A Philosopher's Blog

Mental Illness, Violence & Liberty

Posted in Ethics, Law, Philosophy, Politics by Michael LaBossiere on December 19, 2012
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The mass murder that occurred at Sandy Hook Elementary school has created significant interest in both gun control and mental health. In this essay I will focus on the matter of mental health.

When watching the coverage on CNN, I saw a segment in which Dr. Gupta noted that currently people can only be involuntarily detained for mental health issues when they present an imminent danger. He expressed concern about this high threshold, noting that this has the practical impact that authorities generally cannot act until someone has done something harmful and then it can be rather too late. One rather important matter is sorting out what the threshold for official intervention.

On the one hand, it can be argued that the relevant authorities need to be proactive. They should not wait until they learn that someone with a mental issue is plotting to shoot children before acting. They certainly should not wait until after someone with a mental issue has murdered dozens of people. They have to determine whether or not a person with a mental issue (or issues) is likely to engage in such behavior and deal with the person well before people are hurt.  That is, the authorities need to catch and deal with the person while he is still a pre-criminal rather than an actual criminal.

In terms of arguing in favor of this, a plausible line of approach would be a utilitarian argument: dealing with people with mental issues before they commit acts of violence will prevent the harmful consequences that otherwise would have occurred.

On the other hand, there is the obvious moral concern with allowing authorities to detain and deal with people not for something they have done or have even plotted to do but merely might do.  Obviously, there is rather serious practical challenge of sorting out what a person might do when they are not actually conspiring or planning a misdeed. There is also the moral concern of justifying coercing or detaining a person for what they might do. Intuitively, the mere fact that a person could or might do something wrong does not warrant acting against the person. The obvious exception is when there is adequate evidence to establish that a person is plotting or conspiring to commit a crime. However, these sorts of things are already covered by the law, so what would seem to be under consideration would be coercing people without adequate evidence that they are plotting or conspiring to commit crimes. On the face of it, this would seem unacceptable.

One obvious way to justify using the coercive power of the state against those with mental issues before they commit or even plan a crime is to argue that certain mental issues are themselves adequate evidence that a person is reasonably likely to engage in a crime, even though nothing she has done meets the imminent danger threshold.

On an abstract level, this does have a certain appeal. To use an analogy to physical health, if certain factors indicate a high risk of a condition occurring, then it make sense to treat for that condition before it manifests. Likewise, if certain factors indicate a high risk of a person with mental issues engaging in violence against others, then it makes sense to treat for that condition before it manifests.

It might be objected that people can refuse medical treatment for physical conditions and hence they should be able to do the same for dangerous mental issues. The obvious reply is that if a person refuses treatment for a physical ailment, he is only endangering himself. But if someone refuses treatment for a condition that can result in her engaging in violence against others, then she is putting others in danger without their consent and she does not have the liberty or right to do this.

Moving into the realm of the concrete, the matter becomes rather problematic. One rather obvious point of concern is that mental health science is lagging far behind the physical health sciences (I am using the popular rather than philosophical distinction between mental and physical here) and the physical health sciences are still rather limited. As such, using the best mental health science of the day to predict how likely a person is likely to engage in violence (in the absence of evidence of planning and actual past crimes) will typically result in a prediction of dubious accuracy. To use the coercive power of the state against an individual on the basis of such dubious evidence would not be morally acceptable. After all, a person can only be justly denied liberty on adequate grounds and such a prediction does not seem strong enough to warrant such action.

It might be countered that in the light of such events as the shootings at Sandy Hook and Colorado, there are legitimate grounds to use the coercive power of the state against people who might engage in such actions on the grounds that preventing another mass murder is worth the price of denying people their freedom on mere suspicion.

As might be imagined, without very clear guidelines and limitations, this sort of principle could easily be extended to anyone who might commit a crime—thus justifying locking up people for being potential criminals. This would certainly be wrong.

It might be countered that there is no danger of the principle being extended and that such worries are worries based on a slippery slope. After all, one might say, the principle only applies to those deemed to have the right (or rather wrong) sort of mental issues. Normal people, one might say in a calm voice, have nothing to worry about.

However, it seems that normal people might. After all, it is normal for people to have the occasional mental issue (such as depression) and there is the concern that the application of the fuzzy science of mental health might result in incorrect determinations of mental issues.

To close, I am not saying that we should not reconsider the threshold for applying the coercive power of the state to people with mental issues. Rather, my point is that this should be done with due care to avoid creating more harm than it would prevent.

 

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38 Responses

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  1. Nal said, on December 19, 2012 at 12:56 pm

    Funny how Republicans suddenly get concerned about mental health when gun control is discussed.

    • magus71 said, on December 19, 2012 at 1:35 pm

      Oh, this is a big Democrat agenda? An Obama talking point during his campaign?

      • Nal said, on December 19, 2012 at 1:46 pm

        You mean like this:

        What the Affordable Care Act Means to Mental Health

        Mental health care will become more accessible to more people.

        People won’t be denied coverage based upon their pre-existing condition.

        • magus71 said, on December 19, 2012 at 2:08 pm

          Damn Republicans.

        • WTP said, on December 19, 2012 at 2:39 pm

          Mental health care will become more accessible to more people.

          People won’t be denied coverage based upon their pre-existing condition

          And we will let a million flowers bloom. Interesting that those in charge of Mental Health know these things will or won’t happen..

          • magus71 said, on December 19, 2012 at 3:40 pm

            But WTP, maybe, as I’ve stated, increased access to mental health professionals will make things worse.

            • WTP said, on December 19, 2012 at 5:44 pm

              Oh, I agree. Unless you’re speaking in context of my post below about doctors needing to monitor these patients closely. That was said only in the context of the doctor already having made the decision to prescribe the drug.

              But as to soldiers generally, you would know better about today’s army and probably yesterday’s as well, but my guess is that a lot of the recent mental health problems soldiers are having are related to the pressure of the conflict between the missiion, the rules, and one’s own life-and-death self preservation. All these rules coming in conflict with the fight-or-flight instinct is a terrible burden to place on anyone, even those trained for it. But that’s a guess on my part made in ignorance of this question…Can you tell me if the suicide rates we hear about are concentrated in the front-line combat soldier?

              Another point that concerns me is the unit cohesion in light of the multi-culti army, but no time to get into that right now.

    • T. J. Babson said, on December 19, 2012 at 4:13 pm

      Funny how the Dems want to punish people who didn’t commit any crimes.

      Nal, do you hold gay people responsible for the crimes of Jerry Sandusky? Of course not. Why do you want to hold law abiding gun owners responsible for the crimes of Adam Lanza?

      • magus71 said, on December 19, 2012 at 5:12 pm

        It’s not about that, TJ. It’s about blaming Republicans for something that has almost no impact on the topic of gun violence: Access to health care. This reminds me of the argument that if only Islamic jihadists were educated, they’d know better than to do what they do. Then I look at the senior leaders of al-Qaeda and realize they’ve been given a better education than I have.

        Clearly this issue goes far beyond access to health care (most of the recent mass-killers had above-average access to health care), just as crime is far more complex than the poverty=crime model.

      • Michael LaBossiere said, on December 19, 2012 at 5:59 pm

        The desire to control guns is not generally based on a desire to punish people. Rather, the concern seems to be with the danger allegedly presented by guns. Those who want to control guns do not, in general, seem to be holding all gun owners accountable for the actual killings. Rather, they are concerned with the danger posed by guns (as they see it). There are rather important differences here.

        • magus71 said, on December 19, 2012 at 6:11 pm

          Can anyone agree with my assertion here: Mike, you do not understand the mentality of the Left very well, despite holding many of their beliefs.

        • WTP said, on December 19, 2012 at 6:21 pm

          Those who want to control guns do not, in general, seem to be holding all gun owners accountable for the actual killings
          Except for people like Joyce Carol Oates and a congressman or two who would like to see some NRA members shot. But I’m sure they’re the only ones.

          • magus71 said, on December 19, 2012 at 6:31 pm

            Did you see all the Twitter posts hoping for the death of NRA members? My question is this: What gun laws, if enacted before this event, would have prevented the deaths of of at least some of those school children? I can think of one: Mandatory carry laws for teachers.

            In fact, I say this: Anyone who removes the right or supports the removal the right for people to defend themselves has the blood of disarmed, murdered people on their hands.

            • WTP said, on December 19, 2012 at 6:52 pm

              Yes, saw it on Ace. But this is typical Mike. When an insignificant right-winger says something stupid he highlights the issue. But when leftists, even well known ones who get elected to congress or publish best-selling books, they’re not significant enough to concern ourselves with.

            • magus71 said, on December 19, 2012 at 7:18 pm

              Yes, this is a problem. I’ve been working on this issue for decades. And though my philosophy is to live day by day, not hoping for a damn thing, I continue to hold out hope that Mike will come around. :)

            • Michael LaBossiere said, on December 19, 2012 at 7:33 pm

              I heard of the Tweets-there is always a sick irony in people calling for the death of others because they are angry about deaths.

            • biomass2 said, on December 19, 2012 at 8:19 pm

              “would have prevented”
              or may have prevented?

        • T. J. Babson said, on December 19, 2012 at 6:21 pm

          Mike, how do you interpret these remarks? I see them as trying to focus hate and anger on gun owners.

          “More than anyone else, the NRA is responsible for the more than 12,000 people murdered by guns every year in this country,” said Josh Nelson, campaign manager for the progressive CREDO Action group that organized the protest…”

          http://www.politico.com/story/2012/12/anti-gun-protesters-march-on-nra-85186.html

          • Michael LaBossiere said, on December 19, 2012 at 6:26 pm

            I’d say that the moral responsibility rests mainly on the people pulling the triggers.

            You should break the circle of hate. You are hating on Josh Nelson because you think he is hating on gun owners. Forgive him and let your heart go free.

            • WTP said, on December 19, 2012 at 6:35 pm

              Yeah…Don’t see the hate in TJ’s comment. He simply presented facts. It’s JN who expresses and inspires hate by saying that the NRA is responsible for these deaths. That they are more responsible than any one else. Stop hatin’ the non-haters. If JN is not expressing hate, then what does TJ need to forgive him for?

            • WTP said, on December 19, 2012 at 6:37 pm

              Come to think of it, if TJ is hating on JN, then aren’t you hating on me? Break the cycle, Mike. It’ll only give you ulcers in the end.

        • T. J. Babson said, on December 20, 2012 at 10:27 am

          More evidence. This time a blood libel form a Congressman. The hate mainly flows from the Left.

          During a press conference on gun control yesterday, Rep. Jim Himes D-Conn. blasted Texas Governor Rick Perry for vocally supporting Second Amendment rights for American citizens after the horrific school shooting in Connecticut.

          “So the notion that more Americans quote unquote in the words of Governor Perry, ‘packing heat’ will make us safer is not founded in reality, in facts or in history,” Himes said bitterly during a press conference. “It is founded in the fantasy of testosterone laden individuals who have blood on their hands for articulating that idea.”

          http://washingtonexaminer.com/connecticut-congressman-rick-perry-a-testosterone-laden-individual-with-blood-on-his-hands/article/2516503

  2. magus71 said, on December 19, 2012 at 2:02 pm

    The story is that Adam Lanza decided to commit his murders after he found out his mother was going to have him committed. He had received copious amounts of treatment from a psychiatrist. He had taken psychiatric medication.

    I submit that his “treatment” and the drugs administered to him made him worse. He was taking Fanapt, a drug known to predicate suicidal thoughts.

    http://imgace.com/pic/tag/adams-uncle-james-said-he-was-taking-an-anti-psychotic-drug-called-fanapt/

    The Army I work for is obsessed with psychiatric treatment and meds. And things get worse every year. It’s time we face reality on psychiatry and pharma industry which everyone on the Left would rail against were it any other type of drug but “anti-depressants”. It’s a money-making industry which has little interest in making people better, or telling them that bad feelings fade or that people can improve over time without paying thousands of dollars to psychiatrists.

    This issue affects me very personally. In two marriages, my wives were submitted to psychiatric treatment for depression, as well as the Army’s favorite psych elixir, Zoloft. In both cases the women became people I could barely recognize. And before someone tells me my anecdotes don’t matter because they are anecdotes, do some research. At best, Zoloft is no better than placebo. At worst it ruins a person’s brain. I once read a great quote from a researcher on Zoloft and why people think it is helping them: “Anything that makes me feel like puking and makes me hate sex must be doing something good.”

    I went to various forums to see if other people were experiencing the things I saw happening to the person I married. It was all there. Here’s one list from a forum, which pretty much sums up what I witnessed.

    depersonalization
    inability to emotionally connect with ANYONE (husband, wife, children, etc)
    feeling of being unreal
    extreme fatigue and lethargy
    lack of motivation
    anger and rage
    lack of patience
    0 sex drive
    inability to sympathize or empathize with anyone
    memory loss
    inability to concentrate

    • WTP said, on December 19, 2012 at 2:18 pm

      Many of these drugs, Zoloft, Prozac, etc. that are passed out like asprin should only be given under very strict controls by the doctor. The patient cannot be relied upon to monitor his/her self as the drugs can affect their thinking in this matter. It’s absurd.

      How these drugs affect each individual can be very different and as you say, can produce the exact opposite effect as intended. My “favorite” is Prozac and potential increase in suicidal thoughts. They should only be used in the most extreme circumstances. I’d be interested to know how frequently AL’s doctor was keeping tabs on him.

      • magus71 said, on December 19, 2012 at 3:42 pm

        Thousands of Soldiers on this stuff in Afghanistan, but we can’t drink a beer.

    • Michael LaBossiere said, on December 19, 2012 at 2:29 pm

      As I mention in the post, the mental health field lags behind the physical health field. The physical health field is still very limited.

      The drugs used to treat mental issues, as you note, tend to have terrible side effects and many are of dubious efficacy.

      Some medications and treatments do help, but we are only marginally above casting out evil spirits.

    • T. J. Babson said, on December 19, 2012 at 4:21 pm

      Drugs like Zoloft are indeed very scary and probably don’t do much good. It would have been better if AL had just smoked dope and watched MTV.

  3. Nal said, on December 19, 2012 at 4:56 pm

    From the NEJM:

    Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety

    Both cognitive behavioral therapy and sertraline [trade names Zoloft and Lustral] reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate.

  4. magus71 said, on December 19, 2012 at 6:03 pm

    Ask yourselves today, knowing what we know now, if you were a child, or the parent of a child, would you prefer to go to a school or send your child to a school that arms its teachers, or one that does not?

    • T. J. Babson said, on December 19, 2012 at 11:30 pm

      I would feel more comfortable knowing that a few people at the school were armed and trained how to shoot. Makes the school a harder target. Schools are soft targets because killers know that no guns are allowed there.

      • magus71 said, on December 20, 2012 at 1:11 am

        Wait until a Beslan-like school attack happens here. People think it can’t happen here. Schools are one of the number one targets of Islamic extremists.

  5. biomass2 said, on December 19, 2012 at 10:59 pm

    I’d like to present a different perspective here. I saw an interview today with Jeanne Assam, the ex-police officer who ,in Arvada, Colorado in 2007, shot the rampaging shooter, Matthew J Murray . She was asked directly if she thought arming teachers was a good idea, and she replied that it would not be. Actually she used somewhat stronger language than that.

    • magus71 said, on December 20, 2012 at 1:08 am

      And what were her reasons? Does she think no one but police can be trusted or adequately trained? The hiring procedures for teachers provide a certain level of trustworthiness, so that we can safely say the teachers are much less likely to go on a shooting rampage than are most.

      I know that as a police officer there is no way I could get to a school and get inside in time to stop a shooter before he did some serious damage. There needs to be people on the school grounds who can protect. Children are our most vulnerable class–we owe them an adequate level of protection against the rising tide of psychopaths our society is producing.

      • biomass 2 said, on December 20, 2012 at 10:20 am

        Assam said, among other things, that teachers don’t become teachers to carry weapons. They become teachers because they love children and they love to teach. She’s right, of course.
        Then again, Assault Weapons 101 or Glock 101 would be pretty easy credits– up there on the level with PhysEd 101. Even teachers love cake courses..
        Back at “When is it Time to Discuss Gun Violence? you wrote ” Isn’t it the job of teachers to make sure students are safe?”, and I replied “The teacher has many duties. Safety of the students is one of them.”
        I should have capitalized ^many^ and “One^.
        Above you wrote, disguised in question form, that mandatory carry laws for teachers “would have prevented the deaths of of at least some of those school children. . .”, and I replied “or may have prevented:”


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