Walkabout In The Weminuche Wilderness

Herschel Smith · 05 Aug 2018 · 40 Comments

"There are no socialists in the bush" - HPS All of my physical training only barely prepared me for the difficulty of the Weminuche Wilderness (pronounced with the "e" silent).  It's National Forest land, not National Park.  The Department of Agriculture no longer prints maps of the area, so we relied on NatGeo for the map, and it's good, but not perfect. We have a lot of ground to cover, including traveling with firearms, the modification I made to one of my guns for the trip, the actors…… [read more]

Can Psychiatrists Stop Gun Violence?

BY Herschel Smith
4 years, 8 months ago

NYT:

Soon after the 2012 shooting at Sandy Hook Elementary School, President Obama made mental health care a major part of his plan to curb gun violence. And this week, following the two-year anniversary of that crime, Rep. Tim Murphy is calling for federal legislation he believes would help stop mentally ill people from becoming violent. “I remain firmly convinced we can make tremendous legislative strides in preventing mass tragedies involving someone with a serious mental illness,” he writes at The Guardian.

But according to one recent analysis, mental-health screening may not be the best way to prevent mass shootings — and expecting psychiatrists to identify potential shooters may do more harm than good.

In a paper published in the American Journal of Public Health, Jonathan M. Metzl and Kenneth T. MacLeish investigate a number of common beliefs about mental illness and gun violence, including the idea that “psychiatric diagnosis can predict gun crime before it happens.” They write that “legislation in a number of states now mandates that psychiatrists assess their patients for the potential to commit violent gun crime.” New York, for instance, “requires mental health professionals to report anyone who ‘is likely to engage in conduct that would result in serious harm to self or others’ to the state’s Division of Criminal Justice Services, which then alerts the local authorities to revoke the person’s firearms license and confiscate his or her weapons.”

However, they argue, asking psychiatrists to judge who’s likely to become violent may be the wrong approach. They cite research showing that most gun violence isn’t committed by people who are determined to have mental illness — and that most people with mental illness don’t commit violence. According to one study, “the risk is exponentially greater that individuals diagnosed with serious mental illness will be assaulted by others, rather than the other way around.”

The editorial goes on to pose the salient question as follows.

Dr. MacLeish believes psychiatrists and other mental health practitioners should have a role in the national discussion around guns — just not the role of telling authorities which of their patients will become violent. Rather, “there needs to be a new politics to how psychiatry engages with the gun debate.” As it stands now, he said, that debate isn’t really addressing questions like “why do people feel like they need guns” and “what are the implications of being surrounded by guns in people’s daily lives.”

The question has an easy answer.  Number one, to prevent or otherwise answer or ameliorate tyranny and those who would try to enslave us, and second, for self defense (which is just another form of enslavement, just personal and individual).  Thus the answer(s) finds its roots in the prevention of enslavement.  These are issues we investigate and plumb every day.  They are welcome to join the discussion – it isn’t a new one – but the Psychiatrists may be late to the conversation.  Better late than never.  I welcome the opportunity to persuade others of our position.

But the interesting thing about this editorial is that it continues the theme we’ve noted for a long time (even the NYT is catching on, even if their solution is to employ “mental health professionals” for the purpose of larger gun control efforts), and it is that mental health has nothing whatsoever to do with gun violence or any other kind of violence.  As reader menckenlite has noted:

Control freaks love psychiatry, a means of social control with no Due Process protections. It is a system of personal opinion masquerading as science. See, e.g., Boston University Psychology Professor Margaret Hagan’s book, Whores of the Court, to see how arbitrary psychiatric illnesses are. Peter Breggin, Fred Baughman and Thomas Szasz wrote extensively about abuses of psychiatry. Liberals blame guns for violence. Conservatives blame mental illness. Neither have any causal connection to violence.

There isn’t one iota of difference between the role Tim Murphy wants “doctors” to play and the role of doctors in Nazi Germany.  It all has to do with control for the benefit of the state.  Can Psychiatrists stop gun violence?  No, any more than they can stop any other kind of violence.  But they also shouldn’t allow themselves to be duped into being willing rubes on behalf of a totalitarian state.

Prior:

The Link Between Mental Health And Gun Violence

Guns And Mental Health Bigotry In California

The Myth Of Mental Illness And Gun Violence

ATF Rulemaking On Adjudication As Mentally Defective

Mental Health And Guns: Mentally Defective Because You Believe In The Second Amendment

Guns And The Mentally Ill: A Professional Assessment

The Link Between Mental Health And Gun Violence

BY Herschel Smith
4 years, 9 months ago

I’ve previously cataloged mental health professionals and their reaction to the notion that their patients perpetrate violence more frequently than others.

Clinicians treating patients hear their fears, anger, sadness, fantasies and hopes, in a protected space of privacy and confidentiality, which is guaranteed by federal and state laws. Mental health professionals are legally obligated to break this confidentiality when a patient “threatens violence to self or others.” But clinicians rarely report unless the threat is immediate, clear and overt.

Mental health professionals understand that, despite our intimate knowledge of the thoughts of our patients, we are not very good at predicting what people will do. Our knowledge is always incomplete and conditional, and we do not have the methods to objectively predict future behavior. Tendencies, yes; specific actions, no. To think that we can read a person’s brain the way a scanner in airport security is used to detect weapons is a gross misunderstanding of psychological science, and very far from the nuanced but uncertain grasp clinicians have on patients’ state of mind.

What about diagnoses?

If mental health professionals were required to report severe mental illness (such as paranoid schizophrenia) to state authorities, it would have an immediate chilling effect on the willingness of people to disclose sensitive information, and would discourage many people from seeking treatment. What about depression, bipolar disorder, substance abuse or post-traumatic stress disorder, along with other types of mental illness that have some link to self-harm and impulsive action? The scope of disclosure that the government could legally compel might end up very wide, without any real gain in predictive accuracy.

Diagnosis is an inexact and constantly evolving effort, and it is contentious within the profession. To use a diagnosis as the basis of reporting the possibility of violence to the authorities would make the effort of accurate evaluation much more fraught. And what of the families and friends of the mentally ill? Should their weapons purchases be restricted as well? A little reflection shows how unworkable in practice any screening by diagnosis would be.

“We’re not likely to catch very many potentially violent people” with laws like the one in New York, says Barry Rosenfeld, a professor of psychology at Fordham University in The Bronx….

A study of experienced psychiatrists at a major urban psychiatric facility found that they were wrong about which patients would become violent about 30 percent of the time.

That’s a much higher error rate than with most medical tests, says Alan Teo, a psychiatrist at the University of Michigan and an author of the study.

One reason even experienced psychiatrists are often wrong is that there are only a few clear signs that a person with a mental illness is likely to act violently, says Steven Hoge, a professor of psychiatry at Columbia University. These include a history of violence and a current threat to commit violence ….

Perhaps most important, although people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perpetrators of violent crime overall. Researchers estimate that if mental illness could be eliminated as a factor in violent crime, the overall rate would be reduced by only 4 percent. That means 96 percent of violent crimes—defined by the FBI as murders, robberies, rapes, and aggravated assaults—are committed by people without any mental-health problems at all. Solutions that focus on reducing crimes by the mentally ill will make only a small dent in the nation’s rate of gun-related murders, ranging from mass killings to shootings that claim a single victim.  It’s not just that the mentally ill represent a minority of the country’s population; it’s also that the overlap between mental illness and violent behavior is poor.

And finally,

Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the article in Annals of Epidemiology was quoted in the UCLA Newsroom saying ”but even if schizophrenia, bipolar disorder and depression were cured, our society’s problem of violence would diminish by only about 4 percent.”  That is not very much. When people with mental illness do act violently it is typically for the same reasons that people without mental illness act violently.

And yet … the raison d’être, we are told, for background checks is to prevent the mentally ill from obtaining guns.  Enter Huffington Post (yet again) claiming that gun violence is a medical condition due to “recurrent violent injury.”

An article has just been published that is a must-read for everyone concerned about violence and guns because it places violent behavior in its proper context — namely, as a disease that, in order to see it decline, needs to be handled like other chronic medical conditions. The researchers followed two groups of young men and women, ages 14 to 24, who were patients at the ER in Flint, Michigan, between 2008 and 2010. One group consisted of patients who were admitted for the first time suffering from a serious injury due to an assault. The other group were first admitted for some other medical issue.

Except for their histories in the ER, both groups were basically the same. They were mostly African-American, mostly from families on public assistance, they had the same degree of drug use and the same number who had either been convicted of some crime and/or were on parole. Finally, a majority of the members of both groups reported family incomes below the poverty line. In other words, both groups of patients shared the same social culture that breeds violence, but one group never came to the ER as victims of violent assaults, the other group not only came at least once, but many came multiple times.

The researchers characterized this latter group as suffering from what they call “recurrent violent injury,” which is estimated to cost the medical system somewhere between $600 million and $1 billion per year.

Welcome to the condition of recurrent violent injury.  I’m willing to bet that you’ve never heard of that before.  And yes, the author linked an abstract rather than a paper.  As if on queue, a more studied author tells us something different.  I have to quote at length for you to get the full force of the argument.

When mass shooters strike, speculations about their mental health—sometimes borne out, sometimes not—are never far behind. It seems intuitive that someone who could do something terrible must be, in some sense, insane. But is that actually true? Are gun violence and mental illness really so tightly intertwined?

Jeffrey Swanson, a medical sociologist and professor of psychiatry at Duke University, first became interested in the perceived intersection of violence and mental illness while working at the University of Texas Medical Branch at Galveston in the mid-eighties. It was his first job out of graduate school, and he had been asked to estimate how many people in Texas met the criteria for needing mental-health services. As he pored over different data sets, he sensed that there could be some connection between mental health and violence. But he also realized that there was no good statewide data on the connection. “Nobody knew anything about the real connection between violent behavior and psychiatric disorders,” he told me. And so he decided to spend his career in pursuit of that link.

In general, we seem to believe that violent behavior is connected to mental illness. And if the behavior is sensationally violent—as in mass shootings—the perpetrator must certainly have been sick. As recently as 2013, almost forty-six per cent of respondents to a national survey said that people with mental illness were more dangerous than other people. According to two recent Gallup polls, from 2011 and 2013, more people believe that mass shootings result from a failure of the mental-health system than from easy access to guns. Eighty per cent of the population believes that mental illness is at least partially to blame for such incidents.

That belief has shaped our politics. The 1968 Gun Control Act prohibited anyone who had ever been committed to a mental hospital or had been “adjudicated as a mental defective” from purchasing firearms. That prohibition was reaffirmed, in 1993, by the Brady Handgun Violence Prevention Act. It has only become more strictly enforced in the intervening years, with the passing of the National Instant Criminal Background Check System Improvement Act, in 2008, as well as by statewide initiatives. In 2013, New York passed the Safe Act, which mandated that mental-health professionals file reports on patients “likely to engage in conduct that would result in harm to self or others”; those patients, who now number more than thirty-four thousand, have had their guns seized and have been prevented from buying new ones.

Are those policies based on sound science? To understand that question, one has to start with the complexities of the term “mental illness.” The technical definition includes any condition that appears in the Diagnostic and Statistical Manual of Mental Disorders, but the D.S.M. has changed with the culture; until the nineteen-eighties, homosexuality was listed in some form in the manual. Diagnostic criteria, too, may vary from state to state, hospital to hospital, and doctor to doctor. A diagnosis may change over time, too. Someone can be ill and then, later, be given a clean bill of health: mental illness is, in many cases, not a lifelong diagnosis, especially if it is being medicated. Conversely, someone may be ill but never diagnosed. What happens if the act of violence is the first diagnosable act? Any policy based on mental illness would have failed to prevent it.

When Swanson first analyzed the ostensible connection between violence and mental illness, looking at more than ten thousand individuals (both mentally ill and healthy) during the course of one year, he found that serious mental illness alone was a risk factor for violence—from minor incidents, like shoving, to armed assault—in only four per cent of cases. That is, if you took all of the incidents of violence reported among the people in the survey, mental illness alone could explain only four per cent of the incidents. When Swanson broke the samples down by demographics, he found that the occurrence of violence was more closely associated with whether someone was male, poor, and abusing either alcohol or drugs—and that those three factors alone could predict violent behavior with or without any sign of mental illness. If someone fit all three of those categories, the likelihood of them committing a violent act was high, even if they weren’t also mentally ill. If someone fit none, then mental illness was highly unlikely to be predictive of violence. “That study debunked two myths,” Swanson said. “One: people with mental illness are all dangerous. Well, the vast majority are not. And the other myth: that there’s no connection at all. There is one. It’s quite small, but it’s not completely nonexistent.

In 2002, Swanson repeated his study over the course of the year, tracking eight hundred people in four states who were being treated for either psychosis or a major mood disorder (the most severe forms of mental illness). The number who committed a violent act that year, he found, was thirteen per cent. But the likelihood was dependent on whether they were unemployed, poor, living in disadvantaged communities, using drugs or alcohol, and had suffered from “violent victimization” during a part of their lives. The association was a cumulative one: take away all of these factors and the risk fell to two per cent, which is the same risk as found in the general population. Add one, and the risk remained low. Add two, and the risk doubled, at the least. Add three, and the risk of violence rose to thirty per cent.

Other people have since taken up Swanson’s work. A subsequent study of over a thousand discharged psychiatric inpatients, known as the MacArthur Violence Risk Assessment Study, found that, a year after their release, patients were only more likely than the average person to be violent if they were also abusing alcohol or drugs. Absent substance abuse, they were no more likely to act violently than were a set of randomly selected neighbors. Two years ago, an analysis of the National Epidemiologic Survey on Alcohol and Related Conditions (which contained data on more than thirty-two thousand individuals) found that just under three per cent of people suffering from severe mental illness had acted violently in the last year, as compared to just under one per cent of the general population. Those who also abused alcohol or drugs were at an elevated, ten-per-cent risk.

Internationallytoo, these results have held, revealing a steady but low link between mental illness and violence …

Psychiatrists also have a very hard time predicting which of their patients will go on to commit a violent act. In one study, the University of Pittsburgh psychiatrist Charles Lidz and his colleagues had doctors at a psychiatric emergency department evaluate admitted patients and predict whether or not they would commit violence against others. They found that, over the next six months, fifty-three per cent of those patients who doctors predicted would commit a violent act actually did. Thirty-six per cent of the patients thought not to be violent in fact went on to commit a violent act. For female patients, the prediction rates were no better than chance. A 2012 meta-analysis of data from close to twenty-five thousand participants, from thirteen countries, led by the Oxford University psychiatrist Seena Fazel, found that the nine assessment tools most commonly used to predict violence—from actuarial ones like the Psychopathy Checklist to clinical judgment tools like the Structured Assessment of Violence Risk in Youth—had only “low to moderate” predictive value.

Mental health does not bear on propensity to violence any more than any other condition, or said another way, some mentally ill people are intent on evil just like mentally healthy people.  Not, by the way, that I think that one can logically define “mentally ill.”  Definitions of mentally ill fall prey to a formal logical fallacy.  The definition requires a listing of conditions that doctors consider mentally ill, and thus presence on the list crafts the definition itself.  It’s circular reasoning.

But gun controllers don’t care about that, or the mentally ill either.  It’s another tool to effect their designs on your freedom.  And in conclusion, I would remind you of reader menckenlite on psychiatry.

Control freaks love psychiatry, a means of social control with no Due Process protections. It is a system of personal opinion masquerading as science. See, e.g., Boston University Psychology Professor Margaret Hagan’s book, Whores of the Court, to see how arbitrary psychiatric illnesses are. Peter Breggin, Fred Baughman and Thomas Szasz wrote extensively about abuses of psychiatry. Liberals blame guns for violence. Conservatives blame mental illness. Neither have any causal connection to violence.

Despite this, expect the calls for universal background checks to continue, and the “mentally ill” – whatever that means – to endure discrimination.  Soldiers and Marines with PTSD – are you listening?

Guns And Mental Health Bigotry In California

BY Herschel Smith
4 years, 11 months ago

California Healthline:

On Wednesday, a group of California mayors sent a letter to Gov. Jerry Brown (D) urging him to sign a bill (AB 1014) that would allow temporary restraining orders to prevent individuals who are suspected of having mental health issues or who are potentially violent from purchasing or possessing guns, the Los Angeles Times‘ “PolitiCal” reports (McGreevy, “PolitiCal,” Los Angeles Times, 9/3).

If signed, the bill would take effect on Jan. 1, 2016 (O’Neill, “KPCC News,” KPCC, 9/3).

The bill, by Assembly members Nancy Skinner (D-Berkeley) and Das Williams (D-Santa Barbara) and state Sen. Hannah-Beth Jackson (D-Santa Barbara), would allow family members and friends to contact law enforcement if they believe an individual could be a threat to themselves or others, and officers then could ask a judge for the temporary restraining order.

[ … ]

Meanwhile, Gun Owners of California Executive Director Sam Paredes voiced concerns about the measure being used in an unintended manner. He said the restraining orders could end up being used as a legal “weapon or tool by those who want to cause harm … or discomfort” to individuals who own guns (“KPCC News,” KPCC, 9/3).

Eric Wooten, president of the Liberal Gun Owners Association, said the measure also could be an “enormous disincentive” for gun owners to seek mental health and substance misuse treatment.

Oh, and I’m absolutely certain that no one will ever use said latitude to settle squabbles, right?  Read it again.  “Family members and friends.”  Does that sound rather broad to you?

Besides, it’s a myth that violence can be correlated to mental health, and it’s prejudiced to think so.  And as I’ve quoted before, here is reader menckenlite on psychiatry.

Control freaks love psychiatry, a means of social control with no Due Process protections. It is a system of personal opinion masquerading as science. See, e.g., Boston University Psychology Professor Margaret Hagan’s book, Whores of the Court, to see how arbitrary psychiatric illnesses are. Peter Breggin, Fred Baughman and Thomas Szasz wrote extensively about abuses of psychiatry. Liberals blame guns for violence. Conservatives blame mental illness. Neither have any causal connection to violence. The issue is criminal conduct, crime. Suggesting that persons with legal disabilities are criminals shows the nonsensical argument of this politician and his fellow control freaks.

I couldn’t have said it better myself.

The Myth Of Mental Illness And Gun Violence

BY Herschel Smith
5 years, 1 month ago

Forbes:

Random gun violence is a terrifying fact of American life, because of both the violence and the randomness. Terror bred by violence does not really require comment; they are twinned. But terror bred by randomness does, especially when it leads people to accept as true a reasonable story that is false, when a myth functions as an explanation. And that is what is happening with the way we talk about mental illness and random gun violence. Thankfully, a just published report in the Annals of Epidemiology pulls together the facts we need to consider if we really want to adopt evidence-based policies to reduce random gun violence.

The article, “Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy,” is a comprehensive, critical survey of the available data (and it is surprisingly accessible and  well-written for an academic treatise). It concludes that “most violent behavior is due to factors other than mental illness.”

[ … ]

Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the article in Annals of Epidemiology was quoted in the UCLA Newsroom saying ”but even if schizophrenia, bipolar disorder and depression were cured, our society’s problem of violence would diminish by only about 4 percent.”

That is not very much. When people with mental illness do act violently it is typically for the same reasons that people without mental illness act violently.

In other words, advocacy for mental health checks and blame of the “mentally ill” for violence in the U.S. is not only unfair, it is a ruse intended to hide the real reasons for the advocacy, which is to intrude on civil rights and the moral duty of self defense.

It’s nice to see the recapitulation of things already said about this issue, in fact things I have cataloged.

Clinicians treating patients hear their fears, anger, sadness, fantasies and hopes, in a protected space of privacy and confidentiality, which is guaranteed by federal and state laws. Mental health professionals are legally obligated to break this confidentiality when a patient “threatens violence to self or others.” But clinicians rarely report unless the threat is immediate, clear and overt.

Mental health professionals understand that, despite our intimate knowledge of the thoughts of our patients, we are not very good at predicting what people will do. Our knowledge is always incomplete and conditional, and we do not have the methods to objectively predict future behavior. Tendencies, yes; specific actions, no. To think that we can read a person’s brain the way a scanner in airport security is used to detect weapons is a gross misunderstanding of psychological science, and very far from the nuanced but uncertain grasp clinicians have on patients’ state of mind.

What about diagnoses?

If mental health professionals were required to report severe mental illness (such as paranoid schizophrenia) to state authorities, it would have an immediate chilling effect on the willingness of people to disclose sensitive information, and would discourage many people from seeking treatment. What about depression, bipolar disorder, substance abuse or post-traumatic stress disorder, along with other types of mental illness that have some link to self-harm and impulsive action? The scope of disclosure that the government could legally compel might end up very wide, without any real gain in predictive accuracy.

Diagnosis is an inexact and constantly evolving effort, and it is contentious within the profession. To use a diagnosis as the basis of reporting the possibility of violence to the authorities would make the effort of accurate evaluation much more fraught. And what of the families and friends of the mentally ill? Should their weapons purchases be restricted as well? A little reflection shows how unworkable in practice any screening by diagnosis would be.

“We’re not likely to catch very many potentially violent people” with laws like the one in New York, says Barry Rosenfeld, a professor of psychology at Fordham University in The Bronx….

study of experienced psychiatrists at a major urban psychiatric facility found that they were wrong about which patients would become violent about 30 percent of the time.

That’s a much higher error rate than with most medical tests, says Alan Teo, a psychiatrist at the University of Michigan and an author of the study.

One reason even experienced psychiatrists are often wrong is that there are only a few clear signs that a person with a mental illness is likely to act violently, says Steven Hoge, a professor of psychiatry at Columbia University. These include a history of violence and a current threat to commit violence ….

Perhaps most important, although people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perpetrators of violent crime overall. Researchers estimate that if mental illness could be eliminated as a factor in violent crime, the overall rate would be reduced by only 4 percent. That means 96 percent of violent crimes—defined by the FBI as murders, robberies, rapes, and aggravated assaults—are committed by people without any mental-health problems at all. Solutions that focus on reducing crimes by the mentally ill will make only a small dent in the nation’s rate of gun-related murders, ranging from mass killings to shootings that claim a single victim.  It’s not just that the mentally ill represent a minority of the country’s population; it’s also that the overlap between mental illness and violent behavior is poor.

Whether folks engage in myth-telling because they believe in myths, or just want to mislead, the result is the same.  Communicating lies is both hurtful and sinful.  We are required to tell the truth, and the truth is that there is little to no correlation between mental health, whatever that is, and violence.


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