Happy New Year! I hope everyone had a meaningful holiday season and that your personal family dramas were not too overwhelming.
As many of you know, the suicide rate increases over the holiday season. Most suicide victims are depressed. A few have other mental health diagnoses, such as panic attacks or substance abuse disorders. I feel somewhat qualified to comment on mental health issues. Family physicians diagnose and treat more cases of depression than psychiatrists.
There was a lot of well-meaning, but ultimately misguided, commentary following the Sandy Hook shooting tragedy. I thought I’d try to amalgamate several lines of thinking I’ve been saving for a few months. This post is about mental health. I won’t discuss the gun issue, pro or con.
The first item for consideration is an article from the May 2012 issue of the Atlantic magazine, which contained a story about the irony of Americans feeling more lonely in the social media era than before (“Is Facebook Making Us Lonely?”). It stated that “In 1985, only 10 percent of Americans had no one with whom to discuss important matters. By 2004, 25 percent had nobody to talk to.” It goes on to report that in the 1940s the U.S. had 2,500 clinical psychologists, 30,000 social workers, and fewer than 500 marriage and family therapists. As of 2010, the U.S. had 77,000 clinical psychologists, 192,000 clinical social workers, and 50,000 marriage and family therapists, 105,000 mental health counselors, 220,000 substance abuse counselors, 17,000 nurse psychotherapists, and 30,000 life coaches. The author of the article summed up this reality as “This raft of psychic servants is helping us through what used to be called regular problems. We have outsourced the work of everyday caring.”
The second item is a statement from the Dutch College of General Practitioners calling for fewer antidepressant prescriptions. It recommends that patients with depressive symptoms should at first be given information and, if necessary, help to structure their daily life, together with a short course of psychological treatment. Antidepressant treatment should only be prescribed from the outset if the depression “is accompanied by severe suffering or social dysfunctioning or serious psychiatric comorbidity” such as addiction or anxiety.
Finally, I read commentaries from the Brits about one of the proposed changes from the American psychiatrists in their updated diagnostic bible, DSM-5 (the one that wants to get rid of the diagnosis of Asperger syndrome). Another proposed change in DSM-5 is to classify the grief of bereavement — such as when your spouse dies — as a disease that requires treatments. Many Brits believe it is normal life to feel lousy while you grieve, and such a feeling and experience is not a disease.
Putting this all together, my problem with many of the commentaries following Sandy Hook included (and I don’t know any more about the details of this tragedy than what’s been written and said in the mainstream media):
1) Many U.S. commentators thought that the killer’s condition could have been caught early and treated by the the healthcare industry. I seriously doubt this, at least medically. Best I could tell, there was no severe depression or similar condition in the killer. Unfortunately, there is no pill for angry asshole. And I can’t write a prescription for a person to obtain a meaningful friendship.
2) Many U.S. commentators talked about our frayed mental health system. Never did I hear one of them utter the phrase “family physicians”. The figures from the Atlantic article imply counseling help is out there, though funding for counseling could easily have gotten in the way. If there was a prayer for some physician to possibly have done anything about this in a preventive sense, knowing the child and parent(s) for years and helping them deal with the myriad of issues they surely felt overwhelmed by through parental divorce and the stage of adolescence would be the best hope, the kind of hope that is only fully deliverable by a family physician (Though I think the primary work of mental health counseling should be done by counselors. Family physicians can help with focused moments to complement the counselor’s work.)
3) I heard no U.S. commentator suggest that perhaps a more appropriate solution to prevent this kind of tragedy in the future is for neighbors to get to know one another and support one another. No commentator suggested our increasingly narcissistic culture — I want it my way and I want it now — might have as much to do with the growth of mass killings as anything else. This silence isn’t surprising, since the other content on their networks and the other 500 cable channels has contributed to this cultural shift.
The similar mass killing in Norway in 2011 shows that the Europeans are not immune from senseless violence either, and they are wrestling with the same technological and cultural shifts as we are. However, they continue to demonstrate an underlying belief that all emotional pain is not a disease. They refuse to medicalize normal life.
Many Sandy Hook commentators believed that the solution to the Sandy Hook tragedy is another federal program, another mandated health insurance benefit, or one more societal responsibility put on the shoulders of teachers and schools. The real solution is kindness, mutual support within communities, and friendships. Unfortunately, this is a solution that can’t be mandated or legislated. It is a solution of the soul.