Editor’s note: Five years ago, Stacey Freedenthal, PhD, LCSW, a professor at the University of Denver, wrote a guest commentary in response to the mass shooting at Virginia Tech, where Seung-Hui Cho killed 32 people. Its message rings just as true today in response to the Aurora, Colorado, movie theater shooting in which 12 people were killed and 58 wounded by accused gunman James Holmes. With Dr. Freedenthal’s kind permission, we repost her commentary, which originally appeared on www.denverpost.com:

Treating mental illness

In 1999, when two teenagers shot 13 people to death at Columbine High School and then killed themselves, a memorial was proposed for all the victims – including the shooters.

Outrage ensued. Many parents of the teenagers killed by Eric Harris and Dylan Klebold argued that the boys were murderers, not victims. I can understand their outrage. A memorial for the murdered should inspire loving memories and cleansing grief.

That said, a sad fact remains: People who kill while in the throes of mental illness are victims themselves. Seung-Hui Cho, the shooter at Virginia Tech, stole 32 lives, but it is clear that his life, too, was stolen years ago. I cannot diagnose a stranger from news accounts, but definitely there are signs that he was deeply depressed and probably psychotic, too.

The overwhelming majority of people with mental illness, including those with exceptional disturbances such as paranoid schizophrenia or psychotic depression, do not ever become violent toward others. In fact, violence toward oneself is a larger problem, with more than 30,000 people in the United States dying by suicide every year. But when people with mental illness do kill others, the question becomes not so much who is at fault, but what?

When I have worked with suicidal clients, I have warned them that their minds can play tricks on them. Diseased and untreated (or inadequately treated), the mind can tell outrageous lies. I had a teenage client once who firmly believed that her parents would be happier if she killed herself, and that her suicide would be a gift to them. Imagine! Her parents were not abusive or neglectful monsters. Indeed, the teenager believed her parents would be better off with her dead precisely because they cared so much about her.

For whatever reasons, Seung-Hui Cho’s brain, with its toxic lies, led him to believe that he had to slaughter innocents.

Feeling compassion for a mass murderer does not mean excusing his actions, or necessarily sparing him punishment. It does not mean forgoing feelings of hatred, anger and incalculable grief. It does mean directing feelings of anger at their proper causes: mental illness and the barriers to treating it effectively. Gun proliferation and our culture of violence also undoubtedly contribute, but the underlying problem remains the brain’s uncontrolled impulses and false rationalizations to initiate violence in the first place.

By remembering that mental illness ultimately wrought this tragedy, we can be empowered to create at least one good consequence. As a society, we need to make it easier for people to ask for help with emotional problems, to provide that treatment, and to receive inpatient psychiatric hospitalization when necessary.

So far, we do none of those things. Young people do not seek help for emotional problems, possibly because of the stigma attached. We as a society can send the message that seeking help for emotional problems is no less acceptable or necessary than for the flu.

Other barriers to receiving effective help include a dearth of psychiatric hospitals; difficulties being admitted to a psychiatric hospital or staying beyond a few days; mental health professionals who rely on treatments with no documented effectiveness; insurance companies that provide few benefits for mental illnesses; insurance companies that require doctors to select medications based on costs rather than individual needs of patients; and lack of health insurance altogether.

We cannot change what Cho did at Virginia Tech. We can, however, do what we can to prevent it from happening again. Doing so requires that we keep several things in mind:

Mental illness, though not always curable, is treatable.

Stigma and lack of resources make it difficult for people to receive sufficient, effective treatment or any help at all.

The more we ignore the needs of people with mental illness, the more they will suffer – and, sadly, the more society will suffer, too.

So here we are wrapping up 2011. If you believe the TV commercials, movies and all the rest, celebrating the New Year is the best party of the year, one that everyone wants to attend. But surely not everyone can always be in the frame of mind for a party on December 31. I wondered about those who have to cope with a mental illness and those who care for someone with a mental illness. Surely it can’t be easy for them.

So I posed some questions about this to some Menninger clinicians, and thought I’d share their answers with you. Here they are:

What advice would you give someone currently struggling with a mental illness to help them through New Year’s Eve celebrations?

Thomas E. Ellis, PsyD, ABPP: Keep in mind that most New Year’s resolutions are a waste of time and good intentions, because they are too darned hard and doomed to fail. But here’s one worth considering: To spend a little time each day cultivating kindness and compassion toward yourself. Remember the reverse golden rule: Treat yourself as you would hope to treat others. There are lots of ways of doing this, from meditation that focuses on self-nurturing thoughts to engaging in acts of kindness toward yourself. When was the last time you treated yourself to a funny movie?

Elizabeth C. Cantini, MSN, RN, Professionals in Crisis Program:

1. Sometimes a smaller group with warm and close friends can be safer and more rewarding to bring in the New Year. 
2. Try not to get caught up in the hype and mindset of partying with everyone looking so happy and fulfilled. Everyone has challenges and difficulties to face in life.
3. Celebrating New Years can be fun and meaningful with sparkling grape juice and other beverages without ETOH (regardless of what commercials advertise).
4. Fun can be within reach while maintaining good judgment and discretion.
5. Remember to regulate emotions before, during and after New Year’s.
6. Role play before being around friends if social anxiety is an issue.
7. Keep in mind that everyone needs friendship and affirmation.
8. It is a myth that everyone has to stay up until midnight!
9. Call, contact or visit someone less fortunate.
10. It’s fun to talk about everyone’s goals and New Year’s resolutions.

Dee Henderson, MSN, RN-BC, Comprehensive Psychiatric and Stabilization Program:

For those struggling with a mental illness, some coping strategies for the New Year’s holiday include:

• Stay close to friends or family that understand.
• Take medications as prescribed.
• Get adequate sleep.
• Relax by listening to favorite music or doing other activities that relax you.
• Make realistic resolutions.
• Allow yourself to grieve losses of this year.
• Don’t dwell on the negative.
• Be gentle with yourself.

 Chris B. Webb, CPRP, MT-BC, Rehabilitation Services:

• Refer to your wellness and recovery plan if you have one. If you don’t have one, start one.
• Spend New Year’s Eve with supportive friends and family.
• Spend New Year’s Eve at a place of worship.
• Attend small parties if you are triggered by crowds and loud music/noise.
• Ask how they would like to spend New Year’s Eve that will allow them to enjoy themselves without feeling overwhelmed or triggered.

Frances Fisher, CPRP, MT-BC, Rehabilitation Services: Someone living with a mental illness may view not view the coming of the New Year as a new beginning but rather as just more of the same old struggle. Life is not filled with possibilities; only the hopeless feeling of impossibilities and limitations. These feelings may be exacerbated on a day that is exclusively devoted to the celebration of ringing in this New Year. To this person who is struggling, I would say: Step back from the hype of New Year’s Eve and consider that EVERY day is a new day whether it feels like it or not. Know that recovery from mental illness is real and a possibility for your life.

What advice would you give someone with a friend or family member who has a mental illness to help them through New Year’s Eve?

Chris B. Webb, CPRP, MT-BC:

• Ask them how they would like to celebrate it.
• Ask how they would like to be supported.
• Host a healthy and supportive NYE party with soft drinks, play games, share highlights of the past year or best and worst of the last year and expectations of the New Year.

 Dee Henderson, MSN, RN-BC:

For families trying to support a loved one with a mental illness at New Year’s, some strategies include:

• Reach out to those who are alone or vulnerable.
• Encourage honesty in how they are feeling.
• Let them know you truly care about them.
• Support ways of celebrating that are low-key.
• Don’t compare this holiday with previous ones.
• Focus on the positives.
• Allow them to process feelings with you.

‘Tis the season for giving and getting.

For many in the military, this “season” has been 10 years in the making. Now that the war in Iraq is officially over, the wishes of many loved ones across the country are coming true with the return of thousands of our brave warriors.

While their return will no doubt be joyful, our veterans face an uncertain future. Perhaps, if they remain in the military, they’ll be redeloyed to Afghanistan. If they return to civilian life, they face the prospect of searching for a good job in a bad economy. Either way, many will find themselves facing the challenge of mental health issues like depression, substance abuse or posttraumatic stress disorder (PTSD).

If that’s not enough, there’s also the challenge of combating the stigma of mental illness. According to the Department of Veterans Affairs, research indicates 10-18 percent of veterans are likely to have PTSD following their return home. While many will receive care at VA medical centers for physical care, many won’t seek treatment for mental health problems. The VA offers plenty of reasons why, including the fear of being seen as weak or of being treated differently. Stigma is the new enemy.

That’s why I was so happy to see this video clip of John Oldham, MD, MS, the president of the American Psychiatric Association and the chief of staff at The Menninger Clinic, talking about some opportunities for giving that the APA has in this battle.

(From American Psychiatric on Vimeo)

There’s lots more we can give to help these veterans–Santa, hint hint–and I hope that the coming years will prove that the mental health community has served these men and women as well as they’ve served us.

University of Washington faculty member Marsha Linehan, PhD

The New York Times really knows how to get folks excited. Ever since it published an article yesterday about Marsha Linehan, PhD, a renowned psychologist and researcher, in which she acknowledged her own mental illness, it seems like no one’s talking about much else around here.

And with good reason. While I’m not clinician, I’ve worked at Menninger long enough to know that Dr. Linehan is an influential figure in the mental health field. She’s been lauded far and wide for her work developing dialectical behavior therapy and for her work with some of the most severely ill patients, including those who have attempted suicide. Now that she’s publicly sharing her own history of mental illness, I think it’s likely her influence will expand still further.

No one is immune

Yes, there have been other clinicians who have discussed or written about their own struggles – Kay Redfield Jamison is the first to come to mind – but it still seems like there should be more, especially since the statistics – 1 in 4 adults suffer from a mental illness in any given year, according to the National Institute of Mental Health – surely apply to that group as well as to the rest of us.

I  hope more clinicians will follow her example and cop to being, as the Times quotes one of her patients, “one of us” because that simple, yet courageous decision could well have a significant impact on the stigma that has long haunted those with mental illness. Yes, I know that things are better with regard to stigma than they were 20 years or so ago, but you have to admit that we still have quite a ways to go before stigma is a relic of the past, like rotary phones, VCRs and dinosaurs.

Breaking boundaries

I also wonder what such an admission might mean for the dynamic between patient and therapist. Maintaining boundaries is a big deal when it comes to treatment, as it should be. A therapy session is probably one of the few places where someone can and should say, “It’s all about me.” That’s a sacred time and place in which someone who’s stuggling can focus on their own story, from how it got written to how to change it for the better.

Does a therapist’s revelation of a personal struggle with mental illness change that dynamic? It seems to me that it would have to because the patient is now getting to see beyond the professional aspect of the therapist and into the personal.

I can imagine some clinicians might say that’s a taboo that shouldn’t be broken, but I can also see that it might actually help the healing process. I mean, wouldn’t hearing about a therapist’s personal experiences inspire hope in a patient? Wouldn’t a patient feel a stronger connection with his clinician and might that make for a safer therapeutic environment? Might it not even lead a patient to make greater use of his time in therapy?

Given the play the article has gotten across the Internet, it’s clear Dr. Linehan’s revelation has struck a powerful chord. I, for one, was thrilled to see someone of her stature be so honest and revealing, and I hope she will  be lauded as much for her courage in going public as she has been for her considerable therapeutic and research accomplishments.

Did you see the news stories about 17-year-old Rachel Hachero, the apparently Ivy League-bound Florida student who allegedly pistol whipped her mother and threatened to kill her if she didn’t buy her a car?

Oh, she got her car. She also got arrested.

What makes this situation even more disconcerting is the fact that the mother didn’t want to press charges. It seems she feared an arrest could jeopardize her daughter’s future. (I’m not a clinician, but I wonder if that child’s future weren’t in jeopardy long before she picked up what turns out to have been a stolen gun.)

To help make sense of this story, I turned to Elizabeth Conaway, LCSW, and Joyce Davidson, MD, both of whom work with young adults, many of whom are having a rocky time transitioning to adulthood, at The Menninger Clinic.

I know it’s natural for parents to want to protect their children, but this mom seems to have taken that desire to a whole new level.

Dr Davidson:  We see similar situations a lot in our work, with parents protecting children from consequences no matter what the behavior. Parents provide all kinds of rationalizations for why they’re not being firm with their children or for why they are forever excusing behaviors. The danger, of course, is that in long run, kids can escalate their behaviors, which often become more and more self-destructive. In the extreme, the kids’ behaviors can become destructive not just to themselves, but to others as well.

Elizabeth: One common result of this type of overprotective parenting is that the children never get to feel the consequences; instead, the parents feel them because they’re the ones who have to post bond, pay for a lawyer, replace a phone or computer that was damaged in a tantrum, etc., not the kids. And because the kids don’t feel any discomfort as a result of their action, their behaviors don’t change.

Why do you think parents are often reluctant to let their children experience consequences?

Dr. Davidson: Parents today often seem to want to be their children’s friends, which makes it difficult for them to risk making their kids angry by setting limits or giving consequences. Unfortunately, it’s not an effective way to parent.

Elizabeth: I also think that technology is making it easier for parents to be more involved in their children’s lives via social networking. With cell phones, especially smartphones, it’s so easy to stay in touch and to know what everyone is up to. It may very well help give the illusion of being friends. Plus, it’s simply easier to act like a friend rather than a parent.

Do you think there’s been a generational shift in parenting styles?

Elizabeth: Well, we certainly do hear more about “helicopter” parents, who maintain extreme involvement in the lives of their children, even after they’ve left home to go to college. These parents are known for doing things like calling their kids to make sure they get up and go to class or arguing with professors about a particular grade on the child’s behalf.

It’s almost as if the parents want to delay the end of a child’s adolescence. Whether that’s because they don’t want to face an empty nest or because they’re afraid their child isn’t ready for adulthood, I don’t know. But this kind of behavior definitely retards a child’s ability to make a successful psychological transition to adulthood.

Dr. Davidson: One factor in all this may be the change in family size. A generation or so ago, it was common to have larger families than we often see today; so parents may have been able to risk making them angry by giving consequences to negative behaviors. Plus, having rules and consequences helps keep order, which would have been more important with larger households.

Is it possible that this mother was simply in denial about what in hindsight appears to be some warning signs about trouble ahead for her daughter?

Elizabeth: It’s certainly possible, though we sometimes find that parents think, “If they can just finish college, everything will be OK,” but just graduating from college doesn’t mean issues won’t escalate in the future.

Dr. Davidson: One question I think is important to ask: What’s the value system here? Apparently the mom thought it was more important for her daughter to achieve academically than to obey the law.

So was it a good thing she was arrested, even if her mother refused to press charges?

Dr. Davidson: Yes. This teenager engaged in serious anti-social behavior. While I don’t know what the juvenile system is like in Florida, I do know there are enlightened judges and prosecutors out there who can see that some teens need psychological assessment and treatment, not just jail time, and often they will require that such help be part of the teen’s sentence. I hope that’s the case here.

Let’s say there are parents reading this who may have realized they’re doing their children a disservice by not setting limits or giving them consequences for bad behaviors. Is it ever too late to start setting limits?

Elizabeth: The earlier parents start setting limits, the better it is for everyone involved, but no, it’s never too late. While it can be difficult to alter entrenched patterns, it is possible to shift a family’s paradigm. We work with families all the time to help the family unit change, not just the patient.

Do you have any recommendations for parents, especially those with young children, who might want to learn more about the importance of consequences?

Elizabeth: One book we often recommend to families is The Blessing of a Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children by Wendy Mogel, PhD. It’s a great resource that outlines the importance of teaching kids how to pick themselves up and fix their own problems. When they learn those skills, they have the power to take action and find solutions, and their self-esteem is enhanced. It’s understandable that parents want to rush in when a child is hurting or struggling, but they really do need to let their kids learn how to take care of themselves.

At the beginning of each year, it seems only natural to look forward and think about our concerns for the world around us and about what exciting new developments the world has in store for us. So I posed a couple of questions about such things to a few of our bloggers, some of whom are participating here for the first time, and I thought you might find their responses interesting. I did.

What is one of your primary concerns about the mental health field for 2011?

Martha McCrory, MS, CPRP, director, Rehabilitation Services & Wellness, The Menninger Clinic: One of my primary concerns about the mental health field in 2011 is the cutting and/or lack of funding for mental health services. Funding for mental health is being reduced in many states, which reduces the number and quality of services being offered. It also reduces the number of individuals who can receive services. Another consequence of the lack of mental health funding is due to the reduction of hospital space and community-based services, which can lead to individuals with a mental illness being incarcerated instead of receiving appropriate and adequate services. The lack of funding also affects environments such as institutions of higher education providing adequate mental health services to young adults. This is a grave concern, especially in light of recent events.

Dee G. Henderson, RN-BC, MSN, Comprehensive Psychiatric Assessment & Stabilization Program, The Menninger Clinic: There is a continuing problem with access to adequate, complete mental health care for the uninsured outpatient. The current county system in Houston allows patients to see a psychiatrist for medication updates infrequently, and the lucky ones get to see a psychotherapist once a week. The medications are handled through an overloaded pharmacy system, causing patients to have to use an entire day to be seen and get their medications. The formulary is limited, causing patients to either use medications that are not as effective for them or have more side effects, or they have to find a way to pay for preferred meds out of pocket, which can cost hundreds of dollars a month. Expanding the formulary would be a great first step.

Denise Kagan, PhD, staff psychologist, Professionals in Crisis Program, The Menninger Clinic: The downturn in the economy seems to have resulted in people approaching mental healthcare as essentially a luxury rather than as a necessity – as they are also doing with their physical healthcare. This leads to people putting off seeking help until they are in urgent need, which makes their difficulties more difficult to address and results in greater negative consequences (decreased ability to function, manage self-care, etc.).

Thomas E. Ellis, PsyD, ABPP, director, Psychology, The Menninger Clinic: High on my list of concerns is direct marketing of psychoactive medications to patients. It wasn’t so long ago that advertising on TV and in non-professional publications was not permitted, the belief being that it was the role of the physician to assess whether a drug might relieve a given condition. The “ask your doctor” movement has resulted in patients believing that the drug with the most compelling advertising must be safe and effective, and proceeding to make enthusiastic requests of their (usually non-psychiatric) physicians. Lost in this process are the “talking cures,” psychotherapies that repeatedly have been proven safe, effective and less costly (in the long run), with fewer side-effects. Seen a glossy ad in People magazine lately for psychotherapy? Of course not. Competing with corporations with billions of dollars to invest in advertising is virtually impossible; the result is that suffering patients are often deprived of an effective alternate path to healing.

Jon G. Allen, PhD, senior staff psychologist, The Menninger Clinic: Enthusiasm for neuroscience is entirely justified in light of the demonstrable biological basis of major psychiatric disorders. But I am concerned that we are losing sight of the psychological contributions to biological dysregulation (e.g., the “chemical imbalance”) and that we are underutilizing psychotherapy in comparison with psychiatric medications. Both medication and psychotherapy can be effective for different reasons, and both can be complementary when used in combination. Yet psychotherapy has the unique potential to result in enduring benefit related to new learning, and the same benefit cannot be achieved with medication alone. I have dubbed my concern about excessive enthusiasm for biological psychiatry to the exclusion of psychological treatments “biomania.”

What current development in the field of mental health is most exciting to you?

McCrory: One recent development in the mental health field that is exciting to me is the fact that Permanent Supported Housing is now recognized as an evidence-based practice (EBP) through the Substance Abuse and Mental Health Services Administration. In my opinion, all humans deserve the right to safe and affordable housing. However, many times individuals with a mental illness are stripped of this opportunity. Because this practice is considered an EBP, it provides concrete guidelines in which to implement this practice. This can better ensure that individuals with a mental illness are provided opportunities to procure safe, affordable housing with the supports they need. This practice promotes full community reintegration, which I strongly support as a psychiatric rehabilitation practitioner.

Henderson: It is exciting that Menninger is a part of The Gathering Place as it serves as a model program implementing the concept of Assertive Community Treatment (Lehman, Goldman, Dixon, Churchill, 2004). It is providing the desperately needed outreach of holistic mental health services to the community, providing a wide range of supportive services that I hope will serve as the paradigm for other communities. The need to have access to mental health services is being recognized as far broader than the current systems of hospital-based care can accommodate, both from the standpoint of available beds and available funding.

Dr. Ellis: The most exciting current development by far, in my view, is the growing body of research showing that cultivating awareness and acceptance of thoughts and feelings provides an effective complement to more conventional psychotherapeutic approaches more focused on change. Although the desire on the part of both patient and therapist understandably tends toward reducing or eliminating unpleasant thoughts and feelings, experience (and research) tells us that trying to modify “private experience” is often ineffective and sometimes counterproductive. Consider the effort to get rid of a song in your head or force yourself to fall asleep: The harder you try, the less you succeed. Acceptance-oriented approaches such as mindfulness meditation, a centuries-old practice, teach us that some unpleasant states are simply part of being alive, and that by accepting the reality of our pain rather than struggling with it, we can actually reduce our suffering. Now that’s exciting!

Dr. Allen: Over the past few decades, enormous progress has been made in attachment theory and research. The prototype of attachment relationships is the mother-infant emotional bond; yet we all need secure attachments throughout life to flourish. The essence of psychological trauma, as I think about it, is being alone in the midst of unbearable emotional pain without any prospect of solace in a relationship with a person who can empathize with that pain. Thousands of research studies have yielded a wealth of knowledge about secure and insecure attachment relationships throughout life, from infancy to adulthood. I am excited by the fact that this knowledge is beginning to inform not only the practice of psychotherapy with adults but also the fields of parent-infant and parent-child psychotherapy.

Happy birthday to you,
Happy birthday to you,
Happy birthday, dear SayNoToStigma.com,
Happy birthday to you!

That’s right–our blog just turned 1 year old. We’ve had a great first year, and we want to give a special “shout out” to all our many readers. Your comments have been particularly rewarding, and we do appreciate you taking time to read our posts and participate in our blog. Without you we wouldn’t be where we are today.

We hope you’ll keep coming back to our blog throughout our second year, since we’ll be introducing some new bloggers and publishing some different types of posts. Who knows, we may even have more guest bloggers joining us this year.

So thanks for all your support during the last year, and here’s to many happy returns for SayNoToStigma.com and its loyal readers!

It’s been four days since Jared Loughner allegedly took aim at Congresswoman Gabrielle Giffords, critically wounding her and 13 others and killing six people, including a 9-year-old girl. Which means it’s been four days of non-stop news coverage and water-cooler conversation about the tragedy. Four days of what-ifs, whys and finger pointing.

Everyone seems to be trying to make sense out of something so, well, senseless.

My fear is that the effort, while noble and worthwhile, will be futile. I hope I’m wrong about that, and rest assured,  I appreciate those who try. Of all those sharing their opinions and thoughts, two–Jon Stewart and Walt Menninger, MD–have had a big impact on how I’ve been processing the events of last Saturday.

Jon Stewart (AKA Edward R. Murrow’s successor)

No, he’s not a mental health professional, a religious leader, a politician or even a poet laureate, but for my money, Jon Stewart claimed the moral high ground on Monday’s episode of The Daily Show. In his monologue, he put aside his usual humorous take on political shenanigans to speak from the heart about the shootings. He was eloquent, moving, thoughtful and thought-provoking.

I think he spoke for many who wonder if the state of our politics, which he described as “toxic” and “unproductive,” caused this young man to resort to violence. On the other hand, I wonder if we might be tempted to lay the blame squarely on mental illness and call it a day. If we do that, we give ourselves a pass to avoid reflecting on how our political rhetoric–whether left, right or center–impacts others. Which would be a real shame.

Stewart’s decision to acknowledge that “crazy is rarer than you think” was an important one. Research has shown that people with mental illness are rarely violent; so I’m glad he used his national platform to make that point clear. Plus, we need to make sure that this collective outrage and grief we’re experiencing leads us to make better decisions about how we as a society handle “crazy.” Maybe we’ll even be willing to devote more resources to mental healthcare as a result.

Walt Menninger, MD

First, we had Dr. Menninger’s New Year’s message, which I thought was a great way to start 2011. Then along came the horror of Saturday, which resulted in a great opinion piece by Dr. Menninger in the Topeka Capital-Journal. Not surprisingly, in light of what I know about him, it was an elegant and balanced testimony about our propensity for violence and what we can do about it.

I thought he summed up the debate we’re having about why this happened quite nicely:

“…media commentators focused on what they felt contributed to the event, with special reference to the inflammatory commentary that seemed to encourage aggressive action in the recent political campaigns. Some felt the commentary encouraged such action, while others exculpated inflammatory rhetoric as freedom of speech.”

As it turns out, Dr. Menninger knows his subject. Not only is he an eminent psychiatrist, he was one of 13 members of the National Commission on the Causes and Prevention of Violence established by President Lyndon B. Johnson following the assassination of Senator Robert F. Kennedy.

The commission undertook an extensive review of violence in America, and in case you didn’t know, there’s been a lot of it. And we’ve learned a lot about it, too, including what conditions can lead to violence, even of the political kind. One such condition, from a 1969 task force report, is described as: “a weakening of shared democratic values, or a crisis in which the democratic institutions are incapable of taking effective remedial actions.”

Referencing the last two years of political discourse in America, Dr. Menninger said:

“There has been a great deal of defamation and vilification by commentators on one extreme or the other who make sarcastic and demeaning observations about persons with contrasting opinions. There have been repeated references suggesting violent action as a way to deal with an opposing viewpoint. And there is no shortage of individuals who are both vulnerable mentally or emotionally to such rhetoric, and who have access to a means to take some action about it.”

So true and so sad.

As for the future

For me, the bottom line is this: when mental illness meets up with inflamed rhetoric, you don’t want to be around because no good can come of it. I’m not a clinician, and I’ve never met Loughner; so I can’t say if he really does have a mental illness at all. I also, like Jon Stewart, can’t draw a straight line from pundits’ public statements to shots being fired at innocent people.

But I would like to hope that we will all take greater care choosing our words when talking politics at the dinner table, around the water cooler and in the media. Doing so might just make this country a safer place in which to exercise our right to free speech. It also might give some other 9-year-old fascinated by politics the chance to grow up and actually vote one day. Wouldn’t that be nice?

Editor’s note: For more on the tragedy in Arizona, check out:

• Forensic psychiatrist praises judge’s letter to the New York Times
• To stop violence, we must start with ourselves
• Giffords shooting calls for measured, rational response

In just a few weeks, Menninger will host its second annual Patient Alumni Weekend, which is kind of like a class reunion, only without the alcohol.

Promoting this event got me thinking about last year’s inaugural event. Although I’m not a reunion going kind of girl (I’ve never been to my high school or college or grad school reunions), I went to help out and ended up sitting in on a few of the presentations, one of which was given by my fellow blogger Jon Allen, PhD, who writes a lot about attachment, mentalizing and POT (no, not that kind—the Plain-Old-Therapy kind).

At first I felt a bit funny about going to the presentations: I’m not a former patient, although some probably wish I were, and I was worried I might feel like I was invading the privacy of these former patients.

Well, I went anyway, and the truth is, it was the single most powerful, moving experience I’ve had professionally in the nearly three years I’ve worked at Menninger.

Change is possible

For one thing, getting to hear some of these folks talk about their lives after treatment was amazing. Yes, some still had their struggles—no surprise given the recurrent nature of severe mental illness—but many were clearly relishing newfound balance and hope.

One young woman talked about how dramatically her life had shifted in the previous year or so—something she said she never would have thought was possible before treatment. She moved halfway across the country, enrolled in a new school and found a job. She even used the word “happy” to describe herself. If you could have been there to hear how her spirit seemed to sing as she recounted the changes, you’d probably think what I thought at the time: AMAZING.

Stigma comes in different measures

For another thing, it was fascinating, albeit painful, to listen to former patients talk about how the stigma that still surrounds mental illness—maybe even especially for those who’ve been hospitalized—affected them.

Before I heard this discussion, I guess I was naïve enough to think stigma was an equal opportunity issue and that all mental disorders engendered the same level of stigma. Clearly I was wrong: Many of the former patients had struggled with multiple disorders and/or an addiction, and I learned that some were more comfortable sharing with family, friends and colleagues information about one, but not another, of their disorders.

For instance, one alumna said she preferred to keep to herself that she was treated for alcoholism, but that she was comfortable sharing with her co-workers, neighbors, family members, etc. that she had been treated for a mood disorder. But for another alumnus, it was just the opposite: he said he willingly shared that he was an alcoholic, not that he was treated for depression.

Listening to these former patients talk about this made me glad about three things:

1. They had a safe place to talk about these things (and its corollary: Safe places, like safe houses, are not just necessary, they’re very valuable real estate).
2. I had the chance to learn about stigma from their perspectives.
3. I had my eyes opened to just how complex the issue of stigma is.

Which is to say that we must keep talking about stigma and mental illness. Because if it keeps folks like that young woman who’d sought treatment and turned her life around from sharing their stories of recovery and renewal, we’ll never be free of the spirit-crippling, mind-numbing shame that is stigma. And that would be a shame.

A colleague sent me a recent David Brooks’ op-ed from the New York Times about Alcoholics Anonymous (AA) and its founder, Bill Wilson. And like a good op-ed does, it got me thinking; specifically, it got me thinking about two things:  1) how challenging it can be to overcome an addiction, bipolar disorder, borderline personality disorder or any other mental illness, and 2) how grateful I am that Brooks used his column to highlight AA’s profound impact while acknowledging the complexities of treating addiction, despite considerable advances in brain research and the mental health field.

In the piece, Brooks says “in a culture that generally celebrates empowerment and self-esteem, A.A. begins with disempowerment.”  True enough. And it’s my guess that is partly because mental illness, including addiction, is disempowering. It robs individuals of sound judgment, energy (unless, of course, you’re someone who experiences mania), direction, focus, hope, etc.

I’d even go so far as to say that this disempowerment is the definition of “rock bottom,” a common-enough phrase these days, which in my mind can only be a place of abysmal, unadulterated loneliness. It’s no place for a loved one, or even, dare I say it, an enemy.

Rock bottom

Once in, there’s only one way out and that’s up. And the only way up is through the good strong grip–maybe physically, definitely symbolically–of another person’s hand. In all likelihood, that hand will belong to a stranger, perhaps even to one of the 1.2 million members of AA, each of whom could probably teach the rest of us a thing or two about “rock bottom.”

Which leads me to another powerful statement of Brooks:  “Individual repair is a social effort.” When AA proves successful for one of its members, that success is predicated on the idea of social effort.

This makes sense to me, just as its opposite does:  individual disrepair is a social effort, too.

Between nurture and nature we’re each shaped by things beyond our control–not always entirely, of course, but often enough. These things (childhood abuse, death of a loved one, extreme poverty, family genetics, etc.) have a great affect on us as we mature and become independent adults (or at least try to).

Sometimes the convergence of these things makes us vulnerable as adults to addiction and mental illness. No one ends up dealing with alcoholism or mental illness because they’ve been living in a vacuum; so we shouldn’t expect people to overcome these problems on their own either. And when you get right down to it, the mental health profession has always been a social endeavor between patient and clinician. I mean, Freud wasn’t analyzing imaginary patients on his couch all those years ago….

Milieu therapy

At Menninger, you hear a lot of talk about milieu therapy, which is, according to the Oxford Pocket Dictionary of Current English 2009, psychotherapy in which the patient’s social environment is controlled or manipulated with a view to preventing self-destructive behavior. It may sound like a fancy term for group therapy, but it’s far more than that.

Patients here live for weeks with one another and often see each other at their worst. Because they spend so much time together, they reap the benefit of becoming, as Brooks describes AA members, “deeply intertwined with one another–learning, sharing, suffering and mentoring one another.” They see–and feel–the importance every single member of the group has on the rest of the group. It’s pretty potent, healing stuff, and it’s the social effort of the group members that makes it possible.

I’m really glad that someone as prominent as Brooks shared some of the history of AA. He’s got a big following, and it’s not everyday that addiction finds its way into such valuable real estate as this prestigious op-ed column. It’s clear that the stigma surrounding people with addiction, particularly alcohol addiction, has decreased dramatically since AA was founded, and I think Brooks has, whether he intended to or not, whether he knows it or not, has further destigmatized addiction by devoting a column to the topic.

Now if borderline personality disorder, bipolar disorder, PTSD, schizophrenia and all the rest of diagnoses in the world of mental illness can find their versions of Bill Wilson soon, there’ll be more and more of us who will find ourselves just saying “no” to stigma. Plus, Brooks will have more great stories to tell in future columns, and I, for one, am looking forward to reading them.