12 February 2013

Depression and the Second Amendment: Should I Have a Gun?

I've done a pretty lousy job blogging the last few months. I managed just four posts in all of January, which in turn means I've managed just four posts all year. Tomorrow night, President Obama will deliver the State of the Union address. Noted political theorist Ted Nugent will be in attendance as the guest of a member of Congress. Someone screwed this up, because that won't be fun TV. Bring Nugent to the White House Correspondents Dinner. Then you've got something.

This is often a political blog, though not so political that I feel I live up to the title I selected for it. I content myself that "fraternité" is an umbrella for sharing subjects of common interest such as hobbies. That third definitely dominates over "liberté" and "égalité", though.

One thing that has me thinking is discussion amid the gun control proposals about mental health. A lot of people are unaware, but there are differences in legal definitions about mental health than what are found in psychiatry. I bring this up because it's entirely possible for the law and psychiatry to disagree about the status of a given person's mental health. Case in point: Me.

Legally, I have not been re-classified as anything other than perfectly healthy (mentally, anyway). You and I know, Dear Reader, though that's not accurate. I've reached a fairly stable point with managing my mental health issues but they're chronic. They're always with me. Medicine would be irresponsible to ever say I'm "all better". The most it can say is that I'm "better right now".

My wife actually kept a revolver in her nightstand. There were countless nights in 2011 when I gave very serious thought to killing myself but truth be told I only thought about using her revolver once or twice and neither time did I consider it very seriously. It's just not my style. For one thing, it's terribly messy. Leaving behind a corpse is one thing. That can't be helped when you're committing suicide. But leaving behind a biohazard mess for my loved ones to clean? That's just inconsiderate.

I'm also certain that if I tried to use a gun to kill myself, I'd be that guy who screwed it up and wind up paralyzed or some such, but not actually die. What if I wound up like that patient LL Cool J played on House whose body was completely frozen and everyone thought he was brain dead but he really wasn't? I can't imagine many fates more frightening than that. I'm sure there are some, but I don't want to consider them!

Of course, that was a concern with any means of self-harm I contemplated but for some reason the risk just seemed a lot higher with a gun. I never even opened the drawer to look at the revolver. It wasn't on the table. Furthermore, I never gave even the slightest thought to ever harming anyone else - with, or without a gun. Again, that's just not my style. "I am a lover, not a fighter!"

In my novel, I wrote a scene in which one character uses a Glock-19 to shoot another character in a hotel ballroom. I picked that specific weapon because my brother owns one and he showed it to me. It was perfect for my character: easy to conceal, easy to draw and fire and definitely capable of putting down the target. That's how Glock made the gun and it's how they promote it. My brother invited me to go with him to a firing range some time to actually fire it myself so that I could write about the shooting with more veracity. I've not yet taken him up on the offer, mostly because we just haven't gotten around to it. Besides, I've fired a pistol before and I recall that experience vividly enough that I feel the couple of sentences I devoted to the moment are sufficient.

Here I am, though, contemplating how many other Americans are out there just like me: mentally ill, but not legally identified as such. I'm harmless, to others anyway, but who's to say about the rest? Clearly not everyone with mental illness is as docile as me, or we wouldn't be concerned about such people getting hold of firearms. Should I not be allowed to have a gun on account of my mental health, despite the fact that I have done nothing that would otherwise justify curbing my legal right to one? What about going to a firing range? Should I at least be allowed to do that, at my brother's invitation?

Or, let me flip it around:

Do you feel comfortable knowing there are people out there right now just like me who are presently off the law's radar, but are known to their physicians and loved ones as being mentally ill, who can legally get hold of a weapon? Would you feel comfortable standing next to such a person at a firing range?

Being mentally ill doesn't automatically make someone a menace to society. I've shared my experiences with depression and anxiety so candidly for the express purpose of trying to challenge the ignorance about people like myself. I sincerely hope that anyone who reads my posts about depression walks away with a new perception of patients like me.

Part of speaking so candidly, though, means owning up to the unpleasantness about what it's like. Suppose you wanted to argue that someone who's determined to kill themselves will still find a way even without a gun. You're right, but consider the following statistics from the Illinois Council Against Handgun Violence:

  • Suicide is still the leading cause of firearm death in the U.S.
  • More than half of all suicides in the U.S. are committed with firearms.
  • Unlike suicide attempts using other methods, 92% of suicide attempts with guns are fatal, meaning a temporarily depressed teenager will never get a second chance at life.
  • A gun in the home is 11 times more likely to be used to attempt or commit a suicide than to be used in self-defense.
  • Homes with guns are 5 times more likely to experience the suicide of a household member than homes without guns.

Suppose it's not federal stormtroopers that you need to fear, or even the bogeyman home invader. What if it's your own loved one?

One nice thing about the Internet is that patients facing depression can reach out and connect with people without having to necessarily endure the embarrassment and humiliation that we often face in person. There's a lot less shame when you're typing on a keyboard than when you have to look someone in the eye and explain what's going on with you.

The danger, though, is that someone with depression can reach out online while never saying a word to indicate there's a problem to anyone offline. My online pals and friends probably had a much clearer understanding of just how depressed I had become than 95% of all the people I interact with in person ever had a chance of knowing. My point in this is that if you think, "Well, I would know if someone in my own home was depressed", you may very well not know until it's too late. There are plenty of people out there who didn't realize what their loved ones were going through until it was too late. They spend the rest of their lives trying to figure out what they missed and grappling with the guilt. It's not because they were any less observant than you or any more selfish than you. It's that a big part of being depressed is hiding it.

I honestly don't have answers to any of these questions myself, or any of the obvious follow-up questions they invite. I just wanted to put this all out there for your consideration.

5 comments:

  1. In Australia the most common method of suicide is hanging, followed by poisoning & drugs, then motor vehicle exhaust and then an assortment of other methods. Guns account for less than 6% of suicides so taking away the guns won't stop it, it'll just change it's form.

    I guess the thing that jumps out to me the most though, not just in your blog but through the whole Mental illness/gun debate is the depth of misinformation and myths that still form a large part of the conversation. The understanding the general population has about mental illness is very muddied. One in five people in the general population will suffer an episode of mental illness but the reality is that in many subgroups of the population it's closer to 1 in 3.

    The facts are people with mental illness are no more likely to be violent than the general population. Schizophrenia, Schizoaffective Disorder, Biopolar affective disorder, depression are mental illness. Psychopathy, sociopathy and personality disorder are not mental illness. It's this second group of people that are more likely to be violent and there are clear markers to identify them early.

    Another thing is that suicide is not always the result of depression. In Australia, in most cases, suicide is attempted for reasons other than depression and most people with depression aren't suicidal either. So essentially, the debate around taking guns away from the mentally ill seems to me to be a rather pointless endeavour.

    We like to categorise. It makes us feel safe. A common one is Mentally ill people are unstable and dangerous. I am not mentally ill therefore I am stable, I am safe. It's faulty logic. We're really good at seeing things after the event but in practice predicting violence is far too subjective. The fact is that under the right circumstances any one of us might easily be either the perpetrator or the victim of violence at any time. And that's a scary thing to consider.

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    1. Excellent points, all. I had hoped it was understood that I didn't mean to suggest that restricting access to guns would stop suicide attempts. There are, clearly, any number of methods available. I myself excluded the use of a gun despite having easy access to one.

      I did, however, focus on guns for two reasons. Firstly, it's the topic de jure and secondly because of the disparity of survival rates between firearm-aided attempts and attempts using other methods.

      I definitely agree with you about the problem of misinformation and myths surrounding mental illness. I don't claim to be an expert, though whenever I cite any statistics or facts I will always link to my source so that they can be scrutinized by anyone who wishes to challenge my information. My overall point in this is to put a human face on the subject because right now, people with mental illness are either someone who won't stop crying on their couch or, worse, they're a faceless bogeyman to be feared. It's always been my hope that by sharing my experiences - admittedly, anecdotal - that it might help others see that we're not such a monolithic group.

      The emphasis on guns and the mentally ill that I've encountered the last few months has been on stopping mass killers, but no one has talked about those who only represented a danger to themselves. In fact, I was told on Twitter after posting this blog post that gun-related suicides are "acceptable" losses. The sense there is since you're not going after anyone else, no one cares. That's not very helpful for the 18,000+ Americans each year who commit suicide with a firearm or the loved ones they leave behind. They're not seen as victims of gun violence, and I'd just like to get people to think differently about that.

      I appreciate the thoughtfulness of your perspective on the matter (as well as your civility; something sorely missing in most discussions about this subject!). Thank you.

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  2. You definitely didn't suggest that restricting access to guns would stop suicide. I added the info about Australian suicide info only because I thought it was interesting. Some other interesting facts are that men are more likely to be successful but women are more likely to attempt suicide. Women tend to lean towards the less violent methods like overdose, slitting wrists while men tend to lean towards guns, bridges, car accidents but I digress.

    It occurred to me after I'd written that comment above that the trajectory of depression is probably very different in our two countries given both the cost and access to services. Do people decide not to get treatment because they just can't pay for it? I'm sure that's a big consideration. Here, financial factors aren't an issue. So having counselling, medications, hospitalisations and procedures won't break a person financially. The other big diference in access to treatment is that here a person can be treated involuntarily in the community with medication supervision. To be made an involuntary patient doesn't require hospitalisation and referral for assessment to the public mental health service can be made by anybody at all, so often people get treatment whether they like it or not. In considering this are suicides among people with a mental illness lower here? (I'm wondering, I don't know and I couldn't find any per head of population stats).

    I don't think any death is an acceptable loss and I see your point about the lethality of firearm suicides. I honestly hadn't considered that before. I think in Australia the most lethal is jumping in front of a train. You might not be able to stop suicide but if you can reduce the odds of success than you have that little bit more scope to get in and provide treatment.

    In Melbourne the highest bridge (West Gate Bridge) has just had major renovations to include suicide barriers. Approximately 2 people a month attempt to jump from the bridge and half of them are successful. It wasn't the suicides that prompted the barriers though. It was an absolutely horrific act of a father hurling his toddler off the bridge to prevent his ex-wife gaining custody. Awful. Something had to be done and so the barriers (which had been debated for what would easily have been a decade prior to this) went up and 24 people a year now have to come up with a plan B.

    On the surface you could think that that one baby's life was worth more than the 12 people a year who suicided from the bridge but I don't think that's it. It's that suicide is understandable. We don't like it but we can make sense of it. The other stuff, the mass killers, the school shootings, the hurling a little kid off a bridge, that's just mindless, irrational, horrifying violence and so it provokes a stronger emotional reaction.

    But it's still not mental illness. The guy from the bridge was neither legally insane nor psychiatrically ill. He was just a jerk who viewed people as property and had to have the last say. We want to think he was mentally ill because then we can neatly categorise him as being different to us. I hate to see people with a genuine illness get lumped in together with these people who have no regard for anybody else and who lack all traces of human compassion.

    but back to guns, I don't have the answers either. If anything I only have more questions. Will restricting gun access to people with a mental illness do any harm? I might need to ponder that one some more. (Sorry if I've rambled a bit, I'm tired!)

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    1. You raise some key contrasts between our health care system and yours. Lack of affordable access is one of the most challenging barriers here. Mental health problems are a "luxury" here; if you can afford to get help for them, you're doing well. If not, you're just some poor person who just resents life because you're poor and you may as well just get used to it. What's the point of $100 an hour therapy sessions for someone living at or below the poverty line? Their lives are still going to suck.

      Hell, I'd be seeing a therapist or therapy group myself right now if I could afford one. I can't. Thankfully, my primary care physician is a caring, compassionate woman who takes the time to discuss my mental health whenever I see her. She's not trained in psychiatry, but it's helpful. That's more than a lot of other Americans with mental health problems have.

      Also discouraging is cultural perception about mental and emotional health. Yesterday, I came across a statistic that said 80% of suicides in the United States are men. That gender disparity is pretty conspicuous, but without investigating further I would imagine that the single most important reason for it is that it's so much harder for men here to take the step of seeking help than it is for women. Culturally, there's still such a stigma attached to mental illness anyway and that's coupled with gender role norms that teach us men suffer in silent dignity rather than admit "weakness". It's not hard to connect that dot with our gun culture to see why 56% of male suicides in America are carried out with firearms.

      In thinking about the contrast between the sexes, I find myself wondering: The means that men favor are more "external" in nature. That is, they could easily be used on someone else: Shooting, pushing someone into a train or off a bridge, etc. Women are more "internal" using methods that are much easier to use on oneself than on someone else. You have to have a somewhat cooperative victim if you're going to slit someone else's wrists.

      Do you suppose this is because of how we view the origin of our emotions? That is, that men see them as the consequence of external factors where women see them as an internal shortcoming of their own? That men who reach that point need to "attack" with such violent methods?

      You also bring up another important (if gruesome) point that just as not everyone with a mental illness is a menace to society, not everyone who does something heinous has a mental illness.

      In the course of the Twitter and Facebook aftermath from sharing this post yesterday, someone asked me whether they ought to take away my kitchen knife and car keys, too. The normal retort there is to argue that those things have non-killing utilitarian purposes but instead I just replied that I had to give up my belt and shoelaces when I finally got help. I'm here today because someone did take away my access to potentially harmful objects with which I could not be trusted.

      For him, though, it was just unthinkable to even suggest curbing gun access. He even went so far as to ask me, "What good is your life without rights?" To that, I asked, "What good are rights to a corpse?"

      Setting aside for the moment my own experiences with all of this, and speaking strictly as a writer, I find it fascinating that people who would insist upon owning guns to protect their loved ones would be so adamant about not giving them up to protect their loved ones who may face depression or other mental illnesses that make them so much likelier to harm themselves. I have to imagine there are thousands of men out there right now who have to go to bed at night knowing that they've buried their son because of the gun they insisted on keeping in the home. It's a truly tragic irony.

      (Feel free to steal that for NaNo later this year.)

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  3. oops sorry, I probably could have chosen a less gruesome case study! (becoming desensitised is a bit of an occupational hazard).

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