The Post I Keep Writing After A Mass Shooting

...but first: so much for that "Republican Revival" after Tuesday's election. If your "incredible momentum" can be stalled simply by a major news event sweeping you off the front page... perhaps tales of a Republican Renaissance are a bit premature.

I don't mean to minimize the horrific events in Fort Hood or trivialize them into a political discussion... but yesterday's mass shooting, as these things do, made a quick reordering of priorities possible, and made clear that much of the noise in politics lately has been irrelevant to the real struggles in our real lives. Watching Representative Joe Carter - whose district includes Fort Hood - or Kay Bailey Hutchinson deal, calmly and soberly, with an unfolding event underscored how rarely, these days, we get a news event where the last relevant detail is who's right, or left.

Like many, I was stunned into relative silence as events unfolded yesterday afternoon; for hours, there was so little information, so little clarity around what had happened that it was impossible to know what to say... and yet, it was clear, there'd be something. And by the end of the night, I was struck by the fact that what's clear about yesterday's tragedy is what's been clear in precious ones, and someone needs to say it, yet again: the shootings at Fort Hood are going to be about a man who was mentally ill. And until we do something much more extensive, and more honestly, about identifying and treating mental illnesses, we're dancing around the edges of disaster.

When I started this blog, three years ago, I never expected to be a passionate writer about mental illness. Part of that, I realize now, is that I assumed a lot of people knew the things I've been exposed to for years because of my family's work (especially the women in my family) in the fields around mental health.

And then the Virginia Tech shooting happened.

Looking back, I think the case of Seung-Hui Cho at Virginia Tech did actually change the discussions we've had since. For whatever reason - and I suspect it was the fact that it was a dramatic event in terms of scale and scope - Seung-Hui Cho was the first shooter, it seems to me, whose mental illness quickly became a part of the story that couldn't be ignored or explained away... though many tried. Since Columbine, we've been trying to make sense of what can, often, seem senseless. And I think the gradual evolution of public thought acknowledges that poor mental health plays a significant role. Knowing that, though, doesn't tell us very much about what to do about it.

This is the third time I've said essentially this, and I will continue to repeat it each time: Nidal Malik Hasan was mentally ill. His mental illness, which early reports seem to indicate was not unknown to people around him, was probably not identified properly or treated. And that reality, most of all, is what we need to figure out and deal with if we want to do something about mass shootings, before they happen.

This remains a difficult, uncomfortable topic for many people. For some, saying what I've just said is to suggest that "mental illness equals violent acting out" - an equation which shouldn't be inferred and isn't true. But saying "you can't scare people into thinking mentally ill people are violent" tends to want to ignore the reality: this mentally ill person wound up committing a horrific violent act. Shouldn't we be trying to do more to identify and treat mental illness?

The reality of what we call a "mental health system" in this country, for civilians, is that we have given much of our dealings with mental illness over to law enforcement, the courts, and our jails. None of these groups are equipped, or prepared to deal effectively with the mentally ill, or to evaluate and treat issues around mental health. And in order to wind up with a system where the mentally ill wind up in jail... you have to be ignoring or failing to treat mental health issues earlier and more effectively to prevent the kind of acting out that leads to incarceration.

The Hasan case will complicate our national illusions about mental health: it already has, given that Hasan's training in psychiatry has made it virtually impossible to set aside the role of mental illness in his actions. But just as significantly, because this happened in the military, and because it will shine a much needed light on mental health issues of soldiers, there is bound to be fresh energy around the discussion of how we're not dealing at all well with mental illness in military personnel. And that the military metal health programs are actually better than anything else we've got going... which will be cold comfort when one realizes they amount, often, to little more than the equivalent of using masking tape and paper clips to try and stitch people up. Yesterday, for many, may have been the first exposure to the reality that Fort Hood has a "suicide problem" or that, as Rachel Maddow highlighted, Rolling Stone is shedding light on a string of murders by soldiers out of Fort Carson in Colorado.

Whether Hasan had a breakdown over being sent to Iraq, or was overwhelmed by the stress of treating soldiers with PTSD, or something else entirely... we'll probably never know. But what we can ask, and should try to figure out, is why the Army continued to deploy Hasan to hospitals in its system, even consider sending him to treat soldiers in the field... when he was receiving poor fitness reviews and being investigated for bad acts. We need to ask, as was suggested in reports I saw yesterday, whether psychiatrists and other mental health professionals in the military are under "stop loss" orders that effectively eliminate their ability to leave the service. And whether that pressure to be forced to continue to work, no matter how much stress or personal distress it causes, should be considered acceptable.

And underlying all of this, most distressingly, is realizing that the strain of war is creating an enormous amount of mental health problems for soldiers and their families... and that is an especially irresponsible act in a country where we do little or nothing to effectively handle mental health issues, or deal effectively with most mental illnesses. We cannot conitinue to pretend that we don't know the obvious reality staring us in the face: mass shootings are part of a problem we have in this country dealing with mental illness. And we can't keep throwing up our hands and wondering "how can this happen?" It can happen... because we're not doing enough - or quite possibly anything - about the problem that's actually involved. And I'm going to keep saying it... because I don't know what else to do.

Comments

[What's The Policy?]

At this point it's not an issue of mental illness. It's an issue of *systems* that create untenable situations for human beings. Aren't you tired of writing the same post in response to these incidents? Let's go at least as in-depth into POLICY as we go into an individual's psyche. Yeah, I know, not nearly as sexy or juicy, but policy abstractions on paper are producing human wastelands.

Hasan completed the entirety of his intern/residency requirement at Walter Reed between 2001 and last summer, treating soldiers with PTSD. Daily, he dealt in-depth with much of what we, the public, never see. Troops bearing the horrific deeply personal and physical scars of war.

He displayed a complete grasp of our ultimate mission in the ME, to facilitate the ability of forces in Iraq and Afg to be able to stand on their own.

Though he had recently been promoted to Major, he had repeatedly requested a discharge from the military, including taking steps to speak with an attorney. He wanted out and told the Army he would gladly pay them back for the cost of his medical education.

Passing Hasan along from WR (where he did not rcv positive perf reviews) to Fort Hood and then to be deployed is oddly reminiscent of the systemic dynamic of churches in handling certain priests.
Guy wants out and the response is to send him into battle?

We have to get away from lazy, irresponsible first-order thinking that this is an individual issue, predicated on individuals being weak links.

Every human has a breaking point. In fact, SERE training is designed to make our troops well aware of where theirs is. We've become very good at pushing people over the edge so we can marvel about what is what that finally did it, but we are completely clueless and valueless as a society (but for those in "healing and educational" occupations) when it comes to pulling people back from the edge or, heaven forfend, redirecting them into a more suitable line of work, or even examining alternative conflict resolution, on whatever scale.

It is as if, in the economic turmoil and grasping for resources, we're now compulsively marching in one direction with no turning back. Do or die is a pretty unrefined systemic repertoire, dontcha think?

Here's a comment on personal responsibility: If you're one of the ones perpetuating a system that is designed to break people open, don't be surprised at what comes out and please take note that you are merely a strong link in a completely dysfunctional (adapatively weak) system.

[weboy]

I think you make a number of interesting points, WTP, though not all of it, I think has a lot to do with what I wrote, and some of it probably needs further, or clearer, explanation. I agree that there's a deep, systemic problem with what we ask soldiers to do, and how it affects them mentally, and yes, that's why we should be asking what the Army considers "treatment" of PTSD, especially in field. I touched on that at the end, but I could, easily, do another, full post on just those issues... and I think many concerned people do write on that topic. I share those concerns.

However, I disagree with your assessment that what you raise is "not an issue of mental illness." A system that breaks the mental health of people in it is also causing, and inviting mental illness in. Which is to say, you seem to think we disagree, and I think we're both describing elements of a very large, multifaceted set of problems. I'm not sure that we're going to find answers, or explain what broke Nidal Hasan in just your concerns... and yes, perhaps not even mine. But my larger point - which often gets lost - is simpler: we're behind square one on identifying and treating mental illness and understanding mental health issues, and we need to start doing something to deal in a more comprehensive, earlier way in this regard. When we do... I suspect we'll get to a number of the issues you raise. But we're miles and miles from even starting that discussion, nationally, in a way many people can understand.

WTP, you may disagree with me, and I'd be happy to discuss it further: I appreciate your insight. When I talk about feeling like I "rewrite" the same post, I mean it in the context of a media that - after decades of these incidents - still struggles with how to put them perspective. We need to educate the public, and mass media reporters, to see mental health issues... well before we can explain what those issues are. It's is about individuals and their struggles, but yes, also what you suggest - a systemic set of problems that need to be raised and addressed. All of that matters, all of that needs to be dealt with. And at this point... we're nowhere near even beginning that work.

[What's The Policy?]

Thanks for your comments, weboy. Sure, we're coming at the same issue from different angles. I agree that the msm is doing a poor job of addressing anything other than the sensationalist aspects.

Just found this USNews article re: military MH policy revision:
http://www.usnews.com/articles/news/2009/11/05/new-mental-health-policy-came-days-before-fort-hood-shooting.html

The policy was issued just days before the incident. Last para reads:
Another section of the policy stressed that soldiers undergoing mental health counseling related to "marital, family and grief issues, and counseling for adjustments from service in a military combat environment" would not have that fact held against them when they apply for security clearances. Soldiers, airmen, and marines sometimes cite confusion about what can and cannot be considered in the security clearance process as a reason not to seek counseling for ailments like post-traumatic stress disorder.

I remember listening to an NPR segment while at work just a few months ago. They were interviewing troops (several different ranks, including medical/policy personnel). Their candid interviews left the distinct impression that something, soon, would break, given the stop loss practices, taboo on treatment, risk to career & clearance, no way to opt out and keep an honorable discharge without losing benefits earned for service, etc. You just can run a system like that unless you delude yourself that people can be run like machines. It's insane, more insane than the ones who provide feedback to the system in ways that we don't approve. It's almost a knee-jerk authoritarian meme that has infected down to the civilian community level that if there are symptoms, they belong to the individual. That's first-order thinking. Real change comes from recognizing symptoms as feedback to the system within which the individual is embedded. We have to start the dialogue there or the inquiry is worthless.

It just boggles the mind that we don't have a well-disciplined msm to research the situation beyond whatever will garner ratings. The msm isn't educated on the subject, the public isn't educated on the subject, and yet all seem to participate (knowingly or otherwise) in the very interpersonal dynamics that contribute to trauma, then scratch their heads about why these things happen, some propagating the continued delusion that "symptomatic people" show symptoms because they are weak or defective and the solution is some sort of screen-out in the first place. As if opening up a vacancy for a different human being to encounter the same experience would miraculously change the results. It's a lie we can't afford to avoid calling a lie anymore.

I wish I could share with the whole world the instruction I received regarding systems theory. Who knows, I may take such steps to make that happen in the near future. In the meantime, the radical behaviorist, reductionist morass that passes for scientific inquiry, coupled with shallow journalmalism and a fearful, reactionary public, continue to perpetuate a culture that is unsustainable over the long haul. Unless of course, you are comfortable with casual dismissal of collateral damage. We've only started to become fully aware of how deep the whole dehumanizing rabbit hole goes. But it's reaching a critical mass. You just wonder what it will take for people to pay attention long enough to get educated and make a commitment to changing the way we live.