2 children murdered: Isn't it time to rebuild psychiatry?

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Thursday night, Marina Krim, a mother on the Upper West Side of Manhattan opened the door to her apartment to find her two children dead.  They had been stabbed to death allegedly by their nanny Yoselyn Ortega, who then slit her wrists in an apparent failed suicide attempt.

This horrific act of violence, like so many seemingly inexplicable ones, will likely turn out to have roots in unrecognized and, perhaps, untreated mental illness.  While the Krim children did not die in a movie theatre showing of Batman at the hands of a man dressed like the Joker, they died at the hands of someone who must have been battling demons no less dark and no less commanding.

If we learn the truth about Yoselyn Ortega, it is possible we may learn that she could have been showing signs of a mental disorder and sharing them—either with a clinician or with others around her, in the days or weeks before this tragedy.

I have said this before, but will keep saying it on every occasion it fits:  The mental health care system in America is in shambles.  It barely even exists.  That’s how bad it is.  It leaves very, very ill people under-treated and many not treated at all.  The system makes almost no attempt to educate the public about signs and symptoms of the most severe psychiatric conditions, as though such conditions still embarrass us or still define those suffering them as weak or depraved.

That this inexcusable state of affairs coexists with campaigns to label everything from bread to computers with pink ribbons to conquer breast cancer (which is a good thing, not a bad thing) is testimony to the continuing stigma that leaves so many of those with mental illnesses out in the cold.

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When we invite people into our homes to help care for our children, or when we deliver our children to teachers in schoolrooms, or when we drop them off at birthday parties hosted by other parents, we do so without really knowing whether those entrusted to care for them are psychiatrically stable or not.  We assume they are, more or less, which is a good bet, given the probability of catastrophe.

But where we too often go wrong is in dismissing evidence that all may not be well—an off-handed peculiar, paranoid question, a confused look, unusual irritability, etc.  We are loathe to believe that psychosis could visit someone we know, bending that person’s reality toward destructiveness.  We should not have this resistance, because serious mental illnesses are common enough to touch many of our lives.

I hope that the government will come to understand that mental health care in America is truly in crisis and that many acts of horrific violence could be averted with a robust effort to build a state-of-the-art mental health care system.  The surgeon general should declare war on mental illness—and mean it.  That is a war which, if we conquer our own reticence to fight it, could be very easily won.