Monday, July 28, 2008


When Andrew Hanlon was shot to death while undergoing a psychological crisis in Silverton, Oregon it was but another case of deadly interaction between a person in crisis and police officers charged with maintaining public safety. It is too easy to dismiss the incident as a rampaging person out of control that had to be stopped. But that is precisely what happened as a grand jury found that the shooting was "justified."

"Justified" is, unfortunately, a relative term and is applied in this case with a great deal of assistance from a society that wishes to wash it hands of problems and overlook the real problems that lead to the circumstances that "justify" the actions taken. Taken at the precise moment of the incident, where a person out of control is threatening another persons safety and there is the possibility of the loss of a life, the rules of engagement for police officers allow for "justifiable force" to control the situation. Even so, there is a great deal of discrepancy among police departments over what actions can be taken in crises and the training of officers that are trained to handle such situations. I have yet to see where a police officer has been found to be at fault when firing their weapon and killing a person who has behaved irrationally and threatening. In several of these cases, the shots have been fired multiple times into the back of the assailant. In the Fall of 2007 a young man in Washington County, Oregon was shot in the back as he was running into a building. It might have been that he was running for shelter from being shot with rubber bullets, but a decision was made that he was a danger to the person in the building and was fatally wounded.

While it is hard to live with the process of assigning blame to an officer who is acting under crisis and with split-second decisions being made, there is so much more to all of the stories I have encountered.

On Friday July, 25, 2008 the Portland Oregonian published a letter to the editor from a desperate mother of a young man that reflects the depths of the problem and why we keep reading about young people like Andrew Hanlon that are "justifiably" killed in the name of public safety. For the past two years the mother of the young man in question has contacted numerous agencies and desperately tried to gain access to treatment that would prove effective in relieving the symptoms that her son suffers from. The lack of community resources and access to a system of care is appalling. She has been thwarted at every attempt to gain access to care for her son, even though the laws for mental health care supposedly provide for parity for those seeking treatment for mental illness.

I called her and spoke with her about her efforts. In spite of contacting numerous agencies and social service providers, she has been unable to bring the situation regarding her son under a controllable environment. Her pleas to a child welfare hotline resulted in the following advice. He "might be able to get help if he was arrested, adjudicated, and there was a court order for treatment."

This is the plight that citizens are faced with. There is really no entry point into the service system. The problem is even more difficult for a young man like Mr. Hanlon who happened to overstay his VISA and is technically a citizen of another country. We are playing in a system that has no entry point for services until a crisis is encountered and by the time that happens we have 'justified" ending their life. Hospitals supposedly cannot turn those who cannot pay for health care away from their facility. They can, however, turn away from those who have yet to behave in a dangerous enough manner and leave them at risk for early termination of their life based upon a mental crisis. Over and over, we read story after story of those who have put the public in danger and have been killed because of their creation of imminent danger to others. The real danger is to themselves as they struggle for lack of entry to a system of care that could save everyone from the tragedy that inevitably follows.

When will we recognize the real danger from the lack of access to treatment services?

Thursday, July 24, 2008

Amen, Doctor

A long time ago, back in undergraduate school, one of the questions posed in a discussion group was how do we as students see the study of psychology from a theoretical perspective. The great "philosophical divide" was between the behaviorists championed by B.F. Skinner and his operant psychology and conventional psychoanalytic theory championed by Carl Rodgers and his followers.

The purpose of the question was not to judge the correctness of either approach but to clarify how each viewpoint reflected the theoretical framework of the study of behavior. As I see the arguments unfold about treatment theories and public safety I continue to go back to those discussions about the different approaches to studying behavior.

The terminology "studying behavior" is especially appropriate. If you look at the theories of B. F. Skinner there is a brilliant and elaborate set of rules about punishment and reward, behavior shaping and successive approximations. In the rat lab, we as students were able to shape the behavior of our white rats and get them to press levers for food and achieve remarkable success in training behaviors. At the end of the class and lab sessions, you might have been convinced that a rule book for psychology had been written and all behavior could be shaped and modified.

But every theory has its weakness in its application to all situations. When one looked more carefully at the theory, the principles of rewards and reinforcers were not defined in specific terms, they were defined by their effect on the behaviors of the organism under study. That is to say, they were defined functionally. If a stimulus were presented that increased a behavior it was a reinforcer. The theory did not explain why it was a reinforcer, just that it either was or was not a reinforcer. The problems came when you presented the same stimulus to two different people and got opposite results. Let's say, for example, you wanted to get someone to lift some weights and offered them money to lift the weights. One subject might do the lifting for money, the other may not. Money was a reinforcer in one situation but not in the other because the lifting behavior did not increase.

The same sort of problem exists in what might be called the bible of modern psychiatry, the DSM-IV manual. It is, if one examines it's approach, just what B.F. Skinner's definition of psychology is, a wonderful description. DSM-IV lays out in very detailed terms very elaborate criteria for the categorization of observable behaviors that then codifies the behavior and classifies it as a specific disorder. It is, when followed, a rather neat and tidy description of the behaviors associated with the disorder classifications.

Unfortunately, like B.F. Skinner, it does absolutely nothing to explain the whys of behavior. Realistically, there is no way to explain the why because what psychiatry is primarily based upon is a lot of clues and a great deal of accumulated observation mixed in with some great theories that has few if any real answers.

There should be very little doubt in any one's mind, except for the Tom Cruise's of the world, that real pathology does exist. We even have a pretty darn good idea of the areas of origin and some of the genetic and chemical process involved. But we still do not have definitive answers as to the precise nature of why.

This all leads to Dr. Amen. (Yes, that is his name, Dr. Daniel Amen) Dr. Amen is a psychiatrist that has taken the application of SPECT imaging and is relating the images of the brain to the observable behavior symptoms and interviewing data from psychiatric treatment to more precisely determine the areas affected in the brain from a variety of causes. He uses the SPECT imaging process to suggest medications and to evaluate the effects of those medications. It is a step beyond the typical clinical process and is a bold attempt to bring a higher order of observation to the process of diagnosing and treating problems with the brain. He is to be commended for his efforts to move beyond the boundaries of conventional psychiatry and bring some observable imaging technology to assist the process of understanding pathology and monitoring treatment.

The reliance on a manual and observation to create a diagnosis have lead to a great deal of criticism about the field of psychiatry. Some of it is justified. Those who suggest that the entire field is simply imaginary choose to ignore what has been carefully observed and codified. While it might be easy to suggest that brain function should be completely controllable by any person, clearly it is not and that assumption does not allow for any form of dysfunction. Suggesting that something as complex as the brain could not have disease or dysfunction seems preposterous when viewed in the light of all the other documented physical dysfunctions of the human body. Dr. Amen has chosen to take steps beyond observation and chosen to work toward greater quantification of brain function through observation methods that seek to expand our knowledge of the functions of the brain. I wish Dr. Amen and others like him success in furthering our understanding of the Whys of brain function.

Visit his web site at to see his views on brain function and treatment for a wide variety of diseases. It is well worth your investigation.

Monday, July 21, 2008

Falling Through the Cracks

For those of you prone to suggest that the government really does not understand problems that affect the country, you might want to look at the US Government Accountability Office or GAO for short. In effect, it is a government office that does research into problems that affect us as citizens and reports the findings to government leaders who use this information to craft legislation to help mitigate the findings of GAO reports.

Representative Pete Stark and Senator Gordon Smith asked the GAO to study what happens to citizens who are in the transitional age from childhood to early adulthood that suffer from mental illness. The request was to determine the scope of the problem and what states are doing to deal with the problems presented to those who suffer from diseases such as schizophrenia and bipolar disorder. What the GAO found may shock those of you who are not familiar with the scope and nature of the problem.

The GAO estimated that at least 2.4 million young adults aged 18 through 26, roughly 6.5 percent of the non-institutionalized population in that age range suffered from a serious mental illness in 2006. The actual numbers are even higher because the study did not include homeless, institutionalized and incarcerated persons in the study group. In addition 186,000 young adults received SSA (social security) benefits in 2006 because a mental disability prevented them from engaging in substantial, gainful activity. As a group, they tended to have significantly lower levels of educational achievement.

One of the especially difficult aspects of an early diagnosis and treatment is that the qualification for inclusion into government assistance programs is often lower for children than adults. The transitional process many times results in loss of benefits for children as they transition into adult care programs. This can result in discontinuation of treatment which can exacerbate the symptoms of mental diseases.

The report paints a chilling picture of a complex network of programs that does not coordinate nor serve the needs of the population effectively. To quote the report "families wanted information . . . generally reported feeling overwhelmed by the complexity of the system of agencies and organizations."

The result of this report is legislation proposed by Senator Gordon Smith, Senator Thomas Dodd and Representative Pete Stark, the Healthy Transition Act of 2008. They should be commended for their efforts to illuminate the plight of 2.4 million citizens and their families. Those who are ill enough to be disabled would nearly fill the Rose Bowl stadium and the famed "Big House" in Ann Arbor, Michigan. If you count those who suffer from serious illness you are talking about a number that approximates the attendance for an entire year for any major league baseball team. Every game!

The most shameful part about those who suffer is how they are portrayed. Unlike those who suffer from cancer and diabetes who are seen as sympathetic, those with mental illness are portrayed as flawed or responsible for their condition. Those who know them personally, see the pain and struggle first hand. When we stop and consider the size and complexity of the problem, perhaps we can think about how many suffer and what needs to be done to help treat those who suffer and allow for a path to recover like any other illness. It is not an easy task, but one worth doing to help alleviate the problem of mental diseases.

Senator Smith knows first hand the potential of lack of treatment. His son, Garrett, took his own life as a result of suffering from bipolar disorder. Senator Smith's efforts and his public acknowledgement of Garrett's story helps others who bear the pain of their own personal tragedy. His recognition that Garrett chose a permanent solution to a temporary problem properly reflects what can be accomplished with good access to services. He has taken that tragedy and used it to inspire his service to others. As the parent of one of the 186,000 young adults who make up the members of the study, I can share his pain over the effects of illness and appreciate his efforts to create help for those citizens in need of services. We need fewer cracks in the system and more comprehensive treatment. In the long run, reducing the number on disability and helping those in temporary crisis will benefit all citizens.

For those who are unaware of the problem, it is worthwhile reading the report. For those with family members and loved ones, it is a source for inspiration and hope for a better future. When the numbers and scope of the problem is known, somehow you feel anything but alone.


Welcome to Matters of the Mind, my postings about matters relating to mental health. While I actually majored in Psychology as an undergraduate student, the subject matter was not as much personal as academic. Mental health issues have come to me as a result of family circumstances as my eldest daughter has a diagnosis of schizophrenia.

As I began to process the realities of her illness, the nature of mental disorders and the stigma attached to them began to become more relevant to my daily activities. Almost everywhere I went and almost everyone I spoke to had their own story of their family member, spouse, parent, child or friend that was affected by some type of mental disorder. This exposed a tremendously peculiar feature of our society in that individually and within a family there is often great concern and caring for our loved ones, but within the media and public consciousness there is great scorn and stigma associated with those who suffer from a host of mental diseases.

It is precisely this stigma and misinformation that has led me to the desire to reasonably and rationally discuss many of the aspects of how mental function and dysfunction affects our daily lives.

It matters very little who you are or your position in life if you are to become stricken with a disease of the brain. It happens every day to people everywhere. Famous, privileged, poor, beautiful, ordinary, talented or educated no matter the label, we are all susceptible. The diseases are a non-discriminatory offender.

This blog is designed to examine viewpoints about the diseases, treatments, stigma, research, social implications and any other related topic that is worthy of discussion. There are no limits on the range of issues that can qualify as there are seemingly no limits on the effects on peoples lives. I hope you enjoy the ideas and topics presented and ask for your input into the process of examining the subjects presented.

Again, welcome to matters of the mind.