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Shooting expose cracks in US mental health system

October 10, 2012

Shootings expose cracks in US mental health system. Published 10/2/12. Associated Press.


This article shines the spotlight on patients’ right not to seek treatment and the possible devastation that it could cause.  An example was used of Andrew Engeldinger’s parents struggle to convince Andrew to seek help.  He experienced increasing bouts of paranoia and delusions. Andrew did not believe he needed treatment.  Minnesota law protects people from unwanted mental health interventions.  There has to be an explicit threat that the individual is homicidal and/or suicidal.  The two year journey culminated with the tragedy of Andrew killing four people and himself in a workplace shooting last week.  He had never been diagnosed.


The extreme of violence of Engeldinger, and others (Seung-Hui Cho (Virginia Tech in 2007), and Holmes (Colorado, summer of 2012)) are, according to the article, rare.  Depending on diagnosis, the lifetime prevalence of a mood disorder such as schizophrenia is 20.8% (Kessler 2010).  This number also includes major depression and bi-polar disorders.  If the diagnosis would be a personality disorder, the lifetime prevalence is higher at 24.8%.  This number includes (for instance) intermittent explosive disorder but does not included disorders such as borderline personality disorder.  Unfortunately, the ECA, NCS, and NCS-R did not gather data for extreme cases such as Engeldinger.  Where would have Engeldinger’s symptoms fallen within the DSM? Even if he had a diagnosis, would he have followed up with treatment?


According to the article, 41 states have reversed some laws from the 1970s patients’ rights movement. Some of these laws now can allow the courts to mandate treatment for a specific amount of time.  (Minnesota does not have these types of laws.) The course of patients’ rights have flowed from involuntary institutionalization for failing to comply with culturally imposed expectations of behavior, to the cost-effective measures (more pills, less facilities; Oct. 1 lecture) of medicalization of many disorders and the psychological community’s desire to codify symptoms (Mechanic,”Mental Health and Mental Illness”); to whether or not an individual personally deems treatment a necessity.  This progression of increasing the individual’s rights was essential.  The treatment people would receive as late as the 1950s (Oct. 1 lecture) were dehumanizing.


If someone such as Engeldinger, truly believes there is nothing wrong or that treatment cannot help, where does this leave the friends and families who watch their loved one struggle with mental illness?  If a diagnosis had been applied, would an intervention have helped? Could these horrific episodes been avoided? In the case of Cho, he had been ordered to participant with an out-patient treatment program.  He killed 32 people.


The stigmatization of seeking mental health treatment or caring for someone who is seeking treatment has been alleviated (Horwitz 2010).  However, the choice of out-patient treatment still ultimately resides within the individual. This is part of the dark side of our individualist culture.  We tend to believe what would be most beneficial to ourselves; what reinforces and validates our identity. In some cases, the denial of mental illness is stronger than the concerns of the social group.  The article enforces this idea by ending with the two examples.  The individuals engaged in compliance with their treatment after many years of fighting against it.  They are enjoying their lives but it was a long, hard road.

Carrie Fuller

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