The “Mental Health System” is NOT Responsible for Stopping Mass Shootings

Posted on November 8, 2017 by jcschildbach

JC Schildbach, LMHC

If your power was out, would you call up your dentist and cuss her/him out for not fixing your wiring? If your car wouldn’t start, would you say it was a problem for your plumber? If your spouse filed for divorce, would you seek the help of your dog-walker?

I’ll assume your answer is, “No.”

Yet, it has become a routine part of the American dialog that when mass shootings are committed, not only are we all immediately told by politicians not to ‘politicize’ such situations–politicians being those people in our society who are tasked with establishing law. But we are also told that such killings are a problem of the ‘mental health system’–which has no power to enforce law or even to make anybody get mental health care. All while law enforcement—which is, well, the means by which laws are enforced—is left out of the picture, except to say that if current laws were enforced, then we wouldn’t have such situations, and that no new laws are necessary.

In other words, pro-gun/pro-gun-lobby forces tell us that an issue properly dealt with by the legal system and law enforcement is actually a problem of the mental health system.

Think of all—or even a few–of the forms of human tragedy that involve human actions inflicting harm—or even death–on human victims.

How many of those types of violence are attributed to flaws in the ‘Mental Health System’?

We could eliminate terrorism if only we could fix the mental health system!

Drunk driving could be eradicated if only the mental health system would address the problem!

Embezzlement could be ended if only white-collar criminals had access to appropriate mental health services!

Child molestation is, at base, a mental health issue, not an issue of…what? Access to children?

Granted, it’s possible that terrorism, drunk driving, child molestation and white collar crime could potentially be reduced if those people who engage (or potentially engage) in such actions had mental health supports or other forms of guidance that led them away from those behaviors and toward more positive actions. But exactly when does anybody expect those supports to intervene, and in what form?

Gee, ma’am, we see you’ve been looking up ‘jihadist’ websites, would you maybe like some counseling to help you get those bad ideas out of your head?

Son, I notice you’ve had quite a few drinks, and your car is just outside. Perhaps if I could help you clarify your goals around driving right now, you might see that Lyft would be the better option.

Ma’am, it appears you might be toying with the idea of skimming funds from your clients. Would you mind talking with me for an hour or so, so we can map out some better life goals for you, that you then might be able to share with your friends and co-workers?

Sir, we’ve noticed you frequently hanging out just outside the Claire’s, and it seems you might be taking an unhealthy interest in young girls. Would you, perhaps, like some counseling to prevent you from ever molesting a tween?

Just so we’re all clear, mental healthcare is not predictive, except in the very narrow aspect of identifying factors that might make someone more pre-disposed to one behavior or another. But mental health interventions are rarely brought to bear, unless a person who is at risk for committing a particular act has had the foresight to seek out help her/himself, or the legal system has gotten involved because of harms already inflicted.

How many of the people who blame the shortcomings of the ‘mental health system’ for gun violence and mass shootings could give even a rudimentary explanation of what that ‘mental health system’ consists of, or offer any kind of reasonable, fact-based, evidence-based ideas that might offer even minimal improvements in the ‘mental health system’s’ ability to stop gun violence? How many of the ‘mental health system’ blamers can even explain how anybody would access mental health services…or be pushed into those services if they were a potential risk for mass shooting?

I’d guess that number is hovering somewhere between the number of arms on a rattlesnake, and the number of good sequels to ‘The Godfather’.

One major problem with the argument that the ‘mental health system’ can stop gun violence is that there is no way for the ‘mental health system’ to know who has guns and who does not, aside from the owners of guns (and perhaps their friends and family, where privacy laws don’t get in the way) telling providers in the ‘mental health system’ that they own guns—and that they intend to use them.

That is to say, unless the client of a mental health provider makes a fairly specific threat to use a gun or guns to kill somebody, or multiple somebodies, and the mental health provider knows that the client has access to those weapons, the mental health provider has very few options to stop such violence.

Hell, even in the presence of a specific threat, the mental health provider has few options other than to inform police, and hope the police can act to stop the person making the threats.

And, in case you’re wondering, the police have very limited powers to intervene where potential ‘mass shooters’ have a legal right to own guns, or when those potential shooters have not done or said anything that is actionable by police—like having made a specific threat to use firearms against specific people, and/or in specific places.

So the option to inform law enforcement is often little more than a mental health provider covering her/his own ass. ‘I made the call to 911 at exactly 8:19 p.m. on September 29, 2017, and spoke to operator #224.’ It goes in the client record, just in case it becomes relevant in a court case.

But the cops, like mental health providers, are not some pre-cog, future-crimes superstars, able to cull out dangers just by looking at people. And even those police and mental health providers who might be extraordinarily perceptive are often hobbled by the actual law. It’s rare that somebody can be arrested or put into mental health treatment for something they might do. You see, law enforcement works on principles of catching people who have already broken laws, not on the idea that people could or might break laws. I’m not sure changing those principles would be good for any of us—getting locked up or thrown into mandatory treatment based on what our personal profiles suggest we might do.

The ‘mental health system’ and the people working in that system, are there to help people overcome problems across the broad spectrum of all human problems that people can address with some psychoeducation and guidance aimed at improving self-awareness and promoting behavioral changes. The providers in that system rely solely on the communication of the people they are treating (verbal and otherwise) to convey information that might help to understand those problems and find solutions.

It’s rare for 1) a person intending to commit a mass shooting to relay that information to a mental health provider, or 2) for such a person to even be in treatment at the time s/he (okay, it’s essentially always a he) entertaining such thoughts.

On top of all that, it’s ludicrous that the gun-loving citizens of the U.S.A. somehow see the ‘mental health system’ as the solution to this problem, given their penchant for stereotyping mental health providers as a bunch of uptight women and effeminate men, and mental healthcare itself as being for the weak and obviously insane.

But then, the idea is that the people who would commit mass shootings are the type of people who would obviously be identified and locked up by professionals—because, well, that’s just how things work—right?

It’s as if the pro-gun/anti-gun-control forces simultaneously see mental health providers as the prime movers in the ‘wussification of America’, and, at the same time, super-badass profilers, who can somehow identify, and then take out, the trash that preys on innocent Americans who only want to enjoy a movie, or a day at school, or a concert, or a church service, or any other kind of public gathering, without having to fear being shot.

So what is it, all you opponents of gun control? Is ‘the mental health system’ the only thing standing between you and a bunch of violent psychopaths, hell-bent on shooting up all that is American? Or is the mental health system run by a bunch of anti-American, ivory-tower, namby-pamby know-it-alls who want to take your guns away?

You can’t have it both ways.

The real failure isn’t in the mental health system—or in law enforcement–it’s in the foolish idea that arming everyone leads to greater safety by ensuring the ability of everyone to stop everyone else who shouldn’t be allowed access to arms, and a legal system propped up by people that allow such foolishness to continue.

Yes, Breitbart, 33,000 People ARE Killed with Guns Each Year

Posted on November 2, 2016 by jcschildbach

J.C. Schildbach, LMHC

There is absolutely nothing controversial about Hillary Clinton’s claim that, in the United States, “We have 33,000 people a year who die from guns”–except maybe to those who don’t understand how words and numbers work.

Yet, AWR Hawkins, breitbart.com’s “Second Amendment Columnist,” posted a “Fact-Check” column, titled “No, 33,000 Not Killed with Guns Each Year” following the third presidential debate, claiming that Clinton deliberately inflated the CDC numbers of firearm deaths by adding in suicides. This is not the first time Hawkins has posted similar complaints.

What Hawkins fails to do is explain how suicides by firearm somehow fall outside of the “33,000 people a year who die from guns.” Certainly, Hawkins must understand that somebody who uses a gun to kill him/herself is dead, and did use a gun in order to die—making that person someone who ‘died from a gun.’

Using Hawkins’ preferred language of people “killed with guns each year” still doesn’t change anything. A person who commits suicide with a firearm still was, in fact, killed with a gun.

suicide-gun-mouth

Hawkins also strikes out by putting the phrase “gun violence” in quotation marks, saying that the use of that phrase (which Clinton did not use in the quote he complains about) somehow plays into Clinton’s strategy of fooling the public. But, again, killing oneself with a firearm does qualify as “gun violence”–first of all, because it involves an act of violence; and secondly, because it involves a gun. Or you can reverse that so the gun is first and the violence is second—still doesn’t change anything.

I don’t want to get into speculation about things that Clinton didn’t say, but perhaps if she had used the phrase “gun crimes” or had referred to murders using guns, then Hawkins would have a better argument. But Clinton didn’t. So Hawkins doesn’t.

And, in case you’re wondering, the 33,000 figure is dead-on. Here’s a chart, showing the CDC numbers of gun deaths for the years 2010 to 2014 (2014 being the most recent year statistics are available) clearly showing that gun deaths have reached well above 33,000 per year for 2012, 2013, and 2014, and averaged 32,964 per year for the five-year period.

avg-gun-deaths-2010-to-2014

A handy chart of CDC statistics on gun deaths, lifted from Everytown for Gun Safety at https://everytownresearch.org/gun-violence-by-the-numbers/

Now, I get that gun-loving Americans, including the Breitbart crowd, don’t like to believe anything negative about guns. They also don’t like to believe that they may, at some point, end up so distraught, or so deep in the throes of mental illness, that they might use their guns on themselves, and/or their family members or other loved ones—or perhaps even neighbors or random strangers.

By pushing the suicide statistics aside, or pretending they ‘don’t count’, Hawkins ignores a harsh reality here: that people who own guns tend to kill themselves with those guns far more than they kill an intruder in their home, or otherwise defend themselves from the big, bad, scary world out there. People who own guns kill themselves with those guns more often than criminals use guns to kill innocent citizens; and more frequently than ‘gang violence’ leads to gun deaths.

There is also considerable overlap in the “murder/suicide” category—where gun owners kill their significant others, family members, co-workers, or random strangers, prior to turning their guns on themselves. And because guns are such a quick and effective killing tool, the decision to use them in an act of violence on loved ones or oneself is often impulsive—a few too many bad days in a row, a bad argument following a few too many beers, or even a partner deciding they want out of a relationship, and the gun comes out as the ultimate way to put a stop to whatever is so aggravating.

As for mental illness, Hawkins’ argument becomes even less convincing in the face of all the clamoring about how we don’t have a gun problem in the U.S., but we have a mental health problem. Of course, people who make such an argument are usually talking about the mental health issues of mass shooters. Yet, if we (properly) view suicide as a mental health issue, then the numbers of firearm suicides become that much more disturbing. Gun owners kill themselves at a rate roughly twice as high as the rate of gun murders. That’s a vast mental health issue that’s not being addressed, and that is being exacerbated by guns.

Yes, I know that many of the people who want to argue in favor of guns like to point out that people who commit suicide will find the means to do so, even if you take their guns away–an argument which is demonstrably false in terms of overall lethality. There are many ways to map out the evidence showing this falsehood, including the high rate of suicide by firearm–roughly 50% of all suicides in the U.S. are completed using guns. Another way to conceptualize the difference in suicide methods is to compare suicide completion rates using firearms relative to suicide completion rates using other methods. For instance, plenty more people survive suicide attempts by overdosing on pills than survive suicide attempts using guns.

Those who are willing to brush off the connection between firearms and suicide also sometimes argue that suicide is a matter of personal freedom—of being allowed to end one’s life when one chooses. I will say that I’m not completely opposed to people being able to end their own lives on terms they choose. However, I’ve learned enough to know that people are least equipped to make that decision quickly, impulsively, or while in a deep depression (among many other factors). Very few people attempt suicide while they are thinking in the clearest of terms, or making a rational decision based on a comprehensive review of the facts.

Depression and many other forms of mental illness are notorious for their association with cognitive distortions, aka, “thinking errors”—misinterpreting the world around one, the impact one’s actions have on others, and the view other people have of one (again, among many other factors). As I’ve pointed out before, the idea that a gun keeps one safe is, itself, a cognitive distortion. The suicide-by-firearm statistics make that clear.

There is also, perhaps, a great irony here, in that Hawkins believes he is advocating for gun ownership, when the “mental health” approach to suicide prevention involves removing the means for suicide. That is, safety planning for suicide prevention involves taking away those means most likely to be used in a suicide attempt, while the person at risk for suicide gets treatment.

So, how do we address the mental health problems associated with guns and suicide? Take the guns away, at least until the person moves beyond risk for suicide. Of course, mental health treatment is not predictive. Risk factors can be weighed, and support systems assessed, but given the ease with which a person can use a gun to end her/his own life, a dip back into depression, a few more bad days, a drift away from regular engagement with one’s (positive) coping skills, and the risk can escalate once again.

Hawkins thinks he is supporting gun rights by poo-pooing the statistics on firearm deaths in the United States. But what he is actually doing is pointing out that suicide is twice as big a problem, where guns are concerned, as murder is. His solution is to pretend the people who commit suicide with guns aren’t really people who “die from guns.”

At base, he is arguing that people who commit suicide with guns aren’t really people…or perhaps aren’t really people who deserve the support to go on living.

Guns Don’t Kill People. Stickers Kill People!

Posted on October 4, 2015 by jcschildbach

JC Schildbach, LMHC

For decades, “Guns don’t kill people, people kill people,” and “If guns are outlawed, only outlaws will have guns” did the job of letting tough guys/tough gals let everyone know that they viewed more gun violence and the threat of gun violence as the number one solution to gun violence.

But, with the Internet opening us up to increasingly contentious arguments with complete strangers, and with gun violence reaching into more and more corners of American life—claiming the lives of children at school, moviegoers, and people coming together to worship, to name just a few, the National Rifle Association (NRA) had to get more creative in promoting their simplistic ideology that guns are always the answer.

After all, how do you sell mass murder to people? How do you continue to convince people that guns are the answer to guns? How do you adapt the idea of mutually assured destruction—so effective in the global arms race—to the micro level, getting people to think it’s a great idea right in their homes and neighborhoods?

Well, you come up with more dumb slogans that are effectively meaningless, mostly untrue, and promote the continued stockpiling of weapons among the decreasing percentage of American homes where people actually keep guns.

Just read any comment thread on any article about gun violence or gun control, and it’s guaranteed you’ll see the tried and true “outlaws” and “guns don’t kill” slogans in there right alongside the NRA’s other branding strategy updates: killers will find a way to kill even if they don’t have guns; we just need to enforce the laws that are already on the books; Chicago has strict gun laws/high gun violence; mental illness is the problem, not guns; and so on.

One of the latest buzz-concepts is that “Gun Free Zones” are the problem, not guns. Put that little “gun free zone” sticker in the front window of a business or school, and it will attract mass shooters like fruit flies to old fruit.

Of course, just like every other NRA-sponsored motto, it defies logic, and isn’t actually true in any demonstrable way.

First of all, let’s take a quick look at the origins of the “gun-free zone” campaign. Of course anyone arguing on an Internet comments thread could look up the “Gun-Free Zone Act of 1990”—say, on Wikipedia which shows how completely stupid the “gun-free zones kill” argument is, but why bother knowing anything when it’s so much easier to get angry while being completely wrong?

Beware citizen! Steer clear of this sign or you might get shot!

Basically, the act was put in place 25 years ago to keep high school students from bringing guns to school and shooting each other. Sounds pretty reasonable. Of course, gun lovers jump off at that point and say it didn’t work. Kids are still shooting each other. And, of course the only way to make sure kids stop shooting each other is to make sure more kids have the means to shoot each other.

Yet, as much as it may or may not have kept little Bobby from sneaking a gun into school in his Incredible Hulk backpack, one thing that the Gun-Free Zone Act did NOT do was prevent armed security personnel—and other authorized parties—from carrying guns in schools. In other words, gun-free zones are not actually gun-free. Ideally, they are free from guns in the hands of people who are not supposed to have them—just like the rest of the entire country.

That is to say, The Gun-Free Zone Act, and all of its attendant signs and window-stickers, was a politically-motivated band-aid measure that really didn’t do anything except make a few bucks for businesses that print signs and stickers.

Before the Gun-Free Zone Act, it was illegal for kids to bring guns to school and shoot each other. After the Gun-Free Zone Act, it was still illegal for kids to bring guns to school and shoot each other. The big change was that after the passage of the law, kids could get in lots and lots of trouble for bringing a gun to school, even if they didn’t actually get around to shooting anybody with it.

Due to other situations of gun violence, like mass shootings in post offices and office buildings, numerous business officials, and government bodies also decided they would declare their workplaces “gun-free zones”—basically meaning that employees were not supposed to be packing heat at their cubicles, or while stocking shelves, or sorting mail.

Somehow, though, we’ve gotten to the point where the NRA, and all of the people who parrot the NRA talking points, apparently think it is somehow unreasonable to prevent, say, junior high kids from bringing guns to school, or to keep Jerry in accounting from having a loaded weapon tucked in his waistband while he microwaves his Hot Pocket in the breakroom.

Despite the proliferation of numerous “gun-free zone” signs and stickers, schools and businesses were still free to have armed security personnel on site. And, thanks to “concealed carry” laws, which exist in several states, and often contain provisions to explicitly allow concealed carry in gun-free zones, plenty of people can actually take their guns into “gun-free zones.”

And lets be clear. Umpqua Community College—the latest site of a well-publicized mass shooting, if I get this posted before another one happens—was NOT a gun-free zone, as so many pro-gun folk are claiming. That is, concealed carry is allowed on the Umpqua Community College campus, so long as people are legally allowed to have their guns with them via concealed carry permits.

Still, there are plenty of pro-gun folk, even those who are aware that concealed carry is allowed on the Umpqua Community College campus, who inexplicably–even immediately after acknowledging that concealed carry is allowed on the UCC campus–cannot stop claiming that UCC is a gun-free zone. Apparently, allowing guns in a gun-free zone is not enough to appease some people.

Perhaps what the NRA is pushing for, with it’s blame-the-gun-free-zones campaign, is to allow open carry in schools, and everywhere else.

But what the NRA is actually demanding is the removal of gun-free zone stickers and signs. After all, the NRA has already crafted and passed many laws that have rendered the gun-free zone laws moot.

Sure, plenty of mass shootings, and just plain old shootings have happened in areas that were labeled “gun-free zones,” just like numerous shootings have taken place in areas with no such labels.

But there is zero evidence that any mass shooter ever chose a target specifically because it was labeled a gun-free zone.

And despite the frequent existence of “good guys with guns” in the very same locations where mass shootings take place—whether those are labeled gun-free zones or not—there has not been some sharp increase in citizens preventing mass shootings as the number of guns has proliferated in the United States, or some great reduction in the number of mass shootings as mass shooters get scared away at the possibility that there might be people with concealed carry permits on hand.

In other words, as much as the NRA pushes the idea that more people with guns means that mass shootings will be stopped, there are still a huge number of mass shootings, and just plain-old shootings, taking place in the United States. As much as the NRA has succeeded at establishing more concealed carry and open carry laws, the shootings haven’t stopped, or even decreased.

But it’s so much more convenient to for the NRA to launch polly-wanna-cracker slogan campaigns to its ready audience of parrots than it is for the NRA to engage in any substantive reform of laws that might actually improve the safety of all the “good guys with guns,” as well as those of us who really don’t feel the need to keep guns.

Of course, the NRA exists to provoke gun sales, not to concern itself with public safety.

In fact, the good folks at the NRA have gotten so desperate to distract the American people, that they are blaming an ineffectual band-aid law for gun violence.

So, let’s do it. Let’s take down all of the “gun free zone” signs and stickers tomorrow. All of them. Everywhere. And let’s repeal the gun-free zone laws. They’re nothing but a symbol anyway. It won’t do one stinking thing to stop gun violence, just like taking down the Confederate flag did nothing to stop gun violence.

But maybe we can shut down the talking point about gun-free zones a little quicker.

Then all the people who are suddenly so fixated on stickers and signs as the source of gun violence can get back to working on all those fixes for the mental healthcare system.

It’s World Suicide Prevention Day: Do You Know Where Your Mental Health Is?

Posted on September 10, 2015 by jcschildbach

JC Schildbach, LMHC

Just before I sat down to write this, around 8 p.m. my time, I lit some candles and placed them in the windows of my home–as was requested by the organizers of World Suicide Prevention Day–a small gesture that maybe nobody will notice–but a sign of solidarity nonetheless.

One might ask, ‘Solidarity with whom?’

With those who have died by suicide?

With those who have lived through a suicide attempt?

With those who have been impacted by the suicide of an important person in their lives?

How about just plain everybody?

None of us are immune to suicide, or the impacts of suicide.

A great many of us like to believe we’re immune.

But our mental health is not made up of absolutes. It is not a simple either/or option: mentally healthy or mentally ill.

Suicidality itself exists on a scale of ‘definitely not going to happen today’ to ‘working on it right now.’

And perhaps the more we think we’re immune to issues with our mental health, the more we fail to recognize when we might be tilting toward trouble.

Take a big enough hit to your self image–loss of your job, loss of a spouse or signficant other; maybe add on a string of other bad occurrences–financial troubles, illness, the death of a loved one; mix in a few too many drinks and easy access to means, and who knows what might happen?

More than half of the 40,000+ deaths by suicide in the United States each year involve a gun. How many of those do you suppose were the result of, say, long-term depression, versus a fairly quick unravelling of the deceased’s sense of self, and a lack of knowledge about how to identify and utilize available support systems? How many of those were a booze-fueled ‘screw it’ to a really bad month, or week, or day?

Of course, when one believes one is immune to such problems, when those problems arise, one will be that much less likely to seek out help.

I don’t want to give the wrong impression. Many people who die by suicide have been struggling with mental illness for the bulk of their lives. Many of them have made multiple attempts before they finally die by suicide.

But there are also plenty who die by suicide because they are overwhelmed by circumstances, and have no real idea what to do. They have never given thought to what to do, or who to turn to. They do not want others to think of them negatively–perhaps the same way they have thought of others in similar circumstances.

So we need to recognize that we’re all travelling on the same continuum, that we’re all forever in flux, rather than believing we are in two separate camps that will forever remain apart: the mentally healthy and the mentally ill. Otherwise, we potentially block ourselves off from the need for compassion. It’s much easier to look away when we can say, “Not me.”

So maybe those candles will go unnoticed, or maybe not.

And at least they’re flickering away against the darkness of “Not me.”

Welcome to Me (and My BPD?)

Posted on August 14, 2015 by jcschildbach

JC Schildbach, LMHC

How important is it that movies and television shows get “academic” concepts right?

Sure, superhero movies, action flicks, and even horror movies routinely violate the laws of physics to create interesting visual sequences, and frequently make up pretend science-y explanations for strange phenomena.

But what about when the academic concept is a mental health diagnosis that is supposed to be central to a character’s actions?

Okay, there are numerous representations of people with mental illness in television and film that are just as ludicrous as, say, toxic chemicals causing superpowers, a plague of giant ants, or an out-of-shape ex-cop (or really anybody) outrunning an explosion.

So what about when the academic concept is a mental health diagnosis that is supposed to be a driving force behind all of the main character’s actions in a film that is comedic, but with serious intent? It would probably behoove the movie-makers to get that right? Right?

In Welcome to Me, written by Eliot Laurence, and directed by Shira Piven, Kristen Wiig stars as Alice Klieg, a lottery-winner who decides to channel her newly-won millions into a sort of variety show all about herself, ostensibly due to the effects of her Borderline Personality Disorder.

Wiig, to her credit, plays a fairly credible person with traits of Borderline Personality Disorder. And the film does not shoot for a lot of cheap laughs or cheap thrills at the expense of those with mental health issues (of course, feel free to disagree with me on those points all you want).

Unfortunately, the film botches some really big clinical points in a really big way.

Spoiler alert! Spoiler alert!

The first truly jarring error is when Klieg describes her history of mental illness (to a TV audience assembled for an infomercial on nutritional supplements). She says, “When I was 16, I was diagnosed with Manic Depression. In my 20s it was called Rapid Cycling Bipolar Disorder. Now it’s just called Borderline Personality Disorder.”

Excuse me?

Now, it’s true that “Manic Depression” was once the common term for Bipolar Disorder. But “rapid cycling” is a modifier or course specifier for Bipolar Disorder that generally means a person is having abbreviated episodes of depressive and manic states that are running fairly close together. And by “fairly close together” I mean four or more episodes of mania, hypomania, or depression in one year—not “mood swings” multiple times a day.

As the good people at PsychEducation explain, once mood shifts get close enough together, they can become indistinguishable from relatively normal emotional states. Bipolar Disorder is not just some condition of simple emotional lability or emotional dysregulation, although plenty of people use the term “bipolar” incorrectly in this fashion (hopefully not anyone who is actually diagnosing and treating people, though).

Emotional dysregulation is, however, a common component of Borderline Personality Disorder. It is also relatively common for people who are ultimately diagnosed with Borderline Personality Disorder to have been incorrectly diagnosed with Bipolar Disorder prior to the Borderline Personality Disorder diagnosis.

So, if Klieg, had said “First I was diagnosed with Manic Depression, which is now called Bipolar Disorder. Then they diagnosed me with Rapid Cycling Bipolar Disorder. Then they determined the appropriate diagnosis for my condition is Borderline Personality Disorder,” then the explanation would have made a great deal more clinical sense.

As it is, Klieg’s dialog implies that Borderline Personality Disorder is just the new name for Bipolar Disorder. This is completely wrong.

Klieg (played by Kristen Wiig) intrudes on her own skit, startling the actors and the audience.

Another major problem with the film is the portrayal of the treatment that Alice is receiving from Dr. Daryl Moffet (played by Tim Robbins). It’s troubling enough that Dr. Moffet repeatedly mentions the brand-name drug Abilify—in the sense that a movie about a person with a mental illness essentially uses dialog as a form of pharmaceutical product placement. But what’s even more disturbing is that Borderline Personality Disorder is not itself treated with medication.

Sure, plenty of people diagnosed with Borderline Personality Disorder are prescribed various medications to address other things they might be dealing with, like anxiety, depression, or poor impulse control. They may even be prescribed mood stabilizers depending on the severity of their emotional dysregulation, or anti-psychotic drugs, depending on the severity of their thought disturbances. But the personality disorder itself is not going to respond to a specific drug.

No doubt, plenty of people suffering from Borderline Personality Disorder would love it if there were a drug that would make all their symptoms go away. Different forms of ‘talk therapy’–most notably Dialectical Behavior Therapy (DBT) developed by Dr. Marsha Linehan–can help people with the disorder develop coping skills to address the various fears, emotional disturbances, and behaviors that are common to the disorder, much better than any pill or cluster of pills is going to manage the range of symptoms.

Beyond the issues of medication, there is a scene where Dr. Moffet tells Klieg that he tried to have her put on a psychiatric hold because he thinks she is a danger to herself. Surprisingly, and probably just to get in a bit of expository dialog, Klieg has to ask him what a psychiatric hold is—despite the ongoing implication that Klieg’s decision to stop taking her medication will lead her to be forcibly hospitalized–an implication that wouldn’t generally exist if such a thing hadn’t happened previously.

Perhaps even more surprising is that Moffet thinks Klieg has done something to warrant psychiatric detention. I can’t imagine there are many places where wasting one’s lottery winnings on a self-indulgent TV talk show would be seen as evidence of being a danger to oneself, even if one is doing things like illegally broadcasting phone calls during that show, or otherwise slandering people. But, really, the people running the TV show should have been aware of the legal problems in all that, and should have put a stop to it.

Still, Klieg’s having gone off her medications is a theme throughout the movie, and one which causes great alarm each time someone hears her speak of it—as if the other characters really know what she is being medicated for, and with, and what the obvious, disastrous consequences will be. It is a theme that culminates in a scene, where Klieg dazedly takes a nude stroll through a casino, apparently in some psychotic, or perhaps dissociative, state. She has to be subdued by cops and hospitalized.

And while such a situation is arguably possible for a person with Borderline Personality Disorder, such occurrences are not generally core features of the disorder, and portrayals of such are certainly not going to contribute to greater understanding of the disorder, particularly when they are shown as a natural consequence of not taking one’s medications—I mean one’s Abilify.

Overall, Moffet’s connection to Klieg is largely unexplored. Mostly he just harps on her about how she should get back on her medication—I mean her Abilify. When he (rightly) gets irritated at her for including him in her TV show, Moffet terminates his services with Klieg, by simply handing her a list of other providers.

One would think Dr. Moffet would, at the very least, try to make sure Klieg was actually in contact with another provider, after trying to process with Klieg about how she violated what should have been some clear boundaries, and why he cannot continue to treat her. Given that a fear of abandonment is a core component of Borderline Personality Disorder, and that self harm, suicidal thoughts, and suicide attempts are common among people with Borderline Personality Disorder (in fact, it would have been much more clinically accurate for Klieg to end up in the hospital due to a suicide attempt or self-harm episode after feeling abandoned by her best friend, and her treatment provider, and possibly lashing out at them, than due to a psychotic episode—or whatever that was—from quitting her medications), Moffet’s ‘here’s-a-provider-list-and-a-few-snippy-comments’ therapy termination seems grossly incompetent. Due dilligence anyone?

And while I’m not advocating for depicting people with a particular mental illness in some format that allows viewers to check the symptoms off a list—that’s ‘disorder of the week’ TV-movie territory—the portrayal of Klieg suffers from being too timid in presenting her struggles. While Klieg is fairly off-putting to many of the people in her life, the filmmakers seemed wary of making her too off-putting. For the most part, she really only lashes out at people from her past through skits on her television show, while recklessly upsetting those around her by being self indulgent or impulsive. The filmmakers tried to keep Klieg quirkily unpleasant, in the kind of realm where one might believe that the right medications can keep her likable enough.

It strikes me, though, that the particular diagnosis is largely unimportant to the story, particularly considering how botched the presentation of the diagnosis-specific information is, and how the “off her meds” theme plays out. The film would have worked just as well (or just as poorly, depending on one’s view) knowing that Klieg was in treatment, and on medications, without having to name a particular psychiatric problem. I don’t think the movie would have suffered if, rather than naming any specific disorder, the characters referred only to Klieg having been in therapy, or hospitalized, or on medications. Hell, without the specific diagnosis of Borderline Personality Disorder, the repeated mentions of Abilify might have been at least slightly less problematic.

At the very least, avoiding the naming of a diagnosis could have provided grad students and armchair psychologists with an exercise in identifying possible diagnoses and rule-outs. As it is, I suppose the film could at least provide valuable material for discussion about whether the Borderline Personality Disorder diagnosis seems correct, the kinds of errors Dr. Moffet makes, and about the need to make sure that clients and the people comprising their support system understand their diagnoses and treatments—that whole ‘psychoeducation’ piece that therapists are supposed to do.

Of course, I suppose having a character with a non-specified mental illness would open up the filmmakers to other complaints—such as portraying people with any old form of “mental illness” as psychotic and needing to be on medications, lest they burn through millions of dollars producing a TV show and end up running around naked in public—rather than suggesting that such a problem is specific to lottery winners with Borderline Personality Disorder.

All that said, I didn’t hate the movie. I adore Kristen Wiig. And, like I said, she does a credible job with the material. The movie also mostly avoids the more exploitative angles of both comedies and dramas involving people with mental illness. It’s just that they could have had a much richer story if they hadn’t relied so heavily on the medication angle. Coping adequately with Borderline Personality Disorder takes a great deal of personal work, not just popping a pill–I mean, an Abilify.

And one last thing. I noticed that there was no clear indication from the credits that anybody had been consulted about the accuracy of the Borderline Personality Disorder information. So, I just wanted to float it out there that I’m willing to accept some of that Hollywood money in order to go over scripts and make sure they don’t make a mess out of their clinical details.

*Welcome to Me is currently available streaming on Netflix and Amazon.com, as well as in a variety of other places.

Another Round: American Roulette

Posted on July 28, 2015 by jcschildbach

JC Schildbach, LMHC

Pour another round.

Put another round in the chamber.

And let’s play another round of American Roulette.

Dizzy? Go ahead and get off.

I’m not talking about felt and chips and all that. I’m talking about American Roulette—where we add more and more rounds, to more and more chambers, in more and more guns, point them all at our own collective head, squeeze the collective trigger, then act all surprised when anybody dies.

Then as the bodies are cooling, we start in on a round of all our favorite follow-up games.

Of course it starts with a round of “America’s Next Top Mass Murderer.” This is where media outlets decide what becomes a national story. It’s a complex formula, involving body count, victim age/status, and location. We have so many shots fired so often, in so many places, that we just can’t let any old killings grab hold of the public imagination.

Hell, the public doesn’t have enough imagination to keep up.

Adult males getting gunned down in the “bad part” of town—doesn’t rate unless there’s an insanely high body count. Okay, that’s pretty much true of any killings in the “bad part” of town.

Nightclubs—the same.

Men wiping out their families? Pffbbt! We’ve grown surprisingly numb to the idea of an “estranged husband” gunning down his wife, kids, and maybe a few additional members of his extended family. But moms gunning down their families? That just might work.

Schools—you can maybe get some traction there, although college shootings are getting pretty passé, as are high schools. Elementary schools—still pretty damn shocking.

Churches—those rate pretty high.

Movie theaters—those practically ARE churches.

So, how about grocery stores? public parks? malls? restaurants? Maybe a library or a museum? How about a nursing home? But, really, I have to defer to the experts for how to rank all of those.

Then, once we’ve determined that a mass-shooting is heinous enough to warrant a spot in the public imagination, we move to a round of “Wheel of Blame,” sponsored by the good, pro-murder folks at the National Rifle Association.

Really, it’s just another form of rigged roulette—38 spaces on the spinning wheel, at least 30 marked “mental health” or “mental illness.” When we get lucky, the wheel stops on one of the random spots marked with something we can really get mad at—like racism, or pop culture, or some “foreign” religion.

Because when the wheel lands on something we can get mad at, then we can do something symbolic in lieu of doing something that might actually lower the body count—like take down a flag that hasn’t had any business being associated with any part of ‘the government’ in the 150 years since that cluster of slavery-supporting traitors failed in their effort to destroy the Union. Or we can blame some movie, or some TV show, or some rock star for inspiring a murder spree. Or we can yell at the President to bomb ISIS, or to stop talking to Iran—because that will fix problems right here at home, where we like to kill our own.

Of course, the Wheel mostly lands on “mental health” or “mental illness” and we don’t have to do anything except say “fix the mental health system”—as if there is some magical way to grant psychotherapists the ability to pluck out those who are going to commit mass murder, plop them into a treatment program, and prevent them from ever getting their hands on all the readily-available guns and ammo out there.

But remember that when you spin that Wheel of Blame, you absolutely must avoid the spaces marked “guns”—those spots just go to the house—instant bankruptcy. Go ahead and say guns and lax laws that allow easy access to guns had a role in gun violence. You’ll get nowhere. Our gracious NRA sponsors, the politicians and media they own, and the screaming devotees of the Cult of the Shiny Metal Bang Bang will all see to that.

And even though it’s gotten pretty tired and unnecessary, we’ll run another round of “Not the Time”—wherein such insightful luminaries as draft-dodging, teen-loving, rock-n-roll has-been Ted Nugent, along with other NRA pets, can tell us that now is not the time to talk about gun control—not in the wake of such a tragedy—as they question the patriotism of anyone who would politicize the deaths of people killed by guns—oops, I mean killed by people with guns—oops, I mean killed by bad people with guns.

What’s so great about “Not the Time”—even though it’s getting really tired—is that we’re almost never more than a few days away from a mass murder, even if we are more than a few days away from a mass murder that really caught the public’s attention.

Oh, hey! Now give it up for a round of our newest game show: “Open Carry Chucklehead Brigade”—y’know, that trending ritual where gun enthusiasts decide to go stand outside recruitment centers, or in malls, or near schools, or wherever the latest killing took place, brandishing their big, long weapons out of some bizarre sense that such behavior is supportive of those who are suffering the aftermath of gun violence. Hey…uh…guys…we’ve all been talking, and…uh…nobody feels safer because of your presence. For most people, a group of sweaty guys standing around with big guns does not look like safety. It looks like a meeting of the local chapter of the Future Mass Murderers of America.

I know there are plenty of rounds of plenty of other games I’ve left out—like the obligatory round of “False Equivalencies” (people die from using cars, and knives, and dental floss, and ice cream, and…), and the round of “Enforce The Laws That Already Exist” (as if the NRA hasn’t already made sure that most of those laws have no teeth), and the round of “There Are Already Too Many Guns Out There to Fix the Problem” (got it–too tough, don’t try!). But, damn! Those games are getting so dreadfully boring.

So, where were we?

Oh, yeah—pour another round.

Somebody else is picking up the tab.

Or maybe you are.

Really Lowes? and Sherwin Williams? and HGTV? Mocking Mental Illness as an Ad Strategy

Posted on May 17, 2015 by jcschildbach

JC Schildbach, LMHC

Lowes decided to announce its rollout of Sherwin Williams’ line of “HGTV Home” paint by crafting an ad that plays on popular ideas about some of the most well-known artists in history (and pop culture), each jealously challenging the notion of who is “the most legendary name in paint.”

Well, okay, “Mr. Happy Little Trees” Bob Ross doesn’t come across as jealous.

But Leonardo da Vinci, Andy Warhol, and Michelangelo all do.

Vincent van Gogh just comes across as…well, you can watch it here:

Get it? It’s funny because you think he’s saying “what?” because he cut off his ear. But then you realize it’s actually funny because van Gogh is suffering from psychosis or whatever would make him talk to a pigeon.

Hilarious—right?

He talks to pigeons. How clever.

Of course, nobody diagnosed van Gogh with a particular mental illness during his lifetime, particularly not from a current understanding of mental illness. Perhaps the most popular theory of van Gogh’s troubles is that they stemmed from Bipolar Disorder. Whatever the case, eventually van Gogh died of complications from a self-inflicted gunshot wound, following numerous other episodes of emotional difficulties and self-harm.

I want to be clear that I don’t have any particular axe to grind with any of the businesses in question (even if I should for one reason or another). I shop at Lowes regularly. And even though Sherwin Williams has that terrible “Cover the Earth” logo, all of the paint we’ve used in our home has come from our neighborhood Sherwin Williams store, except for the paint in the upstairs bathroom, and the stain on the deck, which we got at Lowes. And I watch HGTV (and the DIY Network) enough that M wishes I would just get off the damn couch and make our house more beautiful (or at least just quit talking about all those projects and do them).

Still, it’s disappointing to see that the big punchline for the combined Lowes-Sherwin Williams-HGTV commercial involves mocking, specifically, somebody who suffered from mental illness, and, more generally, the idea of psychosis, particularly given that the commercial was rolled out at the beginning of Mental Health Awareness Month: NIMH’s “Mental Health Awareness by the Numbers”

I suppose I could also point out that all of the artists in the commercial are white males. But given how the myriad options for art “jokes” involving white male artists were handled, I don’t have a lot of faith that a woman artist, or a non-white artist, would have fared much better when reduced down to a humorous reference that might be commonly understood.

Self-Infantilization or Supportive Compromise? On the Controversy over Safe Spaces

Posted on April 9, 2015 by jcschildbach

JC Schildbach, LMHC

In her March 21 piece for the New York Times, “In College and Hiding From Scary Ideas” Judith Shulevitz mocks, among other people and things, Brown University student Katherine Byron for setting up a “safe space” for students who might be “triggered” during a debate between Jessica Valenti and Wendy McElroy that was likely to include a discussion of rape culture.

Shulevitz reported that the safe space “room was equipped with cookies, coloring books, bubbles, Play-Doh, calming music, pillows, blankets and a video of frolicking puppies, as well as students and staff members trained to deal with trauma.” Nothing is said about why such items and personnel might have been present, or what the theory behind such a ‘safe room’ might be, other than Shulevitz’s own assumptions about how college students of today are over-parented and overly-sensitive.

Shulevitz goes on to say that, “Safe spaces are an expression of the conviction, increasingly prevalent among college students, that their schools should keep them from being ‘bombarded’ by discomfiting or distressing viewpoints.” Shulevitz does not provide anything other than anecdotal evidence about the alleged increasing prevalence of such a conviction.

On top of that, one major thing that gets lost in Shulevitz’s piece is that the debate between Valenti and McElroy went on. The ideas were not silenced. No speaker was banned.

Instead, Byron, and those who assisted her, offered a place where audience members could go if they became uncomfortable, not necessarily with the ideas being expressed, but with the content of the discussion, which presumably included descriptions of how rape is depicted in popular culture, as well as how rape and rape victims are treated in the news media, by law enforcement, and in other areas of their lives. The safe room was established by the Sexual Assault Task Force, first and foremost, to afford a safe space for trauma victims–not a refuge from ideas.

All the comfort of the joys of childhood…

Perhaps Shulevitz’ mocking of the “safe spaces” is particularly disappointing because she has written other pieces on trauma and its impacts, most notably, a November piece in The New Republic, called “The Science of Suffering” which explored research into how PTSD can potentially be transmitted from generation to generation. In it, Shulevitz includes this succinct and powerful description of PTSD:

Provoke a person with PTSD, and her heart pounds faster, her startle reflex is exaggerated, she sweats, her mind races. The amygdala, which detects threats and releases the emotions associated with memories, whirs in overdrive. Meanwhile, hormones and neurotransmitters don’t always flow as they should, leaving the immune system underregulated. The result can be the kind of over-inflammation associated with chronic disease, including arthritis, diabetes, and cardiovascular disease. Moreover, agitated nervous systems release adrenaline and catecholamines, both involved in the fight or flight response, unleashing a cascade of events that reinforces the effects of traumatic memories on the brain.

Shulevitz’s New Republic article describes research into, among others, Cambodian refugees who suffered through brutal conditions of war. And maybe this is where Shulevitz’ disconnect arises: her inability to see how a sexual assault in the modern-day USA could lead to similar forms of psychological and physical response as living through a years-long period of war somewhere else in the world.

But PTSD just as powerful as that experienced by those who have been through war can arise out of a sexual assault or rape. PTSD is not measured and assigned on some scale where those who experienced the longest, and arguably worst, trauma have the ‘most’ or most severe PTSD.

Complaining of the “self-infantilization” (a term Shulevitz credits to Judith Shapiro) demonstrated by things like the Brown University safe room, Shulevitz also neglects to explore other potential psychological issues stemming from sexual assault, particularly for those who were assaulted repeatedly at a young age. To be clear, I am not assigning a specific causal relationship here (i.e., if this happens, then that is the result, and/or, because a person exhibits this behavior, this particular thing has happened to them) but issues such as Borderline Personality Disorder are often tied to a history of having been sexually traumatized.

Strangely enough, complications associated with Borderline Personality Disorder can include shortcomings in one’s ability to develop into an emotionally mature adult. Along with the repeated hospitalizations, there are frequently tendencies toward anxiety and overreaction to stimuli, impulsivity, fear of abandonment, hostility and perceptions that one is being personally attacked, and difficulties in forming long-term, stable relationships—issues which might, along with PTSD symptoms, be addressed (at least in the immediate sense of a perceived threat) by the “safe room” tactics that Byron deployed.

Rather than exploring the potentially positive effects of the safe room, though, Shulevitz instead uses it, and other alleged examples of “hypersensitivity” at universities, as evidence that today’s college students aren’t tough enough to handle the real world, and that today’s parents are coddling their children too much. But ongoing PTSD, personality disorders, and other psychological manifestations of trauma are not the result of overly-attentive parenting—and are more likely to be exacerbated by the opposite—a lack of attentiveness and support by those who should be providing it.

Still, Shulevitz pats herself and her peer group on the back for being much “hardier souls” than today’s college students–which includes an explanation that, in her day, college students only censored speakers for the right reasons. She writes, “I’m old enough to remember a time when college students objected to providing a platform to certain speakers because they were deemed politically unacceptable.” Shulevitz isn’t particularly clear on how “politically unacceptable” is markedly different from ‘ideas that make some people uncomfortable.’

Perhaps this is a good time to reiterate that Byron and her Sexual Assault Task Force didn’t actually stop anybody from speaking at Brown, but set up a space, off to the side, out of concern for those who might be interested in hearing the debate, but weren’t too confident that they would respond well to it. If anything, it represents a form of compromise much more than a form of censorship.

So maybe the safe room isn’t the perfect answer. Maybe it seems funny and easy to mock as a form of “self-infantilization,” particularly to those who aren’t all that interested in finding out what it’s supposed to mean or accomplish—those people who, as Shulevitz puts it, haven’t learned “the discipline of seeing the world as other people see it.”

Then again, maybe today’s college students aren’t really that different from past generations of college students—and are just exploring different ways of addressing concerns that didn’t exist in the past—or, rather, were ignored in the past.

Because heaven knows, none of us from older generations ever did anything questionable while we were in college, or came up with ideas that older generations might mock, as we tried, in an atmosphere of rapidly evolving technology, culture, and scientific understanding, to navigate a complicated passage into adulthood.

Suicide at the Oscars, part two: ‘The Phone Call’

Posted on March 20, 2015 by jcschildbach

JC Schildbach, LMHC

It was a great year for crisis lines at the Oscars—or, rather, for films involving crisis lines. Not only did the documentary, Crisis Line: Veterans Press 1 take home a statue, but so did the short, live-action film The Phone Call. And, while Crisis Line: Veterans Press 1 tried (perhaps a little too enthusiastically) to convey a sense of the actual drama that can occur at a crisis line, The Phone Call comes across as a disturbingly simplistic endorsement of suicide-on-demand and irresponsible behavior by crisis line workers, all while portraying a dangerously inaccurate view of the function of crisis lines.

I will begin with the same bit of disclosure I placed at the beginning of my piece on Crisis Line: Veterans Press 1: Having spent more than five years working full-time for a crisis line, and continuing to work in a position sideways from, and occasionally overlapping with, such work, I can’t help but come to these films with something of a bias. And I will also offer up a spoiler alert for The Phone Call: if you haven’t seen it, and you don’t want to know exactly what happens, stop reading now.

The Phone Call seems to have generated most of its praise based on the acting of Sally Hawkins (as Heather) and Jim Broadbent (as Stanley/John)—which is undoubtedly solid, even given the ludicrous material. But most reactions seem to ignore any other critical angle—like the crass manipulations taking place in order to make The Phone Call happen at all.

To begin with, the call center where the story takes place seems to be lost in time. Despite the opening shot of the movie panning by a sign that reads “City WiFi Zone,” the crisis center apparently has no computers and no Internet hookup.

Now, I don’t know the current state of crisis line call centers in the UK, or really the state of any such call centers aside from the ones I’ve worked in, visited, or seen in documentaries—all in the United States. But I will say that if a call center in this day and age equips workers only with a pad of paper, a pen, a phone, and a lamp—they are verging on worker abuse. Absent the most dire of funding situations, failing to provide crisis line workers with computers and Internet access is simply unacceptable, given the relatively low cost of such amenities—and the necessity of such items in making it possible for workers to track down lifesaving information—or even to assist callers who are simply trying to access other services.

At one point in the movie, we see Sally Hawkins’ character, Heather, get up from her desk—thankfully she sat at the front of the room near the bookshelves—to try and look up the “mystery caller” in the notebooks where past call records are kept—handwritten on paper.

Add to that the script manipulation of having absolutely minimal staffing. Despite there being numerous desks in the call center, when Heather arrives, there is only one other worker there–Daniel. At the only time Heather even considers enlisting Daniel’s help with Stanley/John, Daniel is talking with another caller, back turned to Heather, and flipping through a phone book, or some other reference material. She immediately (and completely irresponsibly) determines she can’t get Daniel’s attention—as if muting her phone and calling across the room would have been too much trouble to stop somebody from dying.

‘Would you look at that? Daniel’s busy. Guess you really are going to die today, Stanley.’

Stanley/John is also supposed to be a sympathetic character, the main reason being that his wife, Joan, died two years ago after a long struggle with cancer. As Heather questions Stanley/John about other family members he may have, we also find out that he and Joan tried to start a family, but had only one stillborn child, 25 years ago, and then were unable to have any children after that. Certainly, it’s a sad tale. Certainly, we can understand Stanley/John’s despair.

But just imagine being in the same situation as Heather—or really any crisis line worker—being treated the way Stanley/John is treating her. Stanley/John has decided he is going to die, and has decided that whatever random worker answers the phone is going to have to listen as it happens.

John/Stanley sobs, makes vague statements indicating he has taken actions to kill himself, and refuses to provide information under threat that he will hang up to prevent anyone from tracing the call and sending an ambulance. The audience has to accept that either the call center does not utilize caller id—further putting workers in a terrible situation—or that John/Stanley blocked his information, in order for the whole ‘hanging up’ thing to really work as a threat.

Stanley/John eventually reveals that he’s taken “Antidepressants” that he got “from the doctor.” But killing oneself with pills tends to be a lot trickier than most people realize—at least to do it in the calm, and apparently quick way that Stanley/John manages, all while allowing for a conversation and a quick death before the ambulance crew can arrive and try to revive him—and without his body doing its damnedest to try and expel the deadly pills he’s ingested. Then again, perhaps Heather waited a good long while before calling for the ambulance, as she was looking through notebook after notebook to find the right person named John who lived around the corner from the Boston.

The big moment of connection for Heather, where she (mostly) accepts Stanley/John’s decision to die, is when Stanley/John asks in a pressured tone, “Can you just stay there and talk to me? Are you allowed to do that? Can’t you just stay there and talk to me and hold my hand? Isn’t that alright?”

Heather’s answer: “Of course, I can. I’m not going anywhere.”

There are an infinite number of much better answers Heather could have given at that time. For instance: “No, that’s not allowed, Stanley/John. I’m not here to make you feel better about killing yourself. And, to be honest, if I was really doing my job, my co-worker, Daniel, here would know everything that was going on, and probably already have an ambulance heading your way.”

Instead, in the course of the short conversation, Heather passes up numerous chances to make more than just a conversational connection with Stanley/John. For instance, Heather and Stanley/John discuss jazz, including Stanley/John telling Heather he could teach her how to play tenor saxophone properly. Yet, rather than latch onto that, and suggest that Stanley/John maybe teach music, or otherwise get back into music, Heather doesn’t push on that point of Stanley/John’s ambivalence at all.

In fact, beyond asking about immediate family, Heather does nothing to find out if Stanley/John was involved in anything else in his entire life beyond his relationship with Joan. Work? Friends? Family? Hobbies? Pets?

Heather also does nothing to explore what Stanley/John has done to deal with his grief over the loss of his wife. All we know is that he got antidepressant pills from his doctor. Apparently, Heather takes this as evidence that Stanley/John really has made a valiant effort to deal with the kinds of normal struggles anybody feels at the loss of a long-time companion. ‘Oh? You got a prescription? Wow—that was very brave of you. I’m sorry you still ended up feeling something.’

And perhaps the most obvious thing Heather leaves out is asking how Stanley/John’s wife, Joan, might react to Stanley/John’s decision to kill himself. Or maybe we are meant to accept that Joan is the kind of person who would want her husband to die—that she’s something of a monster, and Stanley/John is really stressed out because he’s two years late on following through with their suicide pact.

Throughout the conversation, Heather lets Stanley/John bully her into not talking about the things she should be talking about, all with the threat that he’ll hang up, and the assertion of his ‘needs’—how he just can’t go on without Joan, but really needs someone to ‘hold his hand’ at the end.

We are supposed to find it comforting that once Stanley/John insists that it is, in fact, too late for a rescue, he compliments Heather, saying, “you’ve been wonderful. You’ve been a wonderful friend to me.”

But Heather is not Stanley/John’s friend, and isn’t supposed to be acting in that capacity. And really, if Heather was either doing her job right, or actually acting in a capacity as Stanley/John’s friend, she would have done more to try and help him.

And then we get the most maudlin endorsement of suicide ever committed to film—we see the ambulance arriving outside Stanley/John’s home. The camera switches to an interior shot of the home’s front door. We see someone arrive, and…it’s Joan! We never actually see Stanley/John, only hear him talking to Joan for a while. She talks about how she’s “been looking for” him, and they both agree that they’ve missed each other. So, we get this reunited-in-death sap that makes this suicide seem cute, since it helped an old couple get back together.

‘What, John? You’ve gone and killed yourself? You go to hell for that, don’t you know?’

It’s no surprise that director and co-writer Max Kirby comes out of the world of commercials and music videos. The Phone Call is practically a commercial for suicide, with all the depth of the average music video. It’s a concept piece that tries to press emotional buttons, while keeping the audience from engaging in too much thought.

As we watch The Phone Call, we are not meant to think about the value in going on with life, and finding meaning after loss. We don’t even get a serious look at suicide, depression, or mental illness, because we are given only the most surface reasons for Stanley/John to kill himself. We are supposed to take this all as somehow romantic—the sad, old man who just can’t go on without his wife. Isn’t it sweet that he’s killing himself?

And perhaps even more aggravating is the summation of the movie from its official website: “Heather works in a helpline call centre. When she receives a phone call from a mystery man, she has no idea that the encounter will change her life forever.”

I’m not sure exactly what we are supposed to take away from this tagline—that the big change in her life is that she is now carrying the burden of having sat through this man’s death, while being derelict about trying to help him? The big scene we are supposed to take as evidence of change is one in which we see Heather following through on part of the conversation she had with Stanley/John—to go back and visit a jazz club she used to frequent. We see her getting cozy with call center co-worker, Daniel, a potential relationship that was hinted at early in the movie. ‘Gee whiz, isn’t it nice that all it took was the suicide of an old man to make me get out and live a little? Isn’t this rosé delightful?’

To clarify, my reaction to the movie is not meant as some discussion about the right to die, but about the way crisis lines operate, and the absolutely awful way this is portrayed in the movie. It is simply not the job of crisis line workers—paid or volunteer—to just “hold a caller’s hand” while that caller dies by his/her own hand.

It is a hazard of working at a crisis line that one may end up on the phone with somebody as that person dies. But this is much different than such an occasion being the purpose of that work. A police officer has the potential hazard of being shot on the job—but it is not the police officer’s work to be shot on the job. A teacher may be subject to the hazard of being verbally abused or even hit by an angry child—but it is not the teacher’s job to be verbally abused or hit.

And what kind of horrible people would you be attracting to work at the crisis line if you told them that part of their job was just to listen as people die? What would be considered an appropriate level of intervention if just letting people die was considered an acceptable or even desired outcome?

Heather, like any crisis line worker, when confronted by questions of listening versus intervening, should make it clear that, as much as crisis line workers are there to offer support, they are required to intervene in order to prevent callers from completing suicide. And with experience and training, one will gain a better idea of just when that intervention needs to take place.

In the case of The Phone Call, there was an admission that a suicide attempt was already underway; and for all intents and purposes, Heather did nothing. We are supposed to see that as somehow touching, and even life-affirming.

Don’t just feel about that. Think about that.

And now for the obligatory ending: If you or someone you know is having thoughts of suicide, call the national (U.S.) suicide prevention hotline 1-800-273-TALK.

Suicide at the Oscars, part one: ‘Crisis Hotline: Veterans Press 1’

Posted on March 12, 2015 by jcschildbach

J.C. Schildbach, LMHC

The topic of suicide came up in at least three acceptance speeches at the latest edition of the Academy Awards on February 22, 2015. (Okay, yeah, I’m late to the party again). And perhaps even more astonishingly, two of those acceptance speeches were actually related to films about suicide prevention hotlines. First up is the documentary, Crisis Hotline: Veterans Press 1. (A post about the short film, The Phone Call will follow soon).

Having spent more than five years working full time for a crisis line, and continuing to work in a position sideways from, and occasionally overlapping with, such work, I can’t help but come to these films with something of a bias.

As a matter of fact, I first saw a portion of Crisis Hotline: Veterans Press 1 on a Sunday morning after coming home from an overnight shift at a call center where the crisis line calls represent only one of many mental health functions with which the staff is tasked. Having spent the bulk of my work week on understaffed shifts, I was perhaps a bit resentful at flipping on the TV to see a scene what Bob Hosk, one of the Veterans Crisis Line supervisors who features prominently in the documentary, described as “five hours here at the hotline” utilizing “about four personnel to help one guy.”

Now, don’t get me wrong. I think it’s great that the resources were available and the effort was made, with (spoiler alert) a positive outcome for an active duty service member in Hawaii.

In the time since I first saw that segment of the documentary, I’ve become more familiar with the workings of the military in addressing the epidemic of suicide among veterans and service members, and will say it is truly impressive to see the complete change that has taken place over roughly the last two decades—from an approach to suicide and mental health issues that could be described as ‘don’t ask don’t tell’ to one of increasing and highly-promoted access to counseling services, to working with suicide prevention specialists and investing in the crisis line depicted in the documentary, among many other avenues.

But, back on that summer morning, knowing that in similar situations (an unknown caller making a vaguely suicidal statement, then hanging up) rather than having a specific staff member on shift to call a special “law enforcement” phone number at cell phone company to get information on the caller’s location by pinging cell phone towers, and then being able to devote ‘five hours and four personnel’ to find the caller, whichever one of us took the call would typically end up trying to call back, and, failing any respone from that, doing a quick Internet search on the phone number (like they show in the documentary) and then making a call to 911 dispatch in whatever location the phone number (probably) originated, to report that somebody had called and threatened suicide—‘no, we don’t have a name; we don’t have an address; we don’t know how they might do it or if they tried anything yet; we don’t know if there are weapons involved; no, we don’t know much of anything about anything—we’re following our protocol, sorry to bother you.’ Then on to the next call—which could range from a hospital social worker inquiring about a client’s mental health history, to a client with chronic mental illness telling us about his dinner, to someone struggling to get help for a family member with a mental illness, to…

In the case of Crisis Hotline: Veterans Press 1, my sense is that the caller from Hawaii was truly coming from a place of desperation, and, perhaps, wasn’t aware of other options available to him, or just what sort of response might kick in as the result of the call he made. He may have thought that by hanging up, he could just drop the whole matter. He may have scared himself simply by voicing the thoughts he was having about ending his life, and so tried to walk away from that.

But beyond my initial reaction to the portion of the film I saw back on that sunny Sunday morning, and my somewhat-tempered-by-time-and-new-information response now, I have mixed reactions to the film.

I’ll say that, overall, I think it’s an excellent depiction of some of the most challenging types of work that happen at crisis lines, and at the Veteran’s Crisis Line Center in particular, which the film notes “is the only call center in the U.S. serving veterans in crisis.” (A more accurate description would be that it is the only call center in the U.S. specifically established to serve veterans, and specifically engaging the particular protocols of that call center in order to assist veterans. Any crisis line in the U.S. will take calls from veterans, and do what they can to help. Call centers affiliated with Lifeline routinely take calls from veterans and their families, in part because the callers don’t always ‘press 1’ when prompted to get transferred specifically to the Veterans Crisis Line Center. And, while Lifeline workers typically will explain to such callers that they have not reached the veteran’s line, they always offer to help.)

Semantics aside, not all calls to a crisis line are life and death—or even crises. Each time the phone rings, it’s not a given that the caller is a someone on the verge of taking her/his life, or a family member of such a person. But you wouldn’t know that from watching this film. You only get the slightest whiff of the lighter calls, when, early on, the camera moves through the call center, the sound of constantly ringing phones and poignant snippets of dialog, reaching the microphones at just the right time: “really proud of you…Where were you stationed?..So twice you tried to hang yourself before?…Do you want me to send someone there for you?…Did you get injured while you were out on active duty?…diagnosed with PTSD?…If there’s anything we can do for you…”

Okay, so those don’t come across as all that light. That particular scene is one of many subtle manipulations used by the filmmakers—layering audio to create a particular impression of an “always on” call center. For the sake of drama, the filmmakers leave out audio involving callers who are just seeking information or non-emergency services. They leave out the repeat callers who are really just touching base and giving a brief synopsis of their day. They leave out those calls having any of a number of angles that aren’t even remotely related to suicide.

The filmmakers also choose to escalate the drama in a completely unnecessary way. For instance, the music, most often quiet, involves drawn-out, high-pitched tones that add to the tension viewers are meant to feel—as if trying to talk a stranger out of suicide isn’t drama enough.

I love this woman: Maureen–Crisis Line Responder, Extraordinaire

On top of that, the final segment of the film takes place on Christmas Eve. The scene opens with outside shots of the call center at night, American flag flying, trees wrapped in colorful, twinkling lights, as a soft jazz version of “Have Yourself a Merry Little Christmas” plays–the song adding a sting of dark humor with it’s ‘all our troubles will be miles away’ and ‘let your heart be light’ emotions. The timing of the scene was undoubtedly selected because of the heightened emotions many viewers are likely to have around the idea of a “Christmas miracle” or notions of family togetherness at the holidays. But it also serves to reinforce the popular, but ill-informed, notion that ‘the holidays’—Christmas in particular—are a time of heightened depression and increased suicide, an impression reinforced by a shot of the notepad where the crisis responder has written a quote from a suicidal veteran: “Holidays are depressing.”

There are other things that could be taken as manipulation, but which I think were not only clinically sound decisions, but also place the focus where the documentarians wanted it: on the people working at the crisis line. Not hearing the callers, for instance–while likely done just as much for clinical reasons, as for legal and artistic reasons–provides for greater control over how the information will be presented to the audience, and also removes any impressions viewers might have of the callers based on their voices, or the tones they are using. While I obviously don’t know the specifics of how any of the callers in the documentary spoke or sounded, anybody who has spent time working on a crisis line knows that many of the callers can come across in a way that, shall we say, challenges empathy. Responders need to be aware of the potential biases they bring to calls, and need to develop skills for de-escalating and connecting with difficult callers. At any rate, difficult or not, hearing the callers’ voices would create a completely different film.

Still, one of the most valuable aspects of the film is in giving voice to the crisis line responders, not only in their moments of calm where they appear to be completely in control, but when they are giving voice to frustrations as well. During one call, Robert, a veteran himself, complains that the response time from police is “ridiculous.” In a separate interview segment, Robert expresses the anger that crisis line responders can feel toward callers: “How dare you take your own life?” But part of the reason Robert’s rawness comes across in a potentially endearing fashion is that the filmmakers also let him speak about his struggles with questions of his own abilities, whether or not he has made the right decisions, or whether he made them in time—questions born of situations where the interventions failed.

There are other responders in the film with whom I had a harder time connecting—feeling a sense of kinship, or understanding their particular reactions, or the ways they tried to connect with callers. I don’t want to dwell too much on my snotty, hypercritical reactions, though—or even mention them in any specificity. For one thing, I know only a very limited amount about what was happening in those particular situations. And I don’t know how those people move about in daily life, or in their routine work at the crisis line.

But why I will most back away from potentially harsh or nitpicky-sounding criticism of any of the responders is because I can’t imagine having to work a crisis call with the knowledge that cameras are on me, and that whatever I do could end up on HBO.

That said, there is one responder in particular, Maureen, who comes across as the undoubted ‘star’ of the film. Little is explained about Maureen or her background, except, perhaps, that she reveals that she has sons, as she is complimenting a caller on her handling of a difficult situation.

Beyond that, Maureen demonstrates the perfectly complicated balance of compassion and detachment that is rare in crisis line workers. She is able to connect to the callers, but does not get visibly drawn into the drama, despite mentioning calls that ‘stay with you.’ Early on, we hear her say, “It’s ultimately the veteran’s decision if they are going to live or die…and as a responder, you have to have a really good grasp of that.” Truer words have never been spoken.

Maureen is able to deliver lines of perfect connection to callers–lines that may seem odd to those unfamiliar with such situations. After asking a caller about how his friend (who died in combat) would react to news of the veteran’s suicidal intent, she listens for a bit, then says, “He’d kick your ass? So he’s a good friend.” Maureen is able to drably ‘contract for safety’ with callers, getting them to promise that they at least won’t kill themselves while they are on the line with her, and then works to expand on that promise.

Maureen is the responder featured in the final scene of the movie—the one that takes place on Christmas Eve. Against this backdrop of heightened emotion, she is tasked with drawing a soldier with a gun out of the desert, and back to his parents, despite much of his life unraveling. She is further challenged by limitations on her involvement—having to direct the veteran’s mother on how to bring him home, and then sitting silently, listening, and hoping it all works out.

In the end, Crisis Line: Veterans Press 1 leaves much to contemplate—whether from a clinical or technical perspective—or any of the other myriad perspectives that could be brought to the film. It is incredibly effective in that it is able to provoke a range of emotions, and could, potentially, be used as a tool for training crisis line workers and volunteers, service members and their families, or really anyone who wants a better understanding of how crisis lines work, how the mental health system can be accessed, or how the military is responding to concerns of suicide among its ranks.

It remains to be seen if the film will help draw more workers and volunteers to crisis services, or perhaps scare more of them off. And this is where I have the most difficulty with the film. How much is too much when trying to convey the intenstity of real-life situations? What level of manipulation and film-making technique serves to create understanding, and what level serves to drive only emotional response?

Granted, the vast majority of people who see Crisis Line: Veterans Press 1 will never work in a crisis line call center. But, there’s always a chance they might need one.

So (obligatory ending)…

If you are concerned that somebody you know may be struggling with thoughts of suicide, call (or get them to call) the National Suicide Prevention Lifeline at 1-800-273-8255—Veterans Press 1.

Respect the Blankie

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