Short version: it happened Wednesday, started to get play, and then promptly lost play when it turned out that the attacker had a more or less fake gun. It appears that this person had mental issues: “Vincente David Montano terrorized movie patrons in what looked convincingly like a theater massacre in the making, and police in Nashville, Tennessee, responded accordingly, shooting him dead.” Largely because he did in fact hit people with pepper spray, a BB gun – and much more importantly, a hatchet. And he then advanced on a SWAT team with said hatchet, and that’s pretty much when he got shot.
At some point we as a society need to decide whether we want to keep ignoring the fact that a percentage of paranoid schizophrenics won’t voluntarily keep taking their medication. I mean, I understand that most schizophrenics aren’t particularly dangerous to anybody except themselves, but there’s a percentage that is. What do we do about that?
‘s a vexatious problem, Moe.
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Does individual liberty include the right to go out of your own head?
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Personal *opinion* is .. yes, but only if you do so in a way that protects the safety (and liberty) of others .. i.e. you may swing the dead cat of madness (genetic or chemically induced) but only safely away from others.
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So.
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If person X goes off their meds deliberately more than once, then person X ought be confined to .. something comfortable and with good internet and air conditioning and cable TV .. but with *no* physical access to the outside world.
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Hell, if they stay on their meds in that environment, they can do telecommuting jobs and possibly work as trustees and go nuts on their own time, eh?
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Mew
Humanity’s default solution is to drive off or kill anyone who ‘acts funny’ too disruptively.
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We already curtail freedom by imposing restrictions on that, so I don’t see making people take their meds, or refrain from recreational use as an unparalleled violation of principle. Yeah, if we were talking about people living alone without human contact in the desert, it’d be one thing, but most such would die if put in those conditions.
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Confinement only goes so far as a society has wealth for it. We gave up on confining the mentally ill, because we didn’t think it worth the cost. That may have been when we were wealthier, and we probably had smaller populations in prison, and geriatric care, which may use some of the same capacity.
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Psych meds that moderate suicidal or murderous tendencies are nasty. They have a wider range of tolerable side effects, and the inherent risk from dealing with such powerful factors. It takes character to stay on them, and competent psychiatric oversight to keep them working.
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more parts to follow
The problem, sic, is, as you mentioned, many of the psych meds are really, really nasty stuff. I’ve known several people who, when medicated are basically zombies, having no initiative, no creativity, but not on their meds are occasionally kinda bugnuts crazy, but the majority of the time are just fine, and productive, creative, intelligent people. If, say, one out of a thousand such people becomes dangerously violent, is it right to take away the livelihoods of the other 999?
Good question.
Other questions come to mind, such as:
(1) Do this.
(2) If you do not do (1) you will be forcibly confined.
N.B. In 2004 a man who went off his meds went on a shooting spree, thinking the city was being invaded by aliens. He passed my car and put a shotgun slug through it about 12 inches behind my head. He shot at cars as he went north on US-127 before he ran off the road and was subdued. His six-year old child was in the back seat and he had bathed the child in iodine to protect the child from the alien’s poison gas. He was judged mentally incompetent when he shot and afterwards. He is confined.
No society should have to do more than demand either (1) or (2).
Again, confinement has some issues. Back when they invented a lot of these drugs, they gave them to people they had confined. Huge improvements in quality of life, and ease of control. Well, the hospitals they could afford to run were not wonderful, journalists came in and interviewed the now functional ones, and people decided to let them out. They got out, stopped taking meds, and boom, instant mentally ill homeless problem. I know a place that got a large homeless population after the state hospital there closed.
Confinement has a lot of issues, but many of them were due to the state of communications in and out of the facilities, and the mixing of the deeply nuts with the .. less nuts.
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Seriously, go watch “One flew over the cuckoo’s nest” with a *clinical* eye, and tell me how many different disorders you see all jammed together.
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Internet and the current DSM haven’t been *applied* to the problem of just who needs just what level of social isolation.
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Mew
The folks that I know on psychiatric medication have suffered greatly from the meds. I am morally certain that without them, they would now be dead. Furthermore, the people I speak of have stayed away from recreational drugs. If they had not, they might well now be dead.
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Very many people with their illness do use drugs recreationally, which doesn’t have good results.
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As an aside, self medication for psychiatric illness is bullshit. One cannot self monitor well enough to reliably detect dangerous states of mental impairment, or evaluate if the meds are working.
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At least with some illnesses, those ‘occasional times’ are when the brain is damaging itself, and can become more severe over time.
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Someone who does not use recreational drugs, and does not have a mental illness is more predictible in their poor choices. Recreational drug use can rapidly and without much warning escalate to very high levels of poor judgement. Someone whose severe mental illness manifests as ‘occasional times’, or who stops taking their meds, or whose meds stop working might become very hazardous. In terms of risk management, it can be easier for an employer to justify retaining someone who reliably takes their meds, and checks with the psychiatrist regularly to make sure they are working.
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Why employ the mentally ill, if they won’t practice basic ‘mental hygiene’? Why permit them to drive?
Yes, yes, the meds are terrible, self-medicating doesn’t work.
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Key question: SO WHAT?
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Alternative 1 – person is medicated and suffering, but not a danger to anyone else.
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Alternative 2 – person is unmedicated, but lives in an isolated area, and is not a danger to anyone except staff/other residents.
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Alternative 3 – person is dead, and not a danger to anyone.
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You got a fourth alternative, post it .. otherwise, accept that life sucks some days.
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Mew
continued
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I don’t necessarily trust the effectiveness of meds enough that I’d feel comfortable attaching that level of legal force to noncompliance. Nor do I trust the stewardship of the medical profession in general or psychiatrists in specific. There are good and competent ones. However, the licensing boards have in my opinion permitted some very obvious cases of malpractice. (I am not a doctor, a lawyer or even an accountant.)
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As far as a single person goes, if I love them enough for the effort, and have the legal responsibility, I might see that they are confined or forced to take medication. I have been fortunate compared to others, in that I have not yet been obliged to do so.
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As far as the big picture goes, I doubt we can solve it short of understanding the spinning parts and wanting to solve it as a society. This doesn’t mean a ‘national conversation on mental illness’, or blaming the cops, or relying on information from mysticism and magical thinking.
Did they ever get a count of shots fired by the po-po? It was a few, by the sounds.
Spray and pray, that’s our boys in blue.
Umm you people do realize that mental health meds are far more of a crap shoot then the Mental Health Industry lets on? I’ve seen people go from nice to dangerous because of a change in their meds. I have to wonder with these situations if they did go off their meds or if the medication they’re on actually caused them to become murderous. As an example I have insomnia and every sleeping med I’ve ever been prescribed keeps me up all night. And the frustrating thing is there is no way of telling in advance. For a percentage of the people the medication will work how it’s supposed to but for some people it will have the exact opposite effect and for some people it won’t work at all.
Yes.
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Roulette is a better metaphor. Where there are places you can’t bet on, and failure to win leads to a Russian Roulette penalty game. Recreational users just go directly to the penalty game, the general population doesn’t understand bullets can kill, and you meet folks leaking brain all over the place as they insist they aren’t.
So they lost the genetic lottery.
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That *does not give them the right* to walk around unsupervised while off their meds. Period.
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Mew
I sadly have to contribute an anecdote. A relative of mine who clearly had some major issues shot and killed his dad. “Unexpectedly.” Seriously. We are still dealing with the family repercussions. On medication in prison he seems more lucid and rational. But that’s the trick, isn’t it? Since he was largely non-compliant in recent years about many things there is zero guarantee that he would comply. So when the ‘demons’ of paranoia got him again, who would be next?
Families with adult members with mental health issues are at an incredible disadvantage as they bear the emotional and often financial brunt for the actions, but are restricted from even basic knowledge of the adult child’s medical history and diagnosis.
Something has to change and yes, the balance is difficult. But tell us again how many of the recent “mass shootings!” (as this was being portrayed on the news until, oops, it turned out he had a pellet gun) are done by people with serious mental health issues and yet the focus is on the inanimate weapon?
Family education is important as well as establishing some mechanism for evaluation. Following some bizarre behavior the family in my situation felt there would be no help getting a 72 hour evaluation done as they would just release him. And the friendly counselor the perpetrator saw for an hour to make his family happy 10 days before the murder was not trained to evaluate mental disorders of that magnitude.
I don’t have an answer but it is clear where we are now is not a good place to be for any of us. We need to work on it seriously, and “gun control” is not the answer to this difficult question.
Correct me if I’m wrong here – I’m under the impression that the patient can grant “right to know” to others.
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Perhaps they should be asked to do so more often .. perhaps this is discouraged because doctors don’t like working with someone watching over their shoulders?
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For someone who is declared a danger to self and others, my impression was that the rules changed, that doctors were required to permit others (legal guardian?) access to records .. at least for a time. If not, perhaps this should be changed.
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Mew
My.
Head.
Was.
12 inches.
from.
being.
vapor.
No. I have no problem with locking up people who are mentally…Crazy.
Not one problem at all.
All the philosophy in the world has nothing to say about the person who is insane. No society should have them wandering around.
The regular criminals are bad enough.
Precisely.
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It used to be a boolean choice – you’re either in society, or you’re not. This has changed over time, with the inventions of written language, a postal system, a telephone, and now the internet.
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Today, a person can be electronically “in”, but physically “out” .. they can safely stop taking their meds without being a danger, they just have to be supervised.
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The question is how to pay for it… but I think, given the closer-than-we’d-all-like-to-admit relationship between genius and madness, the creatives will be able to, well, *create* … if given the opportunity.
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Mew