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Sue Lani Madsen: Time to discard outdated stereotypes about mental health

Sue Lani Madsen. (Jesse Tinsley / The Spokesman-Review)
Sue Lani Madsen. (Jesse Tinsley / The Spokesman-Review)

While the struggle with post-traumatic stress disorder is real, the stereotype of mental illness as the cause of violence is not. It’s a cringe-inducing link for those who know and love someone who lives with a mental health diagnosis.

On Veterans Day, we honor all those who served and came back. Time to honor our veterans further by laying to rest a destructive stereotype, the myth of the veteran as a “ticking time bomb.”

It’s a lie.

PTSD is how a normal mind responds to exceptional, stressful events. It used to be seen as a sign of weakness and always has been a part of surviving war, disaster or abuse. According to a broad review of links between mental illness and gun violence published in the American Journal of Public Health in 2015, it was the post-Vietnam War era when “PTSD increasingly became associated with violent behavior in the public imagination, and the stereotype of the crazy vet emerged … despite the paucity of data linking PTSD diagnosis with violence and criminality.”

While all murderers may be judged mentally ill by their actions, those living with mental illness are statistically less likely to commit violence with a gun than the “normal” population, according to the National Center for Health Statistics. Mental illness alone is poorly correlated with gun violence. Continuing to make this link piles yet another burden on those already carrying a heavy load. That false link is what puts young men like Otto Zehm at greater risk.

It’s comforting to think psychiatrists, psychologists and other mental health workers can successfully screen and identify future mass shooters. They can’t. The journal overview states “research dating back to the 1970s suggests that psychiatrists using clinical judgment are not much better than laypersons at predicting which individual patients will commit violent crimes and which will not.”

Many studies have identified the risk factors behind mass shooters as substance abuse, suicidality, economic stress, negative pressure from peers, poor social relationships, access to weapons and being male. The only reliable predictor of future violent behavior is past violent behavior. But not living with a mental health diagnosis.

The last comprehensive gun legislation in the United States passed in 1968 in the wake of the high-profile assassinations of John F. Kennedy, Robert Kennedy and Martin Luther King Jr. And it was 1968 racial stereotypes that linked schizophrenia and violence in the psychiatric community. Black political leaders were profiled by the FBI with “militant forms of schizophrenia as a way of highlighting the insanity of their political activism,” according to the American Journal of Public Health article. Psychiatrists took up the issue of gun control in response to this perceived threat to society. Legislation began to link mental health criteria to the right to own and use a gun.

The mind and body cannot be disassociated. We do have a serious crisis in our mental health care system in the U.S. It’s not a system. We have a shortage of psychiatrists and a shortage of inpatient treatment beds. We have swung the pendulum from overcrowded institutionalization to overcrowded and inadequate community-based care. We provide the majority of our mental health care, ineffectively, in jails and prisons. And particularly for chronic mental illness, a patient must have a village of family and friends in two-way communication with the health care team.

As a new medical school with no curriculum ruts to follow, Washington State University’s Elson S. Floyd College of Medicine is working on a new team approach.

“Mental health care must be fully integrated into primary health care, and that’s how we’re designing our curriculum for the next generation of physicians,” said Dr. Matt Layton, clinical education director for Mind, Brain and Behavior.

We have settled on mental health as safe common ground for discussing gun violence, and we are wrong. Mental illness, PTSD and developmental disabilities of all kinds are not a cause of gun violence and are not predictive of who will commit violence.

We want easy answers. There aren’t any. Like a high-profile assassination, the Texas church massacre is a statistical anomaly and a poor foundation for policy discussion. It’s too soon. The emotional drive to “do something now” blinds us. But it’s beyond time to discard outdated stereotypes about PTSD, schizophrenia and mental health.


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