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December 19, 2012 at 9:18 PMComments: 0 Faves: 0

Crossroads: Mental Illness, Violence, and Accountability

By Jeffrey VanWingen M.D. More Blogs by This Author

The Crossroads

The recent murder spree in Newtown, Connecticut is unthinkable, barely imaginable, and certainly indefensible. Just as indefensible are the Manson Family murders which occurred in the 1960's. The minds behind these crazed killings, Adam Lanza and Charles Manson are clearly not right. Are these individuals mentally ill? Undoubtedly. Given this, how accountable are they for their actions? This blog will open the discussion on the crossroads where mental illness and violence collide.

A Line in the Sand

Mental illness exists on a spectrum, as do various transgressions. I often remind my staff and myself that snappish comments and irritability are as much symptoms of depression as a runny nose is to the common cold. But how can we wrap our minds around this concept in the wake of the Newtown tragedy? We can't; a line must exist, as black and white as it can be, that defines excusable from inexcusable, regardless of mental state. I believe that this line hinges on the rights of life and freedom for everyone. And while harm to others in this regard is inexcusable, punishment may be variable on a case-by-case basis.
 
In the case of criminal behavior, the insanity plea has always been controversial. In truth, the insanity defense is rarely used, but still heavily debated. Some view this defense as a "cop out," much like a child caught stealing cookies and saying, "I didn't do it, my hand did." Or, the insanity defense is put on the same shelf as blaming factors such as alcohol for illicit behavior. 

Nature and Nurture

A guilty but insane verdict will still mean confinement, but rather in a high security mental facility than a prison cell. Having seen both prison confinement and long-term mental institutions I would debate which is actually a more difficult sentence. Is justice served in this way? I really can't offer an answer, but I do know for certain, however, that there is both nature and nurture in mental illness. 

In other words, there is a distinct genetic component, but there's also an all-too-common socially-induced component. I have seen a lot in my career in medicine and I can personally attest to both. My most consistently heart-wrenching experiences have typically come in my work at an in-patient psychiatric facility over the past eight years. It pains me to even mention on the surface the injustices that haunt the pasts of the majority of the patients there. By my nature, I try to imagine walking in the shoes of the people I encounter, but for these people, even the superficial notion of their past is painful - rape and molestation, physical abuse, emotional abuse, neglect, and torture. 

One nationally-publicized example of nature and nurture influencing criminal activity can be found in the book, The Many Minds of Billy Milligan, by Daniel Keyes. The story covers a highly-publicized court case of the successful insanity defense of Billy Milligan. The book painfully documents Billy's torture as a child at the hands of his father, including beatings and even being buried alive. His story confirms that those who make victims have often been victims themselves. But does this offer any excuse for malfeasance?

Mental Illness is Legitimate

The above being said, I feel that we need to further develop our appreciation for the legitimacy and scope of mental illness, and certain stigmas need to be broken down. Our stigma of mental illness only serves to deny its existence. Instead, we sweep it under the rug and let it smolder until it reaches the boiling point. Sometimes it can be easy to forget that people with mental illness are still people, regardless of their actions. Appreciation of emotional problems leads to openness, which leads to earlier recognition, and earlier recognition could mean the potential for prevention of tragedy.
 
I'm not saying that squashing the stigma attached to mental illness is the solution to all violent crimes in this country, but it could be a start, a move in the right direction.  Maybe this is what we should be focusing on as we go looking for solutions such as gun control to prevent future tragedies like Newtown. Things in this arena are blurry at best and definitely not well-defined; simple solutions do not exist. Who knows, maybe I've created more questions by opening this can of worms? What are your thoughts?

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