Evolution: 2013

Two recent horrifying events, the Newton massacre and the subway homicides, raise the topic of psychiatric treatment and the mental health system. Huge gaps become apparent.

Erika Menendez, who pushed an unsuspecting stranger into the path of an oncoming subway on December 27, had an extensive psychiatric history including episodes of violence, hospitalizations and arrests, yet the system provided little oversight of her activities or follow-up treatment.

Since the government began closing the residential psychiatric facilities in the1980's, there have been no facilities to provide long term psychiatric care for troubled individuals. As a result, many have ended up in jail.  Astoundingly, more Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. "We have criminalized being mentally ill," Sheriff Greg Hamilton from Texas said. And instead of saving taxpayer money, jailing the mentally ill proves to be more costly to the taxpayers than residential facilities.

The good news: we no longer burn witches at the stake. We have psychopharmacological treatments for individuals suffering from psychiatric disorders. We've closed the back wards of mental institutions where people lived long lives with no hope for treatment or release. The bad news: jails have become the residential facilities to house many of the seriously mentally ill.

In finding a solution, one shouldn't underestimate the importance of prevention. Dr. Rita Levi-Montalcini, the Nobel Prize winning scientist who died recently at 103. (The New York Times, December 31) offers some insight in her autobiography: "It is imperfection-not perfection-that is the end result of the program written into that formidably complex engine that is the human brain...and of the influences exerted upon us by the environment and whoever takes care of us during the long years of our physical, psychological and intellectual development."

Dr. Levi-Montalcini 's words support the fact that innumerable factors go into the development of each of us as complex, unique individuals. Beyond addressing the results of environmental and biological factors later in life, her statement opens up the subject and possibility of prevention.

And parenting can play a tremendous role in prevention. Yet no public school format exists to educate and instruct about child development and parenting. It is assumed that we know how to raise children. Yet the parent-child relationship is one of the most important, complicated and ever-changing ones. During more than thirty years of psychiatric practice, I have heard stories of many well-intentioned parents who commit grievous mistakes simply because they don't know better.

Conclusion:  Goals to address the prevention and treatment of mental illness and to teach principles of parenting will benefit us all and help to prevent violence. An understanding of the complexity of these problems would be best addressed from an integration of educational, psychiatric, economic and legal approaches (including gun laws; please see my blogs of Dec. 24 and 31).

Dear Reader: I welcome your opinions. jsimon145@gmail.com