Tag Archives: mental illness

Living with Social Anxiety

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I’ve been thinking about writing this for a long time. Probably a few years by now. I think it’s probably about time to out myself.

I’ve mentioned in the past that I’ve dealt with mental illness. But I’ve never gone in depth about it. There are a lot of reasons for that, but the biggest one is just that it’s really frightening to reveal that kind of personal information.

I’ve had trouble with two related things. I’ve written before about the fact that I’m being treated for depression. What I haven’t talked about is the fact that I’ve got very severe social anxiety.

To me, the depression isn’t such a big deal. I’m not saying that depression isn’t serious. I’m not even saying that in my case, my depression wasn’t/isn’t serious. But for me, depression is easily treated. I’m one of the lucky people who respond really well to medication.

Back when I first realized that something was wrong, and I realized that what I was feeling (or, more accurately, what I was not feeling) was depression, I went to see a doctor. On my first visit with him, he wrote me a prescription for Zoloft. Two weeks later, I started feeling better; between 5 and 6 weeks after starting to take the medication, I was pretty much recovered from that episode of depression.

I wouldn’t say that I’ve ever totally recovered. There’s always a lingering residue of depression, which I’m constantly struggling against. It doesn’t go away, but it’s manageable. As long as I’m aware of it, it doesn’t have a huge impact on my life.

On the other hand, social anxiety. For me, that’s a really big deal. That’s the thing that shapes (and warps) my entire life. And as hard as it is to talk about something like depression, talking about SA is much harder.

As bad as people react to depression, the reaction to social anxiety is worse. Depression is commonly viewed as more weakness than illness. But social anxiety is treated as a joke.

It’s no joke. For those of us who deal with it, it’s a huge source of pain. It’s had a huge effect on my life. But I’ve always been afraid to talk about it. The thing is, I think that things like this are important to talk about. Our society has a huge stigma against mental illness. I really believe that needs to change. And the only way that it will change is when we stop treating it as something to be ashamed of, or something that needs to stay hidden. And that means that I’ve got to be willing to talk about it.

Social anxiety is part of who I am, and I can’t escape that. But I can talk about what it is. And I can, publicly, say to kids who are in the same situation that I was in 30 years ago: Yes, being like this sucks. But despite in, you can live a good life. You can find friends who’ll care about you, find a partner who’ll love you, build a successful career, and thrive. Even if your SA never goes away, even if there’s always some pain because of it, it doesn’t have to rule your life. You can still be happy.

The first thing I need to do is to explain just what SA is. But I need to be very clear here: like anything else that involves peoples’ inner perceptions, I can only talk about what it’s like for me. Different people experience things differently, so what it’s like for me might be totally different from what it’s like for someone else. I don’t mean to in any way cast any shade on anyone else: their feelings and perceptions may be different from mine, but they’re just as valid. This is just my experience.

So. What is social anxiety?

It’s very difficult to explain. The best I can do is to say that it’s the absolute knowledge that I’m freak, combined with a terror of what will happen when anyone finds out. I know, on a deep physical level that if people figure out who/what I am, that they’ll hate me – and worse, that they’ll actively turn on me, attack me, harm me.

It’s not true. I know perfectly well that it’s not true. I can feel like this even with my closest friends – people who I know will always support me, who would never do anything to hurt me. But deep down, on a level below conscious thought, I know it. It doesn’t matter that intellectually I’m aware that it’s not true, because my physical reaction in social situations is based on what my subconscious knows.

So every time I walk into a room full of people, every time I walk into a store, every time I pick up the phone, every time I walk over to a coworker to ask a question, that’s what I’m feeling. That fear, that need to escape, that certainty that I’m going to mess up, and that when I do, I’m going to be ostracized or worse.

What makes it worse is the fact that the way I behave because of the social anxiety increases the odds that other people will think I’m strange – and when people see me that way, it increases the stress that I feel. When you’re putting a substantial part of your effort and concentration into squashing down the feeling of panic, you’re not paying full attention to the people you’re interacting with. At best, you come off as distant, inattentive, and rude. At worst, you’re seen reacting in odd ways, because you’ve missed some important social cue.

It’s not a small thing. Humans are social creatures. We need contact with other people. We can’t live without it. But my interactions are always colored by this fear. I have to fight against it every day, in everything I do. It colors every interaction I have with every person I encounter. It’s there, all the time.

When people talk about social anxiety, they mostly talk about it as being something like excessive shyness. I hope that this descriptions helps make it clear that that’s not what it’s really about.

Where’d this craziness come from?

For me, it’s really a kind of PTSD, or so a doctor who specializes in SA told me. I feel really guilty saying that, because to me, PTSD is something serious, and I have a hard time putting myself into the same basket as people who’ve gone through real trauma. But in medical terms, that’s what’s happening.

I’ve written about my past a little bit before. I had a rough childhood. Most of the time when you hear that, you think of family trouble, which couldn’t be farther from the truth for me. I had a really wonderful family. My parents and my siblings were/are great. But in school, I was the victim of abuse. I was a very small kid. I’m fairly tall now (around 5’11”) when I started high school, I wasn’t quite 5 feet tall. At the beginning of my junior year, I was still just 5’1″. So, I was short, skinny, hyperactive geeky kid. That’s pretty much the formula for getting picked on.

But I didn’t just get picked on. I got beaten up an a regular basis. I don’t say that lightly. I’m not talking about small stuff. The small abuses would have been bad enough, but that’s not what happened to me. This was serious physical abuse. To give one example, in gym class one day during my senior year, I had someone tackle me to the ground; then grab my little finger, say “I wonder what it would feel like if I broke this?”, and then snap it.

That was, pretty much, my life every day from 5th grade until I graduated high school. Everything I did became a reason to abuse me. If I answered a teachers question in class? That was a reason to beat me: I’m making them look bad. If I didn’t answer a question in class, that was a reason to beat me: I should be satisfying the teacher so that they don’t have to.

It wasn’t limited to school. My house was vandalized. The gas lines on our grill were cut. A swastika was burned into the street in front of my house. We had so many mailboxes destroyed that we literally build a detachable mount for the mailbox, and brought it in to the house every night. Then in retribution for depriving the assholes of the privilege of smashing our mailbox, they set the wooden mailbox post on fire.

Hearing this, you’d probably ask “Where was the principal/administration when all of this was going on?”. The answer? They didn’t really give a damn. The principal was an ex-nun, who believed that you shouldn’t punish children. If one children hits another, you shouldn’t tell them that hitting is wrong. You should sit them down and talk to them about “safe hands”, and what you need to do for your hands to be safe.

After the finger-breaking incident, my parents really freaked out, and went in to see the principal and assistant principal. Their reaction was to be furious at my parents. The AP literally shouted at my father, saying “What do you want, a god-damned armed guard to follow your kid around?”. (To which, I think, the response should have been “Fuck yeah. If you’re doing such a shit job protecting your students that the only way to stop them from having their bones broken for fun is to hire armed guards to follow them around, then you should damn well do that.”) Unfortunately, my parents didn’t believe in lawsuits; they wouldn’t sue the school, and they just didn’t have the money to move me to a private school. So I got to suffer.

(Even now, I would dearly love to find that principal… I’d really like to explain to her exactly what a god-damned idiot she is, and how ashamed she should be of the horrible job she did. A principal’s number one job is making sure that the school is a safe place for children to learn. She failed, horribly, at that – and, as far as I could tell, never felt the slightest bit of guilt over all of the things she allowed to happen in her school.)

So now, it’s literally 30 years since I got out of high school. But it’s very hard to get past the things that were pounded into you during your childhood. The eight years of daily abuse – from the time I was 10 years old until I turned 18 – basically rewired my personality.

The effects of that are what made me the way I am.

How does social anxiety really affect my daily life?

Socially, it’s almost crippling. I don’t have much of a social life. I’ve got a small group of very close friends who I don’t get to see nearly enough of, and I have a very hard time meeting new people. Even with people that I’ve known for a long time, I’m just not comfortable. Sometimes I really need social contact, but most of the time, I’d rather be alone in some quiet place, where I don’t need to worry about what other people think. I’d really like to be able to socialize more – in particular, there are a lot of people that I’ve met through this blog that I think of as friends, who I’d love to meet in person, but I never do. Even when I have the change, I usually manage to muck it up. (Because I always believe that people are looking for some reason to reject me, I see rejection in places where it doesn’t exist.)

Professionally, it’s been up and down. It definitely has held me back somewhat. In any job where you need to promote yourself, someone with SA is in deep trouble.

At one point, I even lost a job because of it. I didn’t get fired, but that’s only because I quit when it became obvious that that’s what was coming, and there was no point sticking around waiting for it. My manager at the time found out I was getting treated for SA. From the moment he found out, he stopped trusting anything I said about anything. To make matters worse, at the time, he was in trouble for a project that was literally 2 years overdue, and he needed a scapegoat. The “crazy” guy was the obvious target.

As an example of what I mean: one of the times he accused me of incompetence involved actors, which is a programming model that I used in my PhD dissertation. Actors are a model of concurrent computation in which everything is asynchronous. There are no visible locks – just a collection of active objects which can asynchronously send and receive messages. (I wrote a post about actors, with my own implementation of a really silly actor-based programming language here.)

We were working on a scheduling problem for our system. Our team had a meeting to discuss how to implement a particular component of that. After a lot of discussion, we agreed that we should implement it as an actor system. So I wrote a lightweight actors framework on top of our thread library, and implement the whole thing in actors. My coworkers reviewed the code, and accepted it with a lot of enthusiasm. My manager scheduled a private meeting where he accused my mental illness of impairing my judgement, because what kind of idiot would write something like that to be totally asynchronous?

So I left that company. Fortunately, skilled software engineers are in high demand in the NYC area, so finding a new job wasn’t a problem. I’ve had several different jobs since then. SA really hasn’t been a huge problem at any of them, thank goodness. It’s always a bit of a problem because my natural tendency is to try to disappear into the background, so it’s easy for people to not notice the work I’m doing. But I’ve mostly learned how to overcome that. It’s not easy, but I’ve managed.

When job-hunting, after that terrible experience, I learned to be careful to learn a bit about what the work culture of a company is like before I go to work there. I’ve tried to work something into conversations with people at the company after I have an offer, but before I accept it. It gives me a chance to see how they react to it. If I don’t like their reaction, if it seems like there’s a good chance that it’ll cause trouble, I’ll just take a different job someplace where it won’t be a problem. Like I said before, it’s a good time to be a software engineer in NYC – I can afford to turn down offers from companies that I don’t like.

So, yeah. I’m kind of crazy. Writing this is both difficult and terrifying. Posting it is going to be even worse. But I think it’s important to get stuff like this out there.

Despite all of this, I’ve wound up in a good place. I’m married to a lovely woman. I’ve got two smart, happy kids. I’ve got a great job, working with people that I really, genuinely like and enjoy working with, and they seem to like me back. It’s been a long, hard road to get here, but I’m pretty happy where I am.

This has gotten to be quite long, and I’ve been working on it on and off for a couple of months. I think that I’ve got to just let go, and post it as is. Feel free to ask questions about anything that I can clarify, and feel free to share your own stories in the comments. If you want to post something anonymously, feel free to email it to me (markcc@gmail.com), and I’ll post it for you so that theres nothing on the blog that could identify you.

Also note that I’m going to tightly moderate replies to this post. I’m not interested in having my blog turn into a place where jerks can abuse people sharing painful personal stories.

Depression and Arrogant Assholes

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This is somewhat off-topic for the blog, but pretty damned on-topic for my life.

I’ve talked about this before, but it’s the kind of thing that just keeps coming up.

I’ve got a bunch of different medical conditions.

I’m a post-surgical GERD sufferer – for all intents and purposes, I was born without a sphincter at the top of my stomach. That means that acid could easily get out of my stomach, into my esophagus, my vocal chords, and my lungs. Without surgery, I would probably be dead of esophageal cancer as a result. Since the surgery, I’ve had lingering problems with my swallowing reflex being fouled up, being unable to burp or vomit, and suffering from pretty severe chest pain from muscle spasms. I take a variety of medication as a result, to keep it all under control. For over ten years, I took benzodiazapenes every day as part of the treatment regimen for that: benzos are an addictive drug.

I’ve also got some of the worst allergies of anyone I know. When I first got tested for allergies, based on my symptoms, the allergist selected a set of 45 possible allergens to test me with. Most people with bad allergies would show a significant reaction to 15 or so. I came up positive for 42. I needed to get allergy shots for 25 years, and I continue to take antihistamines and inhaled steroids on a daily basis to treat it.

I also have clinical depression, and very severe social anxiety. I take an SSRI every day for the depression, but I’ve yet to find anything that works for the social anxiety.

No one ever gives me any grief about my stomach troubles. I mean, what could I do? The muscle at the top of my stomach didn’t work. There was a huge amount of acid getting into my throat and even my lungs every day! Of course I had to do something about it!

And allergies? Man, that sucks. Everyone feels bad when they see me sniffling, or when I have to pull out an inhaler because I can’t breathe. But you know, luck of the draw, some people get stuck with allergies. No fun, but it’s manageable with medication, right?

But depression? Whoa, baby. Whole different story. Instead of the benign sympathy or indifference that I get from people who hear about my other troubles, I get shit like this:

To be clear, that wasn’t directed at me in particular. No, it was directed at everyone who’s suffering with depression. See, depression isn’t a real illness. People who are living with depression aren’t suffering from a real illness. No, we’re worshipping our depression. All we need to do is stop being such pathetic assholes, and get up and “make strides to improve our life”.

Before I started taking my SSRIs, I didn’t worship my depression. I didn’t even realize that I was depressed. I just felt like the world had gone flat. It’s hard to describe it better than that. I didn’t really feel much of anything. I wasn’t sad. I wasn’t happy. I wasn’t anything. The world was all grays, no colors. Good things happened, and I couldn’t feel good. Bad things happened, and I couldn’t feel bad. My wife was pregnant with our second child, and I wasn’t happy, I wasn’t nervous, I wasn’t anything. I was just flat.

When I finally realized that there was something wrong with me, I got a referral from my doctor, and I saw a psychiatrist, who prescribed medication for me. About two weeks later, I realized that stuff was different, because I was noticing colors. I never stopped seeing them, but they stopped registering – they didn’t mean anything. I literally felt as if I weighed less – like someone had laid an invisible lead blanket on me, and now it had been removed. Something bad happened at work – the project that I’d been working on for the previous two years had not gotten its funding – and I was upset about it!

It was an amazing thing, a total change of the world. The pills didn’t make me happy. With the stuff at work, and the stress of a new child coming, I was probably more unhappy than I was before I started taking them. But the unhappiness was real, it was mine, and I felt it.

After about a year of taking the pills, on the advice of my doctor, I tried stopping it. For people with symptoms like mine, he said that about 40% would relapse pretty quickly, but 60% would be fine without any medication. After about three months without it, the world went back to that flat drab nothingness – I was part of that 40%. So I restarted the medication, and I haven’t stopped since.

I won’t even get into the social anxiety stuff here. That’s even worse that the depression. Depression is commonly viewed more as a personal weakness than an illness; but SA isn’t even seen as that: it’s just a joke.

Contrary to what the assholes out there say, depression isn’t a personal weakness. It’s not the pathetic obsession of weak-souled losers who just need to get off their couch and stop being such a schlub. It’s a real illness. It’s difficult, and it’s painful.

My depression is just as real as my GERD was, or as my allergies and asthma are. It needed to be treated just as seriously as they did. Getting stomach surgery probably saved my life. Getting treated for depression probably did too.

The assholes who try to portray depression as weakness, who mock people for suffering from depression, who make cracks about being nice to our moms and getting off of our butts: they’re not helping. But really, they don’t want to help. They want to feel smug and superior. But they’re doing worse than just not helping. They’re actively making things worse. By reinforcing the stigma against mental illness, they’re making it less likely that people who desperately need help will be able to get it.

So, as I responded to the tweet I quoted above:

Depression and Geeks

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Since this weekend, when the news of Aaron Swartz’s suicide, there’s been a lot of discussion of the goverments ridiculous pursuit of him, and of the fact that he suffered from depression. I can’t contribute anything new about his prosecution. It was despicable, ridiculous, and sadly, all too typical of how our government works.

But on the topic of depression, I want to chime in. A good friend of mine wrote a post on his own blog about depression in the tech/geek community., which I feel like I have to respond to.

Benjy, who wrote the post, is a great guy who I have a lot of respect for. I don’t intend this to be an attack on him. But I’ve seen a lot of similar comments, and I think that they’re built on a very serious mistake.

Benjy argues that the mathematical/scientific/logical mindset of a geek (my word, not his) makes us more prone to depression:

Someone whose toolkit for dealing with the world consists of logic and reason, ideals and abstractions, may have particularly weak defenses against this trickster disease.

You realize that it’s lying to you, that there are treatments, that that things aren’t objectively as bad as they feel. But you know, on some level deeper than logic, that there is no point, no hope and no future. And to encounter, maybe for the first time, the hard limits of rationality, to realize that there’s a part of your mind that can override the logical world view that is the core of your identity, may leave you feeling particularly helpless and hopeless.

You can’t rationalize depression away, a fact that people who’ve never suffered from it find hard to comprehend. But if someone you care about is struggling with it, and it’s likely that someone is, you can help them find a new way to access their mind.

Tell them that you care about them and appreciate them and are glad to have them in your life. Show them that you enjoy being around them and that you love them. And above all, spend time with them. Give them glimpses of an alternate future, one in which they are secure, happy and loved, tear away the lies that depression needs in order to survive, and in that sunlight it will wither.

Most of what Benjy wrote, I agree with completely. The problem that I have with it is that I think that parts of it are built on the assumption that our conscious reasoning is a part of the cause of depression. If geeks are more prone to suffering from depression because the way that our minds work, that means that the way that we make decisions and interpret the world is a part of why we suffer from this disease. The implication that too many people will draw from that is that we just need to decide to make different decisions, and the disease will go away. But it won’t – because depression isn’t a choice.

The thing that you always need to remember about depression – and which Benjy mentions – is that depression is not something which you can reason with. Depression isn’t a feeling. It’s not a way of thinking, or a way of viewing the world. It’s not something that you can choose not to suffer from. It’s a part of how your brain works.

The thing that anyone who suffers from depression needs to know is that it’s a disease, and that it’s treatable. It doesn’t matter if your friends are nice to you. It doesn’t matter if you know that they love you. That kind of thinking – that kind of reasoning about depression – is part of the fundamental trap of depression.

Depression is a disease of the brain, and it affects your mind – it affects your self in a terrible way. No amount of support from your friends and family, no amount of positive reinforcement can change that. Believing that emotional support can help a depressed person is part of the problem, because it’s tied to the all-too-common stigma of mental illness: that you’re only suffering because you’re too weak or too helpless to get over it.

You don’t just get over a mental illness like depression, any more than you get over diabetes. As a friend or loved one of a person with diabetes, being kind, showing your love for them doesn’t help unless you get them to get treatment.

I’m speakaing from experience. I’ve been there. I spent years being miserable. It nearly wrecked my marriage. My wife was as supportive and loving as anyone could dream of. But I couldn’t see it. I couldn’t see anything.

The experience of depression in different for different people. But for me, it was like the world had gone flat. I wasn’t sad – I was just dead inside. Nothing could have any impact on me. It’s a hard thing to explain, but looking back, it’s like the world had gone two-dimensional and black-and-white. Eventually, I was reading something in some magazine about depression, and it talked about that flat feeling, and I realized that maybe, maybe that was what was wrong with me.

When I started taking antidepressants, it was almost frightening, because it changed the world so much. ANtidepressants didn’t make me happy. In fact, for a while, they made me very sad, because I was realizing how awful I’d been treating my wife and daughter. But they made me feel things again. A few weeks after I started taking them, I realized that I was noticing colors. I hadn’t done that for years. It wasn’t that I couldn’t see colors when I was depressed, but they didn’t mean anything.

Antidepressants aren’t a panacaea. They don’t work for everyone. But there are treatments that can help. The way to defeat depression is to do something that changes the way the brain is functioning. For some people, the exercise of therapy can do that. For others, it’s medication. For still others, exercise. The key is to get to someone who understands the disease, and who can help you find what will work for your brain.

My point here is that when we’re talking about depression, we need to realize that most of the time, no one is at fault. People don’t suffer from depression because they did something wrong, or because they’re weak, or because they’re flawed. People don’t suffer from depression because their friends and family are inadequate. Depression is a disease – a treatable, chronic disease. It needs to be recognized, and it needs to be treated.

In my case, my depression wasn’t caused by my wife and daughter. It wasn’t their fault, and it wasn’t my fault. No amount of support, love, and appreciation could have helped, because the nature of my depression meant that I couldn’t see those things. The only thing that anyone could have done for me is recognized that I was suffering from depression, and pushed me to get treatment sooner.

If someone you know is suffering from depression, then they need help. But the help they need isn’t any amount of love or appreciation. It isn’t instilling any kind of hope, because depression kills hope in your brain. The thing that you can do to help is to help them get the treatment that they need.

Mental Illness and Responsibility

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There’s something came up in the comments of the post about Mr. Tangent 19 that I meant to turn into a post of its own. Unfortunately, I never quite got around to it. In light of recent events, and the talk about the man who attempted to kill congresswoman Giffords, I think it’s important to talk about this kind of thing, so I’m resurrecting the in-progress post now.

Quite frequently when I write a post about a particularly odd crank, someone will either comment or email me saying something like the following:

How fine a line is it between being a crank and being mentally ill, how do we differentiate between the two, and how should we individually treat those separate cases?

The gist of this line of reasoning is: the target of this post is obviously mentally ill, so why are you being mean picking on them?

When I look at things like this, I’ve got a rather blunt answer: why does it matter?

In fact, I’ve got an even better blunt answer: Why should it matter?

Over the last few years I’ve learned, from personal experience, what mental illness really means. Personally, I suffer from chronic depression (managed, quite well fortunately, through medication); and I’ve also had a lot of trouble dealing with pretty severe social anxiety. It’s not a lot of fun. But it’s also not relevant to anything I do at work, to anything I write on my blog, to any political or social or religious activity that I participate in.

I’ve learned from some of my friends about bipolar disorder and dissociative disorder. And I’ve got a cousin who is pretty much completely incapacitated by schizophrenia.

I’ve learned a couple of things from those experiences.

First: being mentally isn’t a particularly big deal. There’s a good chance that you know a lot of mentally ill people, and if you knew who they were, you’d probably be amazed by just how normal they seem.

Second: there is a terrible stigma associated with mental illness. That stigma is huge, and it colors everything about how we view mental illness and people with mental illness. The way that we look at someone mentally ill and baby them – say that we shouldn’t hold them responsible for what they say and do in public – that’s part of the stigma! And it’s not anything close to benign. As almost anyone with any kind of mental illness can tell you, revealing your illness to your employer or coworkers can completely change the way that you’re treated. You can go from being a go-to person on top of the world, to be an absolutely untrustworthy nothing overnight if the wrong person finds out. Nothing changes, except their perceptions: but because of the stigma that says that mentally ill people are irrational and untrustworthy, suddenly everything you say, everything you do, can suddenly become questionable and untrustworthy. After all, you’re crazy. (Yes, I speak from bitter experience here.)

Virtually all mentally ill people function as part of society, without people around them even knowing about their illness. But the instant you find out that someone is mentally ill, the instinctive reaction is to say: “This person is mentally ill, therefore they aren’t responsible for anything they say or do” – and as a direct corollary of that: “I can’t trust this person with anything important”. I’ve seen this quite directly in person.

It’s total bullshit. Most mentally ill people are just as responsible, trustworthy, intelligent, and reasonable as people who aren’t mentally ill. Even many people with schizophrenia – one of the most debilitating, hardest to treat mental illnesses out there – can be fully functional, trustworthy, and rational people. I’ll guarantee that every one of you reading this knows someone with a mental illness, and there’s a reasonable chance that there’s someone you know who has schizophrenia, but you don’t know it, because they seem perfectly normal.

The thing is, we could know someone mentally ill for years and never notice anything odd. But for most people, the instant we find out that they’re mentally ill, our attitude changes. Suddenly they’re not trustworthy or responsible: they’re crazy.

If you’re well enough to interact with society, you deserve to be treated as a full member of society. And that includes the negative aspects of being a member of society as well as the positive ones.

In terms of that past post: the author of that piece of crankery is a practicing physician. Perhaps he is mentally ill. But apparently he functions quite well in his day to day life as a doctor – well enough to be able to practice medicine; well enough to be able to make-or-death decisions about how the medical care of his patients. He deserves the respect of being taken seriously. He doesn’t deserve to be pushed off into a bin of crazy people who should be dismissed as not responsible fdor their actions. If he wants to put his ideas forward, they should be treated just like anyone else’s – whether he’s mentally ill or just stupidly arrogant and ignorant doesn’t matter in the least. It’s none of your or my business whether he’s mentally ill. He’s a responsible adult. And that’s all that we need to know.

The only time that mental illness matters is when someone has something that they can’t control. And that’s very rare. Most mental illnesses don’t affect our ability to be reliable, rational, trustworthy, functional members of society. We’re not incapacitated. We’re not crazy. We’ve got just got a chronic illness.

To connect this to the politics of the moment: lots of folks are pointing out that if you look at Giffords’ shooter, at his troubles in school, at his writings in various places on the net, he’s clearly mentally ill, so clearly no one is responsible for what happened.

I’m not a psychiatrist, obviously. Based on his writings, I’d guess that there’s a fair chance that he’s schizophrenic. And that doesn’t matter.

He’s a murderer. He carefully put together and executed a careful plan for a multiple murder. From everything that we’ve seen and heard, he knew and understood exactly what he was doing. The fact that he’s mentally ill doesn’t change his culpability.

Don’t hold the millions of people who suffer from mental illness responsible for the horrific actions deliberately taken by one individual. And don’t say that this one horrible individual isn’t responsible for what he did.