"Mental Illness" and Gun Ownership Laws

After a local man who had been identified as being "mentally ill" (through various previous contacts with the police) had obtained several guns and used them to kill his mother, the newspapers and legislature began discussing the importance of prohibiting "mentally ill" people from getting guns.

The first problem is that all people with "mental illness" are lumped together as unfit for gun ownership.  Does this mean that people who are being treated for an anxiety disorder can't buy guns to protect themselves?  If you've ever had a depression and gotten treatment, are you prohibited from gun ownership?  Exactly what do we mean by "mental illness" and which illnesses render us unfit?

The second issue is that the Federal database used to screen people for suitability to own a gun has to have that data available for all gun sellers.  Where do they get their data?  Are psychiatrists and psychologists going to be required to report any patient to the state or Feds in case they might want a gun?  How much is going to be reported?  Who will have access to these mental health records?

We have always treated medical records as private, and mental health records as especially private and privileged.  We did not want to discourage people from seeking mental health treatment by threatening to make their private problems public.  Where we have not taken such precautions we have created a disaster.  Consider the military situation as regards depression and other  mental illnesses.  When a pilot sees a military psychiatrist, he effectively ends his career.  He will not advance in rank; he will not fly military aircraft; he will not likely be promoted. So he elects to go untreated.  And often this scenario ends with suicide.

In past years I saw military officers in my private practice, which they chose rather than see a paid-for military psychiatrist or psychologist.  Still, they were very concerned about the risk they ran of being "outed" as a "mentally ill person", and in addition they felt it necessary to lie about their treatment status on annual medical evaluation forms.

I think we can consider limiting weapons to people whose judgment is seriously impaired enough to require the state to act as parental supervisor.  Clearly some forms of mental illness are not consistent with gun ownership or flying military airplanes.  But the vast majority of such disorders are consistent with gun ownership.  We can't and shouldn't put all mental illnesses in the same stereotypical bag. 

Since our Constitution guarantees all citizens to have the right to keep and bear arms, are we going to decide that people with a "mental illness" do not have the same rights as other citizens? Are we going to change the Constitution?  How are we going to protect privacy and encourage people to seek needed help, and at the same time protect ourselves against gun owners whose judgment is critically impaired?  The appropriate criterion might be an appraisal of the prospective purchaser's judgment, not of their psychiatric diagnosis.  Perhaps some form of formal mental status procedure evaluating basic judgement, carried out by a mental health professional, resulting in a pass/fail finding, would protect people's right to medical privacy while at the same time not lumping all mental health issues into the single category "mental illness". 

Obesity, depression and recovery

Obese people can be seen as belonging to two separate groups.  "Group 1" is characterized by having a generally satisfactory life, with interests and hobbies (other than food) and reasonably good relationships.  "Group 2" people are usually depressed and/or unhappy, with few or no sources of pleasure other than food. 

Group I people are frequently successful with rigorous diet and exercise programs.  While they may relapse into overeating, they do lose weight at least while they continue the program.  They are able to make a rapid change in their eating and exercise habits, frequently picking a particular date to start and then following through.  Their lives have plenty of good things in them that don't depend on eating.  They frequently have trouble seeing why other obese people have such difficulty losing weight. 

Group 2 people are almost never successful with rapid weight-change programs.  Because they are already depressed or unhappy, they are easily overwhelmed by the amount of change they see as necessary.  They think "I just can't do all that", while envisioning major changes in exercise and food intake.  They have little other sources of pleasure, so that giving up the one and sometimes only pleasure they have, eating, leaves them contemplating a life with nothing rewarding or good in it.  They can't seem to get started.  They don't understand how others can succeed at such a difficult task, which further convinces them of their own inadequacy.

For Group 2 people to succeed, they have to make small behavioral changes, not the large ones they feel overwhelmed by.  They can't deal with losing "a hundred pounds".   They can't accept "no more desserts" or "walking three miles".  They may pick a starting date, but they either don't do it or they give up almost immediately, feeling helpless and intimidated by the task.  Their failures increase their low self-esteem and their depression.

In helping depressed patients overcome their depression, we use what I call the "2-Plate Rule".  This rule applies to all overwhelming tasks, which for depressed people includes almost everything.  The rule states that if washing 2 dishes in the sink is too much to do, change the size of the task by a half. Wash 1 plate.  If that's overwhelming, plan to wash a saucer.  It is crucial that the size of the task be reduced until it can be accomplished, and it doesn't really matter how small the task is as long as it can be done.  My patients are instructed to stop when they have completed the task, and not to treat their success as some kind of trick so they can be urged to do more.  Depressed people need more successes, not more failures.

Group 2 patients need to be assisted in reducing the initial tasks involved in beginning to lose weight until the initial task is something doable.  For instance, the patient may be instructed to pick a task involving exercise or involving diet (not both) and break it down into smaller "chunks".  An exercise "chunk" might involve walking to the end of the driveway and back on the first day, and staying with that chunk for a week (or some specific short length of time).  If they are successful with that task, they might decide that walking to the end of the block is possible.  At the first failure, they are to recognize that they gave themselves too much to accomplish, and that they need to choose a smaller task. 

A diet "chunk" might be to decide to have a smaller dessert, such as a half-piece of cake or pie. Or it might be to decide to not have anything to eat after midnight.  The patient is instructed to stay with their success for at least a week.   Later in their program they can shorten the length of time between changes, as long as they find the task something they can accomplish.  If they have a problem carrying out their task in their time frame, apply the 2-Plate Rule.

How to be happy

A patient told me a few days ago that he had seen a therapist previously for treatment for his depression.  He quoted the therapist as saying "You have to choose happiness".  He commented that if he knew how to do that he already would have.

I agree with him.  We can't "choose" happiness. Happiness happens while we're busy doing other things.  Happiness is something that has already happened while we weren't thinking about it   But there is something we can do to make it possible.

We can choose to let go unhappiness.  When Buddhists say "suffering is optional", that is exactly what they mean.  It is possible to let go our old resentments, hatreds, grievances and fears.  Dwelling on them and making them part of us is how we make happiness impossible.  We can simply let them go.  We don't have to let them define our lives.  If something in our past seems unfinished, we can choose to finish it and let it go.  We can give up the hope of having a better childhood.

 Happiness can happen by itself when we're not busy being miserable.