We need to talk about mental health. And we need to talk about gun control.

“We don’t yet know why this individual did what he did, and it’s fair to say that anybody who does this has a sickness in their minds. But we are not the only country on Earth that has people with mental illnesses who want to do harm to other people. We are the only advanced country on Earth that sees these kinds of mass shootings every few months . . . Each time this happens, I am going to say that we can actually can do something about it, but we’re going to have to change our laws. I hope and pray that I don’t have to come out again during my tenure as president to offer my condolences to families in these circumstances. But based on my experience as president, I can’t guarantee that — and that’s terrible to say. And it can change.” – President Obama

Yesterday another mass shooting occurred at a college campus in Oregon. Our President gave a speech – the 7th speech on a mass shooting that he has had to give during his tenure – and suggested that we, as a nation, have become number to this occurrence. That the reporting of it has become routine. That our reactions and conversations in the aftermath have become blunted. I have to say, I agree. However, I’m going to try to keep talking about my concerns, because this kind of tragedy is never routines for the families who have lost loved ones. We don’t yet know what was going on for the individual who killed ten students this week, but there are many who are waiting for an explanation that could deflect from a conversation about gun control. There are many who are waiting for a mental illness diagnosis to emerge so they can wash their hands of a conversation about gun control and blame the lack of services for people with mental illness. As a therapist, I heartily agree that mental health needs to be available to everyone, regardless of ability to pay. I want nothing more than to see our country step it up in that regard. However. I don’t believe that better access to mental health services will solve the problem of gun violence. I’m going to do my best to illuminate the unique issues of mental health in relation to violence, and why I’m skeptical of focusing our attention on mental health instead of gun control as it relates to mass shootings. We need to talk about mental health. And we need to talk about gun control. [source] I think it’s important to key in on the specific mental illness that is relevant to someone who would open fire on a group of strangers. While I can’t give a formal diagnosis since I‘ve never seen any of these people in treatment, the FBI did conduct some research into the kinds of people who commit such crimes, and found that most of these mass murders are committed by criminals who fall into three groups: psychopaths, the delusionally insane, and the suicidally depressed. In most cases, perpetrators of mass crimes were not in an active psychotic state.  In most cases, the perpetrator premeditated the crime, planning willfully in advance as opposed to acting impulsively. In most cases, the perpetrator was described as a loner with few friends. Most were also described as intelligent.  In every case, the perpetrator exhibited a shocking lack of empathy.  In diagnostic terms, we would refer to psychopaths as having Antisocial Personality Disorder, whereas those suffering from delusions might be diagnosed with Schizophrenia. Here are some of the problems with demanding accessibility to treatment as a prevention tactic for the scourge of mass shootings that plagues our country: Most people with Antisocial Personality Disorder or Schizophrenia do not seek treatment. In fact, not only do they not seek it out, they are usually completely resistant to it, and find ways to avoid it.  The reason for this is that sociopaths are convinced that there is nothing wrong with them. They usually have a heightened sense of their own mental state. With most mental illness, the person suffering has both subjective and objective issues.  For example, a person with depression experiences it subjectively (“I feel bad”) and those around them experience it objectively (“You seem depressed”).  With Antisocial Personality Disorder (and many of the personality disorders), that subjective experience of distress is lacking. While those around them may experience them as cold, calculating, manipulative, or cruel, the sociopath believes himself to be just fine. Similarly, people with schizophrenia may feel some disturbance, but are likely to view the disturbance as an external problem rather than something internal  that requires treatment. Antisocial Personality is a chronic, lifelong condition with a poor treatment prognosis, and Schizophrenia is a late-onset mental illness that is usually chronic as well. In the Diagnostic and Statistical Manual (DSM) that doctors and therapists refer to for diagnosis of patients, there are two categories under which mental health issues can fall.  Axis I refers to most mental health issues, and includes things like depression, anxiety, bipolar disorder, and schizophrenia. Axis II refers to lifelong conditions that are considered difficult to treat. This includes mental retardation, borderline intellectual functioning, and the personality disorders (including APD).  It’s not to say that these people won’t benefit from therapy. But with mental retardation and personality disorders, most therapists accept that you are not going to “cure” the patient or even be able to treat the condition. Rather, you will offer support and resources and behavioral interventions for people living with these conditions. I wouldn’t go as far as to say that antisocial personality disorder is untreatable. But I will say that most with this disorder are unresponsive to treatment, and that many with this condition use therapy as a milieu to practice manipulation rather than as an opportunity for growth. S Antisocial Personality Disorder is difficult to diagnose. Most people with APD will never receive a formal diagnosis. There are many reasons, but primarily it’s because they don’t tend to seek treatment or view themselves as having an issue. Therefore, they avoid contact with mental health professionals who would be able to offer a diagnosis. Friends and family may notice that something is “off”, but they will likely view it in terms of negative character traits “He’s so insensitive”, “She is really manipulative”, “He has serious intimacy issues”, etc. Since antisocial people can be superficially charming, and because they tend to be highly intelligent, they can usually fool people . . . even professionals. We cannot legislate treatment or isolation of people with APD or Schizophrenia. They will always be in the general public, and most of the time they will go undiagnosed.  We cannot force them into treatment. We cannot isolate them.  We cannot go on a witch hunt, trying to diagnosis every person we know who struggles with intimacy or empathy as being a sociopath.  So what can we do?  

We can change our gun laws to make sure that only mentally competent people can own a gun.

Would this be challenging? Yes. Would it require people to pay more out of pocket to obtain a gun? It would. Might I have to pay some more taxes for this? Yep, but I’m willing.  If I have to take a test to prove my ability to safely operate a motor vehicle, it only makes sense that we would apply the same criteria to gun possession in our country. It’s the best way to rule out people with mental health issues that are highly correlated with antisocial and violent behavior.  Here are some ways that we could do that, while maintaining 2nd amendment rights for a majority of the population. Require an MMPI to possess a gun. The MMPI is a time-tested, scientific diagnostic tool widely used by psychologists to determine a person’s mental state. It is excellent at catching antisocial tendencies, as well as psychotic tendencies.  It would be an easy and cost-effective way to rule out people who shouldn’t be gun owners, and I think this step would be a small price to pay for those who want to own a gun, but who have enough decency to want to keep them out of the hands of people who would misuse them. And while I’m focusing on mass shootings, I will note that the MMPI could also rule out people who have issues that are highly correlated with suicide or other violent behaviors. Require three references to possess a gun. This step is required in many countries, and could be very effective. Most people with antisocial behavior are loners, and those they are in relationship with probably see some of their sociopathic tendencies.  Requiring a reference letter from three people that asks pointed questions in regard to their mental state would be one more measure to ensure that sociopaths are weeded out. Require that gun owners be educated on APD and other violent markers.  In most cases, perpetrators of mass killings either obtain a gun themselves, or use a gun owned by family or friends. It would be helpful, then , to require that anyone seeking to own a gun be educated for the warning signs of violent tendencies. Many people may not connect the dots, and requiring education could be the measure that clues a parent in on a potential threat and is therefore more careful with their weapons. Require that gun owners demonstrate how their firearms will be inaccessible to family, friends, and roommates. Too often, personal firearms are stored in ways that allow access to others. My parents were gun owners, and I knew exactly where the gun was in our house.  This can encourage not only intentional, violent crime, but also unintentional gun accidents. I think we need to change laws so that guns must be on your person or in a lockbox.  Better yet, require that guns be sold with a lockbox. Limits the types of firearms and the  amount of ammo that can be purchased. As I mentioned before, most mass shooters have purchased both their guns and their firearms legally. In most cases, assault rifles have been used to carry out mass shootings. It makes sense: that’s what these guns were created for.  I have to ask, then, why is such a weapon available to the general public?  Guns should be used for hunting or for self-defense. I don’t think our forefathers had any concept that their words would be used to invoke a person’s right to own a machine that allows them to kill dozens of people in a few seconds. There are many compelling arguments to banning assault weapons, and I think it’s time for us to assess, as a nation, why we are allowing such guns to be legally sold in our country.  I would agree that a madmen hell-bent on killing a lot of people is going to find a way. But we can make it harder for them but not having these guns available. I think the comparison of the man in China who attempted to kill children with a knife is an example. If you compare the death toll between Newtown and this incident, it’s a compelling reason to outlaw assault rifles. I also think we should limit the amount of ammo that can be purchased, and the amount of bullets that a single gun can shoot before reloading. I can’t think of a single legal incident that would require a gun owner to shoot off 50 rounds before reloading. And yet, this week certainly reminds us why this kind of ammunition is problematic. Senator Feinstein is introducing a bill to the Senate that will ban the sale, transfer, and the possession of assault rifles, as well as big clips, drums or strips of more than 10 bullets.  I think this is reasonable. If you do, too, I urge you to lead your political leaders know. I’m not going to pretend like these measures will solve all of our problems. We will always have madmen living in the general population. However, we can make it more difficult for them to obtain guns. And while it may not keep guns out of the hands of all criminals, it might keep them out of the hands of sociopaths. See . . . sociopaths are not common criminals. They don’t run in circles of criminals. They are loners, and usually buy their weapons legally or take them from a friend. They don’t have connections with people who sell illegal firearms. They don’t have many connections, period. And while they could still obtain a gun illegally, I think it could be a deterrent. Of course, the common criminal will still have access to guns, but the common criminal is typically not bent on killing random civilians. And again, I’m not saying we criminalize guns. I’m saying we rule out the people who shouldn’t have them so they cannot buy them legally. I do believe that making mental health treatment more accessible will prevent some types gun violence. Suicide, domestic violence, “crimes of passion” . . . there are many types of violence that could potentially be circumvented by counseling. In addition, better access and support of families and children with mental health issues could even prevent some children from developing APD, which begins in childhood. But we can’t end there. It’s not enough. It doesn’t address the horror that can be wreaked by a sociopath with a gun. We need to talk about mental health. And we need to talk about gun control. This isn’t a partisan or a political issue, though some will pretend it is. This isn’t a 2nd amendment issue, though some will cry that it is. I think the ideas I’ve outlined above are things that can keep both gun enthusiasts and gun control ideologists happy. But we’ve got to do something. The events of this week illustrate that we can’t keep making excuses. We need to call our legislators into action.  If you agree, I hope you will share this with your friends, but more importantly with your congressional leaders. It’s time to speak up. If my child was one of the fallen, it’s what I hope you would do for me.  It’s what survivors are asking us to do, too.  Even pro-gun, NRA-promoted politicians are calling for change. Guns don’t kill people. But guns in the hands of madmen do. Let’s keep them out of their hands.

PRESS RELEASE: Blogger loses will to write/live after being asked to weigh in on proposed gay discrimination laws

Kristen Howerton, the blogger who regularly writes here, has reportedly given up the will to continue blogging after being faced with writing yet another post about Christians behaving badly towards gay people. The blogger, who has written many times on the topic of how Jesus would respond to the LGBT community, received numerous requests to weigh in on the discriminatory bills being proposed in Arizona, Kansas, Georgia, South Dakota and Tennessee. And while her level of outrage would typically motivate her to respond, this time was different. “I cannot *$#@ing even,” she was heard mumbling as she walked away from her laptop. fall winter 2013 267 Howerton and family in happier times, before she’d heard of SB 1062. In an interview, Howerton disclosed that initially, she believed the proposed bills to be a hoax from a satire news site. When she realized that some conservative Christians were actually proposing a Jim Crow-type law that would make discrimination legal on the grounds of someone’s sexual orientation, Kristen said, “Something inside me just broke. And the constant requests for me to weigh in on the matter just made me want to lay down and take a nap. So I did. And then I watched Paul Rudd lip-syncing and a couple episodes of the Mindy Project and felt a little better about the world. That’s when I realized . . .  I just want to watch mindless crap on YouTube and pretend this isn’t happening.” As Howerton was faced with the prospect of writing yet another post gently reminding Christians of their duty to love others, she suddenly felt that she could no longer go on blogging. “I just cannot handle writing one more response to this kind of ignorance,” she said. “I quit. Rachel Held Evans can handle this bull$%@#.” When asked if perhaps her hetero-privilege was showing by writing a post that focused on how these laws affect her blogging as opposed to the ACTUAL victims of the law, Howerton conceded that perhaps she was, in fact, minimizing the real pain and suffering that this would cause for gay residents of said states. “Look, I know it will be difficult for them. But I went with this ‘press release’ literary device in the hopes that the absolute absurdity of it all could perhaps sway the minds of some of the folks behind this madness.” Howerton went on to detail the many times she has addressed bigotry towards the LGBT community at the hands of Christians. She maintains that satire was her only hope, since previous attempts at using logic, compassion, and the ACTUAL WORDS OF OUR LORD AND SAVIOR JESUS CHRIST had not put an end to the hate. Tune in tomorrow when Howerton gouges her eyeballs with a steak knife while considering how to respond to another unarmed black teen being shot by a scared white man with a gun.

The Kermit Gosnell trial: we’re asking the wrong questions

warning: this post contains graphic details about abortion and infant demise

Over the past week, I have learned about the trial of Kermit Gosnell, the Philadelphia abortion provider who has been accused of delivering full-term babies and killing them by snipping their necks. Like everyone, I have been horrified by the grisly details of his practice. A part of the grand jury report provides harrowing details of the clinic:

This case is about a doctor who killed babies and endangered women. What we mean is that he regularly and illegally delivered live, viable, babies in the third trimester of pregnancy – and then murdered these newborns by severing their spinal cords with scissors. The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths.

The story is shocking, and I learned about it last week, as many people did, when twitter and facebook were flooded with questions about why the case was not being covered in the mainstream news cycle. I had many, many people emailing me and messaging me to please write about this story. But what most people wanted me to cover was not even the story itself, but the angle of the mainstream media cover-up. Most of the posts I saw were in reference to the media silence as well. I’m clearly going to disappoint a few people who assumed that I would corroborate the media conspiracy, but I don’t believe this was the case. If you disagree with me on this, I really hope you will keep reading, because I think we can agree to disagree and then move on to more pressing matters about this story. (Also? Full disclosure: I’m not a fan of abortion. If you disagree with me on that, I also request that you keep reading. I think there are questions about this case that we can all ponder, regardless of our political persuasion in regards to abortion.)  I’ll address the media coverage, but then I want to address a  more important question, one I think should be more important than media coverage: Why did this happen? I am as outraged by this story as anyone. In fact, the first day I read about it I had to close my laptop because it was making me physically sick. When we feel outrage, when we see an injustice, it’s a normal response to look for someone to blame. For many of you, the media became that target. But the media did not make this story happen. The media could not have prevented this. I think we need to figure out where the culpability really lies. In addition to writing for this blog, I have done freelance work for a couple major news outlets. I am openly Christian. I am opposed to abortion morally. I also know other Christians, and pro-life people, who write at nearly every major news outlet I can think of. I know it is easy to point the finger at the “Main Stream Media” as some kind of monolithic liberal propaganda machine, but when you do that you are forgetting that it is made up of individuals of varying viewpoints. There is no giant staff meeting of the MSM in which stories are approved or slashed based on political agenda. There are writers, and there are editors, and everyone . . . EVERYONE . . . is chasing the story.  And what drives the story? Popular demand. Not politics. After the topic started trending on twitter, I saw most major news outlets pick it up. In fact, most of the news sites I read have done several stories on it since then. So if it wasn’t highlighted before, it’s because when the news broke in 2011 (and it WAS covered then), few people paid attention. The story fizzled. We cannot blame the media for this. And let me also point out . . . there are stories of murder and injustice EVERY DAY that do not get attention. If we want to play the game of shocking stories that the media and public ignore, we could be here all day. Remember – the Trayvon Martin case was ignored for weeks until social media made it a national story. But there are plenty of stories of injustice that never make national news. Why some news outlets ran with this story and others didn’t is based on a variety of factors, but the fact remains that it gained little coverage on both MSM and conservative media outlets, with a few exceptions.  I have plenty of friends (and family) who watch FOX news on a regular basis and this story was a shock to them as well.  I did an informal poll on facebook, and most of my readers had never heard of it. The few that had either learned about it from a pro-life site or a feminist site (the most popular answer being Jezebel.com or Feministing). This story  isn’t new . . . Gosnell was arrested in 2011, and the story broke then. It was covered on several major news outlets then:
image [source] Between then and now, it didn’t get a lot of attention until this week, and I tend to agree with Salon’s analysis:

If you’ve never heard of the Gosnell story, it’s not because of a coverup by the liberal mainstream media. It’s probably because you failed to pay attention to the copious coverage among pro-choice and feminist journalists, as well as the big news organizations, when the news first broke in 2011. There would be something rich, if it weren’t so infuriating, about these (almost uniformly male, as it happens) reporters and commentators scrambling to break open this shocking untold story. You know, the one that was written about here, here and here, to name some disparate sources. I can’t speak for big news organizations like CNN and the networks, but let’s think about this question another way: How often do such places devote their energies to covering the massive health disparities and poor outcomes that are wrought by our current system? How often are the travails of the women whose vulnerabilities Gosnell exploited — the poor, immigrants and otherwise marginalized people — given wall-to-wall, trial-level coverage?

And according to the Washington Post, some outlets didn’t cover it because they simply didn’t know about it:

Martin Baron, The Post’s executive editor, offers a more mundane rationale for the newspaper’s lack of coverage: He wasn’t aware of the story until Thursday night, when readers began e-mailing him about it. “I wish I could be conscious of all stories everywhere, but I can’t be,” he said. “Nor can any of us.” The media appears to be responding to the criticism. CNN devoted multiple segments to the story Friday. CBS said it plans two segments and MSNBC will discuss the trial on its “Morning Joe” program Monday. The Post ran a full AP report on it in Saturday’s editions; the paper has also assigned its own reporter to cover the trial in Philadelphia this week.

I know that some people will disagree with me, but I don’t believe there was a media cover-up. But regardless of what we think about that . . . it’s time to move on. Quibbling over bias in the media is not the point of this story, is it? This is a story about a man who was putting women at risk, who is responsible for several deaths, and who murdered viable babies. The media isn’t culpable for that.  Who is? Let’s look further: From the grand jury report, which is available here:

Pennsylvania is not a third-world country. There were several oversight agencies that stumbled upon and should have shut down Kermit Gosnell long ago. But none of them did…The first line of defense was the Pennsylvania Department of Health. The department’s job is to audit hospitals and outpatient medical facilities, like Gosnell’s, to make sure that they follow the rules and provide safe care. The department had contact with the Women’s Medical Society dating back to 1979, when it first issued approval to open an abortion clinic. It did not conduct another site review until 1989, ten years later. Numerous violations were already apparent, but Gosnell got a pass when he promised to fix them. Site reviews in 1992 and 1993 also noted various violations, but again failed to ensure they were corrected.

But at least the department had been doing something up to that point, however ineffectual. After 1993, even that pro form a effort came to an end. Not because of administrative ennui, although there had been plenty. Instead, the Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all… The only exception to this live-and-let-die policy was supposed to be for complaints dumped directly on the department’s doorstep. Those, at least, would be investigated. Except that there were complaints about Gosnell, repeatedly. Several different attorneys, representing women injured by Gosnell, contacted the department. A doctor from Children’s Hospital of Philadelphia hand-delivered a complaint, advising the department that numerous patients he had referred for abortions came back from Gosnell with the same venereal disease. The medical examiner of Delaware County informed the department that Gosnell had performed an illegal abortion on a 14-year-old girl carrying a 30-week-old baby. And the department received official notice that a woman named Karnamaya Mongar had died at Gosnell’s hands. Yet not one of these alarm bells — not even Mrs. Mongar’s death — prompted the department to look at Gosnell or the Women’s Medical Society… But even this total abdication by the Department of Health might not have been fatal. Another agency with authority in the health field, the Pennsylvania Department of State, could have stopped Gosnell single-handedly. The Department of State, through its Board of Medicine, licenses and oversees individual physicians… Almost a decade ago, a former employee of Gosnell presented the Board of Medicine with a complaint that laid out the whole scope of his operation: the unclean, unsterile conditions; the unlicensed workers; the unsupervised sedation; the underage abortion patients; even the over-prescribing of pain pills with high resale value on the street. The department assigned an investigator, whose investigation consisted primarily of an offsite interview with Gosnell. The investigator never inspected the facility, questioned other employees, or reviewed any records. Department attorneys chose to accept this incomplete investigation, and dismissed the complaint as unconfirmed. Shortly thereafter the department received an even more disturbing report — about a woman, years before Karnamaya Mongar, who died of sepsis after Gosnell perforated her uterus. The woman was 22 years old. A civil suit against Gosnell was settled for almost a million dollars, and the insurance company forwarded the information to the department. That report should have been all the confirmation needed for the complaint from the former employee that was already in the department’s possession. Instead, the department attorneys dismissed this complaint too… The same thing happened at least twice more: the department received complaints about lawsuits against Gosnell, but dismissed them as meaningless…
Philadelphia health department employees regularly visited the Women’s Medical Society to retrieve blood samples for testing purposes, but never noticed, or more likely never bothered to report, that anything was amiss. Another employee inspected the clinic in response to a complaint that dead fetuses were being stored in paper bags in the employees’ lunch refrigerator. The inspection confirmed numerous violations… But no follow-up was ever done… A health department representative also came to the clinic as part of a citywide vaccination program. She promptly discovered that Gosnell was scamming the program; she was the only employee, city or state, who actually tried to do something about the appalling things she saw there. By asking questions and poking around, she was able to file detailed reports identifying many of the most egregious elements of Gosnell’s practice. It should have been enough to stop him. But instead her reports went into a black hole, weeks before Karnamaya Mongar walked into the Woman’s Medical Society. …And it wasn’t just government agencies that did nothing. The Hospital of the University of Pennsylvania and its subsidiary, Penn Presbyterian Medical Center, are in the same neighborhood as Gosnell’s office. State law requires hospitals to report complications from abortions. A decade ago, a Gosnell patient died at HUP after a botched abortion, and the hospital apparently filed the necessary report. But the victims kept coming in. At least three other Gosnell patients were brought to Penn facilities for emergency surgery; emergency room personnel said they have treated many others as well. And at least one additional woman was hospitalized there after Gosnell had begun a flagrantly illegal abortion of a 29-week-old fetus. Yet, other than the one initial report, Penn could find not a single case in which it complied with its legal duty to alert authorities to the danger. Not even when a second woman turned up virtually dead… So too with the National Abortion Federation. NAF is an association of abortion providers that upholds the strictest health and legal standards for its members. Gosnell, bizarrely, applied for admission shortly after Karnamaya Mongar’s death. Despite his various efforts to fool her, the evaluator from NAF readily noted that records were not properly kept, that risks were not explained, that patients were not monitored, that equipment was not available, that anesthesia was misused. It was the worst abortion clinic she had ever inspected. Of course, she rejected Gosnell’s application. She just never told anyone in authority about all the horrible, dangerous things she had seen.

I think it’s time to stop questioning the media, and start questioning the Pennsylvania Department of Health, the
Pennsylvania Department of State, and the Philadelphia Department of Public Health for their failure to shut this place down. Why are we focusing on what the media supposedly ignored when the very entities in place to assure this kind of thing never happens totally failed? There were numerous alarm bells on the way that should have warranted investigation, and yet he continued to practice. Is it because these departments were underfunded? Is it because the women involve were poor and uneducated and therefore effectively mute? What happened in the chain of accountability that allowed this to continue? And what about the women? I think that because this story is about abortion, it’s tempting for each side to use it as an illustration to prove their viewpoint. I’ve seen many pro-choice people try to use this as an example of what will happen if we regulate abortion too much. “Women go to clinics like these because they don’t have access”, they say. But this didn’t happen because there was no access to legal abortion. In Philadelphia there are a number of abortion clinics these women could have visited. This is not an issue of access. On the other hand, pro-life advocates want to wave it as an example of the atrocities of late-term abortion, but it’s important to note that Dr. Gosnell was performing illegal abortions (and infant murder).  In the state of Pennsylvania, abortion is only legal until 24 weeks of gestation. So while the debate over late-term abortion is valid, this story does not represent legal late-term abortion. It  represents the actions of a mad man. Let me be clear on this: I think late-term abortion is generally detestable. I think that there are a few cases where it is warranted . . . my friend Cecily had one such tragic experience. She experienced pre-eclampsia during her pregnancy (if you watched Downton Abbey, you will recall what this looks like) and had to terminate her pregnancy – her very wanted pregnancy – to save her own life. It was devastating. Late-term abortions are very rare, (less than half a percent of all abortions) and usually involve risk of maternal demise. They are generally not done for elective reasons or because a woman changes her mind. Which brings me to what I think may be the most important question here – what was going on for these women who came to see Dr. Gosnell? Why were they seeking abortions in their last trimester? I know people have varying views on abortion but I think (hope?) most of us agree that by the 7th or 8th month of pregnancy, we’ve past the point of reasonable decision making. So why is it that these women were seeking abortions so far into their pregnancy? It is unlikely that they were done as a result of some discovery about the baby, because fetal testing is quite expensive. And it seems that most of these women were in good health (at least prior to their abortion), so it doesn’t appear they were seeking an abortion because of a health risk. It’s reported that many of the women were recent immigrants. Most of them were poor. I have to wonder if their abortion was the first prenatal appointment they had during their pregnancy. They must have been desperate to seek an abortion at this point. Were they under pressure from boyfriends or family members? Were they unclear about how far along they were? Were they addicts in need of treatment? Were they in denial about being pregnant? The bottom line here:: I don’t think there is much we can do to prevent someone like Dr. Gosnell from preying on people again. We cannot always squelch evil, but men like Dr. Gosnell, one can hope, are rare. However, for that one evil doctor, there are hundreds and hundreds victims, and I think the victims are what we should focus on. How can we prevent women from being victimized in this way? I don’t like abortion. I am morally opposed to it. But I can concede that regardless of my personal feelings about it, women will continue to seek them. And I can acknowledge that I would prefer for women in desperate situations to have access to healthcare so that they can detect a pregnancy early on, and that there be an option, if they choose an abortion, for that to take place early in the first trimester in a safe medical atmosphere. Being pro-life, for me, means I cannot put my head in the sand about the fact the people will still have abortions if abortion is made illegal. It means I have to concede that it will be a reality. Perhaps this is a conversation those in the pro-life camp need to have. On the other hand, I think this case does illustrate that abortion performed on babies at the point of viability is morally reprehensible, and there are abortion techniques that are a technicality away from what Dr. Gosnell was doing. The details of Gosnell’s behavior towards infants he delivered are horrible, but I have to say that I was equally disgusted reading about the techniques of late-term abortion as I researched for this post. I am frequently disturbed by the causal attitude some pro-choice people have about late-term abortions. I’ve heard so many people say that such decisions should always be left to a woman and her doctor . . . but I think this story points to the need for safeguards. Do we really want to champion abortion on-demand at any stage of pregnancy, even when an infant is healthy and developed enough to live outside the womb?  Perhaps this is a conversation those in the pro-choice camp need to have. I don’t have all the answers here. I’m  just trying to shift the conversation away from the media.  I’ve been reading posts all week that have wrapped this whole story up as a perfect illustration for their case. I don’t think it’s that simple. There should be no glee in sharing this story as a talking point for our own convictions. At the same time, I think there are aspects of this story that require both sides to examine how we look at abortion and health care accessibility. Let’s stop focusing on the media, and start focusing on the victims: both the women and the infants who were hurt by Kermit Gosnell. How do we, as a society, respond?

The biblical definition of marriage and its relevance to marriage equality

Last week, as the Supreme Court began the conversation around California’s contested Proposition 8, social media outlets were buzzing with opinion over marriage equality. In an attempt to show solidarity and support for our LGBT friends, many people changed their Facebook picture to a red and pink image of an equal sign. I did this as well. marriage equality I noticed that, for many of us who run in Christian circles, this change was followed by a number of our Christian friends expressing dismay at our departure from the “biblical definition of marriage”. I watched as many people began to post scripture to argue their stance, pointing to bible passages that refer to homosexuality as sinful. What frustrates me most in this debate about marriage equality is that Christians feel so comfortable invoking the bible when we are talking about government matters. Our country was founded on religious freedoms. The right to worship (or not worship) is one that is afforded every person in this country. Most of us would agree that the separation of church and state was something our forefathers desired. And yet, so many Christians seem perfectly fine in using their own particular religious teachings while arguing about the rights of others living in this country. Since when did the biblical definition of something become the litmus test for state freedoms?  A Hindu person does not agree with a Christian’s biblical definition of God. And yet, most of us would agree that Hindus have the right to worship, congregate, and apply to the state to  enjoy whatever rights are afforded to a religious organization.  Their right to worship in their own way does not detract from mine, nor does it threaten me in any way. It also does not diminish my own definition of God to affirm and support their rights. This should apply to marriage equality as well. Guess what? If you affirm marriage equality, you can still think whatever you want to think about marriage, or homosexuality. You do not have to change your personal interpretation of scripture in order to affirm the rights of others.  You can read Genesis or Leviticus however you like and still agree that others have the right to behave outside of your own belief system. You can also find plenty of forums to discuss how to apply the bible to homosexuality. But the inconvenient truth is that government matters should not be that forum. The relevance of your biblical beliefs on homosexuality in regards to marriage equality? THEY AREN’T RELEVANT. When I see you arguing the bible against that red equal sign, what I hear you saying is, “I would like to impose my religious beliefs on others, regardless of whether or not they share my faith.”  I’ve heard a whole lot of nonsense about “slippery slopes” on Facebook this week, but this tendency to impose our religious beliefs on others is the most dangerous one I’m witnessing. image

the inconvenient truth about mental health and gun control

I’m still reeling from the tragedy that took place last week, trying to process the events and, like many people, wondering what can be done to prevent such a tragedy from befalling other families in our nation.  I’ve seen a growing conversation on the need for better access to mental health services.  As a therapist, I heartily agree that mental health needs to be available to everyone, regardless of ability to pay. I want nothing more than to see our country step it up in that regard. However. I don’t believe that better access to mental health services will solve the problem of gun violence. I’m going to do my best to illuminate the unique issues of mental health in relation to violence, and why I’m skeptical of focusing our attention on mental health instead of gun control as it relates to mass shootings. First, I think it’s important to do some research into the psychological state of the perpetrator of such crimes. To be honest, I don’t love the use of the term “mentally ill” when we describe such people, because mental illness is an umbrella term that includes depression, anxiety, biploar disorder, eating disorders, and any number of other conditions that warrant treatment with a therapist or that result in a DSM diagnosis.  It’s much too general a term to apply to violent behavior.  By that definition, because I struggle with anxiety, I would be under the “mentally ill” umbrella.  And again, while I’d love to see a national shift in treatment accessibility, I don’t think this is relevant to the conversation about killing sprees plaguing our nation. I think it’s important to key in on the specific mental illness that is relevant to someone who would open fire on a group of strangers. While I can’t give a formal diagnosis since I‘ve never seen any of these people in treatment, the FBI did conduct some research into the kinds of people who commit such crimes, and found that most of these mass murders are committed by criminals who fall into three groups: psychopaths, the delusionally insane, and the suicidally depressed. In most cases, perpetrators of mass crimes were not in an active psychotic state.  In most cases, the perpetrator premeditated the crime, planning willfully in advance as opposed to acting impulsively. In most cases, the perpetrator was described as a loner with few friends. Most were also described as intelligent.  In every case, the perpetrator exhibited a shocking lack of empathy.  In diagnostic terms, we would refer to psychopaths as having Antisocial Personality Disorder, whereas those suffering from delusions might be diagnosed with Schizophrenia. Here are some of the problems with demanding accessibility to treatment as a prevention tactic for violent crime: Most people with Antisocial Personality Disorder or Schizophrenia do not seek treatment. In fact, not only do they not seek it out, they are usually completely resistant to it, and find ways to avoid it.  The reason for this is that sociopaths are convinced that there is nothing wrong with them. They usually have a heightened sense of their own mental state. With most mental illness, the person suffering has both subjective and objective issues.  For example, a person with depression experiences it subjectively (“I feel bad”) and those around them experience it objectively (“You seem depressed”).  With Antisocial Personality Disorder (and many of the personality disorders), that subjective experience of distress is lacking. While those around them may experience them as cold, calculating, manipulative, or cruel, the sociopath believes himself to be just fine. Similarly, people with schizophrenia may feel some disturbance, but are likely to view the disturbance as an external problem rather than something internal  that requires treatment. Antisocial Personality is a chronic, lifelong condition with a poor treatment prognosis, and Schizophrenia is a late-onset mental illness that is usually chronic as well. In the Diagnostic and Statistical Manual (DSM) that doctors and therapists refer to for diagnosis of patients, there are two categories under which mental health issues can fall.  Axis I refers to most mental health issues, and includes things like depression, anxiety, bipolar disorder, and schizophrenia. Axis II refers to lifelong conditions that are considered difficult to treat. This includes mental retardation, borderline intellectual functioning, and the personality disorders (including APD).  It’s not to say that these people won’t benefit from therapy. But with mental retardation and personality disorders, most therapists accept that you are not going to “cure” the patient or even be able to treat the condition. Rather, you will offer support and resources and behavioral interventions for people living with these conditions. I wouldn’t go as far as to say that antisocial personality disorder is untreatable. But I will say that most with this disorder are unresponsive to treatment, and that many with this condition use therapy as a milieu to practice manipulation rather than as an opportunity for growth. S Antisocial Personality Disorder is difficult to diagnose. Most people with APD will never receive a formal diagnosis. There are many reasons, but primarily it’s because they don’t tend to seek treatment or view themselves as having an issue. Therefore, they avoid contact with mental health professionals who would be able to offer a diagnosis. Friends and family may notice that something is “off”, but they will likely view it in terms of negative character traits “He’s so insensitive”, “She is really manipulative”, “He has serious intimacy issues”, etc. Since antisocial people can be superficially charming, and because they tend to be highly intelligent, they can usually fool people . . . even professionals. We cannot legislate treatment or isolation of people with APD or Schizophrenia. They will always be in the general public, and most of the time they will go undiagnosed.  We cannot force them into treatment. We cannot isolate them.  We cannot go on a witch hunt, trying to diagnosis every person we know who struggles with intimacy or empathy as being a sociopath.  So what can we do?

We can change our gun laws to make sure that only mentally competent people can own a gun.

Would this be challenging? Yes. Would it require people to pay more out of pocket to obtain a gun? It would. Might I have to pay some more taxes for this? Yep, but I’m willing.  If I have to take a test to prove my ability to safely operate a motor vehicle, it only makes sense that we would apply the same criteria to gun possession in our country. It’s the best way to rule out people with mental health issues that are highly correlated with antisocial and violent behavior.  Here are some ways that we could do that, while maintaining 2nd amendment rights for a majority of the population. Require an MMPI to possess a gun. The MMPI is a time-tested, scientific diagnostic tool widely used by psychologists to determine a person’s mental state. It is excellent at catching antisocial tendencies, as well as psychotic tendencies.  It would be an easy and cost-effective way to rule out people who shouldn’t be gun owners, and I think this step would be a small price to pay for those who want to own a gun, but who have enough decency to want to keep them out of the hands of people who would misuse them. And while I’m focusing on mass shootings, I will note that the MMPI could also rule out people who have issues that are highly correlated with suicide or other violent behaviors. Require three references to possess a gun. This step is required in many countries, and could be very effective. Most people with antisocial behavior are loners, and those they are in relationship with probably see some of their sociopathic tendencies.  Requiring a reference letter from three people that asks pointed questions in regard to their mental state would be one more measure to ensure that sociopaths are weeded out. Require that gun owners be educated on APD and other violent markers.  In most cases, perpetrators of mass killings either obtain a gun themselves, or use a gun owned by family or friends. It would be helpful, then , to require that anyone seeking to own a gun be educated for the warning signs of violent tendencies. Many people may not connect the dots, and requiring education could be the measure that clues a parent in on a potential threat and is therefore more careful with their weapons. Require that gun owners demonstrate how their firearms will be inaccessible to family, friends, and roommates. Too often, personal firearms are stored in ways that allow access to others. My parents were gun owners, and I knew exactly where the gun was in our house.  This can encourage not only intentional, violent crime, but also unintentional gun accidents. I think we need to change laws so that guns must be on your person or in a lockbox.  Better yet, require that guns be sold with a lockbox. Limits the types of firearms and the  amount of ammo that can be purchased. As I mentioned before, most mass shooters have purchased both their guns and their firearms legally. In most cases, assault rifles have been used to carry out mass shootings. It makes sense: that’s what these guns were created for.  I have to ask, then, why is such a weapon available to the general public?  Guns should be used for hunting or for self-defense. I don’t think our forefathers had any concept that their words would be used to invoke a person’s right to own a machine that allows them to kill dozens of people in a few seconds. There are many compelling arguments to banning assault weapons, and I think it’s time for us to assess, as a nation, why we are allowing such guns to be legally sold in our country.  I would agree that a madmen hell-bent on killing a lot of people is going to find a way. But we can make it harder for them but not having these guns available. I think the comparison of the man in China who attempted to kill children with a knife is an example. If you compare the death toll between Newtown and this incident, it’s a compelling reason to outlaw assault rifles. I also think we should limit the amount of ammo that can be purchased, and the amount of bullets that a single gun can shoot before reloading. I can’t think of a single legal incident that would require a gun owner to shoot off 50 rounds before reloading. And yet, this week certainly reminds us why this kind of ammunition is problematic. Senator Feinstein is introducing a bill to the Senate that will ban the sale, transfer, and the possession of assault rifles, as well as big clips, drums or strips of more than 10 bullets.  I think this is reasonable. If you do, too, I urge you to lead your political leaders know. I’m not going to pretend like these measures will solve all of our problems. We will always have madmen living in the general population. However, we can make it more difficult for them to obtain guns. And while it may not keep guns out of the hands of all criminals, it might keep them out of the hands of sociopaths. See . . . sociopaths are not common criminals. They don’t run in circles of criminals. They are loners, and usually buy their weapons legally or take them from a friend. They don’t have connections with people who sell illegal firearms. They don’t have many connections, period. And while they could still obtain a gun illegally, I think it could be a deterrent. Of course, the common criminal will still have access to guns, but the common criminal is typically not bent on killing random civilians. And again, I’m not saying we criminalize guns. I’m saying we rule out the people who shouldn’t have them so they cannot buy them legally. I do believe that making mental health treatment more accessible will prevent some types gun violence. Suicide, domestic violence, “crimes of passion” . . . there are many types of violence that could potentially be circumvented by counseling. In addition, better access and support of families and children with mental health issues could even prevent some children from developing APD, which begins in childhood. But we can’t end there. It’s not enough. It doesn’t address the horror that can be wreaked by a sociopath with a gun. We need to talk about mental health. And we need to talk about gun control. This isn’t a partisan or a political issue, though some will pretend it is. This isn’t a 2nd amendment issue, though some will cry that it is. I think the ideas I’ve outlined above are things that can keep both gun enthusiasts and gun control ideologists happy. But we’ve got to do something. The events of last week illustrate that we can’t keep making excuses. We need to call our legislators into action.  If you agree, I hope you will share this with your friends, but more importantly with your congressional leaders. It’s time to speak up. If my child was one of the fallen, it’s what I hope you would do for me.  It’s what survivors are asking us to do, too.  Even pro-gun, NRA-promoted politicians are calling for change. Visit NBCNews.com for breaking news, world news, and news about the economy   Guns don’t kill people. But guns in the hands of madmen do. Let’s keep them out of their hands.