[Vision2020] Today's Daily News HER VIEW: Don't confuse mental illness with criminality

[Saundra Lund]

Visionaries:

Below please see an *excellent* column that appears in today's Daily News.
I'm very grateful to see this distinction made between mental
illness/psychiatric disorders and personality disorders.  Let's hope the
media -- and all of us -- learn this important distinction.

"HER VIEW: Don't confuse mental illness with criminality
By Elise Augenstein
June 1, 2007

I would like to discuss the meaning of the word "insane." Since the Moscow
shootings of May 19, many people, including University of Idaho President
Timothy White, editorial writers of the Lewiston Tribune, and contributors
to the Daily News, have labeled Jason Hamilton as "insane" or as "mentally
ill." 

There are two reasons I can think of why one might call Hamilton "insane."
The first would be purely by virtue of his actions, that is, "He must be
insane to do something like that."

The second would be because he has a history of mental illness. By all
accounts I have heard his entire history of "mental illness" was an
evaluation at St. Joseph's Medical Center after a suicide attempt in
February and an order by the court for him to get counseling, which he
ignored. By those accounts, all other aspects of his history are purely
criminal. According to newspaper stories, he killed and tortured animals. He
also tried to strangle his girlfriend and was subsequently convicted of
assault.

Let's discuss the definition of mental illness. Since I am a board certified
medical psychiatrist, I believe I have good knowledge of this subject.

Psychiatrists divide medical diagnoses into different "axes." Axis I
consists of psychiatric disorders such as major depression, bipolar
disorder, anxiety disorders and schizophrenia. These disorders have a
genetic and biochemical basis and can usually be treated very successfully
with medication and/or psychotherapy.

Axis II is reserved largely for those phenomena known as "personality
disorders." By definition, a personality disorder is "an enduring pattern of
inner experience and behavior that deviates markedly from the expectations
of the individual's culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress
or impairment." (Diagnostic and Statistical Manual of Mental Disorders,
fourth edition.) The "distress or impairment" caused by a personality
disorder can sometimes be treated, but the individual's personality and
behavior can be extremely difficult to treat, especially since such
individuals are often uncooperative with treatment.

Based on the evidence I have, I would strongly suggest Hamilton's major
psychiatric problem was an Axis II disorder. Many criminals have antisocial
personalities and reports of his past actions certainly fit the antisocial
personality type. His crime has sparked discussion of the inadequacy of the
Idaho and United States mental health system, which is a good thing.
Insurance coverage for mental illness is often pitifully inadequate and
treatment options in this area are limited. However, to link his criminal
behavior with mental illness in general is a huge slap in the face to all of
the many kind, sane, law-abiding citizens whom I treat every day in my
practice. 

By our best estimates, one in 40 adults in the United States suffers from
bipolar disorder, more than 1 percent struggles with schizophrenia, and
about one in 10 adolescents and adults will wrestle with serious depression.
Fifty percent of the American public will need mental health treatment at
some point in their lives. These people are as common in academia as
everywhere else, so you can assume (and I know firsthand) that
demographically peculiar college towns like Moscow and Pullman have as many
people with mental illness as any other place. They are your colleagues at
work, your neighbor, your teacher and your friend. For all of our sakes, we
all need to educate ourselves about mental illness. 

Let's not confuse mental illness with criminality. That would be insane.

Elise Augenstein is a medical psychiatrist. She was trained at the Mayo
Clinic and at Vanderbilt University and was previously a faculty member at
the Vanderbilt University Medical Center. She has a part-time practice at
Palouse Psychiatry in Moscow."