Newtown

The public debate, if we can call it that, which has followed the utterly tragic events in Newtown, Connecticut has been predictably disappointing. We have had Piers Morgan piling in with pronouncements that people under 25, criminals and anyone with a mental health history should be banned from possessing guns – why don’t we just ban guns, Piers, then we won’t have to argue semantics over your surprisingly vague idea?! …

We have had tens of thousands of circulations on Twitter of potentially the worst article I have ever read about mental health and violence following an atrocity and we must not forget that the speculation about Adam Lanza’s mental health history began hours and hours before anyone in Newtown was talking on the record about it. And even when they started talking it was all “might” and “maybe” and “a bit”.

Here’s my point: even if he had a personality disorder and autism or Asperger’s – and we are far from knowing anything of the kind, for certain – did this cause the incident? Plenty of people live in the US with such conditions whilst having access to firearms and they don’t commit such atrocities; plenty of people in the UK without such access to firearms who don’t simply choose a different weapon. Something else or something extra is going on here but I do know this: no-one sufficiently knows this man’s mental state to be proclaiming anything meaningful.

WHAT ON EARTH IS GOING ON?

We had all the usual stuff: “surely he MUST be mentally ill to kill 27 people?” Why must he? The 7/7 bombers killed far more people than that, equally indiscriminately and without any moral or legal basis for their attack. And yet I cannot recall any speculation about their mental ill-health? Nor was any mental ill-health history brought up in the aftermath of the attack, as far as I can establish. So it’s not indiscriminate slaughter per se that gets us to speculate about mental illness. It has to be something else and I’ll come back to that at the end.

We also had a predictable amount of people saying, “We must discuss mental health issues.” Ostensibly, that was the underlying plea in Liza Long’s appalling output. I’m all for discussing mental health issues: in fact many would wish that I discussed it less. But mental health issues were not the only factor at play here, were they? There was the whole issue of guns, quite obviously; but there was also the issues of culture and of social structure. The UK is often held up in comparison to the US around gun laws, precisely because our legislation controls possession of guns, almost entirely. But we are also a very different country in terms of culture and social structures – this is relevant to a debate that transcends the Atlantic about a tragedy in which a British boy died.

Of course, whether the issue being raised in Liza’s description of her own son’s behaviour were mental illnesses or other behavioural / educational problems is also not clear and a matter of taxonomy which varies from country to country.  Some UK Child and Adolescent Mental Health Services (CAMHS) will not accept referrals for ‘Oppositional Defiant Disorder’ or ‘Intermittently Explosive Disorder’: not unless accompanied by additional psychiatric issues.  So is the request here for better mental health care, or specialist educational / parenting support?  Who knows – it is far from clear.  No-one questions that society should do all it can to support parents who struggle with parenting challenges, but we should be wary of over-medicalizing the issues.  Research suggests this can makes things worse.

It is beyond doubt and hardly controversial to point out that the United States of America has a particular culture around guns and a particular problem with gun crime. 9,414 gun deaths in the US so far this year – actually, that figure will have gone up by the time you are reading this compared to when I wrote it – whereas there have been 39 in the UK. Even allowing for population differences, this is a problem almost fifty times the size of ours. So the issues around the whole politics of US gun possession is very relevant, not least because other mass killing-incidents involving firearms, have not involved a suspect with mental health problems and killings by people with mental health problems almost never involve guns. We heard the political right of the US moving to point out somewhat unhelpfully that “guns don’t kill people, morons with guns kill people.” As Eddie Izzard pointed out: the gun helps.

In the UK mass-killing in Cumbria in 2010, evidence was offered to the inquest into the death of the suspect, that he was suffering delusional beliefs and paranoia at the time of the event, but whether those professionals offering that view formally examined him whilst he was alive, I cannot establish.

HOW DO WE BALANCE THESE THINGS?

Even if you could take the relevant issues of gender, age, mental illness, access to firearms, etc., and undertake an analysis of the contribution each would have made to the tragedy, how significant would mental illness have been? Well, it depends: we know from research that where mental health disorders are connected to violence – either causally or co-incidentally – some kinds of disorders are more connected than others. Treating Violence (2007) by Professor Tony MADEN is an extremely important book which does argue that there is some way to go in our understanding of this and that there are raised risks of unpredictable violent behaviour from just some mental health patients. Even then, such risks are most often manifested against a certain set of treatment and social backgrounds. The website Hundred Families has attempted to highlight the recurring problems which we all regret hearing again and again. But in this particular case, I would be very tempted to argue it counts for little – because if illness in and of itself were perceived to give rise to grave risks, we have in all major jurisdictions to handle these risks.

Significantly for this debate about Adam LANZA, such conditions were not the ones that are being speculated upon as being relevant in Newtown. <;<; And we need to remember that we are still in the speculation phase and people are providing very vague information. To read an excellent blog post about Autism / Asperger’s in light of Newtown, see this post by Emily WILLINGHAM.

We also had the usual debate about ‘insanity’. I am well aware that I am at risk of terrible pedantry when I point out again that this was misuse of a legal term that has a specific meaning. Where we use the term outside that meaning, I admit to not being sure what on earth people are getting at, precisely. This is more than being picky, on my part. ‘Insanity’ gets used to mean a wide variety of things: it can be used as a pejorative insult or as a generic description of mental illness as well as in other ways. I’m not sure what’s going on with that or where to start deconstructing it.

BRASS TACKS

So here are some bullet points to bring together my thoughts on this whole affair:

• Speculating about mental illness before we know anything substantive is stigmatizing – and being ultimately proved right about there being some mental health history, doesn’t detract from that stigma.
• Just because there is some kind of mental health history, doesn’t mean that the relevant social issue at play is mental illness – we should ask whether it was causal or co-incidental, to the incident.
• For example, we know that drinking alcohol is a bad idea if you are going to drive a car – this does not mean that all accident involving a driver who had consumed alcohol were caused BECAUSE the driver had consumed alcohol. Always easier just to blame the drink-driver, though, isn’t it?
• Failing to even acknowledge other contributory factors, like guns in this case, renders any analysis fairly shallow – if you want to take about murder, let’s talk about men, let’s talk about young men, let’s talk about access to guns and knives, let’s talk about poverty and social exclusion, as well as drugs and alcohol. All of these things are important to any overview.
• Objecting to the way in which a particular argument is put across, is not to deny the importance of the issues it purports to debate – I object to Liza Long’s blog because it is poorly conceived, in my humble view. I don’t object because it is wrong to discuss mental illness or even to discuss mental illness in connection with violence.

THE AMERICANIZSATION OF MENTAL ILLNESS

Of course, one elephant in the room here is how ‘Americanized’ some debate about mental illness has become. We shouldn’t forget that the conditions listed by Liza Long – Oppositional Defiant and Intermittently Explosive Disorder – are not conditions recognised by all clinicians as valid. Some will even say it’s nonsense.  The nature versus nurture debate as well as the biology, psychology or sociology debate about mental illness are relevant here. We should remember, the United States is culturally, academically and socially different to western Europe in how it conceives, describes and handles issues around mental ill-health. Don’t under-estimate the importance of this. I recommend Creating Mental Illness by Allan HORWITZ.

My theory is, that we’re straight into the mental illness debate because of our human need to demonize the people who commit atrocities of these types – this is a normal human reaction and is to be expected. We saw how this was done after 7/7 – it was not done by creating a moral panic around mental illness: we chose a different ‘folk devil’. In this incident, like with others before and yet to come, we chose mental illness because it will prevent the need to discuss culture and guns laws where this is long, long overdue.

If you don’t know what I mean by Folks Devils and Moral Panics, then you’ve got some reading to do!

Finally, no words can describe my admiration for the staff in the school who we now know took steps in the face of mortal danger to prevent yet more lives being taken. They deserve the admiration and remembrance of us all.

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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012

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I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk