A licensed physician and columnist should know better

BY LENNY SOMERVELL + JENNIFER MORAZES OF THE DISABILITY POLICY CONSORTIUM

The following is a response to a June WBUR column by Pranay Sinha titled, “My Patient Could Have Been A Mass Shooter.” It included lines such as, “How many patients leave their busy doctors’ doorsteps with unexpressed murder in their hearts? Could doctors stop a few shootings just by paying more attention to patients with risk factors for violence? Can we really expect overworked physicians to identify would-be mass shooters in frenetic 15-minute appointments?”

Pranay, I could have been your patient. 

I am a person living with PTSD.  As part of this diagnosis, I have experienced psychotic symptoms. The first time I experienced these symptoms, I was frightened.  I was a PhD student at UC Berkeley, ironically studying stress in the context of social work and education. I did not know what was happening.

I went to the counseling center with my husband.  A doctor looked at me through a window to make his assessment.  He never introduced himself to me or explained what I was experiencing.  I was put in handcuffs despite not displaying violent behavior, brought half a mile up the street to the hospital via ambulance with sirens blaring, and told my husband had to leave my side while I completed an intake in an inpatient setting.  I was terrified.

I am a normal person with a medical condition. My medical condition necessitates certain supports. With these supports, I have a successful career. I have been symptom-free for four years. But because of articles like yours, I fear for how my career, housing, and other opportunities will be affected if someone finds out about my condition.

Pranay, my colleague could have been your patient.  But, so could have many others. And many you are worried about would have never been your patient.

One in five people in the United States lives with a mental illness.  As has been cited many times, most individuals with mental illness are not dangerous.  In fact, mental illness is not implicated in 95-97% of instances of gun violence.  Those with mental illness receiving treatment (whether in the form of psychiatric medications, behavioral change, or lifestyle adjustments that mitigate their condition) are no more dangerous than someone in the general population.  Individuals with serious mental illness are more likely to be victims of violence.  But rather than these facts, our society amplifies the image of a violent killer to depict a person with mental illness.   Mental health is an important topic in our country, but it is no accident that it is only brought up as a topic of national discussion when a shooting spree occurs.  It’s a convenient cover for productive discussions about gun availability and addressing toxic belief systems and entitlements such as racism, homophobia, or misogyny.

An abuser who terrorizes and brutalizes their victims is highly unlikely to ever be your patient, Pranay. Their victims, however, probably will be.

If someone perpetrates or plans a mass shooting, that does not mean they have any currently recognized mental illness. If someone survives a mass shooting, however, they almost certainly will develop one.

The fact is, being a young, white male is a greater risk for violent behavior than having a mental illness. Acts or expressions of misogynistic violence are one of the single greatest warning signs for mass shootings.  US society loves to use the specter of the scary crazy person as a smokescreen to avoid confronting the much more uncomfortable truth that white supremacy, misogyny, and homophobia have bred a violent entitlement in some of our citizens, and that we have armed them. And so, we follow the “proud” tradition of blaming the victims—and the stigma of their diagnoses only grows with each rehashing after another tragedy.

Despite malicious stereotypes, the sloppy logic that people who live with schizophrenia, psychosis, PTSD, bipolar disorder, personality disorders, depression, or anxiety are necessarily dangerous solely due to these conditions is false. These conditions alone don’t cause us to hurt people, do not turn us into violent, unstable, and disturbed villains devoid of reason. They do make us uniquely vulnerable, often to the same angry white men everyone rushes to armchair diagnose after yet another public slaughter.  Often, the instigators of these tragedies do not meet diagnostic criteria, or, even more troubling, their diagnosis played no part in their decision to kill. 

Pranay, I will never be your patient.

Reading your story makes me less likely to see a mental health professional.  Last month was mental health awareness month. Many will never seek treatment because of the stigma associated with it—including the stigma of one’s conditions being associated with violence. Thanks to your article, I now know that there is a good chance that, if I were to consult a mental health professional, rather than receiving understanding, support, sympathy, or help, I would be met with disgust, fear, and an assumption that I am dangerous to others. I would have to worry about my symptoms, words, facial expressions, and demeanor being described derisively and disturbingly to friends at parties, or to the public in articles on the internet. I will never be your patient because I would be terrified that, rather than giving me help and support, you would lock me up against my will and force medications on me through a court order that may have detrimental side effects and give me little or no say in the process. Despite your intentions, you have communicated to those of us who are struggling and might benefit from treatment that we are monsters who do not deserve to be treated like human beings, and you have communicated the same message to everyone around us as well. I will never be your patient, because I will not subject myself to this dehumanization if I can help it.

In your article, you wonder how many patients leave their doctors’ offices with violence in their hearts.  What you should be asking is how many people leave their doctors offices feeling they have not been taken seriously, and with their care needs still unmet.

Lenny Somervell and Jennifer Morazes are directors at the Disability Policy Consortium.