Tuesday, July 24, 2012

The Psychosis of James Holmes

Yesterday, New York Mayor Michael Bloomberg made the appalling recommendation that police officers walk off their jobs until the politicians get the guns off the streets.

In Bloomberg’s New York, a city with draconian gun control laws, gun violence has recently been on the upswing.

Other cities that have strict gun control laws also have the most gun violence. Think Chicago and Washington, D.C.

As of now, Americans own some 200 million guns. The notion that we are going to eliminate guns is wildly impracticable.

This morning David Brooks is more on point when he suggests that we need to have more treatment programs for undiagnosed psychotics like James Holmes.

In his words:

The best way to prevent killing sprees is with relationships — when one person notices that a relative or neighbor is going off the rails and gets that person treatment before the barbarism takes control. But there also has to be a more aggressive system of treatment options, especially for men in their 20s. The truly disturbed have always been with us, but their outbursts are now taking more malevolent forms.

Brooks is right to focus our attention on the killer, not the culture or the politics.

He is slightly off the mark when he prescribes “relationships.”

Keep in mind that Holmes was studying graduate level cognitive level neuroscience. Thus, he was surrounded by people who are especially aware of the signs of mental illness.

He must have known that if he had shared his megalomaniacal delusions they would have tried to have him committed.

So, he dropped out of the program and took the kind of action that, as I mentioned in a previous post, and as Brooks points out, would have affirmed that he was not crazy—that is, that his voices were telling him the truth. He did something that made him as important and famous as they said he was.

Brooks is correct to say that we need “a more aggressive system of treatment options.”

The problem is not the availability or accessibility of programs. Psychiatry is perfectly capable of treating such people with its current programs. There are relatively few undiagnosed paranoid schizophrenics out there.

When Brooks talks of “aggressive” treatment, he is hinting that such patients should be subjected to forced hospitalization and forced treatment.

I suspect that the people who believe that gun control is the solution would fight to the bitter end to prevent the state from forcing treatment on a psychotic who does not want to be treated.

Some patients are treated against their will because they are deemed dangerous to themselves and to society. And yet, it is more difficult, from a legal perspective, to force treatment on someone before the fact, before he has committed murder and mayhem or before he has tried to commit suicide.

Like James Holmes many paranoid schizophrenics understand the system well enough to hide their delusions from those who would see them as crazy.

Some psychiatrists know how to engage a potential psychotic in a conversation that will reveal the extent of his problem. Too many psychiatrists do not know how to converse with patients and simply recite a checklist of questions.

It would also be good if there were a clearer psychiatric consensus that psychosis is a brain disease, not a psychogenic mental illness.

By that I mean that the psychiatrists who went on television to explain that James Holmes became psychotic because of bad parenting or unresolved childhood traumas are misleading us.

No reputable psychiatrist believes that psychosis can be treated by uncovering its infantile antecedents. It is irresponsible even to suggest otherwise.

When James Holmes was studying cognitive neuroscience he was most interested in the biological causes of mental illness. Doesn’t that alert us to the fact that Holmes knew that something was seriously wrong, that he did not know whether it was biological or psychological, and that he finally refused to believe that he was just suffering from a disease?


JP said...

I deal with clients with schizophrenia on a regular basis.

If there's a mass murderer who *should* be found not guilty by reason of insanity, this guy would seem to be it.

Ph.D. neuroscientists *don't* seem to be the type who would really be focused on the symptoms and diagnosis of mental illness.

You know who *is* knowledgeable about this condition? The secret service. I had to deal with a case lately involving them and I'm pretty sure they have specific protocol on how to deal with this because the president is often a subject of delusions.

This guy probably had a psychotic break and couldn't accept it and was unable to figure out which sensory inputs were real and which ones were fake.

He's going to be horrified with himself once the anti-psychotics start to work it he does have schizophrenia. And this entire case is going to be a complete tragedy all the way around.

The entire problem with schizophrenia is that those who suffer from it seem to retain enough ability to interact with reality to be very dangerous to inhabitants of that reality.

Stuart Schneiderman said...

Thanks, JP. I appreciate the opinion of someone who has more direct experience with schizophrenics. My own experience dates back many years.

I tried to avoid the legal issues involving the insanity defense because I do not know enough about it. I have the impression that people who would be considered psychotic can be found responsible for their actions because they did know the difference between right and wrong.

I believe that he is now being medicated, with or without his consent, and I second your excellent point that he is going to be horrified once he discovers that he was suffering an illness.

An Unmarried Man said...

This observation/opinion, and other derivations of it, has become strangely ubiquitous in the wake of Holmes' spree:

"...have more treatment programs for undiagnosed psychotics"

"Undiagnosed" means precisely that, correct? No longer are we just a "nanny state" ... we can add "snitch state" as well. 9/11 accelerated this unofficial government mandate. Who cares if you're not a trained law enforcement officer or clinical psychologist...we need to know when someone is acting "unusual." Big Brother is not the government; it is the government using its citizens as tools.

Stuart Schneiderman said...

Right now, we have decided to wait until something horrible happens. Perhaps, this is the price of freedom.

In most cases schizophrenics do not pass unnoticed, because of their behavior, dangerous, violent and criminal.

Holmes is an exception because he never did anything to show his illness.

Perhaps there was nothing to do about someone like him, but many of the others, who are left untreated because they do not want to be, do become dangerous, to themselves or others.

And then there was the anti-psychiatry movement that helped create the conditions whereby many people who were mentally ill were discharged from hospitals and clinics.

They were not well. They could not deal with the outside world, but they were deemed not to be dangerous, and so they were let out.

These are difficult questions, but there ought to be a medium between a police state and a nation where we allow ourselves to be exposed to people whose illnesses make them a danger.

Malcolm said...

I don't know if you read Daniel Greenfield's article on the subject. Here it is


I hate the word "tragedy" it takes responsibility out of the equation. This was a massacre.

Stuart Schneiderman said...

Thanks Malcolm... it's a very interesting article.

For my part I don't see him as evil. I would no class him with Major Nidal Hasan or the 9/11 hijackers... because they knew exactly what they were doing.

I have probably not seen as many schizophrenics as JP, and I have not seen any recently, but I never had the impression that they were evil... most of the time they are doing what their voices tell them to do.

I still think that they are seriously ill, suffering from a brain disease. If Holmes was shown to have a brain tumor would anyone think that he was evil?

As I also said, the legal issue of whether he knew right from wrong is quite a different question.

Anonymous said...

Although, we do not know as of yet, whether James Holmes was taking antidepressant medication, there is adequate literature (not to mention warning labels on these medications) that suggests serious side effects from taking these medications, including severe personality changes such as hostility, aggression, psychosis, and suicide. These changes can sometimes happen so slowly over time, that even the people closest to you will not allways recognize the changes until, unfortunately it is too late.

Stuart Schneiderman said...

I had read somewhere that Holmes was on Vicodin, so I assumed that if had been taking some other medication we would know about it by now. But maybe not. I am not an expert on the effects of anti-depressants, but someone who is might tell us whether they can produce a psychotic break... my guess would be that they cannot.

Dennis said...

This reminds me a movie where a few liberals who live together decide to make the world a safer place. They posited that if someone could have done away with Hitler before he came to power that millions of people would have been saved. So they develop a plan to invite everyone who holds ideas different than theirs for dinner. At the dinner they would evaluate whether this person was a danger to society and then poison them and bury them in the back yard.
Well as it turned out everyone who disagreed with them was dangerous so they were removed from life. Only in one case did they not poison someone. She was a 16 year old girl who was adamantly agains't abortion. They determined that she, for some reason I forget now, was not a danger to society.
As it were they invited a politician over for the same trial and judgement. Being a politician he recognized the overstepping of bounds these people were engaging in because he was quite familiar with the concept. Imagine that. So he switched the poisoned bottle of wine for theirs and they all died.
Given that any of us who have been around long enough to remember psychiatry run amok beginning with Freud, repressed memory syndrome et al one might understand our reluctance to allow a government made up of people who want to save the world from all those people who disagree with them, not unlike the desire by many on the Left such as Bill Ayers who would use the same methods as in the little story I imparted, to have any say in situations like this because any government that has this kind of power has not shown itself trust worthy.
What if a Hanna Rosen was the person in charge? Would just being a male be a mental disease? Would just disagreeing with the government be a mental disease?
It is always easy to say that there should "be a medium between a police state and a nation where we allow ourselves to be exposed....," but those who want never are satisfied with an inch. Power always wants more power.
I would rather deal with the random event which does not occur very often, such as this, than to subject us to those who would use this to garner power unto themselves. One only has to look at the lengths some have already done in order to use this for their own personal politics.

Stuart Schneiderman said...

Let's understand that people get committed to psychiatric institutions through a legal process, a court hearing. Most of the time it has to be very, very clear that they are a danger to themselves or others.

The question about Holmes is whether he just fell through the cracks or hid his delusions very well. I am certainly not in favor of a police state. I think it might be good idea to think about doing a better job of helping some of the people whom the system misses.

JP said...

The mental health system is pretty underfunded and uncoordinated.

No psychiatric hospital wants to keep any one for any length of time and when they do release people they are always "stable" with a GAF of 60. However, treatment after such a hospitalization is spotty and ad hoc.

Even if you are a danger to yourself or others, you only get to stay for 3 to 7 days and are then released.

The entire psychiatric system needs to be rethought and restructured so that people with serious organic disorders like schizophrenia and bipolar disorder are better handled over a longer term.

Fortunately for the public, most of the time those with serious organic disorders are only a danger to themselves or their immediate family.

Like one paranoid schizophrenic who decided to swim a mile in the ocean with one of his small children while leaving the other one alone on a beach. Or the guy who decided to dump gasoline around his daughter's house because she wouldn't let him in.

And those two examples are of relatively high functioning people with organic brain disorders.

Until I got into this line of work I had no idea that these disorders really even existed. It's not something that's generally discussed in suburbia.

Stuart Schneiderman said...

Thanks again, JP. I and, hopefully, other readers, much appreciate your view from the inside of psychiatry and the way it deals with organic brain diseases and metabolic conditions.

Anonymous said...

The presumption should start with evil , if later they find mental illness then tragedy.

The liberal press always starts with tragedy and really never changes.

JP said...

My brother-in-law's the psychiatrist.

I'm just the lawyer who has to read the psychiatric records to prove mental impairments in court. The fun part is interviewing the client about suicide attempts and hallucinations.

Never thought I would spend any part of my professional life talking about auditory and visual hallucinations.

I never really believed that mental illness existed until I took this job. The weirdest vibes come from the people who are manic. I'd never seen anything like that before.

This guy just seems like he's been hit with the onset of paranoid schizophrenia.

Columbine was evil (one was clearly a sociopath; the other one was an idiot sidekick). Not too much mental illness there. They wanted to kill people for fun.

This guy looks and acts like someone who actually did what the voices in his head told him to do.

He could be faking it, but the entire series of events seems off. If you wanted to kill as many people as possible for fun, why would you tell the police that your apartment was rigged with explosives after you just got done shooting up a theater?

If you're sane and evil, you would want the bomb to go off, so you would keep your mouth shut so that you would become even more famous/notorious to get a higher "kill count".

Bob said...

Good discussion! I have linked to it here: http://bobagard.blogspot.com/2012/07/sane-and-evil-or-paranoid-schizophrenic.html

Stuart Schneiderman said...

Thanks for the link, Bob. I very much appreciate it. I hope that everyone will check out your comments on the question.

Anonymous said...

The guy accumulates guns for months this speaks to the his intent.

Beth said...

My brother suffered IDENTICAL symptoms to Holmes when he withdrew suddenly from SSRI medication - he began with an anti-depressant called Effexor (now known to increase suicidal ideation 5-fold and to cause aggression) his depression rapidly changed to self-harm after taking Effexor for a month, he quickly withdrew from Effexor, the withdrawal symptoms were insomnia and after no sleep for three days he became confused and suicidal and was put on anti-psychotics which zombified him and made him gain 5 stone in weight. Ten years later he began to wean off of the SSRIs, he was doing great, got down to half his original dose, had become active again, then he withdrew from the last half dose suddenly without tapering the dose and he suffered, aggression, mania, hyper-sexuality. amnesia, insomnia, then seizures and post-ictal psychosis and post-ictal bliss. The symptoms lasted almost six weeks, gradually tapering off till he recovered. Luckily for us Doncaster mental health crisis team is shockingly negligent and inept, they put his seizures down to psychological distres??!! and refused to admit him to hospital or write him a prescription to put him back on the drugs (oh wonderful cost-cutting NHS practices!) he was not put back on the drugs and therefore we found out that the symptoms were NOT due to an underlying mental illness but PURELY drug withdrawal symptoms! So, Effexor side-effects included suicidal behaviours and severe insomnia turning a simple case of anxiety into attempted suicide and a mental breakdown from sleep depravation, the SSRI anti-psychotics CAUSED psychosis and seizures! Watch this, you CANNOT judge this case fairly untill you are made aware of the facts relating to psychotropic drug induced psychosis. One thing we know about Holmes is that he was taking a med commonly prescribed for social anxiety and the drug worsened his state of mind causing him to believe he had dysphoric mania (which is actually a label invented by psychiatrists to describe severe drug side-effects as a pre-existing mental illness when the symptoms of dysphoric mania clearly describe symptoms of frustration, anger, stress and anxiety morphing into psychosis and psychotic aggression with the introduction of the psychotropic drugs!?!) http://www.cchr.org/videos/marketing-of-madness/psychotropic-drugs.html

Stuart Schneiderman said...

Thank you for the information, Beth.

Elizabeth Manuel said...

To add to the above info, my brother has since been diagnosed with higher functioning autism and it turns out that autism sufferers have a more permeable blood-brain barrier meaning these drugs enter the brain in larger amounts than normal and accumulate, causing patients to either be effectively zombified or inducing psychosis, psychosis on withdrawal can be due to the fact that the brain has become reliant the higher doses and therefore experiences a significantly increased level of depravation from the sudden dosage decrease and hence more severe discontinuation symptoms. The seizure risk is also increased in autism sufferers as their seizure threshold is already lower than normal and drugs exacerbate this, so post-ictal psychosis is an additional risk when this seizure activity is induced.

Louisa Matsuura said...

I recently heard that James Holmes was going to trial soon. I’m not quite sure about how bad his psychosis is, but some part of me feels that he knew what he was doing when he stepped in the cinema on the night of the 20th of July. I want to know why he did it, what set him off. There’s always something with this people and I hope that it comes to light during his trial.

Louisa Matsuura

Anonymous said...

I'm afraid popular culture is so favorable toward marijuana and other drug use, we may be ignoring the obvious. Note that with EVERY SINGLE MASS murderer occurence in recent decades on American soil, and many in Europe (Breviek), the perpetrator had used narcotics, both legal or illegal. Oddly, the one common denominator in virtually all of them (where we know the medical records) is prior use of marijuana, often lots of it. Holmes is no exception, as well as Klebold and Haris, Loughner, Lanza, McVeigh, the Tsarnaevs, Manson, Bundy, Dahmer, etc, you name the mass murderer and there is a very high probability he was a druggie. Even this last attempt of a school bombing in Oregon, marijuana was part of the equation.

Rather than a "mellowing" effect that is described for marijuana use, it's probably more like a numbing effect. The users simply don't care about anything, one way or the other. In some extreme cases, perhaps in conjunction with other narcotics (prescription or illegal) some folks develop psychosis and of that group a few simply lose their empathy or compassion for human life and their inhibitions to kill.

I think we (as a society) are suffering from group think in a serious way, more than willing to ignore the chance that within our culture or permissiveness and relaxed attitudes, marijuana use over prolonged periods may be playing an integral role in creating these psychopaths. We may just be ignoring the obvious.

Stuart Schneiderman said...

I have read reports suggesting that using too much marijuana when young can provoke schizophrenic symptoms. I am not really qualified to judge the value of the reports, but you might be interested in looking at them.

Anonymous said...

Quick follow-up on that post: Though correlation is not causation, the link between prior marijuana use (months and years, not simply "under the influence") and mass murderers is nothing short of remarkable! Please folks, do the research- the connection is alarming.

Guns are not doing the shooting themselves; it's the crazies who have guns. And so often, I contend, they are crazy because of all the drugs freely available in American society.

Anonymous said...

Oh, thanks for the very quick reply, Stuart. Yes, I have seen some of those reports. Admittedly it's very hard to pin this possible correlation down with any certainty.

It's just we're playing with fire in the barn, the barn is on fire, and we don't want to acknowledge it.