How do you define mental illness?

[gretchenindisguise]

I've been wondering this with all the gun stuff going around and broad sweeping statements of "mentally ill shouldn't have access to guns."

How do you define mental illness?

a) anything in dsm
b) special snowflake

[Doc_Lobster]

I would be perfectly fine with restricting guns for everyone who has a diagnosis found in the DSM. Lots and lots and lots fewer guns.

[papie]

If that is the idea, let's just say everyone is a little bit mentally ill. Voila! No more guns!

[thebamker]

I don't know how to answer this. I don't have any guns but would probably be denied if the guidelines were in any way loose on the definition.

Thing is - even on my very worst day, I never considered the thought of hurting another person.

I think those people are just an extra special kind of fucked up in general.

[cleo29]

I think that is probably a fair guideline. Because even if their condition is not typical to violent behavior, you never know what a person might do.

[Deleted]

I think the lack of a widely known and acknowledged definition is part of the problem.

[UMaineTeach]

Jan 17, 2013 22:21:19 GMT -5 mofongo said:

All found in the DSM, so I don't think it should be a blanket DMS thing.

and it is rumored that in the new update you will be able to be diagnosed with depression much more easily, with less consideration to how long you have felt sad and withdrawn. Like, if you went to the Dr. a week after your mom dies and say you are feeling down - bam depression eligible.

I think mental illness is as hard to define as assault rifle.

And also, we have a system where you are considered innocent until proven guilty, so it's hard to preemptively take away rights based on what someone might have done or might do someday.

[UMaineTeach]

Jan 17, 2013 22:34:18 GMT -5 mofongo said:

Hopefully they would call that Adjustment Disorder or just Situational Depression. I am nerdily (made up word) excited for the new one to come out, sounds like a lot of changes have been made.

I am most interested in the new ASD criteria coming out. I feel like I have been waiting forever. It's like waiting for the smoke to come out of the Vatican chimney when the new pope is picked.

[gretchenindisguise]

Jan 17, 2013 22:32:20 GMT -5 UMaineTeach said:

Jan 17, 2013 22:21:19 GMT -5 mofongo said:

All found in the DSM, so I don't think it should be a blanket DMS thing.

and it is rumored that in the new update you will be able to be diagnosed with depression much more easily, with less consideration to how long you have felt sad and withdrawn. Like, if you went to the Dr. a week after your mom dies and say you are feeling down - bam depression eligible.

I think mental illness is as hard to define as assault rifle.

And also, we have a system where you are considered innocent until proven guilty, so it's hard to preemptively take away rights based on what someone might have done or might do someday.

This already happens. It may not be by the book, but it happens.



Two follow up questions:

So what's the recourse if you're misdiagnosed?


How long do you have to be in remission to get off the list?

[BNL2]

The DSM also has things like Touretts and learning disorders. It makes me uncomfortable to lump people with dyslexia into the same group as people with anti-social personality disorder.

[Deleted]

I consider someone mentally ill who has visited a psych ward within the last year, someone not able to look after themselves due to their mental health, those individuals on medication -- ADs, mood stabilizers, etc., someone whose grasp on generally accepted reality to be weak, someone whose moods/behavior are unpredictable and potentially harmful to themselves or others. 

[kristie]

Lol, I have several diagnoses in the DSM. DH has none. I would never want him to own a gun. His temper comes on quick and he can't be reasoned with for a few minutes.

Military members just back from deployment scare me. Some are fine, some are not even close and it is hard to tell who is who.

So I have to say, not any diagnoses in the DSM. At least the major affective disorders probably need to be on the list, and I guess that technically includes me at some point.

I like the idea of having two people vouch for you. The types of people who want to take out a classroom probably couldn't find two people to vouch for their need for a gun.

[gretchenindisguise]

Jan 17, 2013 23:06:18 GMT -5 neener said:

Jan 17, 2013 22:57:37 GMT -5 kristie said:

Lol, I have several diagnoses in the DSM. DH has none. I would never want him to own a gun. His temper comes on quick and he can't be reasoned with for a few minutes.

Military members just back from deployment scare me. Some are fine, some are not even close and it is hard to tell who is who.

So I have to say, not any diagnoses in the DSM. At least the major affective disorders probably need to be on the list, and I guess that technically includes me at some point.

I like the idea of having two people vouch for you. The types of people who want to take out a classroom probably couldn't find two people to vouch for their need for a gun.

This is interesting...I wonder if some disturbed individuals would pay people to vouch for them/there are people desperate enough to take that money.

My parents were both evaluated by a court-appointed psych recently, who said neither of them have anger problems or mental illness.  LOfuckingL.  

Kristie -did you mean vouch professionally or vouch personally. Either way - I think 2 people to vouch would be really easy for people to do, and impossible to enforce. 

[kristie]

Yeah, I would definitely include schizophrenia on the no gun list. I am not sure what Holmes had, but schizophrenia can be very scary when not managed properly. And I know a large majority are non-compliant or don't have proper access to the care they need.

And I am just kind of talking this out, I really don't know.

The vouch system to me is because these mass shootings seem to be the same kind of person. White, male, loner, anti-social, no friends, family thinks something might be a little off if they even talk to them. I think they would have a hard time finding two people that would say, yeah, they are cool. I am not scared to live in a town where this person has access to firearms.

[Deleted]

I'm really hopeful that in the future we are able to use different diagnostic tools than just lists of presenting symptoms/behaviors. It seems that some mental illnesses show up pretty consistently on MRI and qEEG, but I also know those scans aren't really detailed enough (yet) to be the only data point in a diagnosis. With my husband qEEG data helped his psychiatrist determine what kinds of medications would be the most effective for him pretty quickly instead of the trial and error method more commonly used - it was pretty impressive. And I know that many studies have been done observing scans while eliciting violent thoughts, etc. Overall I wish there were more emphasis on "mental illness" as brain diseases and disorders with more objective definitions.

For now the diagnostic model is it. But I do think that different diagnosis should be placed into different scales of violence before we could use that as an argument for who should get guns and who shouldn't.

[gretchenindisguise]

Going just on the schizophrenic aspect (because I think those are easy to call out and are often the ones who are). Look at base rates of gun violence in our country. Then of those violent gun acts, how many are completed by those diagnosed with schizophrenia? It's a really really small number, isn't it? The prevalence rate of schizophrenia is 1.1%, and of those, the number that is violent is smaller, and of those violent, the number who use guns is even smaller. I think if you could successfully get the guns out of the hands of every single person diagnosed with schizophrenia, you'd see a very negligible impact on gun violence. I'd even gander what you would see would probably be a reduction (albeit small in the grand scheme of things) of self-inflicted wounds.

[Deleted]

Jan 18, 2013 0:57:56 GMT -5 gretchenindisguise said:

Going just on the schizophrenic aspect (because I think those are easy to call out and are often the ones who are). Look at base rates of gun violence in our country. Then of those violent gun acts, how many are completed by those diagnosed with schizophrenia? It's a really really small number, isn't it? The prevalence rate of schizophrenia is 1.1%, and of those, the number that is violent is smaller, and of those violent, the number who use guns is even smaller. I think if you could successfully get the guns out of the hands of every single person diagnosed with schizophrenia, you'd see a very negligible impact on gun violence. I'd even gander what you would see would probably be a reduction (albeit small in the grand scheme of things) of self-inflicted wounds.

Ultimately, gun violence needs real analysis, which may have already been done?

What are the sources, the reasons, the specific types of guns?

What are ideas of multi-pronged approaches to lessen deaths and injuries from gun violence?


I think the mental health question is important is terms of treatment and how to incorporate the mentally ill in our society in a better way than we are presently. 

[gretchenindisguise]

imback - unfortunately a lot of research on gun violence has been completely stymied over the years (yay nra!). Hopefully Obama's lifting on that moratorium will help funnel much needed money into it.

[gretchenindisguise]

Jan 18, 2013 1:06:47 GMT -5 mofongo said:

Jan 18, 2013 0:57:56 GMT -5 gretchenindisguise said:

Going just on the schizophrenic aspect (because I think those are easy to call out and are often the ones who are). Look at base rates of gun violence in our country. Then of those violent gun acts, how many are completed by those diagnosed with schizophrenia? It's a really really small number, isn't it? The prevalence rate of schizophrenia is 1.1%, and of those, the number that is violent is smaller, and of those violent, the number who use guns is even smaller. I think if you could successfully get the guns out of the hands of every single person diagnosed with schizophrenia, you'd see a very negligible impact on gun violence. I'd even gander what you would see would probably be a reduction (albeit small in the grand scheme of things) of self-inflicted wounds.

I agree, I think the most concerning are the anti-socials, intermittent explosives and possibly psychosis nos. It can often be hard to differentiate with some people, they just are 'mentally ill'. I've met patients diagnosed with bipolar and schizophrenia, which I never really believe. I think getting an accurate diagnosis is often very difficult as is the appropriate treatment as well as prediction of future behavior.

And this last sentence is one of the multiple reasons I think "mentally ill shouldn't have guns" argument drives me insane. That and there is no good operational definition of "mentally ill," what happens when someone recovers (even schizophrenia has a 25% recovery rate), what if someone is misdiagnosed, etc etc etc. 

[kristie]

Jan 18, 2013 1:29:18 GMT -5 gretchenindisguise said:

See I think the problem with mentally ill not having guns thing is the mental illness that truly should not have access to guns are the types that will never get a diagnosis or seek out help. How many anti-socials actually get a diagnosis? I don't even know what the mass killers are, they don't seem to be charming sociopaths though. I do think depression diagnoses and guns could help curve suicide rates maybe? Either way I think the more people really want guns, the more I find they are the ones I wish didn't have them. I think we desperately need better health care, but I don't see that affecting the number of school shootings.

Gretchen, in your opinion, do you think there is a mental health link amongst the shooters? Because I don't have a clue what makes people do this.

[Captain Serious]

The NY law and HIPPA require that a person must be of imminent danger to himself or others before information can be shared.

[gretchenindisguise]

Jan 18, 2013 2:15:25 GMT -5 kristie said:

Jan 18, 2013 1:29:18 GMT -5 gretchenindisguise said:

See I think the problem with mentally ill not having guns thing is the mental illness that truly should not have access to guns are the types that will never get a diagnosis or seek out help. How many anti-socials actually get a diagnosis? I don't even know what the mass killers are, they don't seem to be charming sociopaths though. I do think depression diagnoses and guns could help curve suicide rates maybe? Either way I think the more people really want guns, the more I find they are the ones I wish didn't have them. I think we desperately need better health care, but I don't see that affecting the number of school shootings.

Gretchen, in your opinion, do you think there is a mental health link amongst the shooters? Because I don't have a clue what makes people do this.

I think that there is probably a mental health link, in that I think you have to be off your rocker to decide this is the most appropriate way to cope with whatever you're coping with. I don't think there's a mental health link in the idea of "if you have x you will do y". I don't think that exists and I'm afraid the American public doesn't understand that. They give the field way too much credit.

I disagree with your statement of not thinking better health care will impact the number of school shootings. I absolutely think it will, but only if done right. If you're trying to implement the law so that you catch the guy who is in imminent danger, I think you're too late and you're trying to do something nearly impossible. You need to get the help before you could even become that person. If we think of it like a disease, you don't get a polio vaccine after you've come in contact with the polio virus - you get it beforehand. I think that's where we need to be focusing. We need to figure out how to impact high risk people before they get those poor coping skills. We absolutely need secondary and tertiary prevention as well, but I think we're much much too focused on tertiary and we'll nearly always be too late if we wait that long.

And I agree with you re: seeking help, which is why I want it to be a primary prevention type thing and for mental health to turn into a ubiquitous form of health care. I want it to be part of yearly physicals, I want it to be synonymous with blood pressure, asthma, and diabetes. That does a few things a) it can catch people before it's a life/death problem b) reduces stigma of mental health and makes it easier for you to seek it if you've been missed in the primary prevention casting.