Monday, June 4, 2018

Remember Why the Good Lord Gave You Eyes -- Medicalize!

The latest (so far) American mass shooting has produced the usual confused back-and-forth -- no, make that a free-for-all -- about What Must Be Done.  After President Trump declared in Tokyo that mass shootings are a "mental health problem at the highest level", many people were outraged.  (One intelligent response to Trump's statement that "We have a lot of mental health problems in our country, as do other countries" was that it was true, but mental illness doesn't produce frequent mass killings in other countries.)  Glenn Greenwald tweeted angrily, "When Muslims use violence, they're evil 'animals.' When white people do it, it's a 'sad' problem of 'mental health'".

I'm afraid I couldn't resist replying mischievously, "Well, we wouldn't want to criminalize a medical problem, would we?" That was because I remembered (though I can't now find, and I've been looking) an earlier tweet in which, addressing the failure of the US War on Drugs, Greenwald said that it's a bad idea to criminalize a medical problem like drug addiction.  Even if I misremembered and he didn't tweet to that effect, the line is a commonplace in discussion of drug problems in the US today.  The trouble is that drug addiction isn't a medical problem.

That doesn't mean that I think drug use should be criminalized.  Putting the situation in those terms -- criminalization vs. medicalization -- sets up a binary that is at best debatable, as though there were only two options, jail and a doctor's care.  The main reason I say that addiction isn't a medical problem is that "treatment" doesn't work, and most of the reasoning behind medicalizing drug use is flawed at best.  In the US and in other countries under our influence, treatment is often part of the criminalization of drug use, with users and addicts ordered to get treatment, as an alternative or supplement to jail. It should be obvious that forced "treatment" for behavior is not likely to be very successful, and ethical practitioners shouldn't go along with it - but they do, which casts serious doubt on the ethics of those practitioners.  So we get the worst of both models, the criminal and the medical.

For the same reasons, I find myself skeptical about the legalistic approach to gun violence, which is a very serious problem in the US.  Why not medicalize the problem?  For one thing, it wouldn't work either; for another, as Greenwald indicated, treatment would be applied in a biased manner, since there are no objective measures for distinguishing between criminal gun violence and gun violence commited as a result of mental illness.  I noticed after the Sandy Hook massacre that there was a lot of confusion about this: it was liberals no less than rightwingers whom I saw trying to tie access to guns to mental health.  Even people I knew who'd previously denounced the stigmatizing of mental illness leaped to do just that after Sandy Hook.  Some argued that the behavior of the shooter, Adam Lanzer, before the massacre showed that he was "deranged"; others pointed out that he planned the killing methodically well in advance, which is not what one would expect from a psychotic.  Various mental health advocates pointed out that most mentally ill individuals, even the severely ill, are not dangerous to others.  It doesn't appear that we have good, objective psychiatric criteria for spotting dangerous people in advance.

I also find myself ambivalent about the explosion of activism by high-school students demanding action by their government.  I'm glad to see them speaking out, and I can't think of a better cause.  It's fun, and very gratifying, to watch them stand up to conservative politicians and pundits who want them to shut up, since so many of their elders believe that you're supposed to crumble and collapse when you meet opposition and criticism, especially from the Right.  They're bright, articulate, and inspiring.  I'm only uneasy because I don't believe they know, any more than anyone else, how to fix the problem.  But I don't think they know any less than their NRA-loving critics.

I began drafting this post last November, as readers may guess from the reference to Trump's Asia tour in the first paragraph.  It's horrifying and depressing to find that it's still timely.