connecticut shooting Archives

Subtitled: Has Anyone Here Heard of Client/Patient Confidentiality? No? No.

Today, the National Rifle Association had a press conference.

Wayne LaPierre, the Executive Vice President spoke, and I, recently relocated back to Texas for the holidays, slept through it.

Then I saw the transcript, sat bolt upright in my bed, and got ranty on the internet.

The relevant bit (emphasis mine):

The truth is, that our society is populated by an unknown number of genuine monsters. People that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can every possibly comprehend them. They walk among us every single day, and does anybody really believe that the next Adam Lanza isn’t planning his attack on a school, he’s already identified at this very moment?

How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with wall-to-wall attention and a sense of identity that they crave, while provoking others to try to make their mark.

A dozen more killers, a hundred more? How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill? The fact is this: That wouldn’t even begin to address the much larger, more lethal criminal class — killers, robbers, rapists, gang members who have spread like cancer in every community across our nation.

So, since the NRA seems long on rhetoric and short on facts, I thought I’d clear some stuff up for them.

Patient confidentiality exists even if you have mental illness.

Funny how that works, where you have rights still, when you have mental illness. Psychiatrists still have to follow HIPPA rules. In fact, notes on psychotherapy that are kept separate from medical charts are given even more protection. Was the NRA suggesting that we trounce all over patient confidentiality and require all diagnoses to be reported? Just the “dangerous” ones? Would someone like to clarify for me which ones those are?

Therapists are already required to report anyone who makes a credible threat, and warn any possible targets.

This is largely based on the Tarasoff Rule, which came out of Tarasoff v. Regents of the University of California. In essence, when a psychologist or therapist hears a client threaten harm, they are obligated to warn those people who may be in danger. “Protected privilege ends where the public peril begins.” This is one of several exceptions to confidentiality, which can be summed up as confidentiality except in instances of harm to self or others. (Which includes reports of child abuse while another child is in the home, risk of suicide, elder abuse, and any threats or injury or death to another.)

So, say there was a high correlation between being mentally ill and being violent. (There’s not.) And then say the Connecticut shooter was mentally ill and in treatment (As far as we know, he wasn’t.) And then, say he’d confessed his plan… oh wait, there’s already methods in place to deal with that. So your database does what now, NRA?

Not everyone with mental illness is diagnosed.

So would you be requiring everyone to be tested for mental illness then? I mean, I’d be all over that if you didn’t then require that the mentally ill be registered in a database à la sex offenders.

Mental illness isn’t exactly uncommon.

Twenty six percent of American adults meet criteria for a diagnosable disorder in a given year. That, for those of you inclined towards fractions, is one quarter of the population. Since I’ve noticed that it’s somewhat less than a quarter of the population that’s having trouble committing violent crimes with guns, I’m going to posit the radical notion that having mental illness and being near weaponry does not a killer make. Of course, there are some mentally ill people who shouldn’t be near guns. I’ll agree to that easily. There’s also some mentally sound people that we’d rather not have near guns.

Discrimination against the mentally ill is actually a problem.

Nifty research here. (Abstract only if you’re not at a university, sorry.) Basically, the neurodiverse are more likely to be discriminated against by their employers and coworkers, as well as facing disadvantages in competing for jobs. So maybe we could try to avoid making that worse? Like say, by avoiding the creation of a searchable database of those with mental illness?

Note: I’m fully aware that some people with mental illness are violent. So are some neurotypical people. I’d be all over a psychometrically sound test of impulse control/aggression/etc, that tested abilities related to using a gun responsibly. Using science to determine safe gun owners–great! Using a highly stigmatized population to avoid discussing gun control–jerk move.

If you’ve read my work, you know I am massively for mental healthcare reform. Not just a little bit in favor, but balloons and blog posts on blog posts and boundless enthusiasm for it.

But you know when I’m really really uncomfortable talking about mental health?

Right now.

Tragedies are horrible. They’re senseless.

School shootings are especially so. We hurt and we reach out and hug our children and try to make sense of everything. And always, always, we talk about schizophrenia, borderline personalities, bipolar disorder.

Adam Lanza’s mental health won’t be known. Not ever. There’s a lot of things we’d like him answer for–unclaimed Christmas presents and crying families and six year olds with cameras on them and reporters in their faces. We’d like to know why he did it. We want to know what was going on in that mind. There’s no explanation that will put this into perspective. Because, what kind of perspective could it be to understand what would drive you to kill children?

But I’m asking you–begging you, really, to not decide that Lanza had a mental illness. I’m asking you not to make “being a good person” the standard for mentally healthy.

Do not try to rationalize this away with mental illness. Stop talking about how it could have been schizophrenia, stop saying he had to have mental health issues. You do not know.

You do not know his state of mind. When you decide to armchair quarterback him, to stamp him with an “obvious” diagnosis, do you know what you are saying?

Here is a terrible thing. The only thing that could possibly cause someone to do such a terrible, tragic thing is to have This Disorder. Because only people with This Disorder could be so dangerous/awful/scary.

And you, you people who want to look for signs of schizophrenia, who want to talk about how he ‘went crazy’, how he just needed medication, I want you to consider how much harder you are making it for someone to seek treatment.

I want everyone to seek the help they need, and I’d bet you do too.

I want the next person who hears things or sees things, or has invasive thoughts to reach out and have a place to land. I want them to be listened to and to find employment. I want their safety net to care for them and call on the bad days.

I don’t want them torn up with worry that they could be the next shooter, to isolate themselves because they ‘could be dangerous’. I don’t want their friends to worry for their lives. People with mental illness are four times as likely to be the victims of violence. They are more likely to suffer than perpetrate.

You want to care for the living? You want mental health care to be better? Stop making mental illness the scapegoat. You are causing stigma. You are making it harder. You are part of the problem. If today, seeing a therapist was free, treatment was covered as long as it was needed, do you think everyone who needed it would go? If the dominant narrative is that only ‘crazy people’ shoot schoolchildren?

I worked in a research lab developing and testing therapy for schizophrenia when I was 18, where in part, I interviewed participants and tagged along on treatment sessions. To this day, when I mention it–one of the best experiences of my studies–the common reaction is to ask about my safety. My safety from people who patiently let a teenager ask them incredibly personal questions for hours, who let me into their homes and lives. People with mental illness are not inherently dangerous. These attitudes are.

Mental healthcare needs to be better. That is a conversation this country desperately needs to have. Please don’t do it this way.

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Note 1: If and only if a therapist who was seeing Lanza or family member was to come forward and give his diagnosis, I would accept that. However, that doesn’t actually change the point about the narrative we spin about shooters. It’s dangerous and damaging.

Note 2: When you use mental illness as the reason for this shooting, you are ignoring a host of other societal factors that let him buy a gun, that let that gun he bought be a combat rifle.
EDIT: I know that it wasn’t his gun. This was written immediately after the tragedy. Yes, gun culture is still worth discussing.

Note 3: Assuming mental illness without any kind of evidence is also just plain bad skepticism. As if we needed another reason to stop doing that.

Ashley F. Miller

connecticut shooting

A National Database of the Mentally Ill

When You Tie Shootings to Mental Illness