WillSpirit!

Back in March 2000, my moods got a little dicey, to say the least. On Monday, for instance, I might feel fantastic, everything looking like sunshine, my mind bubbling with marvelous ideas for the future. The (pejorative) clinical term ‘grandiose’ would have applied to some of my plans, like the one about founding a ‘museum of the human body’, which I envisioned filling a local decommissioned aircraft hangar. Mostly, though, I was just trying on new hats, given that my old surgeon’s cap needed to be tossed aside (because of worsening neck damage). My thoughts on Monday stood at the peak of optimism; from that vantage the future looked grand.

By Friday all that joy had melted into a sticky tar of futility. How could I go on? After a decade spent growing into a subspecialist in oculoplastic surgery, and only six years as a full-fledged independent doctor, it seemed unimaginable to start all over in a new direction. Words like ‘overwhelming’, ‘impossible’, and ‘catastrophe’ popped into my head many times an hour. The image of beginning as a peon/student in a new discipline looked ludicrous. Added to my career meltdown, I had to accept the fact that Mandy and I had moved out of San Francisco, where we had owned a very unique house that I adored. Now we lived in a brand new but unremarkable suburb thirty minutes away. Not surprisingly, our marriage suffered from the stress, loss, and fear. My whole life looked pretty hopeless.

In that latter frame of mind I returned to my never-completely-absent option of suicide, which I’d toyed with off and on since my first diagnosed major depression at age twenty. My mother, before she died (crippled with depression) when I was six, had a love of the Golden Gate Bridge and showed me pictures of it with wistful vocal tones and dreamy facial expressions. I believe she had imagined living in the Bay Area with my father, back before the divorce. In my mind, the structure became an icon for hope abandoned and dreams forgone. For many years I had considered it my gateway to death. With my world in fragments, its pieces careening out of my hands, I began to step closer to that door.

Then one day I experienced something like waking from a dream: I stood in my garage, loading a knapsack with weights, which I hoped would force my body to sink after I jumped. I had elaborate mechanisms in place to make sure the pack stayed strapped to my back in the face of the final impact’s devastating power. With a shock of clarity, I understood the gravity of what I was preparing to do. I stood with these implements of my destruction scattered around me, and suddenly I regained clarity. I made a decision to live. I called a friend who resided on the same side of the bridge as me. I drove to her house so she could take me over the span into San Francisco, where the mental health clinic stood on a busy street near my old neighborhood. I did not trust myself to safely make the drive across the ‘gateway’ alone.

Once at the clinic, I explained to the social worker everything that had gone wrong in my life, and how desperate I felt. With utter openness, I told her my detailed plan for the plunge, and about how I recognized that my life might end without some help getting back on track. She listened patiently, and then told me she needed to place me on an involuntary hold, a ’5150′ in common parlance. I did not object.

A few days later, I found myself in a dreary psychiatric unit with walls the color of butter and the same gray/white streaked Linoleum flooring I remembered from public grade school. The environment looked anything but cheery, but at least I felt safe. I knew this was the place for me right then. Not a single thought of going AWOL ever entered my mind.

My psychiatrist did not ask me whether I liked being in this place, or if I believed it was helping. He told me he wanted me to stay, and that he planned on extending the legal hold for another twelve days: I would now be on a ’5250′ confinement. I had no objection. I saw no reason to complain about this step. He told me there would be a legal hearing, but that I did not need to go. He did not tell me that California law mandated that a patient’s rights advocate visit me and explain my situation. He also never offered me the option of signing in voluntarily. This was also a California legal requirement. He just told me he felt I should stay in the hospital, that he was establishing the hold, and that there was no reason to go to the hearing if I wanted to remain in the hospital. So I forewent the hearing.

Upon discharge from the hospital ten days later, I received paperwork informing me that my right to possess a firearm had been revoked. By California law, I had to wait seven years before the restriction would be lifted. It was not until later that I found out the federal rule: no firearm possession for the rest of my life.

I do not like guns. So at the time the issue upset me only a little. I did wish someone had informed me of this major implication of the legal hold. Other than that slight sense of betrayal, I let the matter drop. Then, a couple of years ago, Mandy and I were alone in our little place in the mountains. The dense, forested terrain is fairly isolated; there is only one house on every five to twenty acres, and many of the houses are vacant most of the time. That night we sat in our den watching a videodisk, when a man’s face appeared at the window, looking in. Mandy screamed so loud I jumped up involuntarily. I went to the front door, and saw two young guys outside. One stood on our porch, looking in through the glass door. The other leaned against the house at the bottom of the steps; he wore a black sweatshirt with a hood over much of his face. Naively (stupidly), I went outside to talk. I guess my feeling was to show no fear. As it turned out, the man on the porch acted very politely, though his story was murky and shifting. He never gave a good explanation for how he had found his way so far off the road without a car, but he wanted a phone so he could call someone to pick up him and his friend. In the end, I gave them directions for the walk out to the main road. They left.

Mandy was terribly shaken up. We found out afterward that the kid with the hood had moved in with our neighbor down the hill a few weeks earlier. As near as we could decipher, there had been an argument between our neighbor and this young man, such that the kid and his friend were kicked out of the house. They had come to us trying to find a way out of the area; why they did not just tell the truth never became clear. Understanding the situation calmed me down, but my wife never felt as comfortable in our retreat after that. Events a year later amplified her fears: the same kid (allegedly) murdered our neighbor in his armchair, after they argued about turning down the music.

So now a gun does not seem like such a bad idea, but federal law bars me from possessing one. Even if Mandy purchased the firearm, my understanding is that I would be forbidden to use it. In an acute situation of home invasion, I would not hesitate to employ an available weapon to defend my family and myself. Still, it would be better to not have to worry about these legalities. Someday I will probably search out an attorney to help reinstate my rights.

My reason for telling this story, however, is that it highlights the question: how much does society trust those with a history of psychiatric issues? I’ve already related the story of how psychiatry training programs rejected me, despite my stellar academic record, quite likely because I told them the truth about my mental health history. In part, I believe this because shortly after I received one rejection letter I also heard from the state’s medical licensing authority. Nothing ever came of the contact, but it became clear that my divulgence of my emotional difficulties threatened my clinical license. (In some states a medical license can be revoked for the mere record of a psychiatric diagnosis, though in California there also needs to evidence of impairment.)

Now, there are no doubt situations where a person’s mental illness would make them a dangerous gun owner or an unreliable physician. But treating all people with psychiatric hospitalizations (and often those who just have diagnoses without history of institutional care) as potential hazards is discriminatory and encroaches on civil rights. There should at least be some kind of judicial review on a case-by-case basis.

From the story I told, do I sound like someone who should never, ever own a gun? I never contemplated violence against anyone else, and I sought help before doing any harm to my self. The situation was extreme, and I needed assistance, which I engaged and accepted willingly. I would have been happy to sign in to the hospital voluntarily. There was no need for the legal hold at all. (Sometimes psychiatrists will object that a voluntary patient might just walk off the unit, but the law actually prevents this; the clinician has ample time to institute a hold and prevent ‘absconding’ if there is reason to believe it dangerous to the patient or others.)

I would have fought the ’5250′ if I had known the long-term implications. It never even occurred to me that the involuntary detention would be on my record from then on. I certainly had no idea the government would forever rescind a right that, while questionable from a societal standpoint, is extended to every other citizen who is not a convicted felon. California law was violated both by not getting me connected with a patient’s rights advocate and by not offering a voluntary sign-in. It was a travesty all around, but I’m the one stuck with the consequences.

How many people get drunk on a given weekend and murder someone as a result? I would venture to guess the number is substantial. Yet we don’t prevent alcoholics from owning guns. Why should someone who is mentally ill be automatically considered an irredeemable danger to society? Obviously, the horrific campus shootings and other mass attacks terrify the public. After the fact, every one of these killers gets slapped with the ‘psycho’ label, though many have no such history previously. But considering every case of mental illness to be of equal danger to society is analogous to considering every person who loses control of his or her feelings from time to time a potential murderer. Yes, fits of rage can lead to homicide. But most people who get overwhelmed with emotion do not go on to kill. They may sit at home and cry, they may overeat or drink to excess, they may yell. But only very, very rarely do they assassinate their companions.

In a similar way, rare cases of mental illness lead to paranoid delusions of such severity and power that murderous acts result. But the large majority of people labeled psychiatrically ill harm no one. Admittedly, a small percentage does commit acts of self-harm, but only a miniscule number hurt others solely as a result of illness. (Concomitant intoxication or interpersonal conflict may lead to aggressive acts by a mentally ill person, the same as with anyone under those influences, but it is unusual for psychiatric symptoms alone to lead to unprovoked violence against another.) It is obvious that not all mental illnesses are the same, but society’s tendency has been to paint all psychiatric diagnoses equivalently, and treat us all as unreliable and hazardous.

We get our rights taken away as mental health patients, and few (besides us) even consider it a big deal. I really never cared about the gun issue before now. Never wanted a gun. The right to possess one mattered little. Now I see things a little differently. I believe it might be in my family’s interest to have a defensive weapon available in our sparsely populated neighborhood. Most of all, however, I am mad at how ‘the system’ treats me like an unreliable sociopath just because I was brave enough to seek mental health care.