Catch 22: Treating Mental Illness in America

“He has to be crazy to keep flying combat missions after all the close calls he’s had.  Sure I can ground Orr.  But first he has to ask me to.”

- Joseph Heller, Catch 22

In the aftermath of the Orlando massacre, many are focusing more on a criminal investigation and less on the human condition that led up to this horrific act.  Other nations have experienced and mourned acts of violence with multiple victims, but America is remarkable for its level and frequency of mass murders.

Since 2009 there have been eight separate mass shootings which claimed over 200 lives and resulted in hundreds of injuries.  Reporters and politicians often focus on the availability of firearms as provocation for these incidents while overlooking the other common theme in each event: Mental illness.

An attorney friend likes to say: “Crazy is a medical term. Sanity is a legal term.”  This is true.  One’s “sanity” does not come into question until he or she has committed a crime.  Then, courts must determine whether the person 1) had the capacity to tell the difference between right and wrong at the time of the crime, and 2) can participate in their own defense.

Numerous studies indicate one-third of America’s homeless population suffers from mental illness.  We see these people in our surroundings talking to themselves and looking confused.  We rightly assume they must be on drugs.  Without medical support, people suffering with depression or anxiety often will self-medicate with street drugs to control symptoms that are compounded by frightening living conditions.  The homeless represent a small minority of America’s mentally ill.

How many people who are described as “crazy” by friends and family members maintain homes and jobs?  According to a report by the Substance Abuse and Mental Health Services Administration (2014), nearly one in every five people or 42.5 million Americans suffer enduring or chronic conditions such as depression, bipolar disorder(s) or schizophrenia.  The study also indicated 9.3 million Americans experienced mental illness so severe that the condition impeded their day-to-day activities.  To answer my own question, 33.2 million people are trying to hold their lives together while dealing with a mental health issue.

Although most of us have run into people who clearly have some “problem,” most of us are not directly impacted by their struggles.  We know them, talk to them, and develop opinions about whether they are people with whom we want to associate.  We describe them as “weird,” “irrational,” “unreliable,” “angry,” or “creepy.”  We brace ourselves for brief neighborhood and workplace encounters.  Sometimes we feel upset when the “crazy guy” attacks us verbally for something minor or nothing at all.  We seldom think that maybe he cannot control himself.  It isn’t until the same person threatens us that we consider reporting the incident to authorities.

It is at this point that our systems fall apart.  The police will ask if there has been an assault or property damage.  When there was none, we are told the police can’t do anything unless a person is a danger to himself or others.  Likewise, crisis hotlines will say that unless someone is willing to commit themselves to care, there is nothing they can do.  Families are left without support.  Friends can’t help.  Coworkers are hamstrung by company policy.  Even federal agents cannot intervene when the alarming bragging of a person who claims to have ties to terrorist organizations are found to be factually and legally meritless.  In the absence of a clear and present danger, people with mental illness escalate in the privacy of a personal hell.

This is the Catch 22.  Crazy is not a crime until thoughts are acted upon.  There is no safety net for the mentally ill or proactive safeguards for the American society upon which criminal insanity is eventually inflicted.

This incredibly complex problem is at the crux of every mass shooting and every murder-suicide in America.  Legislatively curbing the availability of firearms to prevent mass murder is akin to taking shoelaces away from a person who is suicidal.  People with intent to harm themselves or others will find a way to do so until we address the intent.

We need to remove barriers to mental healthcare and remove the stigmas associated with these medical conditions.  Mental health screenings should be performed routinely by pediatric specialists.  High schools and colleges should be able to fund mental health programs to help people at the time when disorders like schizophrenia begin.  We must do more to educate Americans to not only recognize mental illness symptoms but also to intervene on a sufferer’s behalf.  Rather than reacting in anger to someone who is politically incorrect in the throes of a manic episode or a paranoid delusion, we can compassionately approach that same person to ask: “Are you OK?  Can I help?”

After every violent incident, American communities unite to say that hatred is not who we are.  We promise we will not be broken by the evil that inspired such violence.  Yet, until we unite as a compassionate nation to overcome the causes of such violence, mental illness will continue to break our hearts.

I urge leaders to acknowledge our nation’s mental healthcare crisis and to treat its current state of devastation as an emergency.