El Paso, Dayton, and Mental Illness

Is mental illness behind the mass shootings that occur in America—251 in the past 216 days? President Trump and leading Republicans are blaming mental illness in the aftermath of the latest killings, in El Paso and Dayton. Professional psychologists say mental illness is not the problem, guns, racism, intolerance, and bigotry are. Blaming mental illness for violence dangerously reinforces the stigma around mental illness, making it less likely that those who need treatment will receive treatment.

protest

March for Our Lives protest, Los Angeles, March 24, 2016

“These are people that are very, very seriously mentally ill,” Trump said of the mass shootings. Texas Governor Greg Abbott, also a Republican, said in El Paso after the Walmart massacre there: “Mental health is a large contributor to any type of violence or shooting violence.”

Rosie Phillips Davis, president of the American Psychological Association, immediately pushed back against the blame in a statement on Sunday.

“Routinely blaming mass shootings on mental illness is unfounded and stigmatizing,” she said. “Research has shown that only a very small percentage of violent acts are committed by people who are diagnosed with, or in treatment for, mental illness. The rates of mental illness are roughly the same around the world, yet other countries are not experiencing these traumatic events as often as we face them. One critical factor is access to, and the lethality of, the weapons that are being used in these crimes. Adding racism, intolerance and bigotry to the mix is a recipe for disaster.”

More from the APA president’s statement:

“Our condolences are with the families and friends of those killed or injured in these horrific shootings and with all Americans affected every day by the twin horrors of hate and gun violence.

“As our nation tries to process the unthinkable yet again, it is clearer than ever that we are facing a public health crisis of gun violence fueled by racism, bigotry and hatred. The combination of easy access to assault weapons and hateful rhetoric is toxic. Psychological science has demonstrated that social contagion — the spread of thoughts, emotions and behaviors from person to person and among larger groups — is real, and may well be a factor, at least in the El Paso shooting.

“That shooting is being investigated as a hate crime, as it should be. Psychological science has demonstrated the damage that racism can inflict on its targets. Racism has been shown to have negative cognitive and behavioral effects on both children and adults and to increase anxiety, depression, self-defeating thoughts and avoidance behaviors.

“If we want to address the gun violence that is tearing our country apart, we must keep our focus on finding evidence-based solutions. This includes restricting access to guns for people who are at risk for violence and working with psychologists and other experts to find solutions to the intolerance that is infecting our nation and the public dialogue.”

Here are perspectives from a 2016 interview with Liza Gold, clinical professor of psychiatry at Georgetown University and editor of Gun Violence and Mental Illness:

“Most serious mental illness is only weakly associated with violence of any kind—and with gun violence in particular. Most people with serious mental illness are not violent; most people who are violent do not have serious mental illness. Individuals with mental illness are responsible for about 3 percent to 5 percent of all types of violence in the U.S.—when they do become violent, they are most likely to assault family members or commit suicide.

“Firearm violence committed by individuals with serious mental illness against strangers is one of the rarest forms of gun violence in the US. Of the approximately 33,000 firearm deaths each year, two-thirds are suicides. Less than 1 percent of all firearm deaths in the US occur in the context of mass shootings by individuals, with or without mental illness. So unless the media and politicians are talking about suicide deaths by firearms—which they never are—they are simply perpetuating negative stereotypes and stigma associated with mental illness.

“The thinking goes like this: only someone who is crazy would commit such a horrible act and kill innocent people. We all know that crazy people are dangerous and violent; therefore, it must be people with mental illness who are behind these horrible acts. However, mass shootings are not invariably associated with people who have acute mental illness or a history of mental illness. Some do, but some don’t.

“Improved funding and resources for mental health systems and treatment would of course be welcomed. However, the repeated calls to “improve the mental health system” heard after mass shootings do not result in increased spending or funding. They merely serve as a politically expedient method to avoid talking about instituting sensible firearm regulation.”

Gold says the refrain to keep guns out of the hands of the mentally ill does a disservice to American society:

It reinforces the stigma and negative stereotypes associated with mental illness, making it less likely that those who need treatment will receive treatment.

It does not result in improved funding of or access to mental health treatment.

It allows politicians and media to avoid discussing sensible gun regulations.

Because no effective change results, the American people have come to believe that “nothing can be done” to stop the high toll of gun violence, despite the fact that we are the only country in the world with this kind of civilian gun violence problem.

The APA points to a variety of resources for people who are suffering distress in the aftermath of the shootings in El Paso and Dayton:

Ithaca, Opioids, and Trump

Ithaca and Tompkins County are among the American localities severely affected by the opioid crisis, prompting intensified efforts by local officials. Overdoses are a common occurrence, and authorities report an average of 15 drug-related deaths a year since 2011. In 2016, the number skyrocketed to 21, compared to two deaths in 2007.

President Trump put a welcome spotlight on the opioid crisis this week, declaring it a “public health emergency” and describing it as a plague that has spared “no part of our society, not young or old, rich or poor, urban or rural.” At least 64,000 Americans died of overdoes in 2016, driven, Trump said, “by a massive increase in addiction to prescription painkillers, heroin, and other opioids.”

ithacavoice

Trump said he was “directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis,” but was short on specifics, mainly rattling off various steps that the federal government had previously taken.

Moreover, Trump’s diagnosis of the crisis and prescription for its cure seemed wide of the mark. His speech focused on blaming foreigners—Chinese and Mexicans—for sending illicit opioids into the country, and on criminal gangs for pushing them on America’s streets. (A key part of Trump’s future plan, he said, is a “massive advertising campaign to get people, especially children, not to want to take drugs in the first place.”)

Trump made no mention of two factors that experts increasingly see as fueling the addiction epidemic—pharmaceutical companies pushing legal opioids, and a national mental health crisis in which people desperately seeking relief from depression and anxiety find relief in opioids.

The Atlantic’s Alana Semuels reported in June:

“Ohio’s Attorney General Mike DeWine filed a lawsuit Wednesday against a handful of pharmaceutical companies, including Purdue Pharma, Teva Pharmaceuticals, and Johnson & Johnson. The lawsuit accuses the companies of spending millions on marketing campaigns that ‘trivialize the risks of opioids while overstating the benefits of using them for chronic pain.’ The companies, the lawsuit alleges, lobbied doctors to influence their opinions about the safety of opioids, ‘borrowing a page from Big Tobacco.’

“The lawsuit follows similar recent lawsuits in Illinois, Mississippi, four counties in New York, and Santa Clara and Orange Counties in California. Last month, the Cherokee Nation filed a lawsuit against distributors and pharmacies in tribal court over the opioid epidemic. In January, the city of Everett, Washington, filed a lawsuit against Purdue Pharma, the makers of OxyContin, alleging that the company knew the drug was being funneled into the black market but did nothing to stop it.”

Also in June, the Washington Post’s Lenny Bernstein reported on a study by researchers at the Dartmouth-Hitchcock Medical Center and the University of Michigan that linked greater opioid use and mental health disorders. The researchers concluded that 51.4 percent of 115 million opioid prescriptions written annually in the United States were given to people with anxiety and depression.

“Those patients may have some form of physical pain, said Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine, who led the study team. But their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull it.

“Pain that ‘you may report as a two out of 10, someone with mental health disorders — depression, anxiety — may report as a 10 out of 10,’ Sites said in an interview. In addition, opioids may improve the symptoms of depression for a short while, he said, with patients who experience that then asking for continued refills.

“As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, he said. About half of all opioids are prescribed by primary-care physicians, who also manage most routine anxiety and depression.”

Trump’s declaration of a “public health emergency” did not involve the release of emergency federal funding, but the White House indicated that the president would soon ask Congress for additional funding to combat the opioid crisis. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie of New Jersey, will hand Trump its final report and recommendations next week.

The New York Times quoted experts saying that an effective policy to fight the crisis will cost billions of dollars:

“Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, said that no emergency declaration would do much to alleviate the impact of opioids without a substantial commitment of federal money and a clear strategy for overhauling the way the country treats addiction.

“‘What we need is for the president to seek an appropriation from Congress, I believe in the billions, so that we can rapidly expand access for effective outpatient opioid addiction treatments,’ Dr. Kolodny said in an interview. ‘Until those treatments are easier to access than heroin or fentanyl, overdose deaths will remain at record-high levels.’”

Senator Joe Manchin of West Virginia, a state hard hit by the opioid crisis that Trump singled out in his remarks, called for pharmaceutical companies to pay. CNN reported:

“‘This is a business plan. They are liable,’ Manchin told CNN’s Jake Tapper on ‘The Lead’ when asked if he believes the pharmaceutical industry needs to be found legally liable in some cases for the prevalence of opioids in the United States.

“Manchin added that the companies that supply opioids should be charged fees for the drugs they produce and for having inundated the market with the highly addictive drugs.

“‘This is what’s caused it. Can’t we at least charge the pharmaceutical companies one penny per milligram for every opiate they produce?’ Manchin added.

“‘Every state’s been affected,’ he said of the crisis. ‘I’m ground zero, West Virginia, more deaths per capita, more people addicted per capita.’

“‘This is like fighting a war,’ Manchin said about the need for funding. ‘You’ve got your soldiers on the front line fighting … (but) your guys on the front line run out of bullets.’”

Chart: From the Ithaca Voice, October 13, 2017

Money, Power, and Sexual Assault

April is Sexual Assault Awareness Month. This focus is as urgent as ever, given that our sitting Republican president himself has faced accusations of serial sexual assault and harassment. On April 1, the New York Times published a disturbing and important story about alleged sexual misconduct at one of America’s most influential cable networks, Fox News Channel. The story is an illustration of how sexual assault is enabled by a culture of impunity.

fox

After more than 60 interviews and reviewing 100 pages of documents, Times reporters Emily Steel and Michael S. Schmidt found that a total of five women had received $13 million in payouts from Fox or TV host Bill O’Reilly in exchange for agreeing to not pursue litigation or speak about their sexual misconduct accusations against O’Reilly.

The Times report indicated that two of the settlements contradicted a Fox statement in 2016 that claimed it did not tolerate behavior that “disrespects women or contributes to an uncomfortable work environment.” That statement was made after the Fox’s chairman, Roger Ailes, was fired in the wake of another major sexual harassment scandal at Fox—the company had reached a $20 million with former Fox anchor Gretchen Carlson. Instead, the Times reported, even as the two other O’Reilly cases came up “the company has repeatedly stood by Mr. O’Reilly.”

O’Reilly’s pattern of alleged misconduct, according to the Times:

The women who made allegations against Mr. O’Reilly either worked for him or appeared on his show. They have complained about a wide range of behavior, including verbal abuse, lewd comments, unwanted advances and phone calls in which it sounded as if Mr. O’Reilly was masturbating, according to documents and interviews.

The reporting suggests a pattern: As an influential figure in the newsroom, Mr. O’Reilly would create a bond with some women by offering advice and promising to help them professionally. He then would pursue sexual relationships with them, causing some to fear that if they rebuffed him, their careers would stall.

The Times story indicates that money and power trump the treatment of women at Fox.

O’Reilly’s show The O’Reilly Factor is the No. 1 show in cable news and generates more than $446 million in annual advertising revenues. O’Reilly earns an annual salary of $18 million. That doesn’t include his massive royalties from books that became best-sellers in part because of his prominence as a nightly TV host on Fox, such as Killing Lincoln, Killing Kennedy, Killing Reagan, and Killing Jesus. Describing O’Reilly’s appeal to Fox’s conservative viewers, the Times said he “presents a pugnacious, anti-political-correctness viewpoint and a fervent strain of patriotism.”

In an April 5 interview with the Times on various topics, President Trump was quick to defend O’Reilly: “Personally, I think he shouldn’t have settled. Because you should have taken it all the way. I don’t think Bill did anything wrong. I think he’s a person I know well. He is a good person.”

Trump, who was strongly supported by evangelical religious leaders and voters in his 2016 residential campaign, has also been accused of sexual misconduct by numerous women. An audio tape made on the set of a TV soap opera in 2005 and unearthed by the Washington Post during the 2016 campaign revealed Donald Trump bragging about forcing himself on women including married women:

“You know I’m automatically attracted to beautiful—I just start kissing them. It’s like a magnet. Just kiss. I don’t even wait. And when you’re a star, they let you do it. You can do anything. Grab them by the pussy. You can do anything.”

Like Trump, O’Reilly denies the merits of sexual assault accusations by women against him. In a statement to the Times, he cast himself as the victim:

“Just like other prominent and controversial people, I’m vulnerable to lawsuits from individuals who want me to pay them to avoid negative publicity. In my more than 20 years at Fox News Channel, no one has ever filed a complaint about me with the Human Resources Department, even on the anonymous hotline.

“But most importantly, I’m a father who cares deeply for my children and who would do anything to avoid hurting them in any way. And so I have put to rest any controversies to spare my children.

“The worst part of my job is being a target for those who would harm me and my employer, the Fox News Channel. Those of us in the arena are constantly at risk, as are our families and children. My primary efforts will continue to be to put forth an honest TV program and to protect those close to me.”

Fox issued this statement to the Times:

“…we have looked into these matters over the last few months and discussed them with Mr. O’Reilly. While he denies the merits of these claims, Mr. O’Reilly has resolved those he regarded as his personal responsibility. Mr. O’Reilly is fully committed to supporting our efforts to improve the environment for all our employees at Fox News.”

Even before the Times story broke on April 1, the Justice Department was reportedly looking into the way Fox handled payments related to sexual harassment cases to determine whether the company misled investors.

There may be more to the story to come.

UPDATE 4/19/17:Fox News drops Bill O’Reilly in wake of harassment allegations“—Fox News