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The Enemy Is Apathy

By Lloyd I. Sederer, MD | July 26, 2012
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company. I invite you to visit my Web site (www.askdrlloyd.com) for questions you want answered, reviews, commentary, and stories. My book for families with a member who has a mental illness will be released by WW Norton in the spring of 2013.

Dr Lloyd Sederer on preventing violenceI don't know, I don't care, and it doesn't make any difference.
                           —Jack Kerouac

Congresswoman Gabrielle Giffords was gravely wounded in a shooting rampage that killed 6, young and old, and wounded 13 in a Tucson shopping mall on January 8, 2011. Many imagined that event would move this country to action in ways that would truly reduce the risk of another mass murder.

(MORE: Crime in the Military—Madness, Badness, and Survival)

After the Tucson event, there was a heartening resilience demonstrated by the victims, their families, and their communities. The deep compassion shown them by countless fellow Americans was needed and wonderful to witness.

But that is where the responses ended. Did we see changes in gun and ammunition laws that might prevent the ready access that exists today to weapons that can fire dozens (or more) of rounds in a minute, even those capable of penetrating Kevlar? Did we see schools or other settings where there are youth in crisis or deterioration take action and identify and implement ways to intervene rather than extrude problem individuals? Did we see the introduction of comprehensive prevention, detection, and treatment programs for people with mental health and addiction disorders in community health settings?

I suppose those questions would be academic had not another 12 people died and 59 been physically wounded (and far more emotionally traumatized) in Aurora, Colorado, a mere 18 months later. It is frightening to listen to those who say we need not see this as a call to action. It is frightening because it speaks to and supports the apathy that is our greatest enemy.

Mental health professionals learn early and repetitively that change is really hard. We humans are deeply wedded to our ideas, to how we see the world and behave, and to what are conditioned emotional responses to the world around us. As a rule, change does not happen until the pain of continuing to be the same outweighs the comfort of maintaining the status quo. A highly popular, and effective, method of promoting change called motivational enhancement—ME—How to Break Free From Your Unhealthy Habits, has spread not only throughout behavioral health programs but also into primary medical care because of how much motivational techniques are needed to enable anyone to change.

Apathy was recognized as one of the symptoms of “shell shock” during and after the Great War. Those who are apathetic have lost the capacity to feel and act; they are disconnected and numb. Today we often regard apathy, disconnectedness, as a symptom of PTSD; that is when it afflicts an individual. What do we call it when it afflicts a whole population? A nation? I think that is called apathy.

More important than what we call it is what we do about it: it is only a matter of time before another person tries to equip himself with weapons of mass destruction—not for political purposes but out of the angst, loathing, despair, and mental disturbance that characterize the perpetrators of violence who have dominated our nation’s media and grief ("Random" Acts of Violence Are Not So Random).

We know a great deal about how to reduce the risk of violence in our society and our communities. Knowledge, however, is not the limiting factor to a safer future. Our capacity to overcome apathy and to mobilize human passion, determination, and action is what is in short supply. Individual and collective will eludes us. No meaningful change is just delivered to our doorsteps: we have to work really hard for it to come. Not only is the will to change resisted from within us, it has powerful external resisters as well, perhaps best described by Gandhi who said: “. . . first they ignore you, then they laugh at you. Then they fight you, then you win.”

Apathy drains the suffering we could feel from doing nothing, from staying the same. It dulls the pain needed to motivate change. Apathy is our enemy. Pain, paradoxically, is our ally because it is one of the most powerful fuels we have to impel us to a different and better tomorrow.
 

 

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by Patrick McGorry | July 26, 2012 9:45 PM EDT

Wonderful article Lloyd. We in Australia had this problem to an extent but in 1996 a mass shooting in Tasmania led to much more restrictive gun laws and the Gandhian cycle was certainly evident at that time. The public now are 100% behind this step. However sadly we do recognise that you have a more deep seated problem in the US with the deeply romanticised view of guns in relation to your history, your lobby system and the NRA! But as you say anything is achievable and so best of luck with this campaign from colleagues in Australia.
Patrick McGorry
Melbourne
Australia

by Ronald Pies | July 26, 2012 9:15 PM EDT

Bravo, Lloyd! We cannot afford to be apathetic, or this whole tragic scenario will soon be enacted again, like the theme of the movie, "Groundhog Day."

And to those who insist, "This Colorado shooting could not have been prevented..." and then outline why it was more or less inevitable, I would say this: even a strict determinist understands that the the real public health issue is whether we can and will take measures that make such bloodletting less common in the future--for example, via reasonable and prudent firearms/ammunition regulations, and more robust, proactive psychiatric intervention in cases of recognizable, incipient violence. Of course, we will never prevent each and every tragedy; but we must do our best within the limits of human capabilities.

For two additional perspectives on this, readers may find these pieces of interest:


http://bostonglobe.com/opinion/letters/2012/07/24/ceremony-futility-plays-out-our-reaction-shooting/YpOpWL7NJubG3l5hZmDD2H/story.html

http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=108419&RelatedNewsArticles=true

Best regards,
Ron Pies MD

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The Enemy Is Apathy

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