I have been thinking for some
time about our attitudes as a society toward mental illness and other psychological
abnormalities that seem beyond understanding.
This thought process may have begun
with the reported increase in mass shootings, overt far right-wing violence and
threats, or perhaps with the increase in bullying in schools and online. Certainly, violent people coming to the foreground
of daily News has raised questions for me of why we do not know more than we do
about the functioning of our brains, our hormones and our genes. The emphasis
on criminal minds on TV programs, referred to as “Evil” in some form or another,
have also influenced my thoughts about how we might need to change some attitudes
and behaviors to deal with realities rather than with myths and fabricated
labels.
The negative attitudes,
psychological shortcomings, intermittent explosive outbursts and obvious
character flaws of our pretend president have certainly contributed to my
thoughts about the complicated relationship of genes, hormones, learned
responses and brain functioning. Attempting
to deport sick migrant children, cancelling a trip to Poland because of the
Dorian Hurricane (but then playing golf and congratulating Poland on the
occasion of having been invaded), plus altering a weather chart (an illegal
action) to back up a claim of his that Dorian was headed to Alabama – these
actions have only served to indicate that he may have gone “off the track.” Certainly,
they have pointed to his narcissism (which is listed as a form of “mental
illness”). Moreover, Trump’s spurious charge that “Mental Illness” is the basic
cause for mass shootings has also motivated a desire to explore this subject
(see my previous Blog post for 8/21/2019).
Books and articles have influenced my thoughts as
well. Just recently, I came across an article
titled Increase Funding for Mental Illness Now by Jeffrey Borenstein, MD
( an associate clinical professor of psychiatry
at Columbia University College of Physicians and Surgeons) in “Psychology
Today,” and although it is from 2016, it speaks to several of the issues and
concerns that plague us today. Here are some of its main points (including my
marks for emphasis):
ü
“…it is
impossible to overstate the economic, social and personal toll of
mental illness.
ü “Approximately one in five people live
day-to-day with mental illness. Unfortunately, high-profile, violent incidents
involving people with mental illness continue to reinforce lingering
stigmas.”
ü “The World Economic Forum… asked a group of health economists to estimate global
costs and project costs to 2030. Their estimate based on 2010 data showed
mental disorders as the largest cost driver at $2.5 trillion in
global costs in 2010 and projected costs of $6 trillion by 2030.”
ü “The U.S. National Institute of Mental Health (NIMH) has an annual budget of
$1.4 billion, a figure that has declined more than 10 percent in the past five
years when adjusted for inflation, meaning a substantial decrease in
funding for both basic research and clinical trials.”
ü “Because of the decrease in government funding for young scientists, we
are at great risk of losing an entire generation of scientists.
Scarce resources mean more competition for federal grants …and fewer
incentives to pursue scientific careers.”
ü “We must support new ideas generated by
scientists that ultimately become the next generation of treatments and
technologies for the field of psychiatry--like new and promising
technologies such as optogenetics, and next generation therapies such as deep brain stimulation and transcranial magnetic
stimulation. “
ü “All three of the latter received initial key support
from grants provided by the Brain & Behavior Research Foundation and then further
research grants from the government…but we still need to expand
basic, translational and clinical research to better understand the workings of
the brain and why things go wrong, and test
new medical and psycho-social approaches. “
ü
“Decades after
the deinstitutionalization of mentally ill patients, the United States
still lacks adequate community support, psychiatrists, psychologists,
social workers, nurses and hospital beds. Many people go untreated,
and there are more people with psychiatric illnesses in prison than in psychiatric hospitals“…only through a combination
of public and private funding for high-risk, high reward research will
we generate significant scientific discoveries that will change lives and end
the suffering that psychiatric illness brings so many.”
(read entire
article at: https://www.psychologytoday.com/us/blog/brain-and-behavior/201608/increase-funding-mental-illness-now)
The matters cited above have influenced my concerns
about the causes and results of mental illness. One of those concerns is the obvious
disconnect between Trump’s meme about “Mental Illness pulling the trigger” and
his budgets that decrease funding for research, for seeking original causes and
for development of new treatments. Let me simply share with you certain concepts that stand out at
this point in my evolution on this topic.
1)
Definitions
matter- and Mr. Trump either doesn’t care or doesn’t know
what he is talking about. “’Mental illness’ is a disease that causes mild to
severe disturbances in thought and/or behavior, resulting in an inability to
cope with life’s ordinary demands and routines.
There are more than 200 classified forms of mental
illness (see Part I of 8/21/2019).
2)
A Mind is a
terrible thing to waste – as a
society, we have not spent enough time, energy or money on the study of brain
functioning and mental health.
Yes, we have
studied Psychology extensively, which has to do with human behavior and the diagnosis,
labeling and treatment thereof.
We have become
more familiar with neuroses -- various mental functioning disorders
characterized by anxiety, compulsions, phobias, depression, dis-associations,
etc.) and psychoses-- major functional mental disorders in which the
personality is very seriously disorganized and contact with reality is seriously
impaired) and with
organic disease, brain damage, or metabolic disorder can also result in similar
disorder or dysfunction.
We have been able to recognize and label
certain functional conditions, such as schizophrenia and manic-depressive
disorder, but most functional disorders are characterized by lack of apparent
organic cause, and therein lies a major dilemma. We have advanced in the treatment of symptoms
of many of these disorders by means of therapy and/or medications, but the
organic root causes are generally less well-known, and their study less
prevalent.
Thus, we
have found some answers for the question:
how can we lessen the effects (symptoms; behaviors) of a mental
disorder?
However, we
falter in answering the question: how can we cure or correct the causes
of mental disorders?
Or, more
simply: How can we “re-wire” brain functions (plus genes and hormones/chemicals)
to eliminate anti-social behaviors that bring harm or destruction to the
patient and possibly to others?
In other
words, we can perform surgery on the brain to remove a blood clot, insert a
device that stimulates electrical impulses to lessen epileptic seizures, lessen
or increase a function in parts of the brain, or stimulate production of dopamine
in some patients that may help increase fine motor skills. But can we manipulate the brain, genes and/or
hormones to cure schizophrenia or to eliminate violent behavior? Not yet…
We may be
much further along than I think we are toward answering that question, but I’m
afraid we are also being held back by certain general attitudes, myths and
inadequacies that are all too human and too prevalent, such as:
3)
“You’re an
Animal!” -- In general, our
brains themselves may not have evolved as much as we think they have. After all, when homo sapiens emerged with a
brain that was evolved beyond that of sub-human species, there were certain
functions built-in that had to do with survival in a mostly hostile environment:
fear, flight and fight. Those functions appear
to be preserved in the modern human brain despite historic social innovations,
discoveries and education.
a)
fear – our brains seem
to have absorbed that which speaks to why those with a mental disorder are eight
(8) times more likely to be killed when police encounter them. It speaks to our inability to deal effectively
with homeless persons when mental disorder is present. It speaks to society’s inability to treat
mental disorders in a similar manner to when physical illness or disease
presents itself.
Think
about it. If we encounter a person ranting and raving because of a physical pain or injury, do we immediately recoil or try
to subdue them? Generally, we seek or
provide some sort of help – some sort of treatment – for them. We know from experience that physical
ailments can be treated and/or healed.
That
same confidence is not necessarily extant when we confront the pain,
discomfort, or disorder when presented by a person with a mental malfunction. We immediately experience fear of the
unknown, because we have not been schooled in brain dysfunction; we have not
been educated about mental disorders and their treatment, and we have not been
given enough information to realize what can be done to attend to their
manifestations.
Self-defense
sometimes emerges in the form of isolation or ‘quarantine’, sometimes as protection,
sometimes as flight from or simple avoidance of the persons who manifest
symptoms that we don’t understand. Fear
does that to us. Fear of the unknown holds us back from a deeper understanding
of mental disorders.
b. flight
– early homo sapiens had to be wary of almost everything in order not to be
devoured; thus we find many human beings still unable to overcome isolating
behaviors, mistrust of others, paranoia, violent reaction to strangers and
strangeness, self-protection and ego-centricity, as well as aversion to change
or to anything unfamiliar in their experience.
Is it any wonder, then, that mental disorder is something that the
public would sooner ignore, flee from or make excuses about than to confront with
deeper study and research?
c.
fight – we often speak of our “initial response” when confronted by
behaviors, circumstances or stimuli that tend to provoke or threaten us. That
initial response is more than likely tied to violence in one form or another –
like lashing out, maiming, killing, stringing someone up, taking revenge, or
getting back at, penalizing or inflicting punishment. Even though we tend to hide
such vengeful reactions by talking about seeking justice or pay-back or a life
sentence, we really know what that “initial response” entails. Some act upon it; some do not. Some have learned how to reject it.
Considering
that our initial response is a tendency to react violently to people or
circumstances that provoke, challenge or threaten us, where does that leave us
in terms of support for delving deeper into the cause(s) of such behavior?
4)
“Good vs. Evil” – the human brain has been the source of many
explanations for phenomena that we do not understand. It has created stories, allegories and myths
of all kinds to explain things it just couldn’t otherwise explain or
comprehend.
Sad
to say, some of the most enduring myths and allegories end up in religious
language, doctrine and rituals, simply because faith and belief and sacred
stories have served as foundation-stones for the origin and maintenance of cooperative
groups (communities) of people who have found common ground in turning to gods
for solace, explanation, and/or strength for the most important circumstances
and events of human life.
Thus,
we find ourselves turning to myths and allegories based on religious concepts to
explain the existence of mental disorders.
For
instance, one of the most common references is to “evil” or the “face of evil”
or “demonic forces” when we are faced with mental disorders that cause or exert
harm or death upon fellow human beings.
Mass shooters are too often referred to as “evil” or “in league with the
Devil” to explain their behavior. Such killers,
we are told, have been damaged by evil forces at work on them; some are described
as possessed by “demons”.
Perhaps
equally disturbing are the denials of (or refusal to recognize) patterns of behaviors and
actions that may be evident at early ages in certain children, especially when
such behaviors or actions may clearly indicate mental disorders that need
attention and early intervention.
Some of them include:
- Changes in school
performance or poor grades despite strong efforts
- Changes in sleeping
and/or eating habits
- Excessive worry or
anxiety (i.e. refusing to go to bed or school)
- Hyperactivity
- Persistent
nightmares
- Persistent
disobedience or aggression
- Frequent temper
tantrums
Sometimes
these very symptoms or labels can also act as excuses for dismissing the stigma
of “mental illness.” For instance, if a
parent can use the more acceptable label of “Hyperactivity” (ADHD -- attention
deficit hyperactivity disorder) or “tantrums” to cover a pattern of negative behaviors,
it can serve to dismiss all the rest.
Myths
and labels can also provide us with substitutes for answers when we confront
mental disorder(s). They are diversions
from the question of how brains function, and whether certain behaviors might
be caused by some physical abnormality in that organ. Such behaviors might be corrected, diminished
or ended if we knew how to re-wire the brain.
But, how will we ever know, unless we use science to study the specific functioning
of brains that have been, or currently are, mis-wired or mis-firing?
Trump (along with his administrative
and legislative puppets) is intent on denying the importance of science and the
necessity of medical research. Trump budget cuts in research (especially
through NIH) have negatively affected both health and mental health projects
throughout this nation. Opposition to
change and rampant negativity toward investing in untried but necessary
activity (like spending adequate sums up front for community mental health
clinics) are attitudes holding us back from dealing in-depth with expanded
study of the functioning (‘wiring’) of the brain, hormones/chemicals and genes.
Mental disorders are costing
us precious lives, money, and societal health and welfare. We are failing to provide real answers to the
questions of causes and corrections that could positively affect harmful
behaviors that threaten us all.
Are we so averse to change
and cost that we unwittingly cause harm and poverty to a significant portion of
our population? Remember that statistic
quoted earlier – one in five suffering mental illness? Are our brains so averse to change that we
are disallowing research, innovation and investment to the detriment of millions,
including our own loved ones? Trump
blaming mental illness for mass shootings while cutting mental health budgets
helps to explain why we are not further along in addressing mental health
issues.
There are other factors that
affect brain functioning that cannot be ignored in trying to understand “mental
illness.” The genetic dispositions we
inherit cannot be ignored in our quest for answers. We tend to emphasize physical characteristics
and attributes as “inherited” from relatives.
Sometimes, we recognize that certain emotional traits or tendencies also
seem to be “inherited” such as ‘depression’ or ‘anxiety/edginess’ or ‘a
tendency to be ‘neat’ or ‘attentive to detail’ or perhaps as having an
‘addictive’ personality.’ But gene mapping,
gene analysis and gene therapy (as well as assessment of hormonal/chemical
imbalances) related to mental illness are barely on our radar screen.
Let me raise some potentially
controversial questions in this regard:
1.
why isn’t every
newborn child tested for abnormal gene structure(s), hormonal and chemical
deficiencies and possible brain disorders so that parents (and family physicians)
could be given a report of abnormalities that might be able to be repaired,
with indications of possible treatment(s)? After all, a current uniform newborn-screening
panel with selected genetic and endocrine disorders (mostly aimed at detecting
physical conditions that can cause serious health problems if treatment is not
started shortly after birth), has led to earlier life-saving treatment and
intervention for at least 3,400 additional newborns each year ( (Centers for
Disease Control – The CDC)
2.
why aren’t mental
health examinations administered along with physical examinations for school
age children? We have the assessment
tools available but are not making use of them on an extensive basis.
3.
why isn’t every
person arrested or detained for an offense involving a form of violence given
the option to have a mental health (genetic and hormonal/chemical) assessment
done?
4.
likewise, why
isn’t every person convicted of a violent offense required to have a
complete mental health assessment?
5.
why aren’t judges
and prison authorities held responsible for arranging thorough mental health
testing and treatment(s)?
6.
why isn’t the
subject of mental health and violence required to be addressed in every public
(and private) elementary, middle and high school in this country in a
reasonable manner with testing, professional consultation and recommended
treatment? Detention, suspension,
non-professional guidance counseling or other forms of discipline are not
helpful methods of treatment!
I know there may be touchy
issues of civil rights, government interference and possible privacy rights involved
here, but isn’t violence against innocent people a violation of their rights to
life, liberty and pursuit of happiness? Just how far are we willing to go to
protect the rights of people who carry out violent shootings (and other violent
actions), without equal consideration of the rights of those victims who suffer
loss of life and liberty? Often, we
address rights issues by providing choices, alternatives, protections,
permissions, and some restrictions. If
we want to curtail gun violence precipitated by mental disorders, we must prepare
to weigh loss of some privacy rights against substantial loss of life, a constant
threat of violence in daily life, and the curtailing of our pursuit of
happiness.
It is my opinion that this
could be a new age of discovery related to finding the causes of malfunction in
our brains, genes and hormones. It would
take a new Vision and a new Administration to get this underway. Mainly, it would take a concerted push of our
own brains to overcome excuses, labels, myths and inadequacies that hold us
back from new discoveries and treatments.
So, where can we go from here?
First, we must reject the
Trumpian concept that mental illness is the main cause of mass shootings. However, that is not to say that we should
ignore the fact that there are serious mental disturbances motivating some of
the shooters. In other words, an emphasis
on greater understanding and treatment of mental disorders is worth the effort
and expense involved, because everyone deserves choices that will lead
to wellness.
Second, we know many of the
usual channels for response: education,
research, experimentation, trials, approvals, standardization. However, this is one of those areas (like
curing cancer) that takes in-depth short-term and long-term plans and
planning. We will have to make mental
health a Crusade, a Mission or a Cause or it won’t happen even though its
outcomes could well save billions of dollars. Millions of people could be
delivered from miseries that they do not deserve.
And perhaps, we could see a reduction
in the rate of violent occurrences that not only destroy innocent lives but that keep
society from the preservation of human values like justice, equality, and
greater happiness for all.
Start right where you
are. Be aware. According to
the Brady Campaign, 42 percent of mass shooters exhibited warning signs before committing
their crimes (MotherJones.com).
Understanding,
reporting and seeking treatment for early symptomatic patterns is
a vital necessity. It is especially important to pay attention to sudden
changes in thoughts and behaviors, but not just any one change
indicates a problem that should be assessed (for a helpful list of ‘warning
signs’, consult: http://www.mentalhealthamerica.net/recognizing-warning-signs)
Let me conclude with a few
outcomes that we might see as results of re-ordering brain mis-functioning,
adjusting flawed genes and balancing unbalanced hormones or chemicals:
§ reduction of physical and psychological violence
toward others, such as:
o
need to bully
others; need to control others against their will
o
incidents of domestic
violence, violence against women and minorities; mass shootings
o
enmity toward aliens/enemies/strangers/immigrants/minorities
§ need for revenge and disposition toward vengeance reduced
o
new prisons on
the wane; old prisons emptied of persons with psychiatric anomalies and
conditions
o
sentencing
becomes less about punishment and more about community-service or pay-back of
victims and/or society
o
schools become
points of discovery of new attitudes
§ society gains in new responses and attitudes
o
mental disorder
becomes treatable rather than being an excuse for institutionalizing,
discriminating against, isolating, and stigmatizing those with such disorders
o
trillions of
dollars spent on repairing lives broken by mental illnesses able to be used for
more education, research and implementation of mental health advances
o
new treatments
abound as causes of mental illnesses are discovered
We are not there yet, but we
can be. We are allowing ourselves to be
coerced into believing that institutionalization is the best we can do about
treating mental illness; it is not. We are on the brink of an innovative period
of new discoveries and new approaches to mental health. What we need now is for society – individuals,
private organizations and government entities, especially the federal
government – to seize those opportunities and to lead us to new frontiers of mental
power. This is an era of research and
innovation that should not be delayed or disparaged.
Let us resolve to make the next eight
decades of the 21st century not only an Era of healing of our
physical environment and physical bodies, but also one of discovery of hidden
causes and new treatments for mental and emotional disorders, to heal and significantly
elevate the wellness of our nation and our world.
