America: Where It's Easier to Get a Gun Than Good Mental Health Care
Last spring my younger sister Kathy jumped off a freeway bridge in Phoenix. For better or worse, she lived. Kathy made her first suicide gesture in high school, when she took a handful of, I think, aspirin in reaction to a bad haircut. At the time, she was already, obviously, mentally ill. In middle school, anorexia had drawn her down to a skeletal 38 pounds. Her hair fell out. Her sunken face took on a plastic texture from fat-soluble vitamins that her body couldn’t process. Force-feeding brought her back from the brink, but couldn’t heal her. In the years since, even during three pregnancies, she has never topped 100 pounds, nor has she ever been free of compulsions, body-loathing or debilitating bouts of depression.
Since that first handful of analgesics, Kathy has made an effort to die somewhere between 12 and 15 times: prescription pills, threatened jumps from an apartment balcony and a communications tower, an attempt at drowning, a car set on fire. Kathy is alive because even in the heart of Arizona’s Wild West no one will sell her a gun; a fact she finds immensely frustrating at times that her bipolar illness takes her into another trough of despair.
For three days, Seattle has been reeling, grieving a wave of senseless violence that left five dead, including a shooter who was, from his family’s description, bipolar like my sister. Mentally ill women are most likely to exit this world alone or try to take their children with them. Some men prefer to go out in a blaze of rage and blood. Either way, access to a gun makes the impulse more lethal. Firearms are two and a half times more effective than the next method of suicide, suffocation. According to Centers for Disease Control statistics for 2003-2007, gunshots represented only 3 percent of suicide attempts, but almost half of fatalities. So far this year, over 40,000 people in the U.S. have been shot. By December 31, we can expect to bury about 9,500, each dead at the hands of someone pulling a trigger. Guns were designed to be effective, efficient killing machines, and they work very well.
When someone kills – we ask why? It’s a worthy question. A part of the answer that haunts me (because it seems so preventable) is the way we choose as a society to prioritize our resources. We build for-profit prisons across the country, with lock-up room for minor drug offenders. But while prisons are growing, prevention and treatment services are disappearing.
As a psychologist, I used to have an outpatient mental health practice in Seattle. By the time I quit, it was almost impossible to get public mental health services for a person who hadn’t been diagnosed with a chronic mental illness or acute intent to harm. I told one desperate and suicidal young woman with no health insurance that she could get inpatient treatment if she was willing to go in front of a judge and swear that she intended to hurt herself or someone else. She disappeared, and I didn’t know for weeks if she was still alive. Relentless cuts in funding and services over the last 20 years mean that psychiatrists, psychologists and caseworkers are under constant pressure to pretend someone is more intact than they actually are.
The state of Arizona spent close to a million dollars last year putting Kathy back together after she fell 49 feet. By contrast, they spent a pittance, a few thousand on follow-up mental health assessment and treatment. Kathy’s car-on-fire incident was triggered by her SSI and Medicare being cut off because she had earned a couple hundred extra dollars working at Target over the holidays. Desperate to cut costs, the Social Security administrators decided that she wasn’t actually disabled--this is despite the fact that she has repeatedly ended up in restraints at state and county hospitals.
But even the best mental health treatment in the world won’t prevent some people from just losing it. There are going to be people who want to die. There are going to be people who want to kill. Most of the time the impulse passes. Whether someone dies before it does depends largely on the tools at hand.
I once traveled with a handful of young adventurers and a couple of fishermen in an open skiff from southern Belize to Honduras. In the middle of the night, we stopped on a small offshore island for hot drinks. There we were greeted by a wiry black man in his 60s. A deep scar ran across his face, from cheekbone to chin. Another deformed one arm. He was missing digits. He told us that as a young man he had been attacked with a machete.
I was fascinated and horrified by his graphic story, and one thought embedded itself permanently in my mind: It takes a lot of effort to kill someone with a machete. But with a gun, it takes very little.