Mass Shootings, Mental Health and Gun Control. A Medical Response

Americans are angry. Left or right, rich or poor, white or black or brown or yellow, we are all angry. 9 people are dead, killed on a community college campus by a lunatic with a grudge against humanity. As always happens after such senseless tragedies the national conversation has focused on one question. What can be done?

There is a sense that we “have to do something," but there is little agreement on what that something is. It reminds me of the patient who called to tell me about her advancing cancer. She had been diagnosed months previously and been told that there was no cure. She felt she had to do something so she went to Mexico and pursued multiple alternative therapies. They were unproven and ultimately ineffective but doing nothing did not seem like a viable option. The family wasted thousands of dollars and countless days pursuing the dream of a cure yet changed nothing.

Her story provides a reference point for any discussion about guns in America. Gun violence is terrible, mass shootings are an evil blight on our society, and too many young and innocent people have lost their lives. There is a naturally intense desire for something to be done. That desire is so strong that we need to exercise caution, as it can result in our doing things that ease our guilt and calm our fears but do nothing to actually solve the problem.

As I listen to proposed solutions there are two that are most often repeated. Many say we need stricter gun laws, that we need to make it more difficult for bad people to obtain guns. Others say we need to improve treatment of the mentally ill so we can identify potentially dangerous people in advance. The question that needs to be asked is, “Will these treatments cure the disease?”

When it comes to stricter gun laws it is logical to assume that making it more difficult to obtain a weapon would make crime less likely to occur. As logical as it may appear the truth is that gun laws are as worthless at stopping gun crime as coffee enemas are at curing cancer. Cancer cells are not impacted by coffee in the colon and criminals don’t respond to gun laws. The shootings in Newton, Connecticut and at the community college in Oregon both occurred in states with strict gun laws. A recent survey of men incarcerated for violent crimes confirmed that over 95% of them purchased their weapons illegally. Strict gun laws would not have stopped any of them.

What if we eliminated guns altogether? To return to the cancer analogy, proposing that we remove all of the diseased cells from a person’s body sounds wonderful, but it is impossible and therefore not worth discussing. In a nation with over 300,000,000 million firearms there is no rational or viable way to remove guns from our society. When we remember that we have thousands of miles of unsecured borders and that in such a scenario black market gun sales would be lucrative, such a proposal is not reasonable.

As desperately as we all long to live in a nation where mass shootings do not exist, an honest and thoughtful evaluation of the issue leads to the conclusion that the answer to the problem cannot be found in stricter gun laws. These laws, like alternative medicine for cancer, allow us to feel as if we are doing something and address our need to not feel powerless and to have a sense of hope but offer no chance of curing the disease.

Many have therefore declared that the solution within reach is for us to do a better job of caring for the mentally ill in our society. If we could identify and treat the potentially violent among us the problem might go away. As lovely as this sounds, honest mental health practitioners will admit that there is no effective way to identify these individuals. Those of us who treat mental illness on a regular basis (I see patients with depression, anxiety or bipolar disease daily) can tell you that not all patients who need therapy will consent to it. For patients with personality disorders and bipolar disease refusal of treatment is so common that it is expected.

What most Americans do not know is that the NIH estimates that in any given year 2.2% of the American adult population will suffer from severe bipolar disease. In 2014 that equates to 5,400,000 people. When we add in the 2,690,000 people with Antisocial Personality disorder, and the 2,450,000 people with schizophrenia, we have over 10 million mentally ill adults with diagnoses that might lead to violence. Given the rarity of mass shootings it would literally be easier to find the needle in the haystack. Mental health care in our country is a disaster and it needs to be fixed but any who think that this is the answer to mass shootings is dealing with a different kind of altered reality.

So what can we do?

1-      We can quit glorifying the perpetrators. Media should never release their names. I am personally in favor of all mass shooters being addressed by a derogatory term (I like “pathetic loser”). It will not eliminate the problem, but it will cost nothing and infringe on no one’s rights if the news anchor said, “9 People are dead at a community college in Oregon after a Pathetic Loser opened fire in a classroom.” Let’s remove some of the incentive.

2-      We can be honest about our options and likelihood of success. We do each other no favors when we mean-spiritedly debate proposals that will ultimately accomplish little.

3-      Let’s be willing to consider uncomfortable alternatives. We need to improve the ability of institutions and individuals to defend themselves against attacks. We should consider having trained and armed guards at schools and other vulnerable locations and give thought to allowing trained and qualified civilians who pass appropriate screenings to carry weapons if they so desire. While the thought of millions of Americans having the ability to carry a concealed handgun makes many uncomfortable, the fact is that over 4 million Americans already do, and that the incidence of crime or misuse of weapons for such individuals is lower than that of police officers.

-          Bart

I typically avoid political posts, and tried to remain objective. Thoughtful questions and comments are welcomed. Feel free to share this post with others.

A Whole Lesson from Half of a Butt

“Pull your pants up.”

It was a simple request, as his pants were hanging halfway down his backside. It was 2001 and it was a style commonly seen in teenagers but I did not think it sent the best message under the circumstances. He was a volunteer in the church’s children’s ministry and I thought that for some parents that “look” might be considered inappropriate. As I was the Director of Children’s Ministry for the church I felt it was within my authority to comment on his attire.

I was totally unprepared for the backlash that followed. The teen complained to his mom and the mom complained to the pastor. Before I knew it I was called into the pastor’s office. With a condescending tone he informed me that it was important that everyone feel welcome at church, regardless of the way they were dressed. He told me that I was being judgmental and needed to change my attitude.

He was as unprepared for my response as I had been for his. I told him that I agreed with him that people needed to feel comfortable at church and that was why I had asked the boy to raise his pants! I wanted to make sure that visitors bringing their children to church would not be taken aback by the appearance of anyone caring for their child. I reminded the pastor that serving in ministry was a privilege and that our student volunteers had agreed to follow the policies I had laid out. I told him, “If a student is not spiritually mature enough to submit to leadership in areas of dress, perhaps he isn’t mature enough to serve in Children’s ministry!” The pastor backed down from his position.

As the years have passed I have realized that the attitude of this young teen was not unique. Personal desires dominate our current self-absorbed generation. Little concern is given to the feelings or needs of others. People demand to be accepted “just as they are” and rebel against any suggestion they might need to change or improve anything about themselves. They can dress casually in any situation, use foul language in public, and be generally rude. It is only those who dare to comment who are considered in the wrong.

This me-first, don't tell me I'm wrong attitude is everywhere. I see it in patients who do not want to take responsibility for their health, in alcoholics who want to continue to drink and diabetics who do not want to manage their diets. I have seen it in former employees who want to be paid a high salary but refuse to do anything extra to help a patient. I see it in physicians whose offices are customer service disasters but who refuse to hire the staff or make the changes necessary to improve.

In every case I remind people that excellence only comes with effort, and that if they want to be recognized for excellence they will need to make some changes. No one is perfect and we all need to get better. Getting better requires a willingness to change our behavior and our attitudes. We may even need to pull our pants up.

- Bart

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A Doctor Gets Fired Over a Dog

I had been there for her through her treatments for infertility,a long and  painful recovery from a motorcycle accident and a divorce. Our doctor-patient relationship lasted for over 15 years. It ended over a dog.

Even though she already had a dog, she moved into a new apartment that did not allow pets. Rather than find a new apartment or a new home for her dog she decided to have me write a letter saying that her dog was necessary for her mental health. She was happy with her dog and would be sad without it, which to her thinking meant that her dog was medically necessary. She scheduled an appointment specifically to get the letter.

As nicely as I could I informed her that it was my policy to never write letters for therapy pets. I explained that while pets do provide comfort that is not the same as a pet being medically necessary. As most of the requests I received were from patients who had not been previously diagnosed with a mental disorder I was concerned that I many of the requests were not genuine. As I did not want to make false or incorrect statements it was my policy to ask patients to direct these requests to their therapist or psychiatrist.

She was livid. Her voice rose as she sternly replied, “If you do not write me this letter I will find another doctor.” Never one to give in to threats, I wished her the best of luck with her new physician.

Requests such as hers have become increasingly common as more and more people have discovered the “letter from your doctor” loophole to pet exclusions. Privacy laws prohibit the disclosure of patient information to potential landlords so there is no way for anyone to confirm that a therapy dog is truly necessary. Many eager to please or afraid to offend doctors have joined in the deceit.

I realize that there are people who feel calmer and more secure when accompanied by a pet but I wonder if our society has not taken things too far. We have reached the point where people are averse to even the slightest discomfort. The feelings and comfort of others are ignored as personal desires have become God given rights. People are taking “therapy dogs” on airplanes, supermarkets and shopping malls. I have even seen them at Disneyland. (I would think that being at the “Happiest Place on Earth” would be therapy enough!) 

I have decided that it is not my duty to cater to every desire my patients express and that sometimes saying, “No” is the right response. I consider it a form of therapy.

-          Bart

Comments and questions are welcome. Click the subscribe button to have future posts delivered to your email inbox. The next post, coming on Monday, is the continuation of my series on the evil of adultery. Finally,  Yes those are my dogs in the picture! 

Why You Shouldn't Hate Your Job

Millions of Americans have become spectators in life, sitting on the sidelines and simply watching as others participate in one of life’s greatest endeavors. 1 in 5 American families misses out on the character-building, relationship-training activity that was ordained by God from the beginning of time. In 20 percent of homes, nobody works at all. Everyone in our society suffers as a result.

My first job was as a janitor. Monday through Friday for an hour and a half I went into a small office building and cleaned toilets, emptied trash cans. dumped ash trays and swept floors. I hated it. With no one else around it was lonely, quiet and even a little spooky at times. It wasn’t fun but it wasn’t supposed to be. It was a job. I learned responsibility, commitment and that being a janitor was hard.

As with many teenagers in the 1970’s and 80’s I had several other jobs during high school and college and each taught me important lessons. I scooped ice cream at Baskin Robbins, where I learned inventory management, customer service and how to negotiate a raise. I sold shoes at Thom McAn, where I learned sales techniques, how to close a deal, how to read a customer and that working retail means working evenings, weekends and holidays. I worked on a loading dock for Montgomery Ward, where I learned how to balance a refrigerator on a dolly and unload a truck. I worked for Vons grocery stores, learning more customer service, how to pick quality produce and the benefits and disadvantages of union membership.

In each job I learned what it meant to work, to set aside pleasure and leisure to do what needed to be done. I learned what it meant to be a part of a team and how to work with people who were different from me. I had good bosses and bad bosses, both of which helped me become a better manager and employer. I learned the value of a dollar and how long I had to work to earn something I wanted. I gained self-respect and learned what it meant to do my best even when no one else was watching, or worse, to work hard even when the people who watched did not appreciate my efforts. Every job, every task and every shift was a growth experience.

Today in America, in 1 out of every 5 families, there is no one who is benefiting from the blessings of work. The innumerable lessons are unlearned and are not passed on. There is no one modeling the self-discipline of getting up on time in the morning and making oneself look presentable for the day. No one learning to submit to and interact with a superior, no one learning to negotiate a better deal. No one pays income tax and contributes to society economically, no one participates in making something or providing a service to a customer. 1 in 5 families receives all of its financial support from society, is totally dependent on others for survival..

It is impossible to overstate the long-term negative impact on our society of such dependence. Beyond the obvious fact that no economy can thrive in the long term when 20% of its families do not participate in the production of goods and services is the reality that no culture can thrive if large segments of the population do not receive the education and personal growth that only work can bring. 

Something needs to change. We need to quit referring to work as a curse and a chore to be avoided  and view it for what it truly is, a blessing and an opportunity to be embraced, whatever or wherever the job may be.

-          Bart

Comments and questions are welcomed, and shared with friends appreciated. I can be followed on twitter @bartbarrettmd and can be reached through the website for personal questions or speaking invitation.

Where have all the true Friends Gone?

I speak without fully listening. I interrupt frequently. I dominate conversations. People are intimidated by me. I am hypercritical. How do I know these things? My friends and family told me.

While none of the above messages was pleasant to hear, they have all been essential to my personal growth. They helped me identify my faults, understand the responses of others and grow as a person. If my friends had not cared enough to speak up, if they had simply “loved me for who I was” I would not be the person I am today.

It seems to me that although friends such as these are invaluable they are a vanishing breed. Most people seek out friends who validate and affirm, not friends who challenge and exhort, and our society is suffering as a result.

Not every feeling we have is healthy and not every desire should be fulfilled. It is our friends and family who can lovingly correct is when we wander, who can remind us that “being true to ourselves” is nowhere near as important as being true to our God.

Part of the reason such exhortations are increasingly rare is due to an incorrect understanding of judgment. If there is one scripture even atheists can quote it is “Judge not, lest you also be judged.” Jesus’ was teaching that we should not condemn others and reminding us that we would all be judged one day. What is overlooked in applying His words is that he also taught his followers to follow God’s law and that sin should be addressed. Avoiding condemnation is good, ignoring and accepting sin is not.

Distaste for judgment has become dominant and moral relativism has become the norm. As a result increasingly strange behaviors are becoming common place. Infidelity and sexual deviancy are so common as to be expected and embraced. No one speaks out anymore, no one stands for goodness. If anyone dares make a stand they are labeled as a hateful bigot.

The truth is that all human beings are broken and dysfunctional in one way or another and all of us have feelings and desires that are selfish and harmful. If we do not have people in our lives who love us enough to point out where we need to change and grow, we will do neither.

Let us pray that God will bless us with friends who care enough to correct us and that we will be true friends to those we love.

Bart

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