“I am sharing this story because I am Adam Lanza's mother. I am Dylan Klebold's and Eric Harris's mother. I am James Holmes's mother. I am Jared Loughner's mother. I am Seung-Hui Cho's mother. And these boys -- and their mothers -- need help. In the wake of another horrific national tragedy, it's easy to talk about guns. But it's time to talk about mental illness.”
These are the words that spread across the Internet written by Boise mother Liza Long describing the challenge of grappling with her exceptionally gifted -- and exceptionally aggressive -- teenage son. Long gave a voice to the complicated "risk" burden that lies on parents, doctors and community to identify these potential dangers before it’s too late.
Or as in the case of the “Dark Knight” shootings, to prevent another mother from wearily confirming over the phone after being informed her 24-year-old son could be the culprit of mass homicide: “You have the right person.”
As Long wrote incisively in her essay about her 13-year-old, “I live with a son who is mentally ill. I love my son. But he terrifies me."
I know what challenges she faces, because -- in the words of Long -- I am Adam Lanza’s psychiatrist. I am Dylan Klebold’s and Eric Harris’s psychiatrist. I am James Holmes’s psychiatrist. I am Seung-Hui Cho’s psychiatrist. And it is absolutely time to talk about mental illness.
Parents like Long definitively do not cause these types of mental illnesses that morph into violence. More often than not, the desire is there for the best treatment possible. Unfortunately, my chosen field of psychiatry has a lot of limitations.
In terms of the relationship between mental illness and violence, here is the little we do know. According to APA Council on Law and Psychiatry (Access to Firearms by People With Mental Illness: Resource Document, Arlington, Va., American Psychiatric Association, 2009), "The 'absolute risk' message is that the vast majority of people with mental illness in the community are not violent. The 'relative risk' message is that people with serious mental illness are, indeed, somewhat more likely to commit violent acts than people who are not mentally ill. And the 'attributable risk' message is that violence is a societal problem caused largely by other things besides mental illness (ready availability of guns, for example)."
I have had patients who have believed they were “chosen” to carry out a mission or who started to speak of the devil being present in the form of human beings. But are they violent? Do they need to be locked up? At what point do I inform the authorities when no specific plans to commit violence are mentioned to me, but the words start to become more terror-inducing. “Enemies” are mentioned. “Hate” punctuates every other word. Conscience can appear strikingly absent or little, if at all. Behavior is erratic -- but does not pose a technical threat.
I have had patients that are ticking time bombs.
I know the responsibility that lies upon me. When there is a sense that a patient is near breaking. When it is missed, I spend the rest of my life second-guessing myself and wondering what I may not have seen. It happens. Too often.
It is fair to say that pretty much everyone is enraged at my profession right about now. This is what happens when the time bomb is not caught, not stopped, not prevented.
We as psychiatrists need to find a way to catch our troubled sons -- the next Adam Lanza -- in the moment when he changes from chronically dangerous (that dreaded sense of ticking time bomb) to acutely dangerous (when the violence amps up to meeting the criteria for commitment to a hospital).
Because this boy was missed. That moment is now gone, and we as a nation are grieving with the consequences of the failure.
The only move left is for me to ask for help. And that’s exactly what I am doing.
1) The US Congress: Please create better laws to ensure the ticking time bomb is caught before it is too late. Make it much easier for a family to get a potentially dangerous person into mandated treatment. This means less paperwork, too. We need to support parents and mental health professionals.
2) The US Justice Department: It’s time we enacted a Health Law Court. Have doctors serve as judges and streamline legal proceedings for tough medical and psychiatric cases. Go to commongood.org for ideas on how this can be done.
3) Health Insurance Companies: Man up. My main complaint is with you. You make it so hard to keep people in the hospital when they need to be there, and it’s even harder to keep them in intensive outpatient services. Please create protocols for difficult cases and loosen the purse strings for extremely troubled individuals –- before it’s too late.
4) Network TV: Please create some exciting television that is actually educational about mental illness. Or least give us a “Gossip Girl” who takes her medication and sees her psychiatrist regularly. Less stigma, better health.
5) Drug Companies: You are always trying to ply me with coffee and doughnuts. I have trust issues with you. Don’t want anything, thanks.
6) The Hollywood PR Machine: Please find the mental health community a really attractive celebrity to get the US mental health system some money. I am glad that George Clooney and Angelina Jolie are doing so much for Africa, but can we borrow one of them please?
7) High School Students: Tell the popular kids to stop being such dicks to the odd kids or the ones they don’t understand.
8) Community Psychiatry Health Researchers: You have kick-ass and innovative ideas for how to reform the system. Could one of you put on a sequin dress and walk a red carpet please? We need to get you more money.
Me? I will keep trying to do my job. But I want to be better equipped the next time the risk appears before me. Because these young men need help. We all do.
[For another point of view, see s.e.'s piece "For the Last Time, Stop Conflating Violence and Mental Illness," published simultaneously ]