The Mental Health Punt

By | 2017-06-02T18:30:05+00:00 March 4, 2018|
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While Hillary Clinton unironically titled her biography Hard Choices, it is exceedingly rare for politicians to make them. More often, we are offered alluring and facile solutions that promise good results without costs or tradeoffs. For example, in the face of a bloated, overreaching federal budget, Donald Trump, like Ronald Reagan before him, promised to cut the deficit by attacking “waste, fraud, and abuse.” Obama said his signature healthcare initiative would expand the ranks of the insured and lower healthcare costs. George W. Bush’s stated belief system was “compassionate conservatism,” to be distinguished from the more hard-headed conservatism of the past, which willingly scrimped on social services.

Real politics involves picking a side, weighing one position and its associated set of risks as more preferable to the alternative. America’s Founders protected free speech, even though much that is false, scandalous, or dispiriting may be uttered. The Constitution protects the criminally accused, even though this means some of the guilty will go free. As with these other rights, the right to bear arms also comes at a price, and that cost has arguably become more pronounced as our society has become more fractured and disorderly.

The honest argument in favor of the Second Amendment is that it’s worth it. It’s worth it because the risk of an oppressive government is simply too great to bear and recurs too often historically without this “doomsday option.” And the other argument, made by the author among others, is that even in the absence of some revolutionary moment, we would rather take our chances with our own means of self protection, even at the cost of the occasional horrific shooting spree, than to depend solely and unrealistically on the government to protect us. Indeed, this preference for self-reliance is the defining feature of American life.

Irresolution about this historical American freedom has characterized the emotional debate over assault weapons after the Parkland shooting. Avoiding weighing in on the side of either more order or more liberty, a consensus has emerged around a supposed magic bullet: expanded mental health care and institutionalization. The argument is straightforward. If we deal with the mentally ill population—by expanding care and barring firearms to those deemed sufficiently mentally ill—we can have the best of both worlds. Guns can remain widely accessible and legal, and society as a whole will be protected from maniacs who would perpetrate shooting sprees and similar random violence.

This solution strikes me as mostly an unserious dodge, for which the proponents have not thought through the likely consequences. As with tackling “waste, fraud, and abuse,” the mental health care approach refuses to address unavoidable tradeoffs, nor to take seriously the costs of a robust system of institutionalization.

There are many good arguments for expanding mental health care access, along with involuntary institutionalization. For starters, it will make the majority of us safer. While there were lower rates of imprisonment in the past, there were much higher rates of institutionalization and associated lower levels of homicide and other crime.

But, as in the debate between those committed to the need for a death penalty and the converse passion for rehabilitation, the broad concern for social liberation that characterized the 1960s brought reasonable discussion an end. The subversive Michel Foucault labeled the very concept of mental illness a form of oppression and social control. The mass de-institutionalization that began in the 1960s led to an ongoing explosion of homelessness and disorder in our cities. This false compassion extends further, as many of this population have been re-institutionalized using the criminal justice system.

But suggesting we go back to the 1950s in this regard is about as serious as the idea that the traditional family can be restored with a few changes to the tax code. A social revolution has been underway, and the country is deeply divided on basic questions of the government’s purpose and limits because of that revolution. The age of mass institutionalization grew out of a higher trust, more homogenous society with more concrete ideas of acceptable behavior.

Even from perspective of those on the right, there were undeniable abuses in this system, but they receive little attention. Many patients, otherwise able to be rehabilitated, were made worse by neglect and heavy doses of antipsychotic medicine, as well as the very popular treatment for the hyperactive and eccentric before Ritalin: the lobotomy. It’s been a long time since One Flew Over the Cuckoo’s Nest was on the screen, but it presents a critical view of the tranquility-centered asylums of yesteryear. The old system may be preferable to the world we live in, where the obviously crazy are ignored until they do significant harm, but it is doubtful a consensus on mental health would withstand inevitable cries of discrimination by various victim classes if it were pursued aggressively or, God forbid, if this entailed disparate impact.

This approach has other costs too. The line of mental health and mental illness is a fuzzy one. There are many cases of mild depression, obsessive compulsive traits, and, sometimes, short episodes of psychosis in an otherwise normal life. Many of these people are helped by medicine and therapy. Some grow out of it. Others live a diminished, but harmless-to-others, life. And still others find that depression or other psychological illness is the flipside of great creativity.

At what point would a mental illness disqualify someone to own a firearm? Which government official would most gun owners trust to make that determination? Would everyone who has ever seen a therapist, had the blues, or taken a Valium be disqualified? Such an approach would be illiberal and unnecessary. And it would lead to massive resistance when people who have a very extreme image of disqualifying mental illness find themselves disqualified.

We know that many people with mild mental illness can safely own a firearm and otherwise be productive citizens in spite of their ailments, especially if they receive professional care and have other forms of social support. As with “career killing” PTSD treatment in the armed forces, we should be concerned that fewer people will seek mental health care if an amorphous standard is imposed that would lead to gratuitous and permanent disqualification to own a firearm. There is quite simply no reliable test for who may go on a shooting spree, nor is there a reliable way to determine at what point ordinary mental illness, short of complete madness, should allow the state to revoke this or any other right. Mental health professionals are themselves skeptical that they can easily identify the angry, bitter, grievance collectors who perpetrate shootings. Many of the shooters do not meet the definition of any mental illness . . . they are simply evil.

There is also something rather credulous by conservatives’ embrace of the supposed objectivity of psychiatric science. We live in very political times, and psychiatry is an infamously unrigorous science, populated by those of a leftish bent. The American Psychiatric Association’s diagnostic manual—the famous DSM—is always being revised, and the reasons are partly political. Homosexuality was once classified as a mental illness until 1974, as was Gender Identity Disorder. Now some locales have outlawed attempts to treat homosexuals and transexuals, even though this was standard practice less than 50 years ago.

One aspect is unavoidable: what is considered mental illness varies within the broader society and is inseparable from moral judgment. Much of what conservatives believe—traditional gender rules, the value of corporal punishment—has been labeled as evidencing mental illness. Theodor Adorno infamously labeled practically all conservatives as having a psychopathology in his once popular work, The Authoritarian Personality. We know that in the former Soviet Union the backdoor method of dealing with political dissidents was widespread: they were labeled mentally ill, drugged, and locked away. This could all be defended as a therapeutic and compassionate intervention for the good of the patient and the broader society. Closer to home, we have seen efforts to have Donald Trump removed from office by politicized, long-distance diagnoses of him as mentally ill.

Implicit in the Second Amendment is a fear of the abuse of power by centralized authorities. In a world without guarantees, we have embraced the right of the common people to have a means of authentic resistance to government oppression and to protect themselves from individuals who may do them harm. Putting our faith in the ever-changing, ideological, and imperfect practitioners of mental health care as a solution to violent crime contradicts the fundamental premise undergirding the entire Constitution. Like any other expansion of state power in these disunified times, it should be looked on warily by a nation whose entire political system is rooted in skepticism of excessive state power.

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About the Author:

Christopher Roach
Christopher Roach is an attorney in private practice based in Florida. He is a double graduate of the University of Chicago and has previously been published by The Federalist, Takimag, The Journal of Property Rights in Transition, the Washington Legal Foundation, the Marine Corps Gazette, and the Orlando Sentinel. The views presented are solely his own.