Tag Archives: mental illness

Another Psychologically Troubled Individual with a Gun, another Military Contractor with Security Clearance

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Another Psychologically Troubled Individual with a Gun, another Military Contractor with Security Clearance

What does it add up to? –another mass shooting, another crime at a federal facility, this time the U.S. Navy Yard in Washington, D.C.

 

Alexis

No need for lengthy soul-searching. The shooter had already been identified as psychologically troubled, before Monday’s mass killing. Aaron Alexis was displaying symptoms often associated with schizophrenia and had sought help. Several police stations were already acquainted with him.

A former Navy Petty Officer, he had been disciplined repeatedly for misconduct, leaving the Navy though remaining on the list as a reservist–honorably discharged under early-release, the service unable to general-discharge.

He had had several scrapes with the law, including at least two incidents involving guns–using firearms without need, shooting out the cars of a tire in Washington state and shooting into an upstairs neighbor’s apartment in Fort Worth, Texas.

As often happens, Alexis purchased his most recent guns in Virginia, hub of weapons commerce on the East Coast.

Thirteen people dead, including the shooter. Mental disease or defect, a pattern of erratic behavior, violent incidents including altercations involving shooting guns, military experience and clearance giving him access to a U.S. armed forces facility.

A danger to self and others.

And what do we do, presented with an individual like this? –Why, under the guidance of the cartel-supporting National Rifle Association, we do the obvious: we let him buy all the weapons he wants. Then the led-by-the-nose-by-the-NRA GOP screams ‘Obama’, or ‘government’, or ‘bureaucracy’, or whatever feeble CouldaShouldaWoulda it will use this time, conveyed by the silk-stocking law-lobbying firms its sponsors fund, to the ever-accepting dues-paying ignorant and resentful. The party line is getting thinner by the month, thinner with wear from every drearily predictable incident–but not necessarily thin enough to defeat every well-funded and highly hyped recall effort in every remote area in the U.S.

The only mystery about this mass shooting is why any respectable media outlet in America would pretend that the NRA has any credibility.

“Well regulated,” part 2: Strict constructionism means paid lobbyists?

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“Well regulated,” part 2: Strict constructionism means paid lobbyists?

Picking up where the previous post left off–

“Well regulated” was praise in this country at the time America was born. For eighteenth-century American colonists, well-regulated was everything the ridiculous Georges on the English throne were not. The Swiftian, satire-worthy courts under the British kings were repudiated in the law courts of the new United States, regulated rather than bought, in check rather than ruled by fear or favor. In the new country–or this was the aim–the king as sovereign in every courtroom was replaced by the people, sovereign in every courtroom. Neither judges nor testimony were to be either bought, or coerced. Unlike the English court, where according to reputation anything and anyone could be bought for a price or pushed around if not, in America no private citizen or public official, however understandable his motivations, was to impose his will unjustly on others by force or fraud. “Well regulated” was encomium, but it was more than just a compliment; it was the antidote to force and fraud, the two basic forms of all injustice according to Aristotle, Aquinas, Dante, Milton and the founders. “Well regulated” was the widely applied tag, applied especially to everything self-evidently in need of regulation–militias, governments, the passions of men; taverns, society, commerce. “Well regulated” incontrovertibly applied to individuals as well as to groups, self-governance being as important a principle as governance res publica.

 

Assault firepower

Funny how the gun nuts and their well-paid users on K Street always represent ‘regulation’ as the enemy. But then, our highly paid lobbyists and the politicians in their pockets–former politicians and future lobbyists, respectively–are no constitutional purists. You never see them out rallying against a standing army in peacetime, and in fact they tend to distance themselves from the diehards places like in rural Idaho who do oppose government military. Since they are to a man either Republicans or ‘blue dog’ Democrats committed to the wedge issues of McCarthyism, racism, and bloodshed-ism, you seldom see them even refer to  waste, fraud and abuse in the military-security-industrial complex. The last people to go to about billions in cost overruns by federal contractors are the protectors of quiet super-wealth masquerading as rugged-individualist loudmouths. Currently they do not even mouth off about foreign ownership of U.S. assets, a topic one might think tailor-made for the more-chauvinist-than-thou types.

It will be noted that the massive contradiction to the high principle outlined in the first paragraph above was slavery. Enslaved people did not, to put it nicely, have the full protection of the law and courts created by their enslavers. Predictably, this hideous part of U.S. history also gets exploited by K Street (name used here as metonymy). The gun lobby often reaches out to selected individuals of color, to be part of ‘the new face of gun rights’. The individuals thus selected often get their statements into print or on air, too, on the journalistic basis of man-bites-dog: After all, historically excluded groups have not benefited from the abuses of the weapons industry, so members speaking on its behalf tend to be exceptions. By the same token, the indigenous peoples of the new continent also did not enjoy equal protection under the law in colonial times, nor did women, nor did children, so the gun lobby has its female reps–although even the NRA has yet to argue that children should have the right to concealed carry. Interestingly, you also don’t see the NRA arguing that Native Americans should be carrying semi-automatics, although as with foreign ownership of American property, the topic might seem inviting; Native Americans with their bows and arrows were by all historical accounts ill-matched against the industrial advances of the Europeans. Perhaps for some reason the NRA is uncomfortable with the notion of standing up for primitive societies and indigenous peoples around the globe. Or perhaps defending American Indians just does not comport well with that cowboy image the gun lobby tries to project.

 

Guns Across the Border

UPDATE April 30–This just in:

This cannot be coincidence. The gun fanatics are running a billboard featuring Native Americans. Not subtle: A picture of three Native Americans in tribal dress is captioned in giant letters, top and bottom, TURN IN YOUR ARMS and THE GOVERNMENT WILL TAKE CARE OF YOU.

Native Americans targeted by gun fanatics

Are the NRA or its zombies reading this blog? I refuse to say, “I spoke too soon.”

[back to original post]

Speaking of cartoons, cowboys, and borders–

There is more than one falsehood in the ‘2nd Amendment’ catchphrase. Using the U.S. Constitution to justify military-style assault weapons is bogus, and there is more than one way to point it out. The following are a few:

  • One of the most blatant incongruities is NRA opposition even to sensible policy to reduce shipping arms to drug cartels and gangs in Mexico. Mexican drug cartels have a constitutional right to bear American guns? For reminder, the Bureau of Alcohol, Tobacco, Firearms, and Explosives revealed in 2012 that 68,000 guns traced in Mexico from 2007 to 2011 had been traced to the U.S. The ATF report is linked here.
  • The NRA has continued to oppose any move to keep guns off airline flights, although public opinion lopsidedly supports keeping guns off planes. In late 2011, Transportation Security Administration (TSA) security had found 800 firearms about to be carried on board during the year.
  • The NRA and gun extremists continue to oppose registration, licensing and tracing of firearms even while firearms continue to play a big part in the drug trade. There is a constitutional right to trade weapons for drugs? There is a constitutional right to conceal weapons sold  in drug commerce? Even while U.S. courts are prosecuting the drug trade and narco-terrorism, and are being funded by the public to do so?

Two final observations, quickly:

One is that the gun lobby’s opposition to common sense is itself opposition to the constitution. Our framers had a rooted belief in not putting unlimited power into human hands, any human hands. They knew the dangers too well. The entire U.S. Constitution embodies that belief. In respect to arms in particular, there are no statements of record legitimizing military-grade arsenals for individuals in peacetime.

The other is that, ludicrous as the above examples are, the gun lobby goes well beyond opposing particular (sensible) policies on firearms. In U.S. gun violence, some of the worst problems and many of the deaths occur in connection with 1) domestic disputes, 2) alcohol or other substance abuse, 3) depression or mental illness, and 4) crime. In U.S. politics, the gun lobby effectively overlaps with the Republican Party. What that means in practical terms is that

  • measures to protect women from domestic violence will always get opposed. The NRA, as we have seen, is all hot to trot on a disturbed man’s right to bear arms and shoot his wife or girlfriend, and children. GOP honchos, as we have seen, are always against better rules and enforcement on grounds of either ‘socialism’ or ‘higher taxes’. The taxes pay for the courts that issue restraining orders, for the child support agencies that supposedly enforce supporting children, and for law enforcement for follow-up to court orders. Thus the tragic finale of gun violence to so many domestic disputes.
  • by the same token, measures to protect children and minors, to try to maximize their chances of growing up safely to adulthood, will always get opposed. The NRA is less than zealous to keep guns out of the hands of minors–even when minors are used to run guns for gangs, for cartels, and for narco-terrorism. The GOP displays the same attitude toward safe schools, in general, that it displays toward safe homes, safe child-care facilities, and safe consumer products.
  • for the same reasons, mental health always gets short-changed.
  • crime prevention always gets short-changed.

 

Meanwhile, K Street–to use the popular eponym again–works overtime behind the scenes, to short-change the public and to justify short-changing the public.

Long-term care and pedicures

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Long-term care and pedicures

Of all the weaknesses in American health care, long-term care facilities display the worst. Regular hospitals have their problems; that medical word ‘complications’, as in the familiar phrase ‘died of complications after surgery’, indicates the long-running problem our hospitals still have with keeping clean. Indeed, even a hospital with state-of-the art resources for organ transplant, for example, can show a baffling inability to keep infectious bacteria away from patients. Simple as the notion of cleanliness may be, it often remains beyond the reach of hospital management, and the anti-regulation, anti-inspection, anti-redress mantra of one of our major political parties often puts the problem beyond the reach of the public. But the problems in other health-care facilities pale in comparison to those of long-term care facilities.

Germs and other errors

In part, this is the human factor. Employees in long-term care, after all, often deal with the patients for whom there is the least hope. Long-term care for a patient with advanced dementia, or multiple sclerosis, or some kinds of cancer, means a door that opens only one way. Long-term care for the mentally ill can be even more disheartening. Even without the extra abuse of foisting off small-time drug dealers and other crooks on the facilities–who then prey upon the mentally ill residents, and manage to take from them any small possessions they still have–there is the difficulty of dealing with someone too cognitively impaired to communicate, and above all there is the difficulty of dealing with someone who shows so little potential for future development. Every parent knows the stresses of taking care of a toddler–but a two-year-old toddles at the doorsill of a universe of potential. The strain of constant watching over a young child is more than compensated, not only by love and affection, and by the entertainment factor–So that’s where your keys went/why the dishwasher went on the fritz–but by the constant awareness that the toddler has the possibility of a rich and full life ahead. In taking care of someone with advanced Alzheimer’s, or schizophrenia, or any psychotic condition, think toddler-care squared. Dementia patients, like toddlers, cannot be safely left alone, even for minutes at a time; the severely mentally ill, like toddlers, cannot communicate clearly with medical personnel. The difference from toddlers is that the emotional payback is infinitely less. It takes a healthy, strong, cheerful individual to staff a facility for the care of lifelong underdogs.

Unfortunately, beyond the human factor is the corporate factor. Employees in long-term care tend to be among the lowest paid and the least trained in the realm of health care. Their supervision is much less likely to take into account the quality of patient care than the possibility of union organizing. Indeed, every piece of writing on management of long-term care facilities has as its unwritten rubric ‘This Is How You Avoid Having Your Employees Organize’. That title might as well be printed on every page of every management binder, at least in invisible ink perceivable only to the ever-increasing tiers of sales personnel, business office personnel, and other administrators/handlers of the corporate products that also increasingly influence law firms and universities at every level now.

Best practices pyramid

The result is that you’re lucky to get any care of the patient, or resident. No matter how much you pay, no matter how good the sales pitch, no matter how many pages of forms you fill out as to patient food preferences, daily needs and even medical history, you can count yourself lucky if the person being treated gets day-to-day care at the most basic level. This melancholy conclusion is not only mine, but also that of every person I know and have talked with, about long-term care for older patients and other cases. Setting aside any worse abuses, one old friend told me about a health aide who induced his elderly mother to write a personal check for $85,000–fortunately caught and stopped by her bank. The jewelry of one friend’s mother was stolen from her drawers, by people there to take care of her. A more fundamental problem is that the wrongful acts of commission are far outnumbered by more passive omissions, when health problems become worse when compounded by neglect. One old friend of mine estimates, from observation and experience, that maybe twenty percent of long-term care employees actually take care of the patients.

Actual volunteer, not photographer's model

There is no one-stop, one-shop solution to this problem. Most facilities know already that a good video-monitoring set-up can help. Many states and localities already enjoy the benefit of young volunteers, who come in as part of a school program and estimably boost the cheerfulness and energy of any place they help out in.

Cleaning?

There are, however, some simple steps that as part of a multi-valent approach can up the quality of long-term health care, and can reduce the incidence of health-threatening and life-threatening conditions. Regrettably, these are so simple and down-home that, like hospital cleanliness, they lack the cachet of organ transplant. Therefore they fail to generate support, because they do not attract the resources of high-profile medical procedures.  No corporate structure stands to make money off them.

Saving space and time for now, let’s start with two–dental care and foot care.

Dentists and podiatrists know the importance of healthy teeth and feet. The rest of us have a way to go, seemingly, to catch up. Fortunately for the American public, at a time when health care costs are going up–and of course, as always, the price of health insurance is going up–many tennis shoes, sandals and boots are more healthful, less destructive to the bones of the foot, than earlier shoe models. Plenty of killer shoes are still out there–media attention to anexoria and bulimia has not yet taken in the ankle-breaking shoe substitutes, thin-soled and unsupportive, also marketed to young people. And unfortunately good sneakers are often manufactured abroad rather than in the U.S. But young people today at least have the possibility of growing up with fewer foot problems than did their elders.

Patients and residents in long-term care need foot attention so routinely it’s a shame the issue can’t be built into those training binders for managers. (But see union- and organizing-prevention, above.) Foot issues are a known consequence of diabetes; however, all patients–especially those who cannot speak for themselves, or speak lucidly–need the attention. At the substantial risk of seeming to trivialize this issue, a few stopgap measures could help at the place-to-place level.

One is a visit to the nail salon. Schedule a visit to get a pedicure for the patient, and watch what unveils when the sock comes off. Blisters, bunions, infection, hammertoes, ingrown nails–the pedicurist sees them all, and anything the pedicurist can see, medical personnel should be able to see. The idea here, of course, is follow-up, not just observation for its own sake. It is always risky to use personal anecdote to illustrate a point, but I find it incredible that my brother, in a long-term facility, was hospitalized recently–and two hospitals failed to notice that he had a foot infection. Don’t they disrobe patients in hospitals, take down details in medical charts, and pass the notes along to the physician in charge? Don’t they alert senior medical personnel to any potentially life-threatening condition or wound?

This was in Houston, if that’s relevant.

Back to the pedicure trip–it might sound silly, but it could help. The outing itself would be relatively pleasant for the patients, the feel and look of the manicure and pedicure comforting. Caretakers could be included; they have their own issues, after all. Most importantly, with even a little bit of organized record-keeping, any problems could be noted, and then done something about. Problems the pedicurist could not cure could be treated by physicians soon after. Improving foot health not only reduces the danger of infection to the rest of the body, it also improves the possibility of exercise and mobility.

Dental issues are foot issues on steroids. More than ample clinical evidence has long demonstrated that deep problems with teeth and gums endanger the entire body, including the heart. Veterinarians know it, as well as human doctors–examining the teeth and gums is routine, because protecting tooth and gum health is essential to, for example, the kidneys. So–condensing the message, here–frequent visits to the dentist should be routine for the residents or patients in long-term care facilities, by law, and daily dental care should be part of the daily regimen of assistance as a matter of course.

So why aren’t they?

Once again, see the human factor and the corporate factor above. Brushing twice a day, multiplied by the number of patients, takes time and labor. Management doesn’t want to pay for the labor, or hire the staff sufficient to handle it, or train employees. And while frequent headlines about frail elderly people found sitting or lying in their own feces have shamed most long-term care facilities into providing incontinence care, there have been no headlines about abscesses in the gums.

Final note: Yes, I know this is a buzz-kill. But the daunting size of the target–improving long-term care–has its upside: It’s so big that it would be hard to miss.

more later