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The Podium

Suicide by homicide: Taking mental illness seriously

Adam Lanza is accused of killing 26 people, including 20 children, at an elementary schoool in Connecticut before taking his own life.

NBC News/AP

Adam Lanza is accused of killing 26 people, including 20 children, at an elementary schoool in Connecticut before taking his own life.

A mentally ill young male kills innocents. He had struggled with — fill in the blank mental illness (depression, bipolar disorder, schizophrenia) — and did not receive treatment, or did not agree to treatment, or did not respond to treatment. He and his family tried to get help, but failed, and eventually his family gave up. The young man became a loner, living quietly on the margins of society, until, one day, he had enough and decided to kill himself.

Like suicide-by-cop, he decided to kill himself by killing others, thereby ensuring that police would kill him, and, if not, he could always kill himself at the end. It might be in a movie theater, or a subway station, or at a mall where a politician would speak, or — worse of all — in an innocent elementary school.

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He had access to guns, yes, but it was an insane mind that pulled the triggers, a mind, often, with a treatable disease. We know the disease, we know how to treat it, we have the treatments. It is not lack of knowledge which prevented the tragedy; it was the inability to implement what we know.

And the blame for not being able to implement what we know lays with us, with many members of our liberal American society, who will defend to the death their personal liberties, their civil rights. No, you cannot force outpatient treatment for mental illness in most states. Many will even deny that these mental illnesses are “real.” The blogs are full of critics of psychiatry and drugs and the pharmaceutical industry and the medical profession. It’s all made up, they say. These are “socially constructed” illnesses, whereby the psychiatric profession can exert its power-hunger and the pharmaceutical industry will profit.

If these are fictional conditions, then some very real innocent lives have been lost because of those fictions.

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When will we finally put aside all the discrimination against mental illnesses, which reaches the point of denying their existence, and admit what any civilized, educated society would do: these are real illnesses, often characterized by the refusal of those who have them to accept treatment. Sometimes, society has rights which overrule extreme individual civil liberties. Besides strict gun laws, we need more laws allowing for outpatient commitment to treatment for severe mental illnesses like schizophrenia or bipolar disorder.

The radical libertarian right will hate it, but so will the radical left, who can’t accept the idea of mental illness as real rather than social fiction. And many liberals, who have no problem with forcing people to pay money in higher taxes, will refuse to force people to get their diseases treated.

When both extremes oppose an idea, it must be right. The time has come to let the rights of innocent children come first.

Dr. Nassir Ghaemi is professor of psychiatry and director of the Mood Disorders Program at Tufts Medical Center.
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