September 10, 2016
by Kookie the Shrink
an alter ego of katharineotto.wordpress.com
President, Chair, and CEO, Psychiatrists for Sanity
(and so far the only member)
The August, 2016 issue of Psychiatric Times has two good articles related to recent topics in my senior citizens’ discussion group. One is on gun violence, and the other on physician-assisted suicide.
Gun Violence and Mental Illness
There’s a good interview with forensic psychiatrist Liza H. Gold, MD regarding her book, Gun Violence and Mental Illness. She claims that most serious mental illness is only weakly associated with violence, and gun violence in particular. There are 33,000 firearm deaths each year, and two-thirds of them are suicides. Less than one percent occur in mass shootings. Firearm violence by individuals with serious mental illness against strangers is one of the rarest forms in the US. If seriously mentally ill people do become violent, it is usually against family members or in committing suicide. Those with serious mental illness only commit 3-5% of all types of violence.
When Dr. Gold talks about legislation, she says only felons with a history of gun violence should be denied weapons. Now, all felons are prevented from buying guns. Psychiatrists and therapists should ask not only if the patient owns a gun but whether there is a gun in the household. Better access to mental health care would perhaps prevent suicides (10th leading cause of death in the US and second among adolescents and young adults). There are 40,000 suicides/year in the US with more than one-half using a gun. As many as 90% of people who commit suicide have a history or current diagnosis of a psychiatric problem
We are the only nation in the world with this kind of gun violence problem. Access to mental health treatment would not reduce homicide rates (11,000/year), which are usually interpersonal (domestic, gang wars, etc.)
The most dangerous time for a woman is in trying to leave an abusive relationship. Temporary restraining orders do not prevent the perpetrator from having a firearm, but permanent ones do. Gold says the temporary restraining order should also prohibit firearm possession for the perpetrator.
She says we should educate family members to remove firearms from the homes of those in crisis, such as depression, psychosis, substance abuse, dementia, recent trauma–such as loss of job or relationship–or has a recent diagnosis of serious medical illness.
A commentary, “Physician-Assisted Suicide and the Rise of the Consumer Movement,” by Ronald W. Pies, MD, addresses the current status of so-called “physician-assisted suicide” movement and the ethical implications for psychiatrists. While others refer to “death with dignity,” he likes to think in terms of “life with dignity,” and implies this is the main goal of psychiatry.
Dr. Pies says PAS is now legal in Oregon, Washington, Vermont and California. They are considering a law in Canada that would allow for assisted suicide in mentally ill adult minors. He states the broad terms under which euthanasia is used in the Netherlands.
Dr. Pies correlated this with the growing “consumer rights” movement, which has replaced “physician” with “provider,” and “patient” with “consumer.” He hints that insurance companies–guided by numbers and statistics more than good care–are behind this language pollution. He implies this subtle shift in terminology has dehumanized both parties and has undermined the therapeutic relationship between patient and physician.
My take is medical journals subsist on advertising, primarily from pharmaceutical companies. Content usually reveals the medical bias toward expensive, patented medications and overtreatment for relatively minor problems. The August issue of Psychiatric Times shows a heartening trend toward more clinically relevant information. I commend this issue’s attempt to educate psychiatrists and the public about common sense solutions to common problems.