The most important aspect of preventing gun violence is making sure as much as reasonably possible that criminals and impulsive mentally unstable individuals do not have immediate access to guns and get prompt psychiatric attention.
One confounding problem is the full understanding of what is temporary mental instability of otherwise “normal” people, mental illness, severe mental illness, “mental health,” and effective treatment. This essay proposes a radical new way of approaching the violent person in the community.
“Normal” People and Violence
Only 10 percent of violent people are psychotic. It means that the rest are “normal.”
No easy approach to “normal” (or undiagnosed) people who commit or threaten violence has been found. Except, they surely need assessment for dangerousness and the need for treatment.
The effort to think about “The Normal” is important because the majority of murders and suicides occur in people who did not have current or prior severe mental illness. Technically speaking, they are “normal.” They may have been acutely enraged on the road or in the acute blaze of passion of a romance gone wrong. Is it temporary insanity as opposed to a diagnosed mental illness? In a high percentage, the murderer was intoxicated with alcohol or another substance. In my opinion, people with chronic substance abuse often become mentally ill secondary to the substance abuse.
What Is Mental Illness and Severe Mental Illness?
Psychiatrists, psychologists and other clinicians deal with and diagnose a variety conditions issues from mild anxieties and marital relationship problems to severe mental illness. Severe mental illness can be well- treated, not treated well, or not treated at all. Some psychiatric treatments help angry people but don’t cure them or completely cure potential for violent behavior.
The typically neurotic person, is keenly aware of his or her psychic pain. Psychological pain, like the pain of a severe medical disorder, frequently brings the person to a physician, clergyperson or therapist. Neuroses frequently co-occur with disorders of personality or character. This situation makes treatment more complicated as does substance abuse.
A psychotic person, like Jared Laughner who shot Gabrielle Giffords, the Arizona congresswomen, is in massive denial of his disorder. The denial of a psychotic person like Laughner is the result of his brain chemistry’s disarray. In addition, the psychotic person often refuses to take medication and stay with counseling.
Psychotherapy and judicious medication prescription can help psychotic persons have clearer thought processes enabling them to work and relate more normally to other people. Well treated and followed-up mentally ill people are no more prone to gun or other violence than the normal population. they are probably less violent!
A severe alcoholic or drug addict is also in denial of their problem. There is hope if they “Hit their ‘bottom, ” it is called. However, this “Bottom” is often only grimly recognized after marriages, jobs and friendships are lost. No one is left to buy them drinks or enable their drinking to continue. AA has been a godsend of treatment for many alcoholics and substance abusers.
A person with a personality or character disorder is in denial about his or her offensive, cruel, selfish, un-empathetic, anti-social, disrespectful, inordinately dependent, or destructive behavior. They, in essence, are unaware or barely aware of the psychological skin in which they have lived for most of a life.
Individuals with personality and character disorders only acknowledge a problem when their behavior causes pain or difficulty for others. When confronted, they often blame the messenger who presented the bad news to them. According to the person with severe personality or character disorder, the police who confront them, the boss who fires them, or spouse that leaves them, are the problem.
People with character disorders readily assume that their view of the world is the only true or important view. They are often the last to recognize if ever… their destructiveness or dangerous potential for lethal violence. They are very hard to engage in therapy or treatment programs.
Severe Personality Disorders such as: Borderline, Malignantly Narcissistic, Antisocial , or Sadistic Psychopathic Personality disorders are not psychotic disorders like schizophrenic, severely depressed or Bipolar disordered individuals.
They are often are chaotic, impulsive, suspicious and have poor insight and emotion regulation. These severe personality and character disordered individuals are often far more difficult to treat than severe schizophrenic or depressed persons.
Psychiatric medications often have limited usefulness and people tend to act-out their emotional problems rather than talk them through in psychotherapy. Just when a psychotherapist gets into the core conflicts of these people, they flee treatment, often use substances and act-out their problems into behavior.
People with severe personality disorders while socially dysfunctional, are not technically psychotic or severely mentally ill. They are severe problems and a great expense for American society. They like “normal” persons who are intoxicated and enraged, should not possess guns. A glibly recommended “anger management” program is beyond insufficient for persons threatening or strongly hinting about violence.
America faces an epidemic of severe personality disorder problems. Some of these individuals even impulsively defy and attack police. Young angry, alienated, rejected teenagers can be dangerous and prone to violence, even mass murder, but they are not suffering from diagnosed mental illness. They are often found, however, under the psychiatric umbrella. Their acting out behavior often gets labelled “behavior disorder.” More aggressive treatment programs and legal mandates for treatment need to be creatively developed and implemented aggressively in our communities.
“Patient’s Rights” For Dangerous Mentally Ill People, Their Possession of Guns, and Paradoxes About Treatment
Gun violence and mass murders in America must stop. The section below approaches the issue from the perspective of working psychosocially and legally with violent mentally ill persons.
In myIopinion, a mentally ill person who attempts or overtly threatens violence should have his or her civil rights suspended. Immediate psychiatric and psychological evaluation and a treatment plan must occur. The threshold for detection of violence needs to be much lower than it is currently. After a violent threat or potential threat is detected, an inextricable part of such detected violence potential is the loss of the individual’s second amendment rights for an indefinite time.
All Americans must be mindful that their civil rights are contingent on their taking responsibility for the control of their behavior. Violent threats or actions mean loss of the privilege of their civil rights until they satisfy a civil process to regain their civil rights.
A Proposed Community-Based Process for Handling “The Civil Rights” of Violent People
Prompt and thorough evaluation should be done on anyone threatening or showing warning signs of potential violence. Once a diagnosis is established, the following should be mandated by law.
The suspension of basic “Patients’ Civil Rights” should be legally mandated until the patient is fully and positively involved in their treatment and on the road to out- patient recovery or stability in a psychiatric hospital.
At the point when treatment compliance is established, a select community committee of a lawyer, a psychiatrist or psychologist, and a mature layperson should monitor and act as resources for the patient and his or her family. In the in-patient setting, the patient advocate, a psychiatrist and another patient capable of serving could monitor the issues described below. This mental health group should oversee and assure the community that the following requirements have occurred:
- Cooperation with in-patient treatment parameters or regular attendance at all out-patient treatment sessions must occur for 12 consecutive months.
- It’s the responsibility of the patient to take all psychiatric medications prescribed by the psychiatrist or trained prescriber for a minimum of 12 months.
- Attendance at all recommended individual, group or family therapy sessions has occurred for 12 months.
- No episodes of violent or menacing behavior has occurred according to the therapist(s), family, spouse, or police authorities.
- Loss of designated “patients’civil rights” will be revoked for violations of this process and the person will start the process over again with a new community committee. After the 12 months of responsible compliance, the community committee will re-assess the further treatment plan compliance on a yearly basis for three years before any gun can be purchased or possessed by the individual.
- National, state and local community records of this violence prevention program shall be readily available to gun show and firearm vendors for universally required background checks for all gun purchases in America.
Objections Anticipated
Some will definitely argue that the above process is too stringent and restrictive. Others will say it is too weak. Many mental health clinicians feel that such procedures like those advocated above will prevent violent persons from seeking help. If a potentially violent person is in treatment, such a process would prevent them from mentioning or exploring violent fantasies.
In theory, the ventilating of such violent fantasies are often felt to diminish violence potential or more importantly, help the person to understand the sources of his anger and how to change, control or extinguish the potential for violent behavior.
I feel that a vital part of the therapy of a potentially violent person is the learning of the futility of violence to resolve or gain anything. Confrontation with one’s personal responsibility to obey the law and not harm other people or animals starts in childhood and wisdom about it is hopefully cumulative during family, school and church or community experiences. The above process would hopefully encourage active awareness of individual responsibility and legal and social obligations
Paradoxes For “Patient’s Rights” in Working with Hospitalized Severely Mentally Ill People
Often a hospitalized patient will suddenly become violent or suddenly refuse to take carefully prescribed medications. Often, the staff working most comfortably and compassionately with the patient are the ones attacked. The psychiatrist and nursing staff are in a bind because legally, medications can only be given in an emergency time frame.
Court procedures can be done to force the treatment issue. However, the conscientious patient advocate attorney objects. The assumption here seems to be that full assertion of civil “patient’s rights” is an unalterable and even healthy behavior to help the patient. Actually, the acutely or severely chronically psychotic person is often confused or unable to gain from such assertions.
They can even incorporate their poorly asserted “patient rights” into their paranoid delusional system. Further , they frequently use their power destructively and inappropriately. They assert that they do not have to take medications, go to group therapy, bathe themselves or urinate or defecate in the appropriate locations.
Other patients get angry and provoke or attempt to scape-goat the patient. I feel that the process discussed earlier would help the hospital staff to keep appropriate behavioral protocols on the unit and benefit the patients in their potential understanding about effective living in a community peacefully.
Summary and Conclusion
This article addresses the complexities around gun violence and mentally ill or other violent individuals in the community. A tangible psychosocial and legal process is proposed. It would specify how an individual can forfeit his or her civil rights and how it can be reclaimed in a practical way that would also increase a community’s awareness and involvement in violence prevention.
I hope that pilot projects can be established by legal and medical psychiatric authorities in communities.
from Psych Central Professional http://ift.tt/2ETAzgP
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