A modest proposal

April 18, 2007 § 10 Comments

Okay, this’ll be the last post I write on this topic for a while.

Obviously, I’ve been following the Virginia Tech story quite closely, in part because of my family’s experience with mental illness, but also because I have taught university classes and, with luck, will do so again.  As The Professor keenly observes:

Universities understand physical accessibility very well. We are years behind on mental illness. How one accommodates these diverging interests is beyond me, but if nothing else, the Virginia Tech shootings show once again how crucial this issue really is.

I would like to think that this tragedy will lead to a greater awareness of mental health issues, and, in time, to a greater understanding of them.  But I’m not optimistic.  While we have made great strides in how we deal with depression, anxiety, and ADHD, we may have lost ground when it comes to psychotic disorders such as schizophrenia.  The inability of so many concerned teachers, psychiatric professionals, and even judicial bodies to ensure that Cho Seung-Hui received adequate treatment for his illness, to say nothing of peers and family members, speaks volumes about how little real progress has been made.

Given that psychotic disorders tend to appear during the ages normally associated with college attendance, I would suggest that universities have a special role to play in changing this state of affairs.  Why not establish a network of interdisciplinary research and education centres, the core mandate of which would be to develop new approaches to dealing with mental illness?  Not just the psychiatric dimensions of it, I should add, but the ethical, socio-cultural, and pedagogical ones as well.  What would happen if we drew upon the vast reserves of knowledge that every campus community contains and directed them toward this issue?  What insights might be possible? 

Right.  Now, I should get back to a very different proposal…


§ 10 Responses to A modest proposal

  • It’s so hard to know what to do.

    Yesterday I noticed that one of my co-workers was talking in ways that I associate with someone having or about to have a psychotic episode. I mentioned this to her boss and felt guilty, but if I hadn’t said anything I would have felt guilty too. (I’m not going to be seeing her much, if ever again. So talking to her boss was the only thing I could think of to do.)

    Now her boss is stuck not knowing what to do either.

  • What makes me saddest about these shooting incidents is that someone could be in that much distress without anyone intervening. It says so much about our isolation and powerlessness.

  • Heather says:

    As always, you’re right on the money.

  • Vila H. says:

    The shame is, Alison, that people did intervene, to the extent that they were able to. A court judged Cho to be a danger to himself, but did not go so far as to authorize in-patient care. We’ll never know if it would have made a difference.

    That being said, schizophrenia, which Cho almost certainly had, is notoriously difficult to treat, so it may well not have. At that point, I don’t know if there is anything that can be done, but I do know this: anyone who has been judged to be a danger to themselves or others should not be permitted to own a gun. Period.

    Anyway, I hope your co-worker’s okay.

  • Meds usually are effective for schizophrenia. They don’t restore full mental functioning, but they do help make things less bad. The real problem is often getting someone to take them. My family is grateful that my brother loves his Zyprexa – sleep without nightmares! – but I know other people who have to get depo injections.

    And then there are the people who refuse treatment completely; who make things worse with alcohol and street drugs; whose lives are too unstable for continuing medical care.

    The brain disease isn’t the hardest thing to treat, though it is always debilitating and very sad. It’s the person within society who is hard to treat. (And once someone has partial mental functioning restored, then what? How do they work? How do their co-workers respond to them if they can’t ‘pass’?)

    The shame is not that Cho was completely ignored, but that nobody knew how to make those interventions effective. People knew something was wrong but they didn’t know how to ensure he got the help he needed. That’s a larger societal problem, not a pharmacological one. (Apparently he had a childhood diagnosis of autism, but his parents couldn’t afford follow-up care so he didn’t get any. And that was when he was very young and could have been medicated with or without consent, if that is what would have been appropriate.)

  • john says:

    My perspective is that is was more a sociological problem in his case, causing mental illness.

  • Vila H. says:

    There is a third category, Alison: people for whom current treatment options are largely ineffective. My brother falls into this category; my mother, by contrast, falls into your second.

    There are different forms of schizohprenia, which manifest differently in different individuals. (Gender, for example, is a major but poorly researched factor.) Also, people respond very differently to medication: while Zyprexa has, thankfully, alleviated your brother’s sypmtoms, it did little to mute those of my brother’s. It did, however, cause him to rapidly gain weight, a side-effect that is fatal for some.

    I should add that neither my brother nor my mother use alcohol or street drugs, and that both live in a stable physical home. From what I understand, their form of schizophrenia (paranoid type, which Cho likely also had) makes treatment extremely difficult, for both social and pharmacological reasons.

    From where I sit, your brother is lucky. I would do anything to help my loved ones suffer less, and that they suffer is not for lack of trying. Their experience of their illness is precisely why we need more research, more education, and alternative approaches to the issue, since those that are currently on offer are not enough.

    Anyway, it’s a beautiful day. I’m going outside.

  • Alison Cummins says:

    Vila, yes, you’re right. I completely agree. That’s why I used terms like “usually” and “often” and “less bad.”

    A disproportionate number of schizophrenics consume stuff for various and complex reasons, and when they do it becomes a vicious cycle, but this certainly isn’t the case for everyone. Even when it is, being judgemental is unhelpful. I have friends and relatives who fall in both categories. (None who are currently living on the street.)

    I’m terribly sorry about your brother. I worry enough about mine.

    Yes, enjoy the sunshine!

  • Vila H. says:

    Thanks for the kind words. I suppose all we can do is write through the prism of our own experience and hope that others will understand.

    From my very cursory search, the effectiveness rate of treatment for all types of schizophrenia is between 50 and 60 per cent. Statistically speaking, that’s pretty much a coin toss. The number that really scares me, though, is the estimate of how many schizophrenics will commit suicide within 30 years of their diagnosis: 15%.

    There’s an extraordinary piece about Cho’s struggle with his illness in today’s New York Times. He was like my brother in so many ways, and his family like my own… At the risk of stating the obvious, it all strikes rather close to home.

    Yes, the worry is the worst part, isn’t it?

  • mtlanglo says:

    Oh shoot- I meant to talk about this with you the other day… oh well.

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