The Treatment of Mental Illness

The Treatment of Mental Illness

A recent discussion on the killings at Virginia Tech on April 16, 2007 by Seung-Hui Cho, a student, raised the topic of the treatment of mental illness in the United States.

Cho was not unknown to the mental health or justice system in Virginia. He had been referred for mental health services and to campus security for a host of aberrant behaviors including harassing women on campus and extremely bizarre writings and actions in literature classes. He frightened both former students and professors to the degree that referrals were made and acted upon.

The problem is that the mental health system failed. Despite being diagnosed as a danger, Cho was allowed to remain at the university without ongoing treatment and bought weapons and ammunition both on the Web and at a Virginia gun shop because of a loophole in Virginia law. While that loophole has now been closed, someone with serious and debilitating mental illness can still buy guns at gun shows in Virginia. He also bought additional ammunition at two well-know retail outlets.

But the issue of the access to guns in Virginia and in the larger United States does not begin to address the issue of why Cho’s mental illness was not treated properly.

The treatment of mental illness in the U.S. remains poor. One-to-one and group counseling and therapy are often not available, and if they are many insurance plans limit the amount of time a person can continue to receive treatment. While drugs can assist with the treatment of mental illness, often they are administered without ongoing counseling or therapy.

Dealing with the mentally ill in the U.S. continues to be problematic. Many families cannot cope with a family member who has mental illness. Communities are so dispersed that people with mental illness who may have been accepted to a degree in the past no longer find the cohesive setting in which others care for them and interact with them. Large mental institutions were largely closed during the decade of the 1980s, and the numbers of people living in their alternative, community homes, is infinitesimally small.

One mental health writer, a psychiatrist, held that the most beneficial kind of interaction for people suffering with mental illnesses was interpersonal communication from custodial staff in a hospital that treated these diseases. The latter is a profound observation on the care that the mentally ill receive in this society. The Diagnostic and Statistical Manual of Mental Disorders (1994) is in its fourth edition, with some categories of mental illness broken down into several subsets, yet the tragedy of Virginia Tech has many precursors.

The great tragedy of Virginia Tech will not soon recede in public memory. The poor quality of mental health services will continue.

School Violence

School Violence

You remember where you were and what you were doing when major events take place in your life: the Kennedy and King assassinations, 9/11. So it was with the murders at Virginia Tech.

That horrific scene brought the events of eight years ago to a level of consciousness that made it difficult not to move back in time. I served as a high-school counselor in a small town. Columbine High in Colorado was fresh in the minds of many who dealt with adolescents.

I received a call from a counselor at a nearby religiously affiliated school as I was preparing final schedules for students. In a matter-of-fact tone the counselor from that school reported that my school was about to receive a student who had left his school on the recommendation of that school’s staff. The counselor mentioned that student had had many, many unpleasant verbal confrontations with faculty, administration and fellow students. While private schools are afforded the luxury of jettisoning students who don’t fit in, public schools cannot discriminate.

I filed all of this information in my mind as a footnote to the upcoming school year after speaking with teachers in the school who would have the student in their classes. While my actions may have been prejudicial, Columbine has forced imparting this information as necessary.

At my first meeting with Tim at the beginning of the school year the only remarkable item in our discussion of his assigned courses was the fact that he showed little emotion. The school year moved on and the events of those days became remote. So far back in my memory had the warnings about Tim receded, that when my phone rang late one night, and a detective from the community where I worked spoke, I had trouble naming a student in my caseload who would have been capable of threatening an act of violence against fellow students. When the police detective mentioned Tim’s name in conjunction to a threat made that day in the school cafeteria, all of the events connected with him from the previous summer came cascading into place. The detective asked me to report to police headquarters the next morning.

I spent over an hour with the police being questioned about whether or not I felt that Tim was capable of carrying out an act of violence in the school. In a separate room somewhere in police headquarters Tim was also being interviewed.

Leaving the police department, I walked directly across the street and met with the coordinator of special services to request that Tim be evaluated. The administrator stated that it was too early to begin an evaluation and suggested I fill out the detailed referral form that was used in cases requiring an evaluation. Tim’s mother refused to give her authorization for the administering of the recommended educational and psychological tests.

Within weeks of the threat, one of Tim’s teachers began regularly visiting my office. She reported menacing behavior on his part in her classroom. Days later a parent I had known for many years in the community came into my office in tears and said that her daughter felt threatened by Tim in yet another classroom.

With no period of calm between these incidents, I was shocked when a teacher sent Tim to my office. He wore a T-shirt that had strips of masking tape affixed to both the front and back reading, “I Hate You!” I asked him to remove the tape. Glaring at me menacingly, he violently ripped the tape off the shirt and left leaving a trail of verbal threats.

I scheduled a meeting with Tim’s mother following this incident, but again she refused to sign the referral for an evaluation. The school’s principal finally prevailed upon her to grant consent for testing.

Confidentiality requires that the results of the evaluation remain undisclosed. However, at the conclusion of a meeting in my office, the psychologist who conducted the evaluation stated that he could not definitively assess Tim’s future propensity for violence.

In an act of bizarre “solidarity” with Tim, three students leave black trench coats in their lockers, a frightening symbol of the group that had formed around the gunmen at Columbine. Near the end of the school year Tim is discovered in a stairwell uttering incoherent statements. The school year ended and I breathed a sigh of relief and hoped that the heat of the summer might cool the situation that had developed over the course of the academic year.

The next school year began in the bluster of activity that all years do. In the middle of the fall semester one of Tim’s teachers came down to my office accompanied by her department chairperson. There was a look of fear in her eyes as she handed me the journal that contained a free writing exercise by Tim. The selection contained well-written graphic descriptions of violence and alienation.

I met with the principal, social worker, and psychologist. We agreed that the contents of the journal were indeed violent and the principal decided that she would order Tim to remain home until further testing could be arranged.

Weeks passed and the school department was informed that it was now the subject of a lawsuit filed on Tim’s behalf contending that the school department had violated his rights by punishing him for a free-writing exercise. The judge would ultimately find that the staff should be admonished for not calling Tim in to discuss his writing. He also determined that we had violated Tim’s right to free expression. When the legal representatives from both sides met in the superintendent’s office to discuss these findings, I was told that I would be immediately removed from Tim’s case and he would be reassigned to a different school counselor. The school principal was also admonished by the court for not affording the student due process. Adding to the weight of the case, the judge ordered that the school department pay for Tim’s legal fees.

All of these years later I sat at a table in a learning lab at the community college where I now work with the images passing by me that the media had now emblazoned on our collective consciences from Blacksburg, Virginia. All of the mayhem; the grief and loss; the faces never to be seen again, and I reflect on the days in my office as a counselor and how those events unfolded and were dealt with, and try to comprehend the incomprehensible in the present! When will we as a society honestly discuss the issues of gun proliferation, violence in schools and the treatment of mental illness?

Howard Lisnoff is an educator and freelance writer.

The Vote: An End to Jim Crow Laws

This letter appeared in the Palm Beach Post 4-16-07

Felons can right Bush administration's wrongs

The administration of Gov. Charlie Crist is to be highly lauded for making the large majority of felons who have served their sentences eligible to vote in Florida ("Felons regain civil rights," April 6).

That action may in some ways undo the wrongs that have been unleashed on the United States and the world by the questionable victory of George W. Bush in 2000. A war with no end in sight in Iraq, poor care for wounded veterans, attacks on civil liberties, ignoring the reality of environmental destruction and an inadequate plan in dealing with the aftermath of Hurricane Katrina are only some of the consequences of that election. Those denied the vote must register and turn the tide of these disasters.

HOWARD LISNOFF

The True Meaning of Life

The True Meaning of Life

Passersby stopped and genuflected at the shrine of the holy incarnation of exotic sports cars. Cordoned off at the mall, beneath the warm Florida sun, one aficionado pointed out the nuances of body design to his family that seemed to be enthralled with such meaningless revelations of consumerism.

All The News Unfit To Print--Rejected by the NYT

April 4, 2007

To the Editor:
Re “My Life In The Army,” (Op-Ed, April 3): Robert Wright states, “I wish some people on the left had a deeper respect for the military, but lately the left isn’t where the most consequential disrespect has come from.”

When I entered basic training at Fort Gordon, Georgia in the fall of 1969, drill sergeants routinely referred to the Vietnamese as “gooks.” During one field training exercise one sergeant, who led the training exercise, cynically referred to serious shrapnel wounds displaying what appeared to be “joke shop” body parts he said could be surgically reattached to a wounded soldier. These issues of life and death could hardly afford laughable and cynical treatment from this NCO.

Wright also observes that, “People think of the Army as hierarchical, but compared with the private sector it’s a bastion of egalitarianism.” Compare the latter with an attack by some enlisted men and draftees against National Guardsmen and Reservists in the training cycle I was part of. Combat boots and uniforms were left slashed as a result of that foray.

It was Kent State in May 1970, however, that forever soured my view of the military. Consider also the massacres at My Lai and those carried out by a unit known as Tiger Force in the Central Highlands of South Vietnam during a seven-month period in 1967.

Abu Ghraib and Haditha are now places that can be counted as tales of carnage and dehuminization of both prisoners and civilians. How does any of this do honor to those who serve faithfully, who have been wounded and who have died? And where is the anemic peace movement supporting vigouously those who oppose militarism from within the service?
Sincerely,
Howard Lisnoff

Censored by The Jewish Voice and Herald--Rhode Island

March 13, 2007
Dear Editor:
Re “Refresher on Israeli history for President Carter,” and “Carter, history and the Jew,” (Opinion and Editorial, February 2), both critiques of former President Jimmy Carter’s book, Palestine, Peace Not Apartheid. Yehuda Lev states, “Israel has committed its share of errors in this conflict and also has much to answer for. He continues, “Israelis learned a bitter lesson in Gaza, when after evacuating all Jewish settlements in the Strip, they discovered that it led only to intensified shelling of Jewish communities in Israel proper.”

The United Nations, Amnesty International, Human Rights Watch and Israel’s own human rights organization B’Tselem have all commented about Israel’s behavior in both the West Bank and Gaza Strip. B’Tselem observed, as reported in Norman G. Finkelstein’s book Beyond Chutzpah On the Misuse of Anti-Semitism and the Abuse of History (2005) that, “What renders Israel’s abuses unique throughout the world is the relentless efforts to justify what cannot be justified.” Finkelstein goes on to quote former New York Times reporter Chris Hedges, reflecting on his observations from the Gaza Strip that, “I had seen children shot in other conflicts I have covered…but I had never watched soldiers entice children like mice into a trap and murder them for sport.” Also quoted in Beyond Chutzpah is Amnesty International’s report that states since the occupation of Gaza and the West Bank, Israel “routinely tortured Palestinian political suspects.”

These actions on the part of the Israeli government are not “errors,” but rather the well-documented dehumanization of Palestinians that have continued since the occupation of Gaza and the West Bank began in 1967. The abuses have included the bulldozing of homes in the West Bank and Gaza, denial of access to water, lack of medical facilities for Palestinians, greatly diminished opportunities for Palestinians to work in Israel proper, the establishment of Israeli settlements on Palestinian territory, and the construction of a wall that cuts through territory occupied by Palestinians in the West Bank. While Israel has suffered the horrific actions of suicide bombers, the death toll of the second Intifada has been one Israeli killed for every three Palestinians who have met the same fate. These topics are hotly argued in Israel, as part of democratic discourse, however, the Israel lobby in the U.S. has bristled at any rational discussion of Israeli policy toward the Palestinian people and the vicious reaction at the publication of Jimmy Carter’s new book was hardly unexpected. There is an obvious disconnect in the U.S. within some segments of the Jewish community in being able to reasonably discuss Israeli democracy on the one hand, and the taboo of discussing Israel’s very different and unacceptable treatment of Palestinians in the West Bank and Gaza Strip.

In Shein’s opinion piece, he concludes, “Few in Jewish history have stood with us when we—alone—faced a world arrayed against us, lusting for our downfall or even death.” Thankfully, anti-Semitism is generally a relic of the past in the U.S., and collectively we make up the religious group with the highest income in this country, and usually live lives free of fear. While there exist pockets of
anti-Semitism in the larger world, Jews worldwide have generally been able to live lives free of the horrors of Germany of the 1930s and 1940s. This writer wonders how much contemporary anti-Semitism is fueled by Israel’s treatment of Palestinians in the Gaza Strip and West Bank. Anti-Semitism is wrong anywhere, just as is discrimination against Palestinians!

In Israel, the West Bank and the Gaza Strip it is long, long past due for a reasonable approach to the settlement of this seemingly endless dispute. All parties need to renounce violence against one another and stop the heinous dehumanization that is so antithetical to the Jewish tradition of peace and rational discourse. Painting Jimmy Carter, a fine president and tireless worker for peace, in libelous and slanderous terms will do nothing to bring about peace in the Middle East! Accusing American Jews who criticize Israel as being self-hating, disloyal and anti-Semitic does nothing but diminish Judaism in perhaps irrevocable ways.
Sincerely,
Howard Lisnoff

A Writer Confronts Censorship

There are two types of censorship. For anyone who writes there is the kind imposed by others such as editors. The latter is quite common, especially in traditional media. Another more subtle form of censorship is self-censorship that the writer imposes on himself or herself in order to make written expression acceptable to a particular public. Both forms of censorship are injurious to the search for truth through the written word. They harm both reader and writer.