Tag: Mental Health Reform

We need to do better

Joker: A warning we should heed

At my teenaged kids’ insistence, I took them to watch Joker in the theater, expecting a typical action-packed, comic book movie – not a genre I typically enjoy. Instead, I sat in the darkness, stunned to near-tears by it’s devastating portrayal of how early childhood trauma and untreated mental illness can spiral into tragedy. 

The poignant film explores the backstory of comic book villain Joker: a man named Arthur Fleck who has a disturbing past and a troubling present. It is a compelling and nuanced portrayal of untreated trauma and mental illness. 

Joker is incredibly violent and disturbing, certainly earning its R-rating, but at the same time reflects a reality we are already seeing in our society today. Early childhood trauma is at epidemic levels. Our mental health system is in disarray. We aren’t meeting the needs of the vulnerable around us and sometimes violence and tragedy are the price we pay as a society. 

There’s a huge amount of controversy swirling around the film and it’s portrayal of mental illness. After watching the movie, I believe the real controversy we should be focused on is why we don’t have affordable, accessible, effective treatment for mental illness and early childhood trauma!

"You think Joker is controversial? What's really controversial is that we don't have affordable, accessible, effective treatment for mental illness and early childhood trauma." – Keri Williams Click To Tweet

*** Spoilers Below ***

In the film, Joker, we meet Arthur Fleck shortly after he’s been discharged from a mental health institution. He’s receiving mediocre city mental health services, living in poverty, and attempting to build a semblance of a life for himself.

While the film does not specify all of Arthur’s diagnoses, his symptoms include hallucinations, paranoia, delusions, and feelings of despair, loneliness, and worthlessness. Arthur’s one obvious diagnosis, Pseudobulbar Affect (PBA), fits of uncontrollable laughter, results in severe bullying. We also learn Arthur was abused and neglected by his mother during early childhood. This included severe head trauma as well as psychological and emotional abuse. Arthur has never been able to access the treatment he needs to manage his condition, much less heal, or thrive. He’s completely lacking social skills, unable to hold down a job despite his best efforts, and even with medication, unable to feel happy or optimistic.

Unfortunately, Arthur is not simply a far-fetched character. We have “Arthurs” living and breathing all around us – in our daycare centers, classrooms, workplaces, and neighborhoods. Early childhood trauma is a hidden epidemic affecting millions of people. While victims of early childhood trauma and/or people who have mental illnesses aren’t necessarily violent, the combination of untreated trauma and mental illness with psychosis can be dangerous. Furthermore, high-risk children are not receiving effective treatments in residential treatment facilities. They are aging out ill-equipped to function in the adult world and at high risk of criminal behavior and incarceration. Like Arthur, most of these individuals want to be happy. They want to have good lives. However, we, as a society, fail them by not providing effective, affordable, accessible treatments for trauma and mental illness. Like Arthur, these people struggle to navigate even the basics of life.

Arthur, though teetering like a wobbling house of cards, is trying to build a life for himself. He’s trying to find some happiness. But it’s obvious to the viewer that he simple doesn’t have the resources or skills to do so. And so begins Arthur’s devastating spiral that should be a warning for us all. 

  1. Arthur loses his services (therapy, medications, etc) due to city financial cuts.
  2. He’s fired from the job he loves – sure he made a mistake, but he’s given no mercy or compassion.
  3. He follows his dream to be a comedian, and falls flat. He’s mocked mercilessly.
  4. He’s physically assaulted for laughing (his Pseudobulbar Affect) and in self-defense shoots and kills two men on a train. In a panic, he kills another.
  5. He’s cruelly rejected by the man he believes to be his birth father.
  6. He learns his mother abused him as a child and anger that has been festering in his unconscious for decades surfaces.

The spiral tightens. Arthur is drawn to the rioters who praise him as a vigilante for the killing on the train (which was in fact, self-defense). He becomes more violent and murders several people. In his mind, his path has become inevitable as all other doors – all other options – have slammed closed in his face. 

Does this not reflect the crumbling path of so many young people in our society today? People who struggle on the edge of society: to hold down a jobs, to form relationships, to find their next meal, or place to sleep. This instability is the fate of so many people who have experienced early childhood trauma and/or are mentally ill because they are unable to access effective treatment and services. Is it any wonder that they are hopeless, desperate, and caught in a downward spiral? Is it any surprise that some end up engaging in criminal behavior? That some act out violently?

Towards the end of the movie, Arthur has fully transformed into the Joker. Wearing chalky make-up and a sardonic smile, he sits on a talk show stage and casually confesses to the train murders, Before shooting the talk show host point-blank in the face, Joker says, “I’ve got nothing to lose. Society has abandoned me.” And we can’t disagree: He has got nothing to lose. Society has abandoned him.

It only takes thumbing through the headlines to know that far too many of our most vulnerable have been abandoned by society and with nothing to lose have picked up guns and lashed out violently too. Read more about one recent incident here. This will continue until we prioritize affordable, accessible, effective treatment for early childhood trauma and mental illness.

NOTE: In case it wasn’t clear in this post, I am not saying that mental illness or childhood trauma lead to violent behaviors. What I am saying is that untreated mental illness and untreated childhood trauma can put people on a dangerous spiral.

In the News, We need to do better

I’ve tried the system. It doesn’t work.

Here’s my op-ed on the Parkland shooting printed by the Sun-Sentinel (Feb 2018)

When my son, Devon, was nine he pushed his four-year-old brother down the stairs. It was one big shove that launched Brandon through the air and left him sprawled on the tile floor below. At 10, he punched his teacher and several classmates. At 11, he attacked a woman and dislocated her thumb.

Told a man had fresh dental work, Devon (for the purposes of this oped, I’ll call him Devon) promptly slugged him in the jaw. He was 12. At 13, he punched a young girl in the back of the head, unprovoked, and used his pencil to stab classmates. He still does. At 14, he grabbed a woman’s breasts and genitals threatening to rape her; using a jagged piece of plastic he stabbed a man in the cornea. At 15, he bit a man, breaking the skin and drawing blood; he did $3000 worth of property damage in mere minutes.

Devon, now 16, has verbalized detailed plans to torch the group home he lives in. He routinely threatens to kill himself, me, his siblings, his teachers, and other students.

Nikolas Cruz, the Parkland high school shooter, is a troubled kid, too. While I don’t presume to know Nikolas’ history or diagnoses, Devon and Nikolas are both teenagers, adopted males with behavioral and mental health issues. I adopted Devon from foster care in Broward County when he was four. Like Nikolas, his disturbing record of deviant behavior telegraphs worse to come.

The media is calling the Parkland massacre “preventable” and pointing to missed warning signs. But, I’ve heeded the warning signs. Devon’s received comprehensive mental health services for years. Running the gamut — outpatient therapy, day treatment, therapeutic foster care, group homes, psychiatric residential facilities, mental health hospitalizations — he’s received thousands of hours of therapy. He’s been dealt diagnoses like a hand of Go Fish and is on a cocktail of anti-psychotic drugs.

All these mental health services, like water and sunshine, have unwittingly nurtured Devon’s proclivity for violence. He’s only gotten bigger, stronger, smarter, and more dangerous. I fear he could be the next teen paraded across the headlines in handcuffs.

When Republicans call for greater access to mental health services as a remedy to school shootings, they fail to recognize the mental health system has no meaningful solutions for violent kids like Devon and Nikolas.

Take a walk. Talk to staff. Hug your pillow. These are the coping skills therapists give angry teens to reel in their extreme emotions. The absurdity comes into focus when a teen like Nikolas opens fire on hundreds of innocent victims, taking 17 lives. Would tragedy have been averted if Nikolas knew to pull off his gas mask and take some deep breaths? To put down his AR-15 and hug his pillow?

Psychiatric treatment facilities are virtual incubators for violent kids. They focus on underlying mental health issues promising the negative behaviors will diminish. In these programs, Devon has no consequences for truancy, vandalism, criminal threats, and assault. Not even a time-out. Protected from criminal charges, he’s become desensitized to his own violence and indifferent to social boundaries. It’s normalized his violent responses to even the smallest triggers: waiting his turn, a snarky look from a peer, being served breakfast he doesn’t like.

It’s unlikely Nikolas’ trajectory would have changed even if he’d received the years of intensive mental health treatment Devon has. Mental health facilities are little more than holding pens for kids who are too dangerous to live at home.

I’ve tried the system. It doesn’t work.

Funding to offer these same ineffectual services to more would-be-shooters won’t stop tragedies like the Parkland shooting, especially since Trump nixed the Obama-era regulations making it easier, not harder, for mentally ill people to buy guns. I don’t pretend to know the answers, but I do know a bad idea when I see one: giving these kids access to guns. If we’re not going to do something as basic as keeping deadly weapons out of the hands of mentally disturbed teens, what mental health interventions can possibly keep us safe?

Keri Williams, a former resident of Broward County, lives with her family in Charlotte, N.C., and is working on a memoir about raising her adopted son.