Heaven Is So High — February 17, 2013, Sermon

I delivered this sermon, on mental illness, two months after the massacre in Sandy Hook Elementary School, in Newtown, Connecticut.

*****

The reading is from the article “Successful and Schizophrenic,” by Elyn R. Saks, in the New York Times, January 25, 2013:

Thirty years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to U.S.C.’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone.

I’d like to begin with two anecdotes from my life, with more than 20 years separating them.

To take the later one first, in 2007, I was on the board of my homeowner’s association. There are just 16 households in our subdivision, and one would think that would make governance easy. One would be wrong. We had more than our share of petty bickering.

At one board meeting I brought up a request from my wife, Carol, and me. As many of you know, Carol is a psychiatrist with her office in the Town of Purcellville. She was thinking that she might like to have her office at home, so we were considering building an addition to enable her to do that. I thought it would be good to get the board’s approval in principle before working on any plans.

Carol doesn’t treat any patients in groups. This would generally mean just one more car at a time on our road and in our driveway. Plus, we live on the corner, so Carol’s patients would represent more traffic for just the first 50 feet or so of our street. But the added car traffic wasn’t what the other board members wanted to talk about. It was the people who would be in the cars.

“Mel, does Carol see any child molesters? I guess she wouldn’t want to have any in her home as long as Carl is there, but if she doesn’t see any now, how would we make sure that she won’t see any in the future?”

“Uh, Mel, would Carol’s patients be coming into the neighborhood when our kids are going to and coming from school? Do you think she could limit her hours to just when the kids are in school?”

“Mel, look, I see a psychiatrist, and my daughter sees a psychiatrist, and we take pills, and I can tell you that when we get low on our pills…”

I was devastated that my neighbors were so willing to stereotype and gang up on an entire group of people – everyone who sees a psychiatrist. Carol took it more in stride than I did. It was too painful for me to pursue and for me to stay on the board. We withdrew our request and I resigned from the board.

That’s the first anecdote, and I’ll insert here the disclaimer you sometimes read in the acknowledgements in nonfiction books. In writing this sermon on issues around mental illness, I have occasionally asked for Carol’s help with a definition, with the right way to say something, or with the meaning of some research statistics. But the sermon is my own. Don’t blame Carol for the thoughts I express – or the mistakes I make.

The other anecdote begins on July 30, 1983. It was a Saturday morning and I rose early to drive from my apartment in New York City to a synagogue in the Philadelphia suburbs. My Uncle Eddie was celebrating his 70th birthday, and he wanted the celebration to begin with Saturday services. Eddie had the honor that morning of carrying the Torah in its procession around the sanctuary. Eddie was a tireless volunteer, devoted to his synagogue – not so much to the dogma of Judaism, but to the community of the synagogue. He would have made a good Unitarian Universalist.

I stayed with my Uncle Eddie and Aunt Margaret, their three sons and my mother and brother for what became 12 hours of birthday celebration – through lunch after Shabbos services, a casual afternoon at Eddie and Margaret’s home, and then a dinner with a few more friends, and more casual conversation. Eddie and Margaret’s youngest son, Barry, suffered from paranoid schizophrenia and drug and alcohol abuse. He had been hospitalized in the past, but now he was able to live on his own in an apartment, and on this day a casual observer might have called him the perfect son.

Barry wore a three-piece suit all day despite the heat and was always the first to get someone a drink, empty an ashtray, take out the trash. Unless you had an extended conversation with him, you would not think him strange at all.

Many of you know what happened next. Less than three months later, he shot his parents, Eddie and Margaret Pinsky, to death. Somewhere in the sanctuary is a hymnal bought in their memory.

Those two anecdotes illustrate two poles of a societal, and I would say a spiritual, dilemma, one that has troubled me greatly in the aftermath of what has been called the Sandy Hook massacre. As my fellow homeowner’s association members demonstrated, the “mentally ill,” whatever that term means, are a group subject to considerable bias. But on the other hand, as I know from my own experience, very sick people do sometimes get violent and kill people.

The dilemma is that, with all of the calls to protect ourselves from the “nut cases” who do such things, and with about one-quarter of the adults in the United States suffering from a diagnosable mental illness in a given year, there’s no way to know which nut case might be dangerous.

I remember a few weeks after my uncle and aunt were killed, I left my office building in Manhattan for lunch, and as I walked out the door I saw a filthy, disheveled man running toward the plate-glass window. He stopped just an inch or two from the window and then backed up, ran toward the window again and stopped just the way he had done the time before. I watched him do that a few times, and these words came to me: “And my cousin wore three-piece suits.” I guess that very visible nut case was less of a threat to others than my well-groomed and well-behaved cousin was.

Let’s look at some numbers. The National Institute of Mental Health says that 26.2% of Americans 18 and older have a diagnosable mental disorder in a given year. The percentage of adult Americans availing themselves of mental health treatment and services in a given year is just half of that – around 13%. Half of those with a mental disorder are untreated and probably unidentified.

The 26.2% of the adult population with a diagnosable mental illness equals around 60 million people. Almost 14 million people, or about 6% of the adult U.S. population, have a mental illness considered serious. These statistics don’t include people with drug and alcohol abuse or dependency unless they also have a comorbid psychiatric disorder.

So when we talk about background checks and screenings to keep us safe, who among these 60 million-plus people are we talking about? There are some categories of mental illness that tend to get linked to violence. Schizophrenia, or course, is one of them. According to the NIMH, some 2.4 million Americans, 1.1% of the adult population, suffer from schizophrenia. How about bipolar disorder? About 5.7 million adults – 2.6% of the population – have that disorder. And then there are a couple of million people, 1% of Americans, with antisocial personality disorder, a term that’s also related to the people we call sociopaths or psychopaths.

It’s not accurate to add all of those figures together, since there is some overlap, but in very rough terms there are well over 5 million people in the United States who have schizophrenia, bipolar disorder, or antisocial personality disorder, and then tens of millions more Americans abuse or are addicted to drugs and alcohol.

And then there are those who feel so low with heaven so high. Few of us have not suffered a major depression or been close to someone who has. Almost 15 million Americans – 6.7% of the adult population – suffer from major depression in a given year, and the lifetime incidence is more than twice that. Almost a third of major depressions are considered severe, and that disease – severe major depression – has been tied to some notorious violent criminals.

My neighbors on the homeowners’ association board were fearful of anyone being treated for a mental disorder or who should be in treatment – some 60 million people. But even if we narrowed it down to those serious disorders associated with violence, we’d still have more than 10 million people, or 4% of the adult population (one in 25), to be wary of in any given year.

I apologize for all these statistics, but they help explain why I find it so extraordinarily shocking to hear people talk as though we can identify those “nut cases” likely to commit violent crimes and do something about them. Of course our society can do a better job of identifying and treating mental illness, and giving it the same protections as other illnesses, but stigmatizing the mentally ill – or just the severely mentally ill – isn’t going to help get us there.

I’ve come to learn that my neighbors were not unusual. Studies in 1996 and 1999 found that the vast majority of Americans believe that people with mental illness pose a threat of violence to themselves or others. In those studies, 38% were unwilling to be friends with someone having mental health difficulties, 64% did not want someone with schizophrenia as a close co-worker, and 68% were unwilling to have someone with depression marry into their family.

Understanding the relationship between mental illness and violent crime is like the blind man examining the elephant. And to stretch that metaphor, it’s a hard subject to get your arms around.

First, there are the many types of violent crime, and our emotional reactions to them. Looking only at homicides, mass murders are different from spree killings, which are different from serial killings, which are different from domestic homicides, which are different from stranger killings, and I’ve still left out some categories.

Psychologist J. Reid Meloy has studied mass murders, and he writes: “When a mass murder occurs, it receives instant and pervasive news coverage. Unfortunately, we are prone to overestimate the frequency of an event by its prominence in our minds, and mass murder is no exception. This is a very rare phenomenon and is neither increasing nor decreasing in the U.S.”

Even his statement, made in September 2012, that the rate of mass murders is pretty constant, is open to some debate, depending on your definitions, but his overall point is that we overestimate their frequency, and that at least is clear. He also points out that the motivations and pathology of mass murderers are complex and defy simple generalizations. Plus, they are different in many ways from the motivations and pathology other violent criminals.

First, mass murderers are not impulsive. Dr. Meloy writes: “Research consistently shows that mass murderers research, plan, and prepare for their act of violence for days, weeks, and even months.” For that reason, abuse of drugs and alcohol is seldom involved in mass murders, in contrast to other violent crimes, where substance abuse and impulsivity are big factors. The killer needs to remain calm to carry out the plan.

So are people with serious mental disabilities more likely to commit violent crimes than the general population? The answer is yes – but it’s a very small percentage of all violent crimes, and it’s only sorta true. By that I mean that it’s true especially when you look at people with substance abuse problems as well as serious mental illness. If you factor out people with that dual diagnosis and look at serious mental illness without substance abuse, the increased incidence of violent crime is significant but very small.

And, of course, the statistic you often hear is that people with serious mental illness are two-and-a-half times more likely to be the victims of violent crime than the perpetrators. What confuses the issue, I think, is the phenomenon that Dr. Meloy writes about – the emotional reaction we all have to the well-publicized mass murders and spree and serial killings leads us to exaggerate them and build myths around them.

Dr. Meloy defines mass murder as “the intentional killing of three or more individuals, excluding the perpetrator, during one event.” My cousin Barry fell one individual short of that mark, but he fits the pattern that Dr. Meloy describes in that he calmly and methodically carried out a plan, and I can attest to how calm he was for five days afterward until he was arrested and confessed.

That killing received some press in Philadelphia, but nothing like the attention it might have gotten if there were more victims, and if some of them were not Barry’s relatives. We’d be reading stories about what a nice quiet neighbor he had been. Maybe the cab driver who took Barry from his apartment to his parents’ on the night of the killings would be quoted describing how calm he was. Then some further reporting would uncover his hospitalizations for schizophrenia, and perhaps his involvement with an East Indian guru. Who knows what picture would emerge, or how close to the truth it might be?

To the rest of the world, Barry would be a symbol and an enigma like Adam Lanza and Jared Loughner. To me, he will always be the cousin I loved and played with as a child before his illness set in. So, it meant a lot to me when, three weeks ago, our co-minister, Phyllis Hubbell, lit 28 candles for the Sandy Hook victims. She included Adam Lanza and his mother, and spoke movingly about universal salvation and about grace.

I could never do that as well as she did, but what I’d like to leave you with today is the suggestion that the mentally ill face considerable prejudice. Every once in a while we become aware of another group that deserves our attention, that needs people to go to bat for it. Maybe it’s the turn of the mentally ill.

In part because of the Jared Loughners and the Adam Lanzas and, yes, the Barry Pinskys of the world, we are not doing justice to people like Elyn Saks, the writer of “Successful and Schizophrenic,” and to the patients Carol treats and the many people I met when I was on the board of Friends of Loudoun Mental Health – people who are doing their best to live in the world with serious mental illness. Maybe it is their turn at bat for justice.

*****

The performance below was a dedicated to the Sandy Hook victims.

Copyright 2015 Mel Harkrader Pine

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