Marjory Stoneman Douglas and Dorothea Dix: Unpacking Mental Health and Mass Shootings

By Coral Springs Talk from Coral Springs, United States (Rally at Marjory Stoneman Douglas High) [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

There was yet another horrendous school shooting in Parkland, Florida this week, and the country has begun our by-now-traditional cycle of arguing and politicians offering thoughts and prayers and nothing changing. You see, whenever a mass shooting shooting, in the immediate aftermath most citizen responses fall into one of three categories:

  1. Expressions of sympathy, horror, and shock relating to the nature of the tragedy;
  2. Calls for (and responses to calls for) tighter gun control; and
  3. Discussion surrounding the gunman’s mental health, access to mental health services generally, and rates of violence perpetuated by and experienced by people suffering from mental health issues

It would be inappropriate for me to comment on the first type of discussion, except to say that I am sympathetic, horrified, and saddened by the tragedy as well. And though I have many opinions about the second— I did work nearly five years at a public defender office in one of the most gun-control-loving states in our country — that’s another article for another day. As your Friendly Resident Clinician-Trained Advocate, I’m here today to talk about the third topic–because I’ve been writing about it for years, and it would appear that this issue has reached Craig Ferguson o’clock. If you’re in a hurry and want to know my point upfront, here it is: Most people with mental health issues don’t shoot people, and we have no way of knowing whether better access to treatment would have prevented this tragedy, but we should have better access to mental health treatment anyway.

Are you still with me? Okay, good, because we need to spend a few minutes talking about what ‘mental health issues’ even means.

(This is an important point, because as it happens it’s not universal, and this impacts conversations on the topic something fierce.)

The most commonly accepted (though not universally accepted) definitive text for what constitutes ‘mental illness’ is the Diagnostic and Statistical Manual of Mental Disorders. We’re currently all using the fifth edition, which was published in the spring of 2013. The DSM uses a code system in order to assist physicians and healthcare professionals with providing diagnoses. These codes exist for literally hundreds of distinct disorders, covering everything from mood- and anxiety-based disorders to pervasive developmental disorders to substance-related disorders to psychotic disorders to intellectual disability to personality disorders.

Symptoms of these disorders vary wildly, and it is straight-up medical malpractice to prescribe the same treatment for every disorder. In fact, not every mental health professional is even allowed to diagnose every single disorder on this list–some disorders (like, for example, Autistic Disorder) require screening by a neurologist. About one in five American adults has a diagnosable mental health issue, and these disorders impact every known demographic in this country (though some disorders are known to disproportionately affect populations above or below a certain age, and diagnosis for some, like personality disorders, is contraindicated before a person turns 18).

[Thus concludes the lecture section of this presentation. For now.]

‘Why are we talking about definitions here?’ I hear you ask.

I note all of this because it all adds up to mean that there is no one individual thing that every single person struggling with mental illness says or does in this country. This is a big deal, and it has to be where we begin this kind of discussion, because it means that almost from the very first words of a discussion on Facebook, twitter, or elsewhere many people are talking past each other.

I have heard many people mention recent studies on twitter and Facebook that show that people struggling with mental health issues are actually more likely than the average population to be the victims of violence. These studies reflect a common sense understanding that people who suffer from mental health issues may experience prejudice, discrimination, and vulnerabilities that are not shared by the general population. (There are also many studies linking mental health issues to penal populations, where people with some types of diagnoses may be particularly exposed and vulnerable, but I’ll get to that in just a moment.)

Yet, some people who commit atrocities, apparently including Nikolas Cruz, suffer from mental health issues; this is undeniable fact. Common sense (correctly) tells us that people who ingest substances that create an altered state of consciousness may also experience changes in their insight, perception, and judgment, all of which can lead to violent exchanges. Many (though certainly not all!) people who experience psychotic symptoms, when combined with paranoia, can see and hear things that are not there which cause them fear, and frightened people can sometimes engage in violence. This does happen, though it does not seem to be what happened at Parkland. This is why we, as a culture, have created a ‘not guilty by reason of insanity’ verdict for criminal trials over time–we understand that crime and mental illness may be linked and may affect culpability.

The important point here is that people who discuss violence and mental illness with regards to perpetration and people who discuss violence and mental illness with regards to victimization are both right, and it’s because for all practical reasons there are as many different kinds of people who suffer from mental health issues as there are kinds of people generally within the US. Saying “people with mental illness commit violent crimes” is about as useful as saying “people born with thumbs commit violent crimes.” You were born with at least one thumb, right? Have you used a gun for mass murder lately? Yeah, that’s what I thought.

[With much apologies to anyone out there reading this who was born with thumb aplasia–keep fighting the good fight, my friends.]

So having discussed the concept of mental health generally, there is an obvious corollary question as it pertains to any mass shooting tragedy, but particularly one like our most recent:

Why do I hear people talking about access to mental health treatment like it is going to fix this type of issue?

Access to services and insurance coverage for mental health is is a very big, very long discussion, and one I have written many, many pages about over many years of study. I will try to spare you the treatise and give you a Cliff’s Notes version. But first, I’m afraid there will need to be a history lesson.

[I did warn you that the lecture would resume at some point…]

At one point in time, mental health treatment in this country really was like something out of a horror story; there are numerous accounts of people being kept in dark places, chained to walls, lobotomized, and electrocuted, and otherwise just horribly mistreated. Much of the early reform for treatment of people struggled with mental health issues is credited to Dorothea Dix, an activist from the mid-1800s who remains something of a personal hero to me (even if many of her efforts were later subverted). Once we made the transition from chaining people in basements to creating and maintaining asylums, hospitalization remained the way that we as a country handled serious mental health issues for many decades.

[Arkham residents not pictured.]

Sometime around the 1970s, however, people began to heavily question the practice of institutionalizing people with mental health issues, largely because the thing doctors were noticing about putting people away for long periods of time is that they never seemed to really get better (though there were also administrative costs and a very famous study involved). There was a push to start initiating community-based care in clinics and comparable outpatient organizations–which is a model we still somewhat use today in this country to address issues of mental health.

The thing is, in some ways deinstitutionalization could not have happened at a worse time. You see, the push for deinstitutionalization happened largely in the 1960s and 1970s, which was a time when we were making changes to how health insurance worked in this country as well. And mental health coverage is, among other things, often incredibly expensive, even at the outpatient level. So this ultimately culminated in fewer community health options and more restricted insurance coverage for many people with mental health issues. In other words: People weren’t accessing treatment at the rates they should, because there were fewer places to get it and also it cost more. That’s still true today; less than half of people living with a mental health condition in this country receive evidence-based treatment for their conditions.

Around the time that deinstitutionalization began to reach its peak, people began to notice a disturbing trend about the interaction between mental health and prison systems: the percentage of inmates with mental health issues was going way up. Multiple recent studies have shown that prison populations now contain much higher rates of mental health issues than the general population.

Picture by By https://kazan.vperemen.com/ (Own work) CC BY-SA 4.0 via Wikimedia Commons

An honest and frank discussion about mental health issues in this country would be remiss if it did not also at least touch upon the plethora of other confounding and complicating factors about access to treatment (such as homelessness, incarceration, and autonomy in healthcare decisions, to name a few). But many people believe that fixing these difficulties in accessing services will drive crime rates down, and I think they are right–up to a point. Certainly the number of crimes that are committed due to untreated symptoms will decrease, and I firmly believe that a more streamlined substance abuse recovery system would make a huge impact as well. For these reasons, and because I believe that the American criminal justice system is a grossly inappropriate institution to rely on for mental health treatment, I am a huge proponent of increasing access to mental health treatment in this country.

…which brings us back to Nikolas Cruz. This section is the hardest section of this series to write, because it gets at the real heart of the discussion: How does access to mental health treatment affect tragedies like the one that happened at Marjory Stoneman Douglas High School in Parkland, Florida?

Much has already been written about Nikolas Cruz’s extensively-documented history of mental health issues, telling us that he was diagnosed with ADHD, depression, and “developmental and learning disabilities.” Given what I have read, if one of those “developmental disabilities” wasn’t conduct disorder, I will eat my hat. You see, there’s no noted correlation between ADHD and mass shootings — in fact, most of the main features of ADHD (disorganization, distractedness, inattention, forgetfulness, to name a few) don’t lend themselves to premeditated action at all. And the connection between depression and premeditated murder is attenuated at best. But …well, let’s talk about the diagnostic symptoms of conduct disorder, the adolescent precursor to Antisocial Personality Disorder (which cannot be diagnosed before age 18). I have bolded the things we see reported in the news as part of Cruz’s personal history before the Parkland shooting:

“A) A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following . . . criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

  1. Aggression to People and Animals
  2. Destruction of Property
  3. Deceitfulness or Theft
  4. Serious Violations of Rules

(The remaining diagnostic criteria relate to age, distinguishing from Antisocial Personality Disorder, and absence of signs of other disorders. He probably met the criteria for APD as well, though it would appear no one had diagnosed him with it; you can read those criteria here. The disorder also can occur with or without ‘limited prosocial emotions,’ which is a fancy way of saying ‘this person doesn’t appear to have normal levels of concern or empathy for other humans.’)

As this list suggests, conduct disorder is noteworthy because potential symptoms are disregard for social norms, aggression, destructive tendencies, and a lack of showing of empathy for other people. In other words, the very things that might cause someone to commit this kind of atrocity are potentially enough to diagnose someone with a mental health disorder in the DSM.

(I want to be very clear that diagnoses such as conduct disorder or antisocial personality disorder are by no means a guarantee that someone will commit this kind of atrocity; a person who frequently skips school and then lies about it can be slapped with the same exact diagnosis. As with so many things, it’s a question of severity and also a subjective assessment on the clinician’s part.)

APD Exhibit A: Nikolas Cruz. APD Exhibit B: This guy.

Diagnoses like conduct disorder and antisocial personality disorder are controversial, because some people believe they merely convert criminal behavior into a mental health issue. And antisocial diagnoses are notoriously resistant to treatment, though I personally believe they can be treated in some instances and it is my sincere hope that we identify more effective treatment for these diagnoses soon.

Would access to mental health treatment have prevented this tragedy? It’s tough to say; as a few articles have noted, Florida’s track record of access to treatment is abysmal, and studies show that adequate treatment can definitely reduce instances of violence in general. And perhaps more to the point, Cruz should have had access to treatment because we should live in a country where people receive reasonable evidence-based treatment for their health issues. But on the other hand, we don’t actually have evidence-based practices for treating antisocial issues like conduct disorder, and Cruz’s personal history is a ticky-box nightmare — in particular, there is a long-documented correlation between zoosadism and premeditated murder, and those studies I just mentioned weren’t about premeditated violence; they were about violence generally (and often impulsive violence at that). Treatment — for his documented diagnoses or otherwise — might have prevented this, but it also might not have. And we can’t know, because he didn’t get access to treatment, and then this tragedy happened, and we can’t take it back again.

Access to mental health treatment is a very important issue to me, and I will continue to advocate vociferously for better access to care and services until the day I die. As the first two sections of this series suggest, I do believe that it is incredibly important that we address this issue, for reasons of public safety and humane social welfare. But it is not a panacea, and it is disingenuous and dangerous to discuss the issue as if it were. The fact of the matter is, none of us can know whether it would have helped in this instance. We should have better access to treatment because our entire society benefits from better access to treatment, and it shouldn’t take a horrendous tragedy like this to discuss it.

Living in Troubled Times: A Trauma Resilience Roadmap

Photo courtesy of Wikimedia Commons

Let’s face it: As we’re navigating The Trashfire National Policy of 2017, we’re all getting traumatized — it’s tough to get used to that dull-roar screaming we all hear every time our illustrious President vents his spleen on Twitter. And many of us have other stressors in our lives that are making it even harder to navigate, because life does go on even in the face of an abusive relationship with our government — and life is hard. And all that is before we consider the very real practical realities of living without necessities like food or water, or living without healthcare, or living in fear of physical attacks. In the wake of this weekend of introspection, I’ve had many conversations with folks about how to live instead of just surviving, and in some cases simply about how to survive.

So I’m taking off my lawyer hat for a moment, and putting on my trained clinician hat, to talk to y’all about how to deal with trauma. And to begin this conversation, we need to start with a simple truth commonly understood by first-responders everywhere, and borne out by research: Trauma is a form of infectious toxin. You have to clear it out in order to get healthy, and staying healthy will help you resist it further, both in your own life and when loved ones’ trauma threatens to infect you. And that’s not to say that we should stop exposing ourselves to toxins, which often isn’t possible and in many cases would be morally reprehensible. Rather, I’m saying the opposite: Because we’re all in this toxic soup together, that means we gotta help each other, and to keep doing that we also gotta help ourselves.

So I’m submitting for your perusal a kind of Trauma Resilience Roadmap — concrete suggestions and links to research, separated into three buckets: Do This Immediately, Do This When You Feel Able, and This Will Take Startup Cost But Will Help I Promise. I can’t promise it will fix everything, but it’s my hope that for many people (including myself), it will be a start.


Do This Immediately (or: Emergency Recentering Treatments)

These are the things you need to do when you’re at the stage where you’re asking, “But how do I survive?” Acute crisis mode has its own set of rules, and that can be hard to accept but it’s important to acknowledge. The flip side is that acute crisis doesn’t last forever, and this list will hopefully help you come out the other side.

  • Give yourself permission to tune (non-essential) things out. Whatever secondary things are stressing you out, and I’m guessing this is a large list, it’s okay and even a very good idea to put it down for a moment or two when you’re in crisis. Twitter will survive a Monday without you. That friend who needs an ear about her mortgage payment can find another one this Tuesday. Obviously, this only works on the stressors that aren’t center-stage right now. But I honestly, truly mean this: It’s okay to be ruthless about random stressors when you’re in crisis.
  • Start a list of images and activities that always soothe you. This might be hard if you’re in the middle of a huge amount of stress, but even something as simple as “I feel better when I look at otter pics” and then looking at some otter pics can buy you a tiny bit of cope (which I’ll colloquially refer to here as “cope points”), and that can be pointed towards a larger and more permanent form of help down the road. Don’t aim for an exhaustive list right now; just list the stuff that you immediately think of as bringing you joy and comfort, with a bias towards things you feel able and ready to do right this moment. And if you know things that you don’t feel able to do right now but always help (e.g. going hiking, mindfulness exercises, book-binding), go ahead and put them on the list. But don’t try to do them right now; they’ll still be there when we get to Phase 2.
  • Accept (even trashy) activities that help you tread water. For me, this happens to be inane phone games — they take up my whole screen and block out social media, which means I’m definitely tuning things out as I play (and also, match-3 games are really satisfying for me; I have no idea why). It might be eating junk food for you, or watching really crap television, or reading truly awful fiction novels — things that if you were doing well might make you think “I’m judging myself for doing this right now,” but aren’t actively destructive or harmful. This can also be low-cost things that you’re less likely to be self-judgy about (e.g. watching really good television, eating delicious salads, reading excellent literature) but hopefully you started doing those already with Item #3. If you aren’t, you should let yourself do those things in your spare moments. If you are also doing Item #2, you have more spare moments to do them. 🙂

Here’s a sample beginner list:

1) Watch my favorite movie;

2) Read some really awful fanfic;

3) Look at cat GIFs on the Internet;

4) Cookiepalooza;

5) Play Rock Band


Do This When You Feel Able (or: Convalescent Recentering Activities)

These are the things you need when you’re at the stage where you’re asking, “How do I live instead of just surviving?” It’s my guess that after nine months of President Cool Ranch Mussolini, most of us are who aren’t in immediate crisis are hanging out at this stage. It’s the trauma equivalent of being stuck in bed with a stomach bug yelling “but I wanna eat tacos!” — we’re all well enough to miss things, but not well enough to have them yet. This part of the primer is the transition from “I can’t get out of bed” to achieving your taco-nomming dreams.

  • Stay well-fed. This one can be hard for people in the middle of crisis, for about a million reasons. But once you’re feeling okay enough to pay attention to it without feeling like OH MY GOD A MILLION THINGS I CANNOT EVEN, good food hygiene is an incredibly valuable foundation for mental health; there are lots and lots of studies that show that people who are experiencing trauma are less able to adhere to good food hygiene and also suffer more when they can’t. If you’re a person who has trouble eating when stressed, “good food hygiene” can look like “I ate some Cheetos at midnight before I fell asleep in an orange-coated haze” as long as other, more nutritious calories happened also — it doesn’t literally mean “only eat things that are good for you;” it means “put calories in your system on a regular basis so that a blood sugar crash doesn’t happen on top of everything else.” (Long-term daily Cheeto binges might lead to other problems, obviously, but we’re talking short-to-medium-term here.) Some people do have the opposite reaction to stress, and stress-eat everything in sight; for those people, good food hygiene might look more like “pause and evaluate whether I feel hungry before I put this thirty-first food item in my face.” (Note that we’re discussing common immediate stress reactions to food rather than systemic eating disorders, which obviously have their own set of rules and treatments.)
  • Get enough sleep. This is basically the same as the notes above — good sleep hygiene is a tremendously helpful foundation for mood. But this one is super hard to do if you’re not doing well; I personally find it about a million times harder than shoving food in my face when I’m too stressed to be hungry. For me, optimizing sleep hygiene looks like skipping that third cup of coffee (unless I really need it), taking a melatonin pill before bed, and hoping I don’t have nightmares. Your mileage may vary. But in general, the more other forms of decompression help, the more sleep stops being an elusive beast and becomes a regular part of life again. And that’s a really important step for resilience.
  • Ride the Hygiene Horse generally. There is absolutely zero shame in forgetting to brush your hair, skipping a shower, or otherwise forgetting a regular daily hygiene thing when you’re in immediate crisis — in fact, it’s a common symptom that something is very wrong. But once you’re out of crisis mode, it’s super easy to start being angry with yourself for forgetting things — or doing the opposite, and feeling like you just don’t have the energy for tasks like showering. (Or both. Some lucky people experience both.) But once you’re in “I feel ready to eat and sleep normally” mode, it’s a good time to make sure you’re keeping ordinary hygiene habits all around. They help, and they matter, and not doing them long-term can affect mood and keep you in a dark place.
  • Make a more complete, long-term list of recentering and joyful things. Once you feel able, make a comprehensive list of all the things that bring you joy and help you feel More Able to Even after you do them. Hopefully, most of the things that are really easy (e.g. “Look at doggo pics,” “Reread my favorite novel,” “Eat Cheez-Its”) are already on your list, but this is a good time to add the less low-hanging fruit — things that you know help but didn’t feel approachable in the middle of crisis. It’s also a good time to spend an hour or two really thinking about what brings you joy and comfort — and if you feel able, take your best guess at what is an easy thing, what is a medium thing, and what feels like a hard thing right now. You may or may not feel ready to do all these things (and my guess is some of them will feel super far away), but making a list of them helps you prep and move forward for when you do feel ready. And some of them might feel within reach, which can give you back extra cope!
  • Try simple meditative activities (that aren’t literal meditation). A friend of mine mentioned meditative coloring today, which honestly is a really good low-cost meditative activity. Some people find cleaning to be stress-reducing when they’re at this stage. If you’re like me and find repeatedly stabbing things really satisfying when stressed, embroidery is pretty great. The goal is to aim for things that give you a quick cope point in the moment, don’t eat more than maybe one cope point to set up, and then give you an extra cope point when you can look at them later and think “Look what a productive thing I did!” But at this stage, easy activities that you know how to do and feel comfortable doing mindlessly are best. Bonus points if they’re also on your list. (Also, this is a great way to slowly expand your list! 🙂

Here’s a sample second-stage list:

1) Easy activities — I’ve been doing these all along
Watch my favorite movie; Reread my favorite book; Look at cat GIFs on the Internet; Eat Cheez-Its; Play Caves of Qud

2) Medium Activities — try some of these if I can
Embroidery projects; Meditative coloring; Clean my workspace; Read nonfiction; Cook more meals

3) Hard Activities — I’m not ready for these yet
Learning book-binding; Going on regular hikes; Working on my novel; Going to the gym regularly


This Will Take Startup Cost But Will Help, I Promise (or: Long-Term/Preventative Recentering Activities)

These are the things that you want to keep in your life as you navigate low-grade ambient stressors (such as hearing 45’s voice on the television as he discussed tax reform) — it’s for when you’re feeling well enough that you should no longer be tuning out the white noise that accompanies an inherently traumatizing atmosphere. We owe it to ourselves, and to each other, to do what we can to stay engaged but healthy as we all walk through this nightmarescape. Here are my modest suggestions for how to do that when you’re not in crisis.

  • Get out of the house on your own terms. Meet a friend at a bookstore; go for a walk; get some coffee from that awesome cafe you haven’t been to in a while. Something that requires physical movement, brings you joy, and feels like the opposite of retreating or withdrawing. It’s super-important, by the way, that this be a thing that you are doing for yourself and on your terms, rather than because someone dragged you or guilted you into it. It’s not going to be useful for decompression if you’re being dragged (and you’re not the one doing the dragging).
  • Try some of the stuff marked ‘hard’ on your recentering list. Try your hand (see what I did there?) at watercolor, or some other task that you know brings you joy but has felt far away lately. Don’t be angry with yourself if it doesn’t quite click; these are things that take cope to give cope, and it just means you didn’t have the cope for them yet. Go back to some of the easier tasks and do those — you’re still healing, is all. But if the thing brings you joy and feels net-positive, it’s a really helpful marker for knowing where you are in this process. Plus you got to do a thing that brings you joy! (Note: Now is also the time to purge the list items that you felt kind of mixed about or would be harmful to rely on too long in the long-term.)
  • Try more complex meditation. Some people find going to the gym really meditative. Some people get a lot out of traditional mindfulness meditation, such as guided meditation or progressive muscle relaxation exercises or something similar. I’m partial to singing-based meditation. But basically, this is the time to try varying simple tasks that are meditative through repetition (e.g. coloring, sewing) with activities that are meditative in a more traditional sense. There are lots and lots of studies that show that meditation can be extremely helpful to people for stress resilience, but trying to do it when you’re still actively processing toxic trauma is really hard.
  • Consider setting up a therapy appointment. There is seriously zero shame in setting up an appointment if you think about it carefully and decide you need one. There’s also zero shame in deciding it’s not right for you. Basically, just a good thing to evaluate at some point — people see an eye/nose/throat doctor if they’ve had a sore throat for forever; people should also see a therapist if something has been wrong with their stress or trauma levels forever.
  • Evaluate what stressors you are managing. Some stressors (e.g. natural disaster, getting sick, jerks on public transit) are not avoidable, and will always require navigation and detoxification. Some (e.g. a romantic partner wanting to spend time with you) are stressors when you aren’t doing well, but are either positives or neutral things when you are doing better. And some (e.g. that one friend who wants you to loan them $20 literally every day) are literally always stressors and never necessary to navigate. Figuring out long-term planning for stressors, and how to set boundaries for the random white noise you just super don’t need, takes energy but also is generally a really good step for health. Approaching stressors with intentionality can both help you gate-keep and also give you a sense of control over your situation.
  • Keep doing all the things on the convalescing list. We don’t stop needing the things that bring us joy when we’re no longer in crisis; in fact, ability to do the things that bring us joy is arguably what it means to be living rather than surviving in the first place. And things like good food/sleep/personal hygiene and staying hydrated stop being optional when we’re constantly taking in stress.
  • View your stressor intake and decompression as an equation that needs to be balanced. You can take in more stressors when you have more in place to center you. You can take in fewer stressors when something major is going on — be it crisis, chronic limitations, or something else. At the end of each day, this equation needs to balance, or burnout, depression, and disengagement can occur. And that’s an outcome nobody wants, or even should want.

The reality is that most of us will yo-yo between these three stages as new horrors crop up and create new crises — it’s like a morbid game of Chutes and Ladders that we play with our mental health instead of meeples. And when something serious happens, and you have to go back to the beginning of the roadmap, that’s okay — being able to identify and acknowledge current stage of crisis, and current level of trauma, won’t fix everything. But it’s an important set of tools that we can use to support ourselves and each other. We can get through this, and we will. It’s my hope that this roadmap will help.

This Should Probably Be More Self-Evident Than It Is

Though I don’t believe the inherent morality of humankind is improving with time, the available technology, and particularly our ready access to information, absolutely has. In Jackson’s era, it was possible to go one’s entire life believing racist things that were never disproved within one’s immediate frame of reference. In our current information-laden era, in contrast, it is possible to go to websites whose express purpose is to research rumor and belief and articulate their factual underpinnings — and we have ample scientific evidence negating the idea of racial superiority. Further, the entire nation literally just lived through eight years of efficient governance by a Harvard-educated black man. No one is saying that Obama was not an effective President; in fact, the common Breitbartian complaint and battle cry is that it’s necessary to undo all that President Obama accomplished–because that is a long list.

In other words, antebellum America had commonplace racist beliefs and rigid societal structure that strongly restricted disproof of these beliefs. We, in contrast, have ready access to Snopes and a black President.

This is probably obvious to you, as well it should be, but it also has an important corollary that I haven’t heard anyone talking about:

In this era of ready information, belief in the myth of white supremacy requires more than mere ignorance; it requires active and intentional disregard of available knowledge. For this idea to find purchase, it must be inherently more comforting to the recipient than an acceptance of meritocracy. The myth of supremacy is a security blanket that white racists are refusing to outgrow, and rather than accepting facts they are cocooning themselves in untrustworthy and laughably false information in order to protect the myth. There is no ‘empathy’ that will get around this, because it is the reaction to the myth of superiority that is driving it and the person has already preemptively rejected egalitarian progress.

This is why it is so hard to ‘go high when they go low.’ This is why ‘meeting people halfway’ is a myth. White supremacy in this day and age is a primitive ego defense driven by an ugly desire to see other people fail, and it actively drives society backward.

Advocating to Callous Listeners: Five (Not-So-Easy) Steps

This is a very strange Martin Luther King Day. In my lifetime, we’ve always had a long way to go on race relations–I think most people agree we were not enjoying a post-racial society before the November election–but this is the first time that a President-Elect picked a fight with a civil rights legend the weekend before his inauguration. And, more importantly, this behavior does not exist in a vacuum–our President-Elect ran on a blatantly racist, homophobic, ableist, and Islamophobic platform, and though he did not win with a majority, he did win. And his victory (such as it was) emboldened racist people throughout the country to say what they really think–or, as was the case in many school bathrooms and Congressional floors throughout the country, do what they really think. And most of us who are decent human beings are horrified by this, and want it to change.

However, when many of us with these reactions tried to talk to our family/colleagues/friends/neighbors’ cats who supported Trumpian politics, we had a second horrifying realization: This person we were speaking to did not care about fellow human beings. “The Black Lives Matter movement started because people are dying,“ we told them, and to our abject horror, they just didn’t care. Appealing to a sense of humanity did not work, because the listener did not view the subject population as people.

And this is the point where many of us well-meaning advocates, and especially allies, start to draw a blank about what to even do next. Recognizing the humanity of fellow human beings is so basic to us that we don’t know what to do when someone rejects it–the carburetor in our brain stops turning over, and we stand there sputtering, “But they should!” And we’re right–they should–but they still don’t.

I know something of this challenge, because I spent four and a half years writing about mitigating factors of very marginalized and vulnerable people for a living. Talking to people about their experience above has made me realize it might be helpful to talk about my trial and error process. To that end, I’ve drafted a quick primer on an unofficial five-step process I’ve identified over years as a professional advocate for speaking to listeners who have already reject moral and empathy-based arguments. Though this is by no means exhaustive and makes certain assumptions about the relationship between the speaker and the listener, I’m hoping it’s a helpful start for the average ally and advocate.


1. Let Go of ‘Should,’ And Recognize ‘Is’

This is the first step, but it’s also by far the hardest–if you can manage it, the rest becomes much easier. Most people reading this probably agree that anyone with the empathy God gave a grapefruit thinks that other human beings dying through preventable means is bad. The natural corollary that extends from this understanding is that this person we are speaking to does not, in fact, have the empathy God gave a grapefruit. There’s a real impulse to reject not just that person, but the whole rest of the process–“Well this person is terrible, so until they aren’t, I’m done.” And I hate to break this to you, Dear Reader, but if you have set out to advocate you are not, in fact, done–or at least, not just because this person should have empathy and doesn’t. Nobody is going to make those people play by the rules of basic humanity. People who show they lack empathy to a degree that appalls you still sometimes need to be dealt with, and walking away in those situations is a luxury we’re losing the ability to exercise. You gotta even. I’m sorry.

This doesn’t mean that you have to think this person is wonderful, of course–as soon as you are done interacting with that person in that context, it is appropriate (and even healthy) to blow off steam about how awful it was to engage with them. It’s part of the human condition. But you definitely can’t have a win condition without even playing the game, and that means recognizing the reality in front of you.


2. Identify Goals (Ahead of Time, if Possible)

You’ll note that I said above, “People…sometimes still need to be dealt with.” The obvious corollary is that sometimes, they don’t. The best way to avoid banging your head against a human brick wall for an hour is to have a good idea of whether you need to deal with this person–and the easiest way to do that is to identify your goals. And even when you do need to talk to a person, having a firm understanding of what you’re trying to achieve helps you get in, say what you have to say, and get out–so it’s very helpful to know going in. What are you trying to achieve by talking to this person? Do they control access to a resource you need? Are they engaging in a damaging behavior you want to stop? Are they voting all of our human rights away in the first week of their first session before your eyes? (Spoiler: If your answer is “I want to let them know that their ideas are bad and they should feel bad,” I recommend walking away.)

To help you see what I’m talking about, let’s go through an example scenario–for the purposes of this essay, let’s pretend we are members of Congress, which is both a helpful universal and a pleasant daydream. Mitch McConnell is holding another Senate vote about the Affordable Care Act. The Senate committees have come up with alternate legislation, and it’s just forty blank pages followed by the words “Buy an HRSA.” People may die if we can’t convince some of the Republican Senators who voiced early opposition to the lack of “replace” in the phrase “repeal and replace” to vote differently this time around.


3. Look for Carrots and/or Sticks

Okay, so: You’ve accepted that the obvious appeal to humanity won’t work, because the listener is a jerkfaced jerk. But they’re a jerkfaced jerk who has a thing you need. Now what?

Here’s where the first thing I mentioned becomes really important–because figuring out what is going to be effective requires an understanding of what motivates that person. Please note that I am not adding my voice to the chorus of white people saying that everything will be fine if we just give white supremacists more empathy, which I believe is a dangerous model of thought at best. But in order to advocate, you need to know what a carrot and/or a stick would look like for this person, because everybody has their own carrot and stick–and you can bet that a racist callow person’s stick and carrot probably don’t look like yours.

To continue the example above, let’s talk about what would constitute a relevant carrot and stick for your average Republican Senator. Though this is an incredibly complex topic, for the purposes of this exercise let’s assume the carrot probably looks like money, or political capital. The stick probably looks like being voted out of office.

So as we’re navigating negotiation with these Senators, we need to either figure out why the ACA will save/earn them money or figure out why they should fear what their constituents will do if they accept this legislation.


4. Offer a Carrot or Raise a Stick, and Preferably One that You Believe

This is another hard but crucial step, because it requires you to take on the listener’s paradigm long enough to persuade them. It honestly does help to believe what you are saying, for several reasons. First of all, a credible argument tends to carry more weight; a thing even you don’t believe is generally not that persuasive to other people. But more importantly, an argument you can accept as true helps you remember is that speaking this person’s language doesn’t mean you hold their values, or that you agree with them–it just means you need something from them and you have to figure out how to coalition-build in order to make that happen. It’s helping them figure out why they want to do this thing you want them to do anyway. (And lastly, though perhaps this should go without saying, it is never a good idea long-term to lie your way to a built coalition, as this creates many problems for both you and others throughout the process.)

Let’s go back to our replacement plan vote. Though I’m generally a carrot person by personality and trade, in this instance I think the stick is easier to argue. As I noted above, this is incredibly complicated, but for now let’s pick one stick: That preserving the ACA probably will not save these Senators money, but constituents relying on the ACA will not be happy to see their health insurance evaporate–even if they currently don’t know it. Elaborating on that is where the advocacy starts, and ideally is the vehicle by which change happens. Awesome and canny Senators that we are, we talk with the folks who are already wavering about why their instincts are good and this move is risky. We note their specific reelection dates. We note how long it would take the ACA to be effectively repealed. We observe how close the end date will be to their campaign season. We heroically refrain from yelling at them. We generally try to persuade them that their scary inhuman boss won’t even be their boss in two years if they do this now. In an ideal world (or at least, in this tiny scenario we have built), we are successful.


5. Take Care of Yourself After the Rinse/Repeat Cycle Ends

Most people’s minds aren’t changed in a single five-minute session; it takes a lot of work and internal screaming and fantasizing about shaking them by the shoulders. This process is hard on a person, and appropriate self-care should be treated as a necessary step. Do what you need to do in order to stay healthy, and that tends to be different things for different people. I encourage you to think of self-care as the final step of the advocacy process, because it’s that crucial.

To wrap up, let’s talk about final steps in the Congress scenario. After several grueling hours of arguing convinces my Republican colleagues to vote against the bill, I am tired and hungry. So I reward myself. By eating their share of the vote-o-rama pizza.