From Cafe Racer to Santa Barbara: It’s not a mental health thing

Cafe Racer Memorial

Remembering those who died at Cafe Racer Credit: Donna DeMuertos/Flickr

The toll of mass murders rings with miserable persistence these days. It’s becoming dully familiar, an ongoing trauma that won’t pause long enough to let us grieve, let alone hope to prevent the next time. According to USA Today we have suffered 248 mass murders since 2006 — including this week's tragedy in Isla Vista near Santa Barbara. Even if you exclude killings during burglaries or robberies, there have been 217 mass murders.

As the poet Stanley Kunitz said, How can the heart be reconciled to its feast of losses? Here in Seattle, we remember those who died at Cafe Racer and in the parking lot of Town Hall two years ago today. The killer was a mentally ill man whose family loved him but felt helpless to reach him, a man whose brother described him as “really angry toward everything,” and “so stubborn you can’t talk to him.” A solitary figure who was welcome at Cafe Racer except on a few occasions when he was asked to leave because he was “snapping” at people.

The murders in Isla Vista stir another round of anguished questions. “When a mad man goes on a killing spree…who’s to blame?” asked Time. Slate considered one possible answer: “Did Elliott Rodger’s Therapists Fail?”

“Rodger met with trained mental health professionals, the people we rely on to identify dangerously disturbed individuals, and they apparently failed to perceive the depth of his problems,” writes Slate’s Brian Palmer, noting that the Isla Vista murders happened despite Elliot Rodger’s family’s concerns, and despite a visit on April 30 by law enforcement officers who saw nothing that raised a red flag. 

I can’t blame people for looking to the mental-health profession to prevent violence that is senseless, mad. Calls for reforms to the mental-health system have become almost as familiar as the tragedies that inspire them. And all agree that our mental-health system has serious problems, many of them stemming from the avalanche of funding cuts in recent years that makes it harder all the time for people who want help to get it.

But as a therapist, I know how unrealistic it is to imagine that therapy, or psychiatry, or even involuntary confinement can fix what’s broken in this epidemic of violence. As a colleague said, “People don’t blame oncologists for the fact that cancer still kills people. But they expect mental illness to be something altogether simpler than cancer.” Something is killing Americans, 900 and counting since 2006, according to USA Today. Whatever it is, it’s not simple. 

(Well, maybe one aspect of the phenomenon is simple to understand if not to solve: Many lives would be saved if we had reasonable gun control in this country to make killing much harder, and much slower, to do.)

No mental-health diagnosis explains why some people go on killing sprees. Schizophrenia seems to gets blamed lately, more often than other disorders — but as Richard A. Friedman pointed out in a recent New York Times op-e the vast majority of people with schizophrenia never commit violence. While it’s true that some individuals with paranoid schizophrenia on rare occasions lash out at others they perceive as threatening, drug and alcohol abuse triggers far more violence than mental illness does.

In fact, it’s probably more accurate to say that something in American culture drives the schizophrenics among us to feel particularly unsafe, and on rare occasions to act out violently. Our schizophrenic neighbors, friends and family members may be canaries in our cultural coalmine, highly reactive to stressors the rest of us are better able to tune out. Schizophrenia

The Schizophrenia Research Foundation in Chennai, India, has found that the auditory hallucinations — the “voices in the head” — heard by American schizophrenics are much more violent than the ones heard by schizophrenics in India. Researcher T.M. Luhrmann thinks that “local culture may shape the way people with schizophrenia pay attention to the complex auditory phenomena generated by the disorder and so shift what the voices say and how they say it.” 

Luhrmann thinks this may be partly because Americans tend to fearfully reject the whole idea of voices in the head, making the experience of having them more alarming than it would be in a more receptive culture. She cites an international self-help movement called Hearing Voices, which encourages people to engage with the voices they hear, identifying them, finding out about them and negotiating with them as a way to reduce their violence over time. 

But it’s hard to ignore an even more obvious link. Look at how violent American TV shows and movies have become. Without judging this phenomenon or having any way to explain it in terms of cause and effect, it’s still undeniably true that Americans today share remarkably vivid, disturbing and violent imagery under the guise of entertainment. 

The overall incidence of schizophrenia is pretty similar around the world — suggesting that there is some organic basis for it — but its symptoms and severity differ markedly by culture. A 1992 World Health Organization study found that schizophrenics fared much better in traditional or developing societies, and worse in industrialized ones. 

If you know anyone with schizophrenia, it’s not hard to see why the industrialized world is especially challenging. Schizophrenia makes it hard to function as an individual in a competitive world.

I once was lucky enough to spend time in an Egyptian village in the late 1970s, before technology or even electric lights had arrived there. One of the villagers had long, impassioned conversations with people no one else could see. He also had a way of seeing through everyone’s pretensions. He could tell jokes no one else could get away with. 

counseling therapy

Village life was not utopia. It was difficult in many ways. But this one man, who would almost certainly be diagnosed with schizophrenia if he lived in the developed world, had a secure, safe place in his village. He could wander the wide-ranging mysteries his perceptions opened to him, and if he forgot to feed himself along the way, sooner or later someone would feed him and give him a gentle push toward the door of his home. 

Contrast his life with that of a typical client in a mental-health agency in Seattle. I remember one man, early in my training, who gave me the most baffled, hurt look when he asked me, “Why do people on the radio lie to us?” 

“I can tell that the woman who’s talking about Macy’s isn’t really happy,” he went on, “but she’s pretending to be happy. Why?” 

He felt injured by the woman’s lies, and I could see why, because he had a point. He was accurately perceiving the incongruence in her voice. All of the lying we do to each other in the name of advertising can’t be good for us. But most of us, whose brains aren’t quite as strongly bathed in dopamine in certain places where my client’s brain was constantly overstimulated, can tune advertising out. He couldn’t. 

I’ve thought of him, over time. I wonder what he makes of Game of Thrones, if he watches it. I hope he doesn’t; if he does, he probably thinks it’s a documentary.

He can’t safely wander down the street without a real risk of being robbed or beaten. He can’t help going on mental excursions, but these can be terrifying when there’s an underlying sense that the body is unsafe. 

He can’t shield himself very well from other people’s fear or hostility. He can’t help feeling the impact of a general aura of unspoken mood in a crowd. The way his mind processes input makes it all but impossible to selectively shut out some stimuli while accurately interpreting others’ intentions — the fundamental tasks it takes to function as an individual in a competitive society.

A colleague of mine once summed it up nicely when we were chatting at a party, using terms I think he borrowed from economist Jared Bernstein: 

“Schizophrenics do much better in WITT cultures than in YOYO ones.”

YOYO stands for: “You’re On Your Own,” as in competitive individualism. As in the ideology that says each of us needs to have unlimited weapons because life is a war and we’re all ultimately alone in the fight. WITT means, “We’re In This Together.” I often think that when therapy helps, it’s not because we therapists have magic bullets. It’s certainly not because we control the people who consult with us. If someone wants to end his life in a blaze of random violence, I’m not sure how a therapist could change his mind. Unless he still had some hope alive in him; unless he secretly wanted to be stopped. 

I think what helps is that in the process of therapy, simply by meeting the way we do, we create a little WITT society of two. And that’s a way to begin repairing and proliferating WITT to the point that therapy’s no longer needed. 

People need each other’s cooperation and care if we are to negotiate safely all the hazards involved in living. Those among us who have schizophrenia are especially vulnerable, because of the way their brains process experience. But what the most vulnerable among us need, we all need. And what drives them mad is damaging for all of us. 

Credits: Photo at bottom of first page: Alaina Abplanalp/Flickr

Photo on the second page: Alan Cleaver/Flickr

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