An Admitted Slippery Slope

Shannon from CO, who is a long time blog reader, left an urgent and heartfelt comment on my last blog post, one that deserves some thoughtful consideration by all of us.  She spoke of the very real slippery slope we approach when we speak of the how to best approach the treatment of the severely mentally ill.  Indeed, the idea of forced medicating and the loss of individual liberties that would mean is not something to take lightly, I agree 100% with that, Shannon.

I am a bit of an odd duck.  I am an amalgam of liberal and conservative thought, and I don't like to have myself pigeon-holed into any "camp", which is the main reason I am a declared independent.  Some might call me liberal based upon one conversation, and another call me conservative.  What i think I am is moderate or centrist, left leaning on some issues, right leaning on others.  Probably, most of us are closer to that than the fringes on either side of the aisle.  I am someone who believes in the right to bear arms, and at a young age was taught to shoot by my Dad who drilled into me gun safety and never had a loaded gun in the home and kept his arms under lock and key...in an unused gun safe that now sits in my own garage.  I owned my own .22 single shot rifle at 14 years old.  And clearly, I believe in the rights of the individual, as our decision to homeschool and be responsible for our kids' education reflects.  So the whole idea of the intrusion of "Big Brother" is one that I do take very seriously, and cringe when I think of the ways in which we could lose our liberties.

However...however...at what point do we begin to be honest about the needs of those who are, for a time in their life, unable to help themselves?  Even if we are not thinking about possible future victims, don't we, as a country, have some sort of responsibility to them?  It is a dilemma of the most conflicting sort.  Once a child reaches the age of majority, in most states a parent or other loved one is completely unable to get long term care for someone who is almost always unable to recognize, due the severity of their own condition, that they are in desperate need and sliding down a slippery slope of a different kind.

As I read part of the Wikipedia entry for the Virginia tech shooter, Seung-Hui Cho, it states what part of the problem is.  His parents had tried to get help for him since early adolescence, but once he turned 18 he was beyond their legal reach.  The entry is below with my own bolding inserting:

During the investigation, the matter of Cho's court-ordered mental health treatment was also examined to determine its outcome. Virginia investigators learned after a review of Cho's medical records that he never complied with the order for the mandated mental health treatment as an outpatient.^[64] The investigators also found that neither the court nor New River Valley Community Services Board exercised oversight of his case to determine his compliance with the order. In response to questions about Cho's case, New River Valley Community Services Board maintained that its facility was never named in the court order as the provider for his mental health treatment, and its responsibility ended once he was discharged from its care after the court order.^[64] In addition, Christopher Flynn, director of the Cook Counseling Center at Virginia Tech, mentioned that the court did not notify his office to report that Cho was required to seek outpatient mental health treatment. Flynn added that, "When a court gives a mandatory order that someone get outpatient treatment, that order is to the individual, not an agency ... The one responsible for ensuring that the mentally ill person receives help in these sort of cases ... is the mentally ill person."

This is the problem we bump up against all the time, and to me it makes so little sense it borders on the absurd.  We are asking a mentally ill person to be responsible for ensuring they get their own care.  Obviously, that doesn't work at all in many cases.

I won't pretend to have the answers, but what I do see is a need for a much larger national conversation about how best to handle such individuals.   Shannon, your very valid concern is what has kept this a "hands off" topic for so long in our country.  They are concerns I share, and I daresay much of America shares as well, but when we are at a place where Kindergartners are being shot to death in the halls of their own schools, they are concerns we can no long avoid dealing with because of our own discomfort, but need to address openly and honestly in an effort to find at least some solutions.

Believe me, Shannon, when I say no offence at all was taken by your comments.  I brought them to the forefront here on the blog because I think we all need to talk about these issues, informally in our homes, and in more structured settings like the halls of Congress.  What are we willing to live with?  What does seem to be the fair and just approach to the treatment of mental illness...or gun control?  And perhaps most importantly, can we wait any longer before being willing to have the hard conversations?

Because I, in large part agree, with Shannon, I am having an internal struggle about when to the rights of the individual become subordinate to the rights of the whole?  Is this a gun control debate we need to have, or is it a mental health debate?  Are our very freedoms at stake if we enact legislation that limits certain behaviors?  No one wants Big Brother running our lives for us.

And yet the faces of 6 and 7 year olds continue to stare back at us, pleading with us to at least try and do something to stop this sort of carnage from happening again.

I was reminded in Shannon's comment that there, but for the grace of God, go I, when she said that whatever decisions we come to as a nation in the coming months might drastically effect those I know and love.  I have seen up close and personal in my family, and I am not speaking about my children, the destruction that mental health issues can bring about.  Thank God it was all more self-destructive than directed outwardly, but the ripples certainly stretch well into the future and touch other lives no matter what.  But I do ask myself the question, if I were in that position as the mother of a child such as Adam Lanza, or even one with lesser issues, what sort of help would give me the sense that all possible was being done to avoid calamity?  I can say, with certainty for us, that we would ere on the side of caution.  Some would ere on the side of individual rights.  Both might still find themselves facing media cameras one day, the unintended targets who are the only ones who can offer any sort of explanation to the question, "Why?"...while still being completely incapable of answering it.  For we all know that regardless of the approach, mental illness will still be around, and in some cases, even the most invasive of efforts can fail.  That is another component to why this conversation is so hard to have, because at times it can all feel so darned hopeless.

As the past few days have had us all trying to wrap our minds around the very special sort of grief that the parents of those 20 children are feeling, we may not be privy to the sort of years long hell any family of a mass shooting killer has experienced.  There is something wrong with their child, and they know it.  They are sometimes afraid for their own lives, as last Friday and many other times proves they well they should be.  As they watch that perilous slippery slope their child slides down which can only lead to unknown future heartache, they claw and scratch to help their child regain some semblance of sanity before they commit some unspeakable act that send them tumbling into the pit, forever unreachable.

Curiosity and real interest has me wondering, if we approached the families of some of these killers, had they had a choice of forced medication or not, what path would they have chosen?  Would they have fought for the rights of their child and their freedoms?  Or would they have gladly reached for the Rx and felt great relief that at least some help was at hand?  The truth is, after the fact, I'll bet that most might weigh in on the side of forced medication.  After all,  who wouldn't do anything in the world to retroactively prevent the sort of heinous acts their loved one committed?  But were the question to be asked before the act, I think it would be perfectly normal for a parent to say, "No, we don't need to resort to that.", for the very reality of what their beloved-yet-terrifying child is capable of just can't ever really sink in.  We may know something is terribly wrong and in quiet moments we might be able to allow a smidgen of brutal understanding in, but for the most part, what parent  really can look into the eyes of the child they have nurtured and desperately loved for so long and see in them the capacity for harm that lies beneath?   It's why after once of these incidents we often hear people saying, "We knew he was upset/struggling/having issues but we never in a million years thought he'd really hurt someone."

Sometimes, it is the even more powerless outsiders who can clearly see it, as in the case of Jared Loughner.  His community college professor sent emails prior to his rampage about him.  Here is what she had to say:

“We do have one student in the class who was disruptive today, I’m not certain yet if he was on drugs (as one person surmised) or disturbed. He scares me a bit,” Lynda Sorenson, a 52-year-old wrote in an e-mail to friends on June 1. “Hopefully he will be out of class very soon, and not come back with an automatic weapon.”

“We have a mentally unstable person in the class that scares the living crap out of me,” Sorenson wrote in another e-mail on June 14. “He is one of those whose picture you see on the news, after he has come into class with an automatic weapon.”

Or about Seung-Hui Cho, it was reported that as early as 8th grade he had created a "hit list" of students he wanted to kill.  Here is what fellow students of his at that time shared:

In 1999, during the spring of Cho's eighth grade year, the Columbine High School massacre made national news. Cho was transfixed by it. "I remember sitting in Spanish class with him, right next to him, and there being something written on his binder to the effect of, you know, ' 'F' you all, I hope you all burn in hell,' which I would assume meant us, the students," said Ben Baldwin, a classmate of Cho.[25] Also, Cho wrote in a school assignment about wanting to "repeat Columbine". 

All the signs were there that a future horror was in the making.  In most cases, post-event research and interviews reveal that there are very few times when at least one person hadn't predicted that the perpetrator was in real need of help.  What is so maddening is that the help that is necessary is just out of reach for a wide variety of reasons, all of which really need to be addressed...laws that keep us from getting help for someone, inadequate facilities or trained professionals, cost of care and long term management, and sometimes the unwillingness of someone close to the ill person to really and truly internalize how very dangerous they have the potential to be.  It is not just one factor, it is many, all of which need to be taken off the shelf, thoughtfully examined, and then perhaps we can come to some sort of agreement about what course of action is most respectful of the individual, while still attempting to protect the rest of the world as well.  

And lest we forget, most of the time these young men (for that is who we are really talking about) are suffering in such ways that they take their own lives as well.  So, that causes me to ask the rhetorical question...if one of these young men were alone with no semi-automatic weapons, in a hospital room and threatening suicide, would we feel it was appropriate to force medicate them in order to save their lives?  And if the answer to that is yes (and it does happen), how do we then justify the argument of the rights of the individual over the rights of the whole?  Wow, this stuff is the sort of thing that Constitutional experts and ethics specialists wrestle with.  I guess any of us can be forgiven for also finding it hard to wade through our thinking surrounding such very important issues that will change our country forever.

When one thinks about it a little dispassionately, there are hundreds of ways in which we have already agreed on how to legislate the rights of the whole over the rights of the individual, and no one screams over those.  For example, we make people take driver's tests to prove they are safe on the roads, and if they don't pass or grow to old to see well enough, we remove their driving privileges because we all know it is safer for them, and for everyone else.  Every time we step into an airport we allow ourselves to be searched, and as many incidents remind us those searches often go way over proper boundaries, but we all agree to it because we'd like to remain in the air on those planes, rather than victims ourselves.  For goodness sake, since the Patriot Act, I recently discovered I don't even have the right to see our children's library record and fines on screen, even though they are minors and I am legally responsible for them!!  But we allow that in the interest of public safety.  And yes, I was hopping mad over it and don't like it one single bit.  There you go again, my own conflicted feelings surfacing over those issues of individual freedoms.

What was most ironic was the (as usual) anonymous comment that came in right after Shannon's thoughtful comment.  It was the weary, tired phrase that does carry some truth to it, " Handguns do not kill anyone. People kill people with guns."  

Exactly, that is why, no matter how difficult, this conversation has to include more than "Get guns off the streets."  As usual, with difficult problems there are no easy answers.  But because it is hard does not mean we ignore it, as we have the prior 61 times in the last 30 years.  Even if we are extremely uncomfortable with the slippery slope, we need to have a serious national discussion about it, about the ramifications of any legislation we might enact that has to do with firearms or mental health care.  We may try something, find it is not the best solution, and look for another.  Ignoring it, though, is the worst "solution".

I don't have a clue what's best.  I am working through it in my own mind, weighing and balancing, just as so many are after Friday's sad event.  None of us really does have the answers, not by ourselves. And regardless of the outcome, there will always, always be some who will be extremely disappointed and upset over the results.  It is another reason why our polarizing positions need to be shelved, as most likely, solutions we find we can live with as a nation will be found somewhere near the middle.  We are a country that will never give up its guns, but perhaps we can come to some sort of rational middle ground that everyone can accept which will at least cut the risks a little.   We are a country passionately protective to our personal freedoms (and rightfully so, I might add), but maybe somewhere between "impose medication on everyone" and "they have the right to refuse care, even if they are not in their right mind" we can find a narrow road we all can agree makes sense.  

Even with change, we will never stop incidents from this from ever happening again.  But as statistics in other countries reflect, we do not have to live like this is a common, everyday occurrence.  It is only in our inaction that we can be 100% certain that history will, indeed, repeat itself.

I think we all need to walk up to the slippery slope and peer over the edge.  We might find that there is a safe ledge there, if we look hard enough for it.  Thanks Shannon, for inviting me do a little more peering myself, both now here on the blog, and in the days to come.  While we might find ourselves disagreeing, I am...as you urged me to do...being very careful about what I advocate or vote for.  We all need to remember that just because we might find ourselves on differing sides of an argument, that does not mean that our perspectives have not been reached with just as much thoughtfulness as those who adamantly disagree.  Respect, at all times, is what keeps the conversation moving forward in helpful directions. And I say that, not as a reminder to Shannon, but as a reminder to myself, to never assume that someone's differing opinion was somehow reached through rash thinking.  It's just different, that's all.  

Regardless, we all find ourselves standing on that slope...and if we can't find ways to come together, we might all tumble down with no safety harness.