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No One [Knows Much] About Crazy People

Well, not “no one.” Still, the levels of ignorance, too often coupled with hostility or sheer meanness, remain unacceptably high in this country. We in what I’ve called “the sub-nation” must never assume that the people we encounter will have even a working knowledge of severe mental illness: not a relative, a next-door neighbor, a caregiver, a police officer, a stranger in the park or on the street–not even the President of the United States.

Below are three recent bits of evidence that prove my point. The first is the text of a Facebook post by Scott Carpenter, a leading reform advocate based in Iowa.

Scott and his wife Leslie, who have seen a family member stricken, are among the strongest voices in America for what needs to be done. Yet not even they are immune from incidents of unexpected and bewildering hatefulness:

“So we’re helping to set things up before a Moms Demand Action Rally in Iowa City.
An elderly man walks [up to me] and says that ‘the problem isn’t about guns. It’s about crazy people.’
Leslie (against my advice to not engage) indicates that we have a son who has a serious mental illness and that he should come listen to he comments in an hour or so. He declined.
Then he said, ‘your son and all of the crazy people should be taken out in a field and shot. That way they could be useful as fertilizer’.
Please don’t ever think that a day of activism is easy.
Scott J. Carpenter”

When you have caught your breath from that, please follow the two links below.

The first link is to some remarks that President Trump made to campaign workers before a political rally in New Hampshire, in which he continues his strange and uninformed characterization of the mentally ill as, collectively, a horde of depraved killers that must be rounded up and swept into asylums. This and other tirades show that Trump knows nothing about insanity and cares less: his real agenda is deflecting attention from the ongoing mass-shooting crisis: The article leaves no doubt about this:

“Trump said many other Republican leaders and the public don’t want ‘insane people, dangerous people, bad people’ owning guns.”
CNBC.com: Trump says US should build more mental health institutions to combat gun violence: https://www.cnbc.com/2019/08/16/trump-suggests-more-mental-health-institutions-to-combat-gun-violence.html

The second link offers a rebuke to the president delivered by Angela Kimball, the acting CEO of the National Alliance on Mental Illness.

“Words matter, Mr. President. ‘These people’ are our friends, neighbors, children, spouses. They’re not ‘monsters,’ ‘the mentally ill’ or ‘crazy people’ – they’re us. Talking about reinstitutionalization only further marginalizes and isolates the one in five people with mental illness. Instead, we need to be talking about the power of early treatment and effective intervention to change lives.”
NAMI.org: NAMI’s Statement Regarding President Trump’s Comments On Reinstitutionalizing People With Mental Illness: https://www.nami.org/About-NAMI/NAMI-News/2019/NAMI-s-Statement-Regarding-President-Trump-s-Comments-on-Reinstitutionalizing-People-with-Mental-Ill

These are but a couple of examples of incidents and attitudes that repeat themselves daily in America. They underscore the urgency of the seminal five-part manifesto organized by advocate Dede Ranahan and made widely available online and to presidential candidates last week. (Ranahan’s mentally ill son Patrick died in an institution in 2014.) The lessons in Ranahan’s great document are many and vital.

What I have outlined above constitutes just one. It is at once tiresomely repetitive and freshly urgent: We can never assume that any given individual–not even our Chief Executive–knows much about crazy people. And we must work relentlessly to change that.

P.S. Mental healthcare advocates Scott and Leslie Carpenter discussed the challenges they experienced when seeking proper care for their son Patrick during an interview with The De Moines Register. What they share is both heartbreaking and informative. I encourage you to take a few moments to watch their interviews below to better understand how mental healthcare policies and procedures often fail to provide effective or compassionate care to the mentally ill. If you would like to share your own experiences of mental healthcare for yourself or a loved one, I invite you to comment below.

Stories from the front lines of Iowa’s mental health crisis

“Mentally Ill Monsters”

In the aftermath of two traumatic mass shootings, the president re-invokes a horrid, distorted falsehood about the mentally ill.

And there it is: history’s defining damnation of sufferers of incurable damage to the brain, distilled into a three-word phrase of transcendent ugliness and stunted understanding.

The phrase was uttered on Monday. It was uttered to identify the provenance of the weekend’s massacres by shooters using legally purchased high-capacity semi-automatic weapons toward their collective harvest of 31 people dead and some 50 wounded.

The phrase was uttered by the President of the United States. It left stains, stains which, in moral and intellectual terms, replicated the stains of blood shed by the shooters’ victims.

*Donald Trump | Image Credit Gage Skidmore via Flickr*

Blaming “mentally ill monsters” (or “nut jobs,” or “wackos,” or “lunatics”) for such carnage is a morally repugnant, if time-tested device for shifting the public’s passion for safety away from gun control and toward the presumed demons in our midst. The president could not have been more transparent in exploiting the device. “Mental illness and hatred pulls [sic] the trigger, not the gun,” he instructed us, going on to label one of the shooters as “another twisted monster.”

In fact, it is a settled truth in psychiatric research that victims of brain afflictions are no more prone to violence than the general population. The prominent advocate Dj Jaffe makes an important stipulation: that the untreated mentally ill—those not stabilized by antipsychotic medications—can be more likely to cause harm to themselves or others. Still, implying that mental illness itself equates to degenerate aggression serves only to further isolate and punish the most helpless members of our society; to herd them back toward the dark corners and confinements of “insane asylum” days.

And herein lies the “intellectual” stain that President Trump’s words help spread: most people—like the president himself—do not understand mental illness: what it means, how it occurs, how it differentiates, why its victims behave as they do, and how even its most abject sufferers can be aided, often stabilized, by medications and therapy. In this vacuum of understanding, people tend to substitute prejudice, false science, myth, and hostility toward “crazy people.”

Briefly:

“Serious” mental illness—the kind in question here—is rare and unique. And incurable. Unlike alcoholism or anger or depression, serious mental illness is rooted in genetic flaws of the brain. Its various names include schizophrenia, schizoaffective disorder, bipolar disorder—similar yet not interchangeable conditions. It results in a loss of reason and rational control; hallucinations and the hearing of voices; alienation from family and friends; and, yes, sometimes—rarely—violence.

My wife and I have educated ourselves about serious mental illness because we’ve had to. It invaded our family several years ago, causing the suicide of a beloved son. Unfortunately, this is the painful route to understanding for most people: a loved one is stricken.

The costs of this cluelessness describe a cone of destruction that widens from the stricken individual through society.

The cone draws in and ravages parents and siblings of the stricken. It can cripple the finances of families without adequate insurance to cover treatment and medications. It drains human capital from the workforce, and thus economic revenue. It reduces the budgets of hospitals that can’t get reimbursement for their mentally ill patients. It overburdens police, whose lack of training and, sometimes, self-restraint, can result in death by gunshot of unarmed people in psychosis. It coarsens our criminal-justice system: think of schizophrenic adolescents hustled into jail by untrained or uncaring judges, where they await trial—often for weeks and months—while their unmedicated psychosis deepens. Think of solitary confinement. Think of a brain-afflicted child, perhaps your own (as countless parents must) ensorcelled in a cell, abused by fellow inmates and guards, with no end in sight, no comprehension. No hope.

Now think about “mentally ill monsters.”

Mentally ill monsters are not the source of our current crisis of public massacres. The monster is the gun: too many guns, with too little restraint and oversight regarding purchase. To his credit, President Trump gave lip service to keeping guns away from those “who pose a grave risk to public safety,” and to strengthening gun laws generally.

But leave the gun issue aside. Part of any president’s duty—a foundation of his “bully pulpit”—is to educate his fellow citizens on matters of complexity and urgent public import. The nature of serious mental illness, and the reclamation of its victims, comprise one such matter. The president could make a great, galvanizing contribution to ending the centuries-old oppression of “crazy people.” He could lead us in that direction. He could educate us. But first he must educate himself.

Zip It, Scaramucci!

Thanks, Mr. Scaramucci, for (as you would no doubt put it) pissing on our parade.

Anthony Scaramucci at SALT Conference 2016 By Jdarsie11 (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Your verbal golden shower came down on a day that otherwise would be recalled with sunlit joy and celebration by all Americans: Friday, July 28, 2017, when, in the early hours, the Senate narrowly defeated a destructive, long-dreaded bill that would have vitiated the Affordable Care Act, and rained down havoc on the most helpless members of our society. On the poor. On the elderly. And on the mentally ill, many of whose struggling caretakers depend on the Act’s Medicaid provisions to pay for their imperiled loved ones’ medications and treatment. “Suffering humanity,” as Dorothea Dix call them. Us.

True, the Senate managed to keep the wolves from ravaging “the miserable, the desolate, the outcast” (Dix) by only a single vote.

(And thank you, Senator John McCain of Arizona, for casting that decisive vote, one of the most courageous and restorative gestures in American political history.) True, certain congressional leaders were callously pleased to keep the threat of repeal alive, and the dread among potential casualties ratcheting upward, for seven years before decency narrowly prevailed. And true, this legislative rough beast’s hour could come round again, and it could arise and slouch toward Washington to be reborn.

All true. But early on Friday, suffering humanity caught a rare break. And we will take what we can get. It should be a day for celebrating, for parades.

But on second thought, no. Better to stay indoors to avoid the stench, or venture outside only with galoshes. Because on Thursday, Anthony Scaramucci came along and relieved himself of some stuff he’d been holding in. Figurative fly unzipped, the White House’s brand-new “Communications Director” communicated to the New Yorker magazine exactly how much he knew or cared about chronic mental illness, about its victims, and about those whose lives and emotions are bound up in the scourge.

http://www.newyorker.com/news/ryan-lizza/anthony-scaramucci-called-me-to-unload-about-white-house-leakers-reince-priebus-and-steve-bannon

Within hours, nearly all major news outlets had reported Scaramucci’s hot flow:

https://www.nytimes.com/2017/07/27/us/politics/scaramucci-priebus-leaks.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

The paragraph below, taken from the Times report, is representative:

“Mr. Scaramucci, who has so emulated Mr. Trump’s style that colleagues privately call him ‘Mini-Me,’ made clear in his conversation with The New Yorker’s Ryan Lizza that he is trying to push Mr. Priebus out. ‘Reince is a fucking paranoid schizophrenic, a paranoiac,’ he said. Mr. Scaramucci complained that Mr. Priebus had prevented him from getting a job in the White House until now, saying he ‘blocked Scaramucci for six months.’”

Mind you, Scaramucci’s now-famous rant was not on the topic of mental illness, per say. Divinely, it was on the topic of leaks. He could not hold in his vengeful fury over the fact that leaks had been flowing out of the White House in a steady stream, and he was pissed off about it, and he thought he knew who was leaking, and that man’s career was as good as in the toilet.

And indeed, the press coverage focused almost entirely upon Scaramucci’s complaint, and upon the spectacularly obscene language he employed in his tirade to the New Yorker’s Lizza. The man does appear to have an uncommon predilection for using his own genitals as metaphor, which has emboldened me to adapt that general framework in this essay.

Yet (to get, finally, to my point) it was neither Scaramucci’s attack on Reince Priebus nor his affection for scatology that is my concern here. Rather, it is his recourse to “paranoid schizophrenic” and “paranoiac” that makes my blood boil.

Here, after all, is the man whose public voice (god forbid we should hear his private voice!) is, by definition, the voice of the Administration. What Anthony Scaramucci thinks and says, especially in conversation with reporters, can fairly be construed as an extension of what his chief, President Donald Trump, thinks and says. (And if that is not the case, we must ask why the president did not fire or at least rebuke him following his use of “paranoid schizophrenic” and “paranoiac” as expletives.)

This usage cuts far deeper than mere coarseness or ugly language, which we have come to expect in Donald Trump’s administration. “Paranoid schizophrenic” and “paranoiac” are terms of neuropsychiatry, and they have specific referents: to individuals whose brains have been severely damaged by malign genes acting in harmony with environmental stressors.

Among the many burdens endured by the chronically mentally ill and those committed to safeguarding them is the misuse of “paranoid schizophrenic,” “paranoiac,” and a several other medically descriptive words: their misuse as hateful epithets, with the implication that those who answer to such descriptions are somehow morally inferior. The widespread acceptance of this misuse is part of the lifeblood of stigma, the uninformed and biased contempt for the mentally ill that still stands in the path of enlightened, and necessary, reforms.

In attempting to smear Reince Priebus with the labels “paranoid schizophrenic” and “paranoiac,” White House Communications Director Anthony Scaramucci has given para-official legitimization to the ongoing stigma and to the destruction it causes. He has gratuitously dishonored the mentally ill of this country and wounded their protectors. He has almost surely articulated the unfeeling, uncaring, irresponsible attitude of the Administration toward “crazy people.”

And the dark ugliness of his rhetoric has robbed the celebratory day of July 28, 2017, of some of its celebratory luster over a rare victory for the mentally ill.

I have no way of knowing, of course, how Anthony Scaramucci himself feels about his rash outburst of schoolyard invective, or whether he plans to apologize for it, as he should, instead of dismissing it as “colorful language,” as he dids.

I do know this, though: he has no reason to flush with pride.

TRUMP’S SHADOW FALLS UPON “CRAZY PEOPLE”

The president’s likely choice for a new fox to watch over the mentally ill henhouse summons the sardonic old joke: “‘Cheer up,’ I was told. ‘Things could be worse.’ So I cheered up, and sure enough. . .”

via The Wall Street Journal

The Trump administration is struggling to fill a top mental-health post, a job created last year to coordinate the efforts of far-flung federal agencies.

https://www.wsj.com/articles/trumps-latest-pick-for-mental-health-post-has-helped-prosecutors-secure-convictions-1492554280

FLORIDA ON MY MIND

The news started coming out of Ft. Lauderdale around mid-afternoon on Friday, as I was preparing a different blog entirely:

I imagine that all of us who happened to see the first news-breaks instantly pared the possibilities to two: Terrorist shooter. Or psychotic shooter. Those of us who weren’t tied up in actual useful work stopped what we were doing and started clicking around the news sites on the Internet. At least five dead, several more wounded. The shooting occurred in the airport baggage claim area.

The airport baggage claim area?!

The updates trickled in. We learned that the shooter had been “taken into custody.” (A rare outcome: normally—as it were—the shooter “ends the spree by taking his own life,” or else is “brought down by a policeman’s bullet.” These industrialized phrases have become as familiar to us as our own names.) Yet in this case, a twist: not so much “taken into custody” as gone limp on the terminal floor, face down, waiting to be hauled upright and carted away.

Probably not a terrorist, then. Yet we waited for further facts and factoids to appear and be confirmed, as we have been trained to do. As many of have been trained to do. Some of us.

Waited, until we decided it was safe to—what?

On the TV screen behind the computer, the factoids crept in their steady pace: “’He just started shooting people.’” “Suspect clad in Star Wars T-shirt.” “Mass chaos.” The regulation sheriff, his regulation civilized dark necktie knotted in place, stepped to the regulation microphone and spoke of “this cowardly, heinous act.”

Somewhat later we learned that “officials” had identified the “suspect” as “26-year-old Esteban Santiago.” And that 26-year-old Esteban Santiago was a “troubled Army veteran.” He had served a tour in Iraq.

Another update revealed to us that after 26-year-old Esteban Santiago’s flight had landed at Ft. Lauderdale, he had simply withdrawn his weapon, a semiautomatic handgun, from his claimed luggage begun killing and maiming people standing near him. (He had discreetly withdrawn the weapon in the men’s restroom.) We learned—or we were reminded, in the case of those of us who had managed to squeeze it out of our memories for the sake of restful nights—the explanation for the baggage claim area as the site of the shootings: under current aviation security rules, passengers may carry loaded guns in their luggage as long as they declare the fact to “authorities.”

“Security” rules!

We learned that 26-year-old Esteban Santiago had dutifully made that declaration, so there should have been no problem.

We did not learn that an armed Good Guy With a Gun stepped up to shoot this Bad Guy With a Gun. Perhaps this did not happen.

We learned that in states that boast “open-carry” and “concealed-carry” permission laws, states such as Florida, people may enter “unsecured” sections of airports with their open or concealed “carries,” fully equipped to draw and shoot.

At about the same time, we learned—this time from a “senior law enforcement official” quoted in the New York Times—that 26-year-old Esteban Santiago had entered an FBI office in Anchorage, Alaska several weeks ago and made “disturbing remarks” that prompted “officials” to “urge him to seek mental health care. One “official” disclosed that “Mr. Santiago, appearing ‘agitated and incoherent,’ said “that his mind was being controlled by a U.S. intelligence agency,”

A brother of the shooter reported that he had hallucinated, and had reported hearing voices. The brother remarked that Santiago had been discharged from the National Guard after being demoted for “unsatisfactory service” and had asked for psychological help, “but received little assistance.” The brother asked, “How is it possible that the federal government knows, they hospitalize him for four days, and then give him his weapon back?”

No one seemed to have an answer.

The updates carried on into the evening; the facts and the factoids crept along, and the “officials” popped up and disgorged their industrialized sound-bites, and disappeared. Some of the “officials” were “senior.” All of them dazzled with their acute inductive reasoning. An FBI agent disclosed to the press, “Indications are that he came here to carry out this horrific attack.”

This same expert continued, presumably with a straight face: “We have not identified any triggers that would have caused this attack.”

Our topmost elected “officials” and officials-manque were on the case. Florida governor Rick Scott hurried to Ft. Lauderdale—to the executive airport—where he wondered how this thing could have happened in such a state as his Florida. The governor sternly warned that “the citizens of Florida will not tolerate senseless acts of evil.” Someone asked the governor whether this meant perhaps that the citizens would demand, and the government would provide, a rollback on the law permitting guns in airports.

The question affronted Scott’s sensibilities. How inappropriate! How insensitive to sully this moment of grieving with politics!

The New York Times later reported: “The shooting came as Florida lawmakers were preparing to consider legislation that would relax [emphasis mine] prohibitions on firearms. State laws allow for the purchase of rifles, handguns and shotguns without a permit, though a license is required to carry a concealed weapon in the state.”

The governor, perhaps seeking to further quell anxiety, reported that he had been in close touch with custodians of higher authority:

“I have reached out to President-elect Trump, and spoken to him and to Vice President-elect (Mike) Pence multiple times to keep them informed, and they told me whatever resources that we need from the federal government, they would do everything in their power to make that happen.”

By Saturday afternoon (as I write this) the nonsense had curdled, as it always does by the second or third day of such stories. Curdled into stale righteous partisan argument over where to place “the blame”: Terrorism? Psychosis? Guns? Traumatized veterans?

All potential for redemptive action had dissipated, once again. The usual “official” posturing and the nonspeak of the usual “authorities” laid bare, as they always do, a few precious revelations of unintended truth. We ache to know “the truth” of what touched off the Ft. Lauderdale airport shooting, as we ache for the truth every time something like this happens. Terrorism? Psychosis? Our citizen arsenal of three hundred million guns? Which of these stands out as the first cause, the prime mover, of the ongoing nightmare that rides on our sleep?

I have come to believe that even to ask this question is tantamount to burying the answer. Each component in this triad has its body of impassioned accusers, and each body of accusers tends to dismiss the other two as trivial or false.

I believe that these “discrete” elements of our national humanitarian crisis are not discrete at all; they are mutually reinforcing elements of a diseased whole, and they cry out to be addressed—healed—holistically. And with reason, rather than partisan defiance.

No one need take me aside and explain quietly what an absurd pipe-dream this sounds like; what a useless appeal to “kumbya” mush. But I don’t intend altruism here; I intend to promote survival, as individuals and as a society.

We can begin collectively to address terrorism, untreated mental illness, and the obscene availability of demonic firearms.

Or we can reconcile ourselves to a baleful updating of John Donne’s holistic call: “Never send to know for whom the ‘official’ pretends to mourn. He pretends to mourn for thee.”