Bad Show” podcast.

    http://www.radiolab.org/2012/jan/09/

  19. 19.

    @Apame – The book I referenced above, Obedience to Authority, describes all of the different variations that Milgram tried (putting the person who is being shocked in the same room as the shocker, putting multiple subjects together, etc.) and the varying levels of compliance, not just the more well-known experiment. It also includes pre- and post-experiment interviews with the subjects, which are pretty fascinating. Sorry that I didn’t include a lot of nuance in my comment – I figured it was already overly-long. :) And I love radiolab.

    So, just to be clear, though there were significant variations in what people were willing to do depending on how the experiment was staged (Milgram tried 19 different variations) and there was always a percentage of people who refused to participate no matter how the experiment was formatted, it nevertheless struck me that more people are willing to do things that they feel morally uncomfortable with than we might think. It is incredibly easy for people to rationalize or justify themselves for behaviors that another part of them feels is wrong, and Milgram’s experiments bear that out. That was all I was trying to say; the line between good and evil is not necessarily a clear one.

  20. 20.

    So true. Your comment just reminded me of that radiolab episode and how it made me go, “Reeeeeeally? Wow.”

    Just wanted to highlight it here.

  21. 21.

    Thanks, Angie, for the link.

  22. 22.

    Boy, it sure looks like the media skewed her comment. Because the caller was a reporter, therefore he didn’t have the shooter. He had the mother on the phone. It sounds like she was referring to herself, as she claims. That’s a shame, because no doubt she and her husband are in for it. Mind you. I’m not ignoring the anguish of the grieving loved ones. But if I had to make a choice (God forbid) I rather be a mother of a victim than a perpetrator. I couldn’t live with that burden.

  23. 23.

    Someone asked why people don’t act before something happens? Unfortunately, in many states you are not allowed to interfere until something happens.

    As far as the op. I began having problems with depression/anxiety/panic attacks as a result of taking high doses of steroids for a bleeding disorder.. I wish doctors would do a better job of explaining the side of effects of certain medications had I known the side effects I would have said no. The last time, I was on 100mg of steroids a day I felt like I could have not only hurt myself, but someone else, but, I knew that this was from the steroids. I called my doctors and I told him I was taking myself off the steroids and I didn’t care what he thought about it, Period. I have a new hematologist, and I’m making an appointment before I have another hematological event and I’m telling him before hand that I will no longer allow myself to be placed on them.

    The other thing I wanted to say, is I wish church would stop telling people that they are filled with Satan, Depression is caused by a chemical imbalance in the brain. You have no control over depression so if you need to take an anti-depressant, take it, there’s no shame in that either.

    I would like to share some things that have helped me, in addition to therapy, medication, I have a service animal, Beau makes sure I get up and get out, we walk about four miles a day(which helps with the anxiety) and because he so cute, forces me to talk to people because they all come up and talk to me because they want to pet him. As long as he doesn’t mind, I don’t mind. He’s a great stress reducer

  24. 24.

    I wanted to thank everyone who has shared their own experiences with mental health. I am so glad that people are willing to talk about this (on this blog, and openly with ward members and family). I think this is an important step toward reducing the stigma surrounding mental health issues.

  25. 25.

    I completely agree. As soon as I heard about the shooting, I thought, “No one seems to empathize with him. I’m sure he’s had it tough and that he just got to the point where he snapped.” I’ve felt like if things kept going the way they were without help, I would snap, too. I’m lucky to have found low-income insurance and a very supportive boyfriend, but what if I didn’t have those? Your three points are so important.

  26. 26.

    this the first time reading this site. i find it very interesting. thank you all for the interesting topics and discussions!
    i live in a wonderful ward in california wiith great brohers and sisters, and find myself living absolutely isolated. i have a different life experience than normal and find that other lds have a tremendously difficult time hearing or seeing different points of view. this is unfortunate but not very different than non-lds cultures. while i strive to be of more service in my ward i find that to preserve myself i have to interact only in the most superficial and infrequent ways with ward members. so far i find that i agree with many of the feelings being expressed within this blog. thank you for the interaction.

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