Saturday, June 25, 2011

Guns don't kill people, community mental health care kills people

When Victoria Flores-Paniagua left the Express-News (IIRC, she said she's writing a book, but I think the stench of FAIL wafting off Scott Stroud just got to be too much), the paper replaced her with O. Ricardo Pimentel, a Wisconsinite with no clue about anything Texas and not a single legitimate qualification for the job other than, apparently, the right politics.

He has been a reliable hack; I generally ignore his column after reading the headline, much as I generally ignored Flores-Paniagua, Victor Landa, Jan Jarboe Russell, et al.  (I regularly read Mike O'Rourke, Carey Clack, and Kathy Clay Little; I read Carlos Guerra and Roddy Stinson back in their days.)

I couldn't pass up today's, though.  The headline was a real kicker: Why does anyone need an assault weapon?  Longtime readers may recall that I addressed just this subject a while back.  It will surprise absolutely no one to learn he uses the same tired lines of the anti-gun folks:

We should not be so inured to the mayhem that we shy from the obvious question: Why should anyone who isn't a soldier or a police officer have a magazine that holds 90 rounds and a weapon that can accommodate it?
As collectors items? For use in shooting competitions? Because you can? These don't qualify as needs that outweigh society's need to be safe.
The right to bear arms is not so expansive that reasonable limits aren't already imposed. You generally can't have a machine gun. Or a howitzer. Or grenades. Or shoulder-fired missiles. Not prejudging his guilt or innocence, but there is no reason Gonzales or anyone else should have an assault weapon that accommodates a 90-round snail drum. They have the potential not just to kill but to overkill.

Now, to be frank, I'd usually just roll my eyes and wander off at this point, or maybe leave it up to Erik to fisk the stupid.  But ol' O. Ricardo managed to get on my last nerve with his nonsense, and it's the nerve labeled Mental Health.

The case he is using as his springboard for another insult to law-abiding gun owners is the one I talked about just a few days ago.  The shooter was Mark Anthony Gonzales, who was strung out on alcohol and anti-depression meds when he killed Deputy Vann.  At this point, anything I say is mere speculation, but I can almost guarantee this: depression was not Gonzales's only problem.  I would wager that he's got a long history of mental health issues. 

For the sake of argument, though, let's assume his only problem was depression.

The way we approach mental health care in this country is simply fucked up.  Because Psychology is separated from Medicine, it is seen as a lesser discipline.  Psychological illnesses are treated differently by insurance companies, except for when they're not.  And that's actually worse

Let's look at Gonzales's issue, depression.  There are brain chemistry differences apparent in patients with clinical depression--a deficiency in serotonin, typically  The largest current class of anti-depression medicines is called selective serotonin reuptake inhibitors.  What these do is partially block absorption of serotonin so that extracellular levels increase.  Sounds good, right?  Well, here's the thing.  One possible side effect of SSRIs is a doubled risk of suicide (this may well account for the fact that suicide is more likely in a depressed person who is in recovery):

Suicide. The risk that antidepressants will incite violent or self-destructive actions has become the subject of renewed controversy. One reason for concern is the increasing number of children and adolescents receiving prescriptions for antidepressants. When compared with a placebo, all antidepressants, including SSRIs, seem to double the risk of suicidal thinking, from 1%–2% to 2%–4%, in both children and adults.
You see the obvious connection here, right?  Incitement of violent actions is a known side effect of anti-depressant medication.  As Sgt. Vann's widow said, Gonzales was signing his death warrant when he made the decision to combine alcohol with antidepressants.  And the thing is, he may well have been self-medicating in an attempt to cope (poorly) with other side effects of the medicine, which include, according to this Mayo Clinic article,  insomnia, blurred vision, fatigue, dizziness, and anxiety.  Seriously, how sound would your decision-making skills be under those circumstances?  Now, I am NOT trying to excuse Gonzales's actions, not at all.  He is 100% guilty of shooting the deputy, and I hope he has a swift trip to the death cell.  Shooting someone is an extreme, pathological thing to do.  His meds didn't make him do it, but I will contend that the decision to treat his depression through pharmacological methods made the risk much higher than it would have been otherwise.

The kicker?  Medication isn't even the best way to treat depression.  Will it work?  Yes.  Is it  vital for getting some patients immediate, initial relief?  Quite likely.  But it should not be looked on as a long-term solution.  Or any sort of solution, really.  It will treat the immediate symptoms of depression, but ignores the underlying issues which led to it in the first place (chronic stress, for instance, can lead to serotonin depletion).  Therapy not only has just as good a chance of treating depression in the short term, it has a better long-term prognosis--fewer patients relapse after therapy than after taking anti-depressants. 

The gold standard for treating severe depression?  Electroconvulsive therapy.  Shock treatments.  Y'know, those horrible things from One Flew Over the Cuckoo's Nest?  Yeah.  It boasts a more than 75% cure rate.  The course of treatment is about a month long, and it's considered safe enough to use on pregnant women.

But it's mean, and so it's not often used.  Nevermind that modern ECT has minimal side effects; we all have this mental image of an unanesthetized patient flailing and breaking bones, and so it's seen as a worse choice than a treatment with the very real potential of leading to the patient's death.

This is the crux of my frustration with Pimentel's column.  He's worrying about the proliferation of guns, even as he acknowledges that "that the ambush attack on Sgt. Vann still could have occurred and still have been deadly even if the shooter had used something other than what was used."  

But when it comes to an issue that might make an actual DIFFERENCE in preventing murders--improvement of mental health treatments--Pimentel is absolutely silent.

I guess it's just not on his list of issues to care about.  Pity, that, as poor mental health care is the issue that led to the shooting of Rep. Giffords and a couple of years back led to a mother murdering her newborn son with a sword, as well as countless other murders over the years, and improving it would save one hell of a lot more lives than any sort of weapons ban, no matter how targeted.


TBeck said...

I suffer from generalized anxiety/depression. I take medication that helps level out the worst spikes, but the real key for me is identifying the thought patterns that reinforce and exacerbate the condition. Drugs will only take you so far.

Mattexian said...

Under the "no-one needs an 'assault weapon' meme", perhaps Mr O Whassi-name Hack would like to defend his home with no hope of police backup after a hurricane, with only a single-shot pistol, rifle, or shotgun. As long as his theoretical scenario involves only one thug breaking in or attacking him at a time, it'll work great... but ya know, even the cops don't use their old 6-shooters anymore (except as a personal backup), instead opting for those eeeeeeevil "high capacity" magazines, since badguys tend to run in packs of a half-dozen or more, and sometimes the badguy won't drop after being shot just once (the inconsiderate bastid!).

As to the mental health problem, it's starting to look similar to the "Operation Gunwalker" scandal coming out, that certain officials failed to foresee that their decisions would have unintended consequences, or worse, they hoped that this would be an outcome, in that cutbacks in public mental health care would lead to increases in violent crimes committed by the mentally ill, so that then those officials could justify further restricting the rights of everyday citizens to own firearms. (See the CDC treating gun violence as a health problem, thus wanting more laws to control the "behavior.")

TOTWTYTR said...

The right to freedom of the press is not so expansive that reasonable limits aren't already imposed.

For example, no one needs a word processing program that allows one to write thousands of words in a few minutes. It's obvious that the authors of the Bill of Rights didn't foresee this technology, so journalists should be restricted to drafting their columns with a quill pen.