Another Troubled Mind: A Dominican Nun and Jesuit Educated Child and Adolescent Psychiatrist Shares His Struggles with Guns and Mental Illness
By Neal Spira
It appears we have our answer on addressing assault weapon access in any meaningful way: there will be none. The Democrats are completely scattered with 5 different US Senators with 5 different bills to be introduced in the 113th Congress next year. All of the Republic leaders have developed sudden selective mutism. There is no comment from John Boehner, Speaker of the House and third in line to the Presidency. His 2nd in command, Eric Kantor, who loves the camera, also absent. Nothing from the Senate leader Mitch McConnell. Six weeks ago Romney could have been our President elect, no comment from him. Where are John McCain and Lindsey Graham who threw daily tantrums in front of the media over the 4 dead adults at Benghazi? They too are absent. The Republicans and the NRA have calculated this emotion and momentum too will disappear in a few weeks. With no committed Republicans, especially in the Republican controlled House of Representatives, there will be no meaningful action. I am tired of the words “conversation” and “meaningful dialogue” that seem to be the popular lingo on this since last Friday’s shooting. “Restoring Sense of Safety in the Aftermath of a Mass Shooting: Tips for Parents and Professionals,” this is the title of the pre-prepared handout I received by email when I arrived at work Monday morning. I must have missed this in Residency training and it was not on my Board exams. I wonder how I got by without it. How did my Mom raise 8 kids without guidance on how to talk to us about mass shootings? I guess I will now have to have this plasticized and place it with my CPR instructions and Earthquake Safety Response guides for quick access. Is this where we are, so ready to respond intellectually to mass shootings but so unwilling or unable to do anything to prevent them?
Yesterday, I also received an email sent out to an email listserv of Psychiatrists, from a Psychiatrist, a father of 9 children, with numerous Internet links provided to mass killings from every country going back to the mid 1800’s. His comment was: we need to keep a “historical perspective.” I was a bit unclear on his point, so I asked him if his point is that those who do not study history are doomed to repeat it, or was it to create a sense of “learned helplessness?” He responded that it was the latter and that he feels we all need to have “realistic expectations” and accept that these mass killings have always, and will always, occur. He stated that in his work with soldiers he believes that creating in them realistic expectations reduces the psychological traumatic reaction to combat. Boy, is this sobering, parents should have “realistic expectations” that their 6 year old might be gunned down at school in a mass shooting, then their psychological traumatic reaction will be less severe. So in this Psychiatrist’s (father of 9) opinion we should be in the tranquil state of “learned helplessness.” As I understand it “Learned helplessness” comes from studies on rats placed on a float in a tub of water and they try to get out of the tub by swimming and they try and try but can’t and eventually they will stop swimming and just stay on the float. Are we to accept that we are helpless about trying to prevent these mass shootings?
Not long ago I sat across from a mother who has 23 guns in her home and I informed her that her 15 year old son (a bright, talented, athletic kid) planned to kill himself with one of the guns and he knew where the bullets and gun cabinet keys were kept and also how he could break into the cabinet. When I discussed a plan to prevent his access to the guns her response was “my guns are my friends and I am not removing my friends from my home.” Yesterday, another mother of a young soldier expressed concern about his PTSD and anger issues and his drinking and his refusal to go to Mental Health. When I asked her if he had easy access to guns, her very first response was to bring up Friday’s shooting and she used the words ” I am very afraid that the antigun people will use this to take away our guns.” She was not immediately “afraid” that her angry, troubled, excessively drinking, soldier son might use one of the many guns he had access to, to harm himself. Legislation will not alter these attitudes. **
Over the past 2 years every boy from age 8 to 17, except one, that I have needed to admit to a hospital, has been hospitalized over addiction to violent video games. They all were playing many hours everyday, failing in school, getting up in the middle of the night to play then threatening the parents, and having violent outbursts if the parents placed any limits on them. The anger in their eyes in my office as I discussed the need to eliminate the games was nothing short of frightening. Over the past several months I guess I have seen the natural progression of this video game addiction disease: from an 8 year old whose school counselor contacted me because he was fascinated with death and war and talked of killing people and was having angry rages in school; then there is the 11 year old repeatedly threatening suicide and attempting to jump out of a moving car, becoming suicidal at summer camp because they had no video games; more recently a 14 year old playing violent video games up to 5 hours daily on school days, more on weekends, texting suicidal threats because his parents limited his video games due to failing grades, currently refusing to go to school because of denied access to video games. This last boy had such dark circles under his eyes and such seething anger when I first met him that his affect is burned into my memory. I can say this, they all are doing dramatically better at this time, but I cannot predict the final outcome for them. I do not know whether depression lead to video game addiction or the reverse, but I suspect violent video game exposure for some does something to the Serotonin level in the brain leading to depression and obsessive behavior. I think we need to think about it this way, most people who get a flu virus will not die but if we have an epidemic of the flu virus some vulnerable individuals will. Violent video games in young boys are like a flu virus epidemic, some individuals are vulnerable to getting very mentally sick from them.
Perhaps I am writing this because I am jaded. Over the past few weeks I have dealt with a very suicidal, nearly 17 year old, adolescent who refuses voluntary hospitalization. In my State, since he is over age 12 (at age 13 here they have total control to refuse mental health treatment), under our law here, a Psychiatrist cannot involuntarily commit him to a hospital. So I see him but I must call the “County Designated Mental Health Professional” (CDMHP) to evaluate him for “imminent risk” to harm himself or others or “gravely disability” from his mental illness, then there is the final step of determining if “the least restrictive alternative” has been tried. Night after night the CDMHP determines that he is actively suicidal but not “imminent” and determines he is “gravely disabled” but determines the “least restrictive” alternative is that he see me or his Psychologist every day. I have no openings, I am not a hospital and not an Emergency room, so I add him in at the end of every workday. Every day he is still suicidal and has some plan he will not disclose and his agreement with the CDMHP is only for 1 day. Each day I have to go through the same routine. I do wish that talking to me was always an immediate cure, but it is not. I do wish medication I might prescribe always worked or always worked immediately, but it does not. Thankfully the parents have the ability, and eventually make the decision, to travel across a border to another State with more rational understanding of an adolescent’s ability to decide things for themselves and, again thankfully, their insurance covers.
Perhaps I am writing this because last Thursday, the day before this mass shooting of first graders, teachers, a Psychologist, and a principal, I attended an elementary school meeting (something I rarely have time to do) at a school that was a twin, in my mind, to Sandy Hook Elementary School. I walked through the double set of doors (no buzzer) dressed in a black coat. I found the meeting room down on the right and I sat with the Principal, the classroom teacher, the school counselor, the mother and grandmother around a small table. I was there to discuss an 8-year-old boy with an obsession with violence and very negative talk about himself, struggling in school and with violent rages having to be frequently removed from the classroom. I had been in frequent communication with the school because the situation was so challenging for them and because follow through by mother and grandmother with appointments with me and counseling was not happening. A miracle had happened, sometime in the previous 3 weeks, there had been an amazing turnaround. He was happy and had not had any rages in 3 weeks and was getting all of his schoolwork done and was happy about his work and even did a great class presentation. I will apologize to the media here, yes I put him on medication for both depression and AD/HD and he finally had been getting it consistently for about 4 weeks. It turned out the mother and grandmother had not been giving the medication because of what they read in the media about these medications, but they were not admitting this to the school or to me. The admission came when I called the grandmother 4 weeks before, after a frustrated conference call to me from the school counselor and principal telling me he was still having rages every day. I expressed my concern to the grandmother about not showing up for appointments and not seeing his non-school counselor and my concerns that perhaps the medication was making him worse. After that call and fully discussing what she read about antidepressants and AD/HD medications, she agreed to consistently give the medication.