The troubled waters we are in

The troubled waters of hate and violence we are collectively in are deep and the long-term answers to our own safety, as well as our evolution as a caring culture, are complex. This is my humble attempt to discuss how mental health services as a solution to violent shootings is a myth.

My introduction to mental illness was as a teenager. A boyfriend had spent time, before coming to the school where I met him, at a school for young people with emotional problems. He eventually left the school where we met, returning the year after I graduated. That year he tried to commit suicide. He was a nice guy. In my teens I didn’t really understand what his emotional problems were, though he talked with me a bit about them. Another boyfriend saw a psychiatrist once a week. Another classmate, an unattractive, geeky chess prodigy with few social skills, committed suicide over an “older” women he met at a chess match. I’m sure she never knew of his infatuation or reason for taking his own life.

While in college in Washington D.C. I had more experiences being around people with mental health challenges, people I met from the D.C. community (no, they weren’t politicians).   Wanting to be a historian, I primarily studied Asian countries. Courses in the history, anthropology, art and philosophy of Asian cultures filled my two years at American University before I transferred to the University of Oregon and graduated with a degree in social sciences. I did not know these early experiences around people with mental health troubles foreshadowed my eventual work as a social worker, including working in mental health services with people diagnosed with schizophrenia and bi-polar disorders.

I was never afraid of my teen-age boyfriend, not then nor years later when he visited me on the west coast. In retrospect, what I did learn about him (some of it from his mother, including his putting cigarettes out on his arm when he was in the school for emotionally challenged children) indicated he likely had schizophrenia. There were few medications available at the time. Though he had an intensity that could be scary, I never thought he’d harm me, he had a kind heart. Other troubled people I knew never seemed dangerous, not only at the time, but also in retrospect after years of working with people struggling with mental illness. When studying for a Master’s degree in psychiatric rehabilitation I read pages of case histories, none were about people dangerous to others. In the years I worked one-on-one with people whose hallucinations, voices, delusions, mood swings and other serious symptoms were very debilitating for them, causing them to be isolated and often behave in bizarre ways, I met with them in their apartments or community settings, where I might have been considered vulnerable compared to those who saw them in clinic settings, yet there was only one person I felt uncomfortable with. I learned people with serious psychiatric disabilities were more likely to harm themselves than others. Statistics back this up. It may happen, but that is not the norm.

If you add personality disorders, and/or drug induced symptoms, you change the picture, and the person.

“there are no reliable cures for insecurity, resentment, entitlement and hatred.”

This quote, from an excellent editorial in the New York Times, “The Mental Health System Can’t Stop Mass Shooters”, could be describing characteristics and attitudes of many people, including some successful politicians who think of their own financial gains over the needs of those they are supposed to be serving; corporate heads who show little concern for the welfare of their employees or the communities where they dump toxic wastes; professionals who take advanced of vulnerable, trusting clients; coaches, teachers, actors or anyone who sexually abuses those they have authority over. The list goes on. These people have personality disorders*, often narcissistic personality disorder, sometimes borderline personality disorder, and they live and work in all areas of our society. Some, not able to be successful within socially acceptable means or the acceptable definition of success, or unable to get the attention they need*, may commit heinous crimes such as rape or murder. They feel entitled to have what they want and someone got in the way of their gratification, someone pissed them off. The difference between the former list and the later example is a matter of opportunity or degrees on the continuum of personality disorders, or both.

People who have narcissistic personality disorder, or borderline personality disorder, are the “mentally ill” who do the most damage to others, and they are the least likely to seek help, or benefit from it if they do. It’s everyone else who has a problem, not them. They are rarely diagnosed.

The issue of mass shootings is not a mental health issue solvable by offering mental health services to individuals (though better mental health service are always needed). It is a societal issue where many people have become desensitized to others, where narcissism is becoming a “norm”, replacing empathy and compassion for, and cooperation with, others. Where those most in the limelight are setting a standard of “I’m right, and anyone who disagrees with me, or doesn’t give me what I want, is wrong and doesn’t deserve ______. ” Fill in the blank – food stamps, a job, health care, social security benefits, the right to live in the country of their choice, or maybe to live at all.

If you do not believe this has become a “norm” take time to read the comments written under many on-line articles or Facebook posts. See how people respond to those they disagree with, or whom they do not share the same values or perspective. (You can also read the articles listed  below addressing this societal problem.)

People with personality disorders are often liken to 2 year olds in their emotional development. They, like 2 year olds, should not have access to guns, nuclear weapons, shouldn’t be politicians, shouldn’t be playing with dangerous chemicals, or the rights of other people.

Mass shootings occur because people who are, or at least pass as, mentally healthy can buy weapons designed for mass killings, weapons designed ONLY for killing people, not for hunting deer, not for target shooting, designed to kill as many people as possible.

As long as this new “norm” of narcissism, of “entitlement”, is sanctioned by the role modeling of public figures there will be killings. Making the weapons unavailable for mass shootings is only a first but crucial step to ensure better safety for others. The other steps are complex and require honest reflection how, as a society, we got to this place of narcissistic entitlement. This place of “me first”, others be damn. Of hate, not love.

*Definition of Narcissistic Personality Disorder: grandiosity, lack of empathy for others, need for admiration and attention, described by others as arrogant, self-centered, manipulative, demanding.  A person with NPD may concentrate on grandiose fantasies (e.g. their success, brilliance), be convinced they deserve special treatment, believe they are superior or special, have difficulty tolerating criticism or defeat. They frequently take advantage of others to reach their own goals, can be charming to achieve to those goals, disregard the feelings of others, need constant attention and often go to extreme behavior to get it.

Borderline Personality Disorder has many of the same characteristics, with the addition of lack of impulse control, often engaging in risky behavior and in self-destructive behaviors. People with BPD usually do not feel a strong sense of importance, but more of being misunderstood. Those with NPD feel others lives revolve around them, those with BPD will become obsessed with and feel their life revolves around another person, becoming intolerant of that person not giving them the attention they need.

Related internet articles:

Me, me, me! America’s ‘Narcissism Epidemic’

Research says young people today are more narcissistic than ever

Is Social Media to Blame For the Rise In Narcissism?

Narcissism: The science behind the rise of a modern ‘epidemic’

6 Signs of Narcissism

Carrying stories for others

I’ve never written or even talked much about my work life. Much of my work life involved the stories of other people’s lives. Recently somebody made a remark implying that since I never had children, I’d never had responsibilities for another person. I would never equate anything I’ve done to parenthood, and hold with great regard, awe and respect, my siblings and friends who are parents, a role like none other, with all that life can give in joys, stress, challenges, love, disappointments, and every other human emotion and experience. However, like many friends who never had children by choice, circumstances, or biology, I’ve had responsibilities in the lives of others in diverse ways, most recently in my mother’s life as she struggled with and declined from Alzheimer’s. Later reflection on the remark caused me to recall women I helped find safety from domestic abuse, children I reported concerns about because they showed clear signs of abuse or neglect. I thought of some of the people I worked with in my private practice, even students in classes I taught. Occasionally someone will come up to me and say how much a class they took helped them, telling me how. Most of all I thought of the people I worked with when working at Community Mental Health.  I was hired to set up community support for people who had psychiatric disabilities, people diagnosed with schizophrenia and bipolar. Though I was not responsible for their lives, I was an important relationship for them primarily because they often lived lonely lives and the time we spent together was the only time they talked to somebody who treated them with respect and appreciation, who knew they had an illness but also knew they were smart and had dreams and desires, like everyone.  Some of those relationships spanned nearly 10 years.

Some of the men were not much older or younger than myself, often I was the only woman in their age group who ever paid them any attention. Other clients, women younger, or older, or my same age, had no other women friends to chat about the things women chat about. It is out of respect I’ve never talked of these people, it is the code of ethics for a profession where people carry in their heads and hearts the stories of other people’s struggles, even after much time has passed. Some of the people I worked with have died and many years have passed, so with the same respect and compassion I’ve always had for people living with the struggles of mental illness, I tell the stories of a few. For me it is like opening a book I read once, yet never told anyone about.

Bi-weekly I visited a man living in a tiny single apartment behind a house his parents owned. No one lived in the house. He was overweight, rarely went out because he was uncomfortable doing so and very paranoid of people. He stayed at home with his cat in the cluttered, dark, shade drawn apartment. I’m allergic to cats. Walking into his home with the stench of body odor and a cat box rarely emptied, cat dander and thick dust everywhere, my nose ran and eyes itched immediately and for hours after I visited him. I had to wash all the clothes I wore that day. He was very smart. Astute about people, he talked about his large eccentric family. His parents owned several businesses but he lived only on the disability check he and most the people I saw received. Our visits consisted of me sitting in the only available chair opposite him in the lounge chair he pretty much lived in. He talked of his life and told stories and secrets from the past about family members. He would tell me the same stories, sometimes there would be new ones. He had an intuitive understanding of the nature of people and I often thought that perhaps, though he was the one with the mental illness, he might have been the only one in his eccentric family that truly was sane. He had diabetes and several years after I no longer worked in that job he died of complications from the diabetes. I drove by the apartment, closed up, and wondered what happened to his cat, and thought of all the stories that died with him.

Another man I saw also lived in a tiny apartment. He began to have a crush on me which I realized only after we stopped while on a drive (my job was often to get people out of their apartments for a change of scenery) and he asked if he could kiss me. It was a scary moment, we were standing on a bluff, he was taller and weighed much more than me. I said some form of no in the most diplomatic way I could to a person with severe paranoid schizophrenia. Most our visits were sitting in his apartment, me listening to many of his obsessive, paranoid thoughts. He eventually stalked and killed his father, who lived in another town. I realized later it was inappropriate for me to be asked to continue to work with him after the bluff incident, I was not following my intuition when I wanted to say I wouldn’t.

There were two older women I saw. Both were diagnosed with bipolar and each had been hospitalized many times throughout their lives for bizarre behavior. When I came into their lives age had mellowed them and the disease had loosened its grip, though its presence was still obvious. One once shined the copper bottoms of all her pots when the mania was coming on. I suggested she make a conscious effort to do so each time, then we’d both know that she might need help, the pots could be the conversation started. It became an endearing part of our relationship and her way of letting me know either she needed more help, or she’d had a bad spell but was ok. She had the best looking revere ware! I always wanted to bring her mine! She was bright, talked of many life stories and heart breaks and over time became fond of me and I of her. The other woman also talked of her past, her daughter, who she was beginning to have a better relationship with, and her paranoid thoughts about her neighbors in the apartment building. We went shopping together and ran errands, she loved going to thrift stores. Both these women have died, and though their lives were often hell, I believe they died in peace, a peace they came to during the time I knew them. They both talked of their deaths and enlisted my help making  prior arrangements, not morbidly, but matter-of-factly. Neither had a lot of control over many aspects of their lives, but they wanted to say how they would be treated when they died.

There was a young woman with schizophrenia I invited to attend an out-of-state conference for both professionals and people with psychiatric disabilities. My colleagues thought I was the crazy one traveling so far with her and staying in a motel for three nights. Her behavior was thought to be unpredictable. But what was the point of all I knew and believed if I attended this conference alone? It was an act of trust and bravery on both sides. I had confidence in her and our relationship and I believed my trusting her would help her to trust herself, in spite of thoughts she couldn’t control. We completely enjoyed each other’s company, driving north out of Salt Lake, where we flew to, doing a little sight-seeing before we went to the small town where the conference was held. I was so proud of her participation at the conference.  I helped this young women get an apartment and move from her parents house and over many years she asked me questions all young women want to know as they think of their future, of men, of how they look and the questions she had as she tried to navigate life with thoughts she didn’t understand and couldn’t trust. It was with heart ache we had to end the relationship when I left my job. She asked if we could be friends and I said yes, after a year and after she had another “case manager”. We did see each other several times a year later, but in spite of her illness, and because of her illness, she had the insight to say it was confusing for her to know what she could say to who, so we discontinued our visits. Many years later her father brought her to where I was working to see me, it was a sweet reunion, brief, but the affection we both felt was still evident. She thanked me again for all I did for her.

These are only a few the stories, a few of the people whose lives I hope I touched, at least for a moment, in a positive way, even the ones that had sad endings. There were the young people I arranged hospital or treatment stays for, or visited while in hospitals or treatment facilities to see if there was a place for them in the larger community. I could go on, but I will close the book in my heart where I continue to carry the stories of many people.