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I am a psychiatrist. I have spent most of my career studying people who kill other people.Not long ago I evaluated an adolescent who, like the Newtown shooter, first killed a parent, then shot up his school, wounding and killing many of his classmates.Could this massacre have been prevented? I think so. The adolescent I saw had much in common with the Newtown shooter.
1)He was a loner and was considered peculiar by his classmates because of his preoccupation with violence.
2)When obsessed with violence he wore black or camouflage, signalling his state of mind.
3)He was fascinated with weapons and prevailed on his parents to buy him a glock.
4)He went target shooting with his father (a passtime encouraged by his therapist as a means of bonding.)
5) He made his preoccupation with shooting known by speaking of it to classmates and writing about it in school assignments. It was no secret.
Unfortunately, of all who later told of the boy's fascination with violence, none took him seriously.
6) He had psychotic symptoms which were obvious (e.g.auditory hallucinations) which were observed by his teacher but ignored and/or punished.
Do the above similarities between the adolescent I saw and the Newtown shooter matter? You bet they do!
There are others in our schools and in society at large whose recurrent violent ruminations and preoccupations are signals that they are struggling with impulses to act on these preoccupations. They go out of their way to make their demons known.
We tend to look away. We leave it to others to respond.Believe it or not, several of the murderers I have evaluated were turned away from mental hospitals just prior to their committing murder. Psychiatrists hate violent patients.
Teachers, friends and acquaintances are reluctant to call attention to their peer's violent proclivities lest they be seen as over-concerned or  intrusive. Others worry about being sued.
I would suggest that adolescents and adults be made aware of the numerous clues available that  friend or acquaintance may be preoccupied with violence and may be about to "blow." They must also be taught to share their misgivings with a responsible adult.
Will mistakes be made? Of course.
On the other hand, some potential shooters might get the help they are seeking and thus be prevented from acting on their darkest urges and fantasies.

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Comment Preferences

  •  Good advice, doc (15+ / 0-)

    Of course it's a lot more complicated than that, too. Mental Health has always been the redheaded stepchild . Low funding equals fewer avenues to access, fewer beds in facilities for emergencies, etc. Not to mention the Pharmaceutical end of things. People stop their meds for lots of reasons, including the fact that the meds don't always make a body feel all that good.
    Single payer/Medicare for everyone would go a long way towards helping the situation.
     Tonite is a bevy of daries concerning this subject. I hope your expertise is taken advantage of by more people.

    "The United States is a nation of laws: badly written and randomly enforced." -Zappa My Site

    by meagert on Sun Dec 16, 2012 at 04:58:40 PM PST

  •  I've worked in nursing homes, clinics, (11+ / 0-)

    and other sundry places. All kinds of ages, all kinds of disorders.

    Too many people don't understand that broken minds can be as debilitating as broken bodies.

    The old Cherokee simply replied, "The one you feed."

    by teacherjon on Sun Dec 16, 2012 at 05:12:44 PM PST

  •  I am probably not alone in saying that I have (11+ / 0-)

    always been afraid of people that accept violence as something either permissible or attractive. I don't like violent movies or books (you can imagine what I am stuck watching after reading that!) because my fear and empathy dials get pinned on max and it's just physically uncomfortable for me. Sometimes it's easy to see in others and sometimes not. Sometimes it's just a "vibe" that is odd and uncomfortable.

    I met a serial killer (William Bonin, the Freeway Killer) and his brother used to live where I do. I can tell you, every sense I had said both of them were dangerous. They used to come into a restaurant I worked in at the time he was killing, though who knew? It was almost like the hair on my neck would stand up. They were absolutely creepy. Both of them (though I don't think the brother was ever implicated, it's hard to believe he didn't know something was very, very wrong).

    Several times I have been in situations where things were just ALL wrong and I was extremely lucky, though I did once have to bail out of a second story parking structure onto a freeway embankment at San Diego State to avoid what I later learned was a rapist. If not for a warning from a professor advising me against wearing hiking boots in the parking structure (I was in field geology at the time) for safety reasons, I may not have been quiet so agile.

    I know instincts are said to play a big role in fear, but I don't know if that is really true. Regardless, when my instincts kick in, I listen. If they aren't true, nothing lost.

    202-224-3121 to Congress in D.C. USE it! You can tell how big a person is by what it takes to discourage them. "We're not perfect, but they're nuts."--Barney Frank 01/02/2012

    by cany on Sun Dec 16, 2012 at 05:20:52 PM PST

    •  A dangerous field in which to play (7+ / 0-)

      To the best of my knowledge, Bonin was executed. Suffice it to say , many factors played into his violence.He wasn't born that way.If you work in this field, my word of advice is don't interview by yourself. It could be fatal.

      •  He was executed (and I am anti-death penalty) (6+ / 0-)

        in the mid 90's I think. No, I don't work in the field. I am familiar with his background only because I read about it. I know he was molested as a child and had priors for molesting, himself.

        Believe me, I could NEVER work in your field. I am not made of the stuff to do that.

        I came into contact with him after college as a server in a small rural restaurant. His brother lived up the road.

        They both frightened me. I hated waiting on them.

        202-224-3121 to Congress in D.C. USE it! You can tell how big a person is by what it takes to discourage them. "We're not perfect, but they're nuts."--Barney Frank 01/02/2012

        by cany on Sun Dec 16, 2012 at 06:44:01 PM PST

        [ Parent ]

    •  I've met one too, hitchiking through Chicago in'75 (1+ / 0-)
      Recommended by:

      Fifteen years later I read a book on John Wayne Gacey, with photos in the middle. As a read the description of his modus and his vehicle, ya' wanna' talk about hair standing up, I turned to the photos, and there it was, the very distinctive back end of the same pickup I'd last seen pulling away from me at the bottom of an exit ramp after I had firmly declined his offer to go home with him and "have a beer", and that same smiling creepy face. At the time I was not so much frightened as I was just very very certain that I was NOT going home with him, and not just based on general principle but also on a strong feeling that something was very wrong with "support your local clown" bumpersticker guy, one of the very few of the thousands of people who picked me up over a long if not distinguished hitchhiking career whose face and car I still remember.

      Two other times on that same trip (it was a long one) I got into cars that I might not have come out of whole, but did, because I listened to my instincts and proceeded without fear, and a great deal of good luck. It definitely helps to be male and in good physical condition, but one guy had a gun and the other time there were three big Navajo fellows who didn't much like my white ass out in the middle of their res. Ultimately I came away with the distinct impression that it was my lack of a fear based response that played the primary role in diffusing the scripts running in their heads, where the possible victim is supposed to be either terrified or enticed into participating in their internal drama.  And, when I say lack of fear I don't mean courage, which is an active thing, but simply a non-response. Weird, I blame Carlos Castaneda.

      That said, I've also been up close and very personal with a person suffering from hypermania, repeatedly, and I can say for sure that some folks don't give a damn what your reactions or your physical prowess are, you WILL be drawn into their drama merely by proximity.

      IMHO destigmatizing mental illness from the current status as a character fault, demon possession or god's punishment for the bad behavior of the subject's parents, and reacting to it with compassion rather than fear would go a long way toward fixing the problems of not so random violence like the current tragedy. Perhaps not coincidentally, my antennae are pretty sensitive to the chaos vibe. Its probably part of the reason I live out in the woods ;-).

      Just getting a handle on the knobs and dials.... Hey, don't touch that!

      by Old Lefty on Mon Dec 17, 2012 at 01:47:04 AM PST

      [ Parent ]

      •  yikes. i just read about him. I remember this, but (1+ / 0-)
        Recommended by:
        Old Lefty

        not well. boy, you seriously dodged a bullet there.

        202-224-3121 to Congress in D.C. USE it! You can tell how big a person is by what it takes to discourage them. "We're not perfect, but they're nuts."--Barney Frank 01/02/2012

        by cany on Tue Dec 18, 2012 at 02:03:02 AM PST

        [ Parent ]

  •  These two thought-provoking articles... (7+ / 0-)

    highlight how difficult and complex the issues of childhood/ adolescent mental health are and how dealing with this issue is in this country, at this time:  

    'I Am Adam Lanza's Mother':

    ...A Mom's Perspective On The Mental Illness Conversation In America...

    ...I live with a son who is mentally ill. I love my son. But he terrifies me.

    (Note:  Michael is 13 years old)

    ...A few weeks ago, Michael pulled a knife and threatened to kill me and then himself after I asked him to return his overdue library books...

    The mom describes many, many, repeated incidents like the one above.  She describes her struggles with her son's behavior, including years of psychiatric treatment, medication, calling 911 and having her son hospitalized.  

    ...On the intake form, under the question, “What are your expectations for treatment?” I wrote, “I need help.”

    And I do. This problem is too big for me to handle on my own. Sometimes there are no good options. So you just pray for grace and trust that in hindsight, it will all make sense...

    When I asked my son’s social worker about my options, he said that the only thing I could do was to get Michael charged with a crime. “If he’s back in the system, they’ll create a paper trail,” he said. “That’s the only way you’re ever going to get anything done. No one will pay attention to you unless you’ve got charges.

    I don’t believe my son belongs in jail...But it seems like the United States is using prison as the solution of choice for mentally ill...

    This article also is disturbing in many ways: Can You Call a 9-Year-Old a Psychopath?
    For years, Anne and Miguel have struggled to understand their eldest son (Age 9) ...whose periodic rages alternate with moments of chilly detachment...

    Michael’s problems started, according to his mother, around age 3...

    ...When Anne and Miguel first took Michael to see a therapist, he was given a diagnosis of “firstborn syndrome”...

    ...Over the last six years, Michael’s parents have taken him to eight different therapists and received a proliferating number of diagnoses. “We’ve had so many people tell us so many different things,” Anne said. “Oh, it’s A.D.D. — oh, it’s not. It’s depression — or it’s not. You could open the DSM and point to a random thing, and chances are he has elements of it. He’s got characteristics of O.C.D. He’s got characteristics of sensory-integration disorder. Nobody knows what the predominant feature is, in terms of treating him. Which is the frustrating part.”

    Then last spring, the psychologist treating Michael referred his parents to Dan Waschbusch, a researcher at Florida International University. Following a battery of evaluations, Anne and Miguel were presented with another possible diagnosis: their son Michael might be a psychopath....

    The idea that a young child could have psychopathic tendencies remains controversial among psychologists. Laurence Steinberg, a psychologist at Temple University, has argued that psychopathy, like other personality disorders, is almost impossible to diagnose accurately in children, or even in teenagers...

    •  charging sick children with a crime (7+ / 0-)

      Probably the worst thing in the world would be to get a sick child designated delinquent. He will never get help that way. Instead he will be sent to a detention center and then graduate to adult prison. Settle for almost any diagnosis except antisocial personality or its equivalent. often such a diagnosis means "I really hate that kid."Opt for treatment if you have the chance.

    •  Ronald Effing Raygun gutted mental health care (2+ / 0-)
      Recommended by:
      kurious, Ortelius

      and criminalized mental illness by default after shutting down the system in the '70s as Governor of California, S.O.B. He carried that further as president and our 'friends' on the right have continued the narrative into the present; not 'there but for the grace of god go I or mine' but 'I am well because god loves me, and you are not well and to be feared and punished because you are a bad person'. How very 'Christian'.

      Just getting a handle on the knobs and dials.... Hey, don't touch that!

      by Old Lefty on Mon Dec 17, 2012 at 02:29:51 AM PST

      [ Parent ]

      •  "Deinstitutionalization: A Psychiatric... (1+ / 0-)
        Recommended by:
        Old Lefty

        'Titanic" This PBS Frontline report explores the ramifications of deinstitutionalization:  

        ...Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions; it has been a major contributing factor to the mental illness crisis...

        The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history...

        Thus deinstitutionalization has helped create the mental illness crisis by discharging people from public psychiatric hospitals without ensuring that they received the medication and rehabilitation services necessary for them to live successfully in the community.

        Deinstitutionalization further exacerbated the situation because, once the public psychiatric beds had been closed, they were not available for people who later became mentally ill and this situation continues up to the present. Consequently, approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment...

        One of the factors for deinstitionalization was the poor care and conditions in many of those institutions...
        Deinstitutionalization was based on the principle that severe mental illness should be treated in the least restrictive setting. As further defined by President Jimmy Carter's Commission on Mental Health, this ideology rested on "the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services..."8
        But the conundrum is that:  
        ...For a substantial minority, however, deinstitutionalization has been a psychiatric Titanic. Their lives are virtually devoid of "dignity" or "integrity of body, mind, and spirit." "Self-determination" often means merely that the person has a choice of soup kitchens. The "least restrictive setting" frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies...
        What Reagan did was open the doors of the institutions, without providing any viable alternatives.  In fact, politicians have now left many of the mentally ill--and their families--with no place to go, without effective resources to deal with their specific issues.

        To add to the dilemma:  Families Mostly Powerless When Mentally Ill Adult Resists Help (Note: "Adult" includes anyone 18 and above)

      •  agreed (1+ / 0-)
        Recommended by:
        Old Lefty

        As I said, psychiatrists and hospitals hate violent patients.

  •  I've worked with elementary school children (10+ / 0-)

    who could not function in regular classrooms.
    Some were so impulsive and angry that they could not connect with others, and left a chaotic trail of conflict wherever they go.  
    Skillful early intervention is so important.  Social skills can be nurtured, trust can be built, and lives can be changed.  
    It is a wonderful feeling to see a special education student who has overcome behavioral difficulties return to a regular classroom.  Mental health services for troubled children is a wise investment, for it goes a long way in preventing later life tragedies.

    If cats could blog, they wouldn't

    by crystal eyes on Sun Dec 16, 2012 at 05:32:25 PM PST

  •  I am still stuck (5+ / 0-)

    on the media and their Asperger's syndrome talk. I think of my lovely mild young friend who has to live in our society while dealing with it and I get mad on his behalf.

  •  I forgot (6+ / 0-)

    to thank you for your diary presenting your professional view.

    •  chocolate (0+ / 0-)

      my first response got eaten. I admit I had more than my share of chocolate today. I'm still sad and frustrated by the response to the shootings in the media.

      •  A fellow (0+ / 0-)

        chocoholic (I won't tell you hubby makes and sells chocolate.)

        PS-I hope the president and his crew have been preparing a plan and waiting for the right moment to start on it and that the people have their back. Too many children dying stupid avoidable deaths.

        Off to have some more chocolate.

  •  Wish this was getting huge attention (5+ / 0-)

    What you have to say is so important.

    This, I believe, is the conversation we should be having.

    This health care system is a moral atrocity. Dr. Ralphdog

    by AllisonInSeattle on Sun Dec 16, 2012 at 10:07:49 PM PST

  •  Does the DSM (2+ / 0-)
    Recommended by:
    ericlewis0, Ortelius

    have a checklist for explosive violent potential? If not, perhaps it should;
    (1) violent thought patterns repeatedly expressed to peers and others
    (2) close association with weapons in the home
    (3) inability to form close lasting affiliations with groups or idividuals
    (4) ......?

    Just getting a handle on the knobs and dials.... Hey, don't touch that!

    by Old Lefty on Mon Dec 17, 2012 at 01:53:22 AM PST

    •  stopping potential volcanoes (1+ / 0-)
      Recommended by:
      Old Lefty

      An important  4) would be a history of abuse at home and at school. In my other case, the adolesc It's usually a combintion of intrinsic and environmental influences.l

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