Monday, July 23, 2012

In Defense of Damaged, Crazy, or Insane

It seems like people are always doing awful things. Each time they do, everyone else searches for the reason(s) why. The farther out of your own realm of experience, the farther what that person did from what you feel you could possibly do, the easier it is to see them as an "other," talk about them as the "other," as someone completely foreign to you and the world you live in. While I understand this impulse, feel it myself in many situations, I feel myself wanting to scream out about just how hurtful this can be to the "other" who isn't an other, to the people you know and love who might also be different in the way that you're dismissing the "other" as being.

After the murders in Aurora, CO, there has been a vacuum as to the motives behind why this killer did this, which I have heard many fill with the words damaged, crazy, or insane. Few that I've read use these words are interested in exploring these issues further, but instead use it in a dismissive way. "Why are we asking any questions about why he might have done this? Clearly he is damaged/crazy/insane." That's it. The story ends there for them. To me, it also seems to imply that the arrow works both ways. Not only did he do these things because he is damaged/crazy/insane/whatever word they chose, but people who are damaged/crazy/insane/etc do things like this, so what can you do? Let's all just throw our hands up and say that it's got nothing to do with me. But that implication hurts people like me, people like those that I know and love, people that I'm sure are present in everyone's lives, people who are damaged or crazy or insane. And, yes, if you read this (or any of my blog posts for that matter), thinking that it sounds like I'm angry, that's because I am. Nothing wrong with a bit of anger now then. Dismissing me because of my tone also means erasing my voice, my experience, my life. 

So I'm going to try to take things one by one. Let's look at "damaged." I read someone in the rather civil comment thread to this post say that the shooter was "clearly mentally and emotionally damaged, and almost assuredly was born that way" Asserting that someone was damaged from birth makes me ask if this damage is something that can be tested for, if this damage always leads to violent behavior like this, and, if so, what the commenter thinks society should do with people who test positive for this kind of "damage." I think that the more common use of the term "damaged" to describe someone who has committed an atrocity like this is that the trauma they have experienced in life has had such a profound effect that they are, if not broken, then severely impaired, in a way that leads them to commit these acts. So, the short of it is "people get fucked up when bad shit happens to them." Alright. That's true. If bad shit didn't happen to these people, they probably wouldn't have done these things. But bad shit happens to everyone. Some people get out mostly unscathed. Some people develop mental health issues as a result of that bad shit, especially when combined with "damage" they were born with. I've met many people when I was hospitalized and  people in my group therapy who have all had bad shit happen to them and been fucked up by it. I think that most of us would be insulted if you implied that we'd ever do something like what happened in Aurora. I also think that those people's loved ones would argue with you if you said that they would do something like this because of the trauma they've suffered. So where do you draw the line between what bad shit or the extent of the bad shit that happens and when you automatically commit mass homicide? And how much does that allow you to not attempt to deal with the person or the trauma they've been through, because, well, the damage is done?

Before I go into talking about the "crazy" label, I want to jump forward to quickly cover the "insane" label. Insanity is no longer in scientific or mental use, but is only legal terminology, referring to a person cannot tell right from wrong, or fantasy from reality. The perpetrator may very well have been insane, but very few mentally ill people who commit crimes are eligible for an insanity defense, as most mentally ill people still know right from wrong. I know that for most people it is impossible to think believe that someone who knows right from wrong could do something like this, but there is often an internal logic to the perpetrator which precludes an insanity ruling. Of course, most of the time when a person uses the term "insane," they aren't referring to legal terminology at all.

Closely related to both "damaged" and "insane," in fact what I think many people mean when they use those words to describe someone, is mentally ill or crazy. (I've written before about my own ambivalence about the current way that mental illness is treated, as well as the ways others are trying to reframe it. And, personally, I often use "crazy" to describe myself and behaviors that are closely linked to how my mental illness is exhibited, but I think of it as more of a reclaimed word than the word I think should be used by the general public.) The NAMI website states: "Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning." I think that it is safe to say that at least a few of those things would seem to be true of the anyone who did something like this, but, even if mental illness is an underlying reason, it is unfair to paint the whole of mentally ill people with that brush. Mental illness is such an overarching term for a wide variety of diagnoses which means that it includes a multitude of individuals who are just trying to live their lives the best they can. The majority of schizophrenics are not the homeless man, mumbling to himself. The majority of bipolar people aren't...well, whatever stereotype people have for us, especially after there's a widely publicized crime perpetrated by someone who has been diagnosed as bipolar. You get the picture. This erases the way that the majority of people experience mental illness, the majority of whom are law-abiding upstanding citizens. During my hospitalizations and experiences in treatment, I don't think I've ever met a felon. If my fellow patients had committed any crimes, even those in the hospital that was used by the cops as a dumping place for people that they picked up off the street but had dubious grounds or not enough room to hold in jail, they were misdemeanors- property destruction, petty theft, drug use, getting into fights- not causing serious premeditated harm to others. Even then, it is few and far between. I think that most of the people I've met during hospitalizations or in group therapy would be offended by the assumption that they are criminals as a result of their mental illness. 

Another big problem with dismissing the perpetrator as mentally ill is that it dismisses the idea that something more could be done to help mentally ill people, particularly this person. I think that there is a debate to be had about the benefits of long-term (often involuntary) in-patient (including commitment) treatment versus outpatient treatment, but currently those are both options that are proving too costly for most people, families, and even communities, especially in this economic downturn. As was pointed out after a mentally-ill man, who's family said that they "could see this coming," opened fire in Seattle's Cafe Racer in May, killing six, most community-based outpatient mental health providers are severely understaffed and overworked, which is only getting worse as states budgets are getting trimmed more and more each year. I would also add that the increased difficulty in getting someone involuntarily committed, which I see as good on many levels, means that there is less funding "needed" for those facilities, which results in fewer of them as well as poorer conditions in the ones that do exist. What do you think that means for the people who want to be voluntarily hospitalized, who know that they need the security and intensity of inpatient care during a particularly bad period or during a medication change? 

In my experience, it's difficult for many people to even get the mental health equivalent of a drug rehab program. Even though my family wanted me to do it shortly after my original diagnosis, there was no local facilities for that kind of treatment and it was hit or miss whether our health insurance would cover it. I know a family that had to liquidate their 401k so that one parent/spouse could get 90-day inpatient treatment and the only facility is over ten hours away. As for community-based outpatient treatment, I obtained services from our county's mental health facilities for over a year, both prescriptions for my medications as well as once monthly talk-therapy, for a very reasonable, sliding-scale fee. Through school and then my husband, I had medical insurance, and started treatment with a psychiatrist that had treated me during a hospitalization. Even when I no longer had health insurance, my family ultimately decided that it was worth it to pay for a psychiatrist that I could get an appointment to see within two business days if I had problems with my medications, as opposed to the very caring nurse practitioner at the county facility, who I had to wait a month to see when I had an emergency with my medication and who was mostly just happy when I was still taking my medication as prescribed. Last summer and fall, when I realized that things weren't getting any better with time after my uncle's passing, my parents decided that it was worth it to pay out-of-pocket for my intensive DBT therapy, instead of me going back to our county mental health facility for my on-going treatment. It was a tough choice but one I'm glad they made, glad we currently have the resources to make. 

So, using "he's crazy" as a dismissal of the motivations of this perpetrator erases all debate about the current state of mental health care in this country, as well as the hard work of so many people who are dealing with and seeking treatment for their mental health concerns in that system. It also perpetuates the stigma of mental illness, which can be a stumbling block to seeking or continuing treatment. Before you use "crazy" as a dismissal, think of the mentally ill people you know, or just those dealing with mental health issues that will affect most humans at some point in their life (grieving, mild depression, trauma, etc), and if you think that their "crazy" means that you think they will, or even could, do what this man did. And, if you think it's possible, ask yourself if you're willing to keep dismissing the possibility until you instead find yourself dismissing their actions. 

I don't claim to have any answers about why the perpetrator did this, but I don't think that those answers will ever be as simple as "he's damaged/insane/crazy," even if those things did play a role. It may seem easier to write these events off this way, but never very accurate. Only even mentioning being damaged or crazy in the context of criminal behavior means that it's the only picture of mental illness that you are acknowledging exists, even while your mentally ill loved one is right there. 


TyRoy said...

Only thing I have about this is choice. But I can’t really get my thoughts right but I will try anyway.

The main thing is, who gets to make the choice? Some board like with paroles? Parents?

Same thing goes with the individual with mental illness. It is not a choice. I don’t think there is or will identify a gene. But I will get to more on that.

Sticking with genes for now. It is like finding the ‘gay gene’. Could be good for some, proof that it isn’t a choice. But a la Dark Knight Rises; what if it is used for bad? For instance, to get rid of ‘the gays’. The same could be said about/for the ‘crazy gene’.

But then, if there is something you can do about a particular mental illness, would someone choose to be crazy? I am not ‘Mr. Phil, PhD’ so I don’t know. [I am making a joke when I probably shouldn’t but I couldn’t resist. I like Happy Endings too much.] I understand that some drugs make people feel foggy or not like themselves. So what happens then?

And also what about if the illness doesn’t have medicine? Does that person stay in a hospital all the time?

What if a false positive comes up and someone doesn’t have anything? It is just as hard to know what to do if you do know.

Free will is so fundamental. How can we choose to strip that from anyone?

AvaAlso said...

Personally, I agree. With mental illness, I think that it would make it easier if there was a blood test or DNA test to confirm a diagnosis, to guide a doc to a better treatment sooner, but I wouldn't want it to have been done pre-birth, though there might be other mentally ill people who disagree with me. If they could identify a gay gene, would we then have less gay people because some parents would abort? As for medication, I think that also is a highly personal matter.

What I really want to advocate for is less stigma for the individuals, less dismissal of horrifying behavior as "what do you expect from crazy people?", and a greater availability and wider range of treatment options for those who want or need it.