Will Colorado Theatre Massacre Reignite the Debate Over Forced Treatment?

In the minds of many, Colorado may be  ground zero for mass murder.  Columbine High School in LIttleton.   The lone gunman who shot and killed  churchgoers in Colorado Springs.  And now the horrific mayhem and loss of life caused by yet another young man in a crowded theatre in Aurora.  Besides their genders and ages, all these alleged or actual perpetrators were also tagged with a diagnostic label;  schizophrenic, paranoid, bipolar, etc.

I'll leave the detailed clinical, academic and legal analysis to other writers and bloggers.  I want to talk about fear.  The real fear that people living with a psychiatric disability have when such tragedies take place.   Fear that some, medical providers,  advocates, family members, political leaders will call for changes in the law to force people to be evaluated and treated against their will.  

This morning I opened the Denver Post and read the headline that screamed for my attention (just for the record, the 'voices' on the front page were not yelling at me);  "Suspect Saw Psychiatrist".    The first sentence of the article says, "James Eagan Holmes-suspected in the Aurora movie-theatre attack- was seeing a University of Colorado psychiatrist to whom he allegedly mailed a notebook before the July 20 massacre, court documents reveal."

 Wow.  He saw a mental health professional!   A psychiatrist no less.  How many visits with her did he have?   What kind of screening or assessment was completed?   Did she refer him to a counselor?   What kind of medications, if any, did the doctor prescribe?  What indicators were there that he might have paranoid or violent thoughts and plans?   A gag order and mutiple 'patient-doctor' privacy motions filed by  defense counsel will probably keep America in the dark about the answers to these questions until the man has his day in court.

When I first saw the news on the Internet about the mass muders in a city just 70 miles north of where I live in Colorado Springs, I thought, "Oh no.  Not again!" People gunned down with high- power military assault weopons in a crowded theatre.  Nothing good will come of this.  Families and friends out for a good time, their lives cut short or their bodies and minds mangled by a cold-blooded killer who was immediately taken into custody.   If this young man is tried and convicted, he must face whatever sentence the courts impose.   Whether one labels him  a monster or a madman,  he broke the law and must face the consequences.  That's my personal take on the case.

However, there is another large issue to be addressed here.  Bloggers posting their comments online were saying such things as; "I wouldn't doubt it if the man turns out to be bipolar,  they can have psychotic episodes."  or  "You can be smart and a nut case at the same time.  Most serial killers are highly intelligent sociopaths."  Then there is the expert analysis by a former FBI profiler interviewed on ABC News; "It is very probable that this man had started a slide into paranoia symptoms  over a year or so-- schizophrenia, (and the) symptoms were probably mild at first.."

These are snippets of what Americans think, read, watch and listen to.  A  couple of days after the events of that hellish night, I looked for research literature about mental illness and violence.   I discovered an article by Dr. E. Fuller Torrey entitled, "Stigma and Violence:  Isn't it Time to Connect the Dots": (Schizophrenia Bulletin, June 7, 2011).  In the opening paragraph he writes, "Stigma against mentally ill persons is a major problem and has increased in incidence.  Multiple studies have suggested that the perception of violent behavior by the seriously mentally ill is an important cause of stigma.  It is also known that treating mentally ill people decreases violent behavior.  Therefore, the most effective way to decrease stigma is to make sure that pateints receive adequate treatment."

Well, I connected the dots in Dr. Torrey's article, hearing the academic background noise of 'assisted outpatient treatment" (code words for forced chemical restraints).  He uses lots of statistics and literature citations to make his case for the 'solution' to reducing violent behavior in patients with serious mental illness (schiozphrena and bipolar specifically), and therefore making greater strides in reducing stigma against the mentally ill.  As an end-user of behavioral health services with a disagnosis of bipolar disorder, I strongly object to (1) my peers and I being referred to by medical labels , (2) the assumption that all  health care providers can properly assess and 'treat' us.", and (3) brushing off the very real fears and civil rights concerns of my peers.

I do agree that there is probably a strong correlation in academic studies and in the minds of the American public that there is a growing perception that  (so-called) insane people are mass muderers".   I also agree that quality behavioral health care can reduce the likelihood of violent acts by some people of have a psychiatric diagnosis.   The need for balance between public safety and civil liberties is  difficult to achieve, but there is no time like the present for honest, thoughtful and yes, passionate debate on this topic.  As a society we must be careful to not allow public opinion to run amok and put our political leaders in policy straight-jacket that could easily create laws that have unintended consequences that will neither reduce stigma or criminal behavior like we witnessed in Aurora.

Before closing this blog entry, I want to quote a line from the website of the Bazelon Center for Mental Health Law;  "..."forced treatment is a serious rights violation, it is counterproductive, being deprived of autonomy discourages people from seeking care, undermines therapeutic relationships and long term treatment."   As a peer advocate and provider, I say, "Amen!"

The alternative is to give in to the use of chemical restraints after rudimentary assessments by an army of poorly trained, overworked and underpaid behavioral healthcare workers,  such psychiatirc evaluation requests initiated by a family member or neighbor and enforced by the police powers of the state-- which will then be permitted to force medication compliance on citizens who may or may not have a "mental illness".    I would rather have honest, spirited debates where my peers are given equal access to the microphone...than hear a knock at the door and be handed a  supeona to permit a social worker or a police officer to inspect my medicine cabinet and my confidential medical records.