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.

10 Things Patients Want From their Doctors

Unhappy with the service you receive from your doctor? Want to tell them how they can do a better job? Here is a list of things patients all deserve from their doctors, feel free to share it with your physician.

Patients deserve-

1-      A smile. They deserve one from the receptionist and from the doctor. They are the reason we all have a job!

2-      A doctor who is on time. Patients understand that we have emergencies but also know that we do not have emergencies every day. Repeated long waits tell patients that we are uncaring and disorganized. My personal solution to the problem is to schedule same day illness appointments at the end of the morning after I am done with scheduled patients. My scheduled patients then have the time they need.

3-      A meaningful apology. When I am behind more than 30 minutes I give out Starbucks Gift Cards as an apology. This 5 dollar gesture lets them know that their time is important.

4-      Access. When patients are sick and want to be seen, we need to see them. If that means working late or working through lunch we need to do that. If we are not available when they need us, what good are we to them?

5-      Timely responses. We need to return our phone calls every day and notify patients of test results as soon as they come in. Worried patients should not have to worry needlessly. When we communicate quickly we tell them we care.

6-      Listening. I am not a naturally good listener and I am easily distracted by the computer screen. I have trained myself to step away from the computer and to sit down when there is something important to communicate. A minute or two of my undivided attention means a lot.

7-      Eye contact. Computers make this harder, but it is important. No one wants to look at the back of our head when they talk.

8-      Clear explanations. Doctors too often rush through instructions at an unintelligible pace. In my office I type out instructions that the patient can pick up as they leave. I have learned to be specific and clear. I don’t just write “ice your leg three times a day”, I have learned to write “Ice your leg for 20 minutes three times a day.”

9-      Honesty. When I don’t know something, I say so. When something is outside of my area of expertise, I share it. Patients know we are human and appreciate it when we admit it.

10-   Time. Some patients need a lot of it. Instead of rushing and trying to handle 6 things in 10 minutes, I ask patients if it would be okay to bring them back in a week or two for a longer visit. When I say that I want to make sure I have enough time to address all of their concerns appropriately and that it is hard to do a good job when I rush, they always understand.

When I first started in practice I did none of these things well (I do not naturally communicate warmth, I am more of a problem-solver type). As a result my patient satisfaction scores were only average. It took years of effort to incorporate these behaviors into my practice. The result has been happier patients, high patient satisfaction scores, a happier office staff, and a happier me!

- Bart

Thanks for reading. Comments and questions are welcomed, and shares are truly appreciated (just click the button)

 

The Beauty of Intimacy. Adultery Part 4

As harmful to the soul and psyche as premarital relations are, they pale in comparison to the damage of adultery. Adultery takes emotional havoc to an entirely different level. When someone has sex outside of a marriage, it is a betrayal of trust and intimacy unlike any other. When the marital bond of oneness comes undone, the consequences to families, children, and individuals are incredibly severe. When we understand the terrible damage done it is easy to understand why God included the prohibition against adultery in His Ten Commandments. It is exceptionally important.

Adultery’s damage can best be understood in the context of the beauty that God intended for marital intimacy. The more beautiful the object that is damaged the more tragic the loss. Graffiti on a bridge overpass is ugly; graffiti on the ceiling of the Sistine Chapel is a catastrophe. All immorality is wrong and sinful, but when the masterpiece that is God’s plan for marital purity is ruined by the stain of adultery it isn’t just wrong, it’s a tragedy. The greatness of the tragedy of adultery, the violation of the marriage covenant, is profound evidence of the beauty God intended for marriage. Conversations with people who have known no other partner apart from their spouse confirm the beauty intended by God.

This exquisite quality is evident in the attitude towards sex I have seen in faithful men. The sexual desires in men who have only been with their wives are not merely desires for sexual release or for a physical act. There is much more to it than the mere pursuit of pleasure; faithful men desire their wives. They don’t want to be with just any woman; they want to be with the woman God gave them. This directed desire creates a powerful bond of attachment. When these men think about sex, they think about their wives, as they have no other frame of reference. This passion for their wives is intensely personal and private. By default their wives become their sexual ideal. This is truly a wonderful thing.

The strong attachment that results from undiluted intimacy has additional benefits beyond physical union. When a man’s wife is truly his and a woman’s husband is truly hers it gives rise to strong nurturing and protective emotions. As years of faithfulness accumulate, the emotion grows. I have seen this in my own marriage. I can honestly say that after twenty-six years of marriage my love for and connection to my wife has grown with every passing day. Love truly blooms with faithfulness over time. As clichéd as it may be, our relationship is the most beautiful thing I have ever experienced.

Country singer John Berry echoes my feelings in his song, “Your Love Amazes Me”: 

I’ve seen the seven wonders of the world, 

I’ve seen the beauty of diamonds and pearls

But they mean nothing baby Your love amazes me

I’ve seen a sunset that would make you cry

And colors of the rainbow, reaching across the sky

The moon in all its phases, Your love amazes me

It was, is, and always will be God’s desire that one man and one woman share such a bond. This physical and emotional bond of unity is the foundation of marriage and, by extension, the foundation of the family.

- Bart

Thanks for reading, and a special thanks who share these posts with their friends. This post is the 4th in an eight part series on adultery taken from my book, Life Medicine. The book is available through this site and on Amazon.com. A small group study guide can be accessed through this site as well. I am in the process of uploading a video series on the book to my vimeo page, www.vimeo.com/bartbarrett

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

Questions or comments? Please share them! You can have future posts delivered to your inbox by subscribing to the blog or follow me on Twitter @bartbarrettmd.  

Sex, Marriage and Waiting. Adultery Part 3

I have seen in my medical practice the emotional pain that results from broken sexual relationships. The damage I have observed supports the idea that the sexual bond is exclusively designed for marriage. The oneness of flesh created by a sexual union is meant to endure. When couples break the bond much harm is done. 

I have seen many young people troubled with the intense emotional pain brought on by the loss of a girlfriend or boyfriend who had been their first sexual partner. When they are mature enough to be able to express themselves they have told me of the profound sense of loss. Deep sadness came when they realized that they had given away something they had hoped to share with their life’s one true love. Many times they had given themselves away in the belief that they had found their soul mate, only to discover they had lost something they could never get back. 

One particular young lady comes to mind. I can recall the visit when she shared her grief. Then twenty-one, she had just been dumped by her boyfriend of the previous five years. He had been her first and only sexual relationship. To her, that was something special. She had thought that he was her life mate, her future husband; yet now that was clearly not to be. She felt used, shamed, and less womanly. She thought she was damaged and less attractive to other men. She had fallen into a major depression that was worsened by an associated anxiety disorder. She required significant doses of medication just to function each day. 

The medication helped her get through each day, but it did not deaden the emotional pain she was suffering. Her emotional pain left her with two choices. She could acknowledge the truth that she had made a serious error in giving herself to her boyfriend, or she could tell herself that sexual relationships were normal when dating and therefore no cause for shame. She knew the truth and was struggling with its ramifications. She had made a grave mistake, one that could be forgiven yet never undone. 

This young woman’s loss illustrates the seriousness of sexual immorality prior to marriage. When people give themselves away before marriage, their future marriage loses a degree of intimacy. A secret told to many people isn’t really a secret, and when the most intimate act known to mankind is shared with many people, it loses some of its power. I have seen many promiscuous individuals who were later unable to sustain intimate relationships. The powerful bond intended by God was so weakened by casual sex that it appeared lost forever. Waiting is important!

- Bart

This is the third of an 8-part weekly series on Adultery and Faithfulness taken from my book on the 10 Commandments, Life Medicine. You can have the future posts delivered straight to you email inbox by subscribing to the blog, just click on the link. I am currently teaching through the book at a church in Fullerton. Videos of the lessons are available at my vimeo page, www.vimeo.com/bartbarrett .