Wednesday, January 23, 2013

How Do We Define Mental Illness?

While I've been the first on several web sites to mention a link between psychotropic "medications" and the pattern of violent insanity observed in the Newtown and Columbine murders (and other mass murders followed by suicide), Philip Hodges raises important concerns about the hazards of using an undefined label of "mental illness" to restrict the freedom of any individual...

When I say we need for anyone using Prozac, Paxil, or similar medications (see to be closely supervised, that's a clearly defined recommendation. These drugs are known to cause violent insanity for only a minority of users, but we don't know which users, or how long an individual can safely use these antidepressants. Closely supervising all users is the only realistic way to find out whether there is any reliable way to predict which ones will become violent.

But antidepressants aren't the only drugs associated with violent insanity. Before the serotonin-boosting drugs became popular, violent insanity was often associated with street drugs. Moments of violent insanity (or, more often, moments of dizziness or loss of consciousness) are associated with Flomax, a non-hallucinogenic "relaxant" prescribed by urologists for physical problems. People with emotional issues may suffer lapses of judgment or surges of "energy" that convert ordinary angry moods into violent outbursts under the influence of relatively safe drugs, including beer. People planning violent acts--criminals like Timothy McVeigh, or soldiers like Ishmael Beah--may deliberately use stimulants to help them override inhibitions and kill non-combatants. Where can we draw the line?

Since I've been calling for closer supervision of those specifically at risk for violent behavior, I'll propose two guidelines for identifying the people it's worthwhile to try to supervise:

(1) People currently using medications that are known to alter brain function. If we're serious about saving lives, we need to recognize that, for this purpose, the distinction between violent psychotic patients and ordinary people on ordinary medications is not useful. We need to make sure we're talking about a specific, temporary condition rather than a permanent personality trait.

Most Americans have at some time used some drug that altered our brain function; local anesthetics aren't supposed to alter brain function, but here I stand to testify that just a slight overdose of Lidocaine made me unfit to drive for twelve hours. And my concern here is primarily with the people who seem obviously different from psychotic cases, like the murderer who demanded execution last week, who need to be permanently institutionalized. People like me, during those twelve hours after a dentist gave me two Lidocaine shots before replacing a tooth filling! We don't have "a history of mental illness" that needs to follow us through the rest of our lives, and probably most of us feel like going home to bed after taking an anesthetic or painkiller...but if we're allowed to drive ourselves home from the clinic, we're the ones most likely to kill you.

(2) People who have committed violent crimes and been found legally insane during a trial by jury.

We need to make sure that any attempt to keep the violently insane, and the potentially violent and/or potentially insane and/or stoned, from handling dangerous weapons--which include things like cars, hammers, pencils, and hard shoes, as well as guns and knives--does not allow people to be labelled mental patients, and supervised, merely because they have:

-- sought counselling for grief, depression, anxiety, phobias, teen angst, confusion, or traumatic stress, but not been medicated

-- had behavior problems in school

-- been described as "disturbed" or "confused" by people with reasons to wish to discredit them--political enemies, opponents in lawsuits, mental patients who resent their sanity, or whatever

-- done things others perceived as "crazy" in the sense of bold, daring, wacky, comedic, or innovative

-- used drugs that altered their brain function in the past, as most of us have.

In short: either restrictions on behavior should be part of a contract to which a patient agrees before receiving medications, or they should be found necessary by due process of law.