You can probably name several Olympic gold medalists and star quarterbacks who have blown out their knees, or major-league pitchers who’ve had Tommy John surgery. But most of us can’t name a single celebrity who has struggled—successfully, anyway—with depression or another mood disorder. Even celebrities are afraid of losing their jobs or being seen as a danger to their children. Wealth, power, and the love of the public is no defense against that stigma.
My own experience with anxiety showed me the risk and shame involved in making my pain known to others. I believe I am a profoundly honest person—sometimes to a fault. And yet, when I was experiencing spikes of panic, I felt so ashamed of what I was going through, so humiliated by my inability to “get on top” of the problem, that I went to great lengths to conceal my experience. Afraid of being seen as weak or unstable, I had done my utmost to hide (or at least, disguise) my inner storms from colleagues and friends.
And I’d been able to do so with little difficulty, even though I believed my mind was trying to kill me. I’m sure my colleagues and casual acquaintances noticed all was not well. Does Sue look thin/shaky/pale/distracted to you? Except there was a perfectly good reason for me to seem under the weather. No wonder she seems run-down—you know what she’s been through. Just as I had once said to Tom, Dylan’s course load must be too heavy; he looks tired, and Of course he’d rather play video games than hang out with his parents; he’s a teenager!
Once I’d emerged on the other side of my own health crisis, I could see how shrouding it had isolated me. But the experience also helped me relate to others who hide the enormous pain they’re in. Most of these issues are treatable, as long as people get help. Yet many do not seek the treatment they need, and stigma is one reason why.
If you hurt your knee, you wouldn’t wait until you couldn’t walk before seeking help. You’d ice the joint, elevate it, skip your workouts—and then, if you didn’t see any improvement after a couple of days, you’d make an appointment with an orthopedist. Unfortunately, most people don’t turn to a mental health professional for help until they’re in real crisis. Nobody expects to heal their knees themselves, using self-discipline and gumption. Because of stigma, though, we do expect to be able to think our way out of the pain in our minds.
As soon as my own anxiety disorder was under control and I began to emerge from the quicksand, it was suddenly as clear as day: a brain health crisis was a health issue, the same as a heart condition, or a torn ligament. As with those health issues, it can be treatable. But first it has to be caught and diagnosed. Every day, mammograms and breast exams help doctors catch and treat cancers they would have missed fifty years ago. I survived cancer myself because of these, and can only hope that someday we’ll have screenings and interventions at least as effective for brain health.
Indeed, we must. Like many other diseases, brain illnesses can be dangerous if they are not recognized and treated. The person most likely to suffer from a destructive impulse is usually the one who has it. In some exceptional cases, people may behave violently toward others as well. That’s not a given, or even a likelihood, but it does happen. Untreated illnesses can jeopardize the people who have them, and those around them.
When people who are struggling cannot get access to the lifesaving treatment they need, it puts them at increased risk of doing harm to themselves or others. Self-medication with drugs and alcohol is common when people aren’t getting proper treatment and support, and abusing those substances is a factor that dramatically increases the likelihood of violence among those with mental illness.
Whenever I interviewed an expert for this book, I asked them this question: How do we talk about the intersection of brain disorders or mental illness and violence, without contributing to the stigma? Dr. Kent Kiehl summed it up neatly: “The best way to eliminate the belief that people with mental health issues are violent is to help them so that they’re not violent.”
? ? ?
It’s very hard to know who is going to commit an act of violence. Profiling doesn’t work. But violence can be prevented. In fact, threat assessment professionals have a saying: Prevention does not require prediction. It does require, however, that we increase overall access to brain health interventions.
Dr. Reid Meloy, a pioneer in the field, uses this analogy: A cardiologist may not know which of her patients is going to have a heart attack, but if she treats known risk factors such as high cholesterol in all of them, cardiac events will go down. The rates will improve further if she attends closely to patients at increased risk—the smokers and the overweight—and they’ll go down even more if she makes sure that patients who have already had heart attacks comply with heart-healthy programs and take their medications.
A similar tiered system is already working in some schools. At the tier-one level, everyone should have access to brain health screenings and first aid, to conflict resolution programs, and to suicide prevention education. Peer intervention programs teach kids to seek help from trained adults for friends they’re worried about without fear of repercussion.
A second tier of attention is trained on kids going through a hard time—a student grieving a lost parent, one who has suffered teasing or bullying, or those in known high-risk populations. For instance, gay, lesbian, bisexual, and transgender kids are at disproportionate risk for bullying, so special efforts might be made to connect those kids to resources.
The third level of intervention comes into play when a child has emerged as a particular concern. Perhaps he or she has an ongoing emotional disorder, has talked about suicide, or—as Dylan did—has turned in a paper with violent or disturbing subject matter. The student is then referred to a team of specially trained teachers and other professionals who will interview him or her, look at the student’s social media and other evidence, and speak to friends, parents, local law enforcement, counselors, and teachers.
The real beauty of these measures is not that they catch potential school shooters, but how effectively they help schools to identify teens struggling with all different kinds of issues: bullying, eating disorders, cutting, undiagnosed learning disorders, addiction, abuse at home, and partner violence—just to name a few. In rare cases, a team may discover that the student has made a concrete plan to hurt himself or others, at which point law enforcement may become involved. In the overwhelming majority of these cases, though, simply getting a kid help is enough.
“People who are involved in targeted violence are usually involved because of an underlying issue,” Dr. Randazzo told me. “Often, that is a mental health issue. Usually, those mental health issues can be resolved if they are discovered and treated effectively. Better mental health resources can without question help to prevent violence.”
If we are serious about preventing violence, we must also recognize the cost to society when we make firearms so easily accessible. Dylan did not do what he did because he was able to purchase guns, but there is tremendous danger in having these highly lethal tools readily available when someone is at their most vulnerable. These risks are demonstrated, and we must insert them into the equation when we are talking about how we can make our communities healthier and safer.
? ? ?
When tragedies like Columbine or Virginia Tech or Sandy Hook happen, the first question everyone asks is always “Why?” Perhaps this is the wrong question. I have come to believe the better question is “How?”