Wednesday, November 14, 2018

Psychiatric Experts and Mass Murder

On the question of mass killings, the conventional wisdom has concluded that the problem is gun control. There is a certain logic to the argument. For those who are especially simple-minded, it is incontestably true that if there were no guns there would be no gun violence. And yet, citizens own over 300 million guns. Taking them away is not just daunting. It would be nearly impossible.

Would it not be easier and more effective to provide treatment for the few dozen psychotics and psychopaths who are prone to these acts of senseless violence. As you recall, the great majority of the shooters in these murders were known to be severely troubled. Yet, as the laws are now written, it is nearly impossible to have them committed to a psychiatric hospital involuntarily. That includes James Holmes in Aurora, Colorado and Adam Lanza in Connecticut.

You can thank the civil liberties lobby for placing the good of an individual suffering from a brain disease ahead of the public good.

Today, looking at the Thousand Oaks, CA massacre, Bruce Bawer has some additional observations, made more poignant by the fact that the son of an old friend was among the victims.

Bawer places considerable blame on the psychiatric profession, on the people who are supposed to know these things. But who fail miserably… because they are afraid to pronounce judgment on someone they ought to know to be a danger to himself or others.

As for the Thousand Oaks killer, his mother knew that he was dangerous. His neighbors called the police. The police sent him to see mental health experts… who said that it was not a problem:

Looking at a couple of newspaper reports, I discovered that the killer was a former member of the U.S. Marines who had served in Afghanistan and who had apparently come back home with PTSD. His mother, with whom he lived, had been “terrified” he might hurt himself or others, and his conduct was so disturbing that neighbors called the cops. The cops, in turn, had him looked at by mental health “experts,” but they determined that he was of no danger to himself or others.

Bawer has had other experiences of the same kind, in New York City, among other places. He explains the case of an individual he knew, and who was being treated by a psychiatrist and a psychologist:

For months before I came to this determination about the person in New York, he had been regularly seeing a psychologist and a fancy Central Park West psychiatrist, neither of whom recognized that he required hospitalization and medication. Instead, they professed that he was, yes, “of no danger to himself or others.” They were busy giving him talk therapy – an activity that, as I could see (but they couldn't), was only making him sicker. While these doctors were insisting he was basically OK, he was, unbeknownst to them, frequenting some of the seediest bars in Manhattan, where, he told a mutual friend, his goal was to get infected with HIV so he could then pass it on to others.

Not a danger, they said???

These so-called experts are, one supposes, intimidated or incompetent or both:

... the simple fact is that in the minds of too many of these practitioners, the hesitation to deprive mentally ill persons of their freedom of movement even for a temporary period, while being treated and getting better, routinely trumps any inclination to keep them locked up, under observation, and safe until they're definitely healthy again.

Often enough psychiatric interviews involve reading off a list of questions, of the kind: Are you planning to commit suicide? Do you want to harm other people? If the patients answer in the negative, the psychiatrist concludes that he is not a danger to himself or others.

So, Bawer sees in the rash of shootings a symptom of professional failure. He rightly questions the value of mental health expertise:

The bottom line here is that all of this so-called mental health expertise is, with a very few exceptions, a scam. The ranks of psychiatrists and psychologists are filled with incompetents who have no business deciding whether or not a mentally ill person should be hospitalized – or, once that person is hospitalized, have no business deciding whether to send him home. Topping off their incompetence is, in all too many instances, an overweening arrogance. You might think that if everyone who is closest to a person thinks he needs help, that fact would carry some weight with the psych professionals. On the contrary, one often gets the impression that these practitioners enjoy, and even pride themselves on, dismissing the pleas of a potential patient's loved ones. Perhaps they resent the idea of family members playing doctor or making diagnoses.

He concludes:

To be sure, dethroning these quacks may not be the only answer to mass murders such as the one in Thousand Oaks, but it's one of the answers. There is an urgent need for a more competent and aggressive approach to examining disturbed individuals such as this ex-Marine, and “experts” must be compelled to err not in the direction of respecting patient freedom but, rather, in the direction of protecting public safety. Depriving someone of freedom of movement for a few days, weeks, or even months while he is being treated for a dangerous illness is better than allowing him to roam free, acquire a gun, and rob others of their lives forever….

And that's all there is to say. We have to do better. And doing better means, in part, ending the reign of these crank doctors, these useless mountebanks, these credentialed incompetents, and putting in a tougher, tighter system of mental-health screening run by tough-minded people with some goddamn sense.

As David Foster occasionally reminds us, we are so enamored of credentials and so ready to assume that credentials bespeak expertise that we bow down meekly to the authority of psychiatrists. If I have been pointing to anything on this blog, for more than a decade, it is this: the mental health profession is in very bad shape. It has made some progress in psychopharmacology, but the world of talk therapy, the kind that Bawer saw being offered to his acquaintance in New York… is a joke.

It reminds me of a story from Marseilles, France. A psychiatrist in a mental hospital wanted to release a man. Her colleagues all declared that the man was dangerous and that, if released, he was very likely to kill someone. The psychiatrist released him anyway. He then went out and killed someone.

For her dereliction and poor judgment the psychiatrist was charged and eventually convicted of manslaughter. When the French are tougher than you are, you have a real problem.


Ignatius Acton Chesterton OCD said...

We are suffering from legalism, credentialism and activism in so many areas of American life, and this is no exception. The root cause is single-issue activists, the enabling factor is our legal system, the firewall is credentialism — which feeds more legalism — and the result is that nothing happens. Our lives get worse. And we have mass shootings to boot. But I suspect the root cause is the homeless activist.

What is a “homeless advocate”? I would assume someone who advocates that a homeless person has the civil right to live out in public space as he pleases, without no limits. Homelessness = freedom. Except we know this is not the case. Homelessness is a horrible way to live, for all kinds of reasons. And homeless people, in their lifestyle and environment, make public spaces unpleasant for themselves and everyone else.

So when someone (sensibly) wants to remove a psychotic person from the street, the homeless advocate is indignant, and intervenes. How do they intervene? By siccing lawyers on the government to prevent a public official for having someone treated or institutionalized. The government, short on resources, acquiesces to the threat of a lawsuit. And the problem goes on.

By another route, loved ones may want their psychotic cared for or evaluated — to protect themselves and society at large. They take the suspected psychotic to a shrink. The shrink may now be faced with a dilemma: “Will this psychotic sue me for taking his freedoms through false diagnosis?” After all, there are mental health advocates out there, too. The psychiatrist/psychologist has the time and cost of many years of training — regardless of quality — in institutions of higher learning and specialized training. These institutions and programs in the “helping professions” are notoriously skeptical (almost reflexively hostile) to any kind of “judgment” about another human being. The shrink is to be open-minded, listen, and err to the side of caution with any kind of label. The legal jeopardy only heightens the risk, as most shrinks bill by the hour. You don’t make any money defending yourself from a lawsuit. That, and it’s unlikely you’ll be pursued by authorities for malpractice, which is very difficult to prove. It’s easier to pronounce the person sane. The patient is the client, not the government or the psychotic’s family. It’s a twist-a-plot of considerations, and ultimately the best move is the presumption of wellness, or innocence. Kind of like another profession we all know.

I am not surprised that the psychiatrist/psychologist is risk-averse. They’ve been told all their careers that their duty is to the health of the patient/client. Except in rare circumstances. Contrary to popular belief, mass shootings are extremely rare. So the risk to professional standing, licensing, credentialing, professional ethics, etc. creates a massive barrier to being loose with a psychotic diagnosis. Add to that the fact that many rights and opportunities are taken away for life following a psychotic diagnosis. It’s a big deal!

I agree that the mental health profession is in trouble. But I also believe the legal profession is out of control as well. And unchallenged activism like the kind encouraged by our universities at all levels is the training ground for a reckless kind of individualism. The result: we all suffer. While there is no perfect way to deal with this, we would need to overturn decades and decades of professional ethics and training which favors the rights and needs of the individual. In Western society, that would be a very, very hard sell. One could say it’s the price we pay for our values.

Those are some tough choices to make. The easier route is to blame inanimate objects — GUNS. For all the liberals who talk endlessly about how issues are so complex and solutions so complex, the gun seems like the most simplistic go-to panacea of them all.

Dr. Irredeemable Dreg said...

I merely note as footnote to IAC that with 300,000,000 guns in private hands, if guns actually were the problem it would be a problem of such bloody magnitude that "debate" would be moot. Citizens would be mowed down in such overwhelming numbers that entire law enforcement and medical apparatuses would be instantly overwhelmed, and first responders and medical personnel could themselves be saved only by martial law and military use of heavy weapons, if at all. If licensed hunters in America were an army, it would rank as the largest army in the world.

Sam L. said...

"You might think that if everyone who is closest to a person thinks he needs help, that fact would carry some weight with the psych professionals." I suspect these people are never asked or are not allowed to talk with these professionals.

Guns: Knives are cheaper and more widely available, with no waiting time for purchase. Then there are sticks and ropes/cords.

Ares Olympus said...

For perspective against hysteria, it can be instructive to compare the death counts in various events:
1. 1993 Waco Siege - 76 dead (by fire)
2. 1995 Oklahoma Bombing - 168 dead, 680 non-fatal
3. 2001 9/11 attack - 2,996 dead, 6,000+ non-fatal
4. 2005 Hurricane Katrina - 1,836 dead
5. 2017 Vegas shooting - 59 dead, 422 non-fatal

So the deadliest mass shooting in 2017 was only fractionally as bad as other events. So if you're a wannabe mass murder, guns are not clearly the most effective tool. Most of us will never be killed by a gun, and most of us will never personally know someone murdered by a gun, and many of us will live our entire lives without even see a gun pulled out in fear or anger, much less fired. Even many police officers will finish a 30 year career without ever shooting their gun at a suspect.

And if we leave the US, we have a truck attack with 87 dead, and 434 injured:

So we all just need to relax and consider crazy people exist, and it is hard to identify which ones will be violent until they do, and in a free country some of them will get access to guns, and there's nothing we can do to stop that, but must of us will be fine, so we just need to accept the innocent deaths as no different than ordinary natural disasters that often kill far more. We all can be prudent in the risks we take, and know even when the worst happens, victims will have access to the best trauma care system in the world.

Anonymous said...

Today's psychiatry seems not to have an understanding of root causes of mental illnesses, which themselves are ill defined, their definitions constantly shifting. Its approaches to both root causes and mental illness definitions seem hugely influenced by currently popular ideas or even dogma. It does seem to have some success with certain clear-cut conditions, but this seems largely empirical.

With all due respect to this blog's author, I think today's psychiatry is about where physical medicine was in the 18th century.

Anonymous said...

The French psychiatrist Daniele Canarelli is a man. He was acquitted on appeal, but the case has legal ramifications.

Ignatius Acton Chesterton OCD said...

Sam L.,cyou forgot stones. Which will break bones. But all we offer for solace is words, words, words...

And I might add as a footnote to DID’s footnote to punctuate the point that mass shooting MAY BE the price we pay for a society based so strongly in favor of individual rights. And, by the way, let me count myself as part of that group — with sensible limitations. For all the prattling-on about solutions like gun control, the fact remains that there will be choices based on categories. That’s the way society MUST operate, in the aggregate. Not everyone will be looked at as an an individual any more than the IRS looks at one as an individual. We must be s society based on laws or else everything will be chaos. But my issue in all of this is that the legalism has become so rigid and ossifying as to no longer be a tool. Laweyers WORSHIP law, as it is their means for status and legitimacy — otherwise, all they would be are talkers (like Jim Acosta, who is not taken seriously outside the DC circle of his profession). We all have to get along, and stuff has to work. Our Rube Goldberg leviathan caricature of an M.C. Escher drawing is what law has become. We serve it, rather than it serving us. This is dangerous. And when we ignore the Second Amendment in favor of peripheral, extra-Constitutional considerations to protect the emotional well-being of nutcases, we are in trouble. And that is exactly where I believe we find ourselves. Something has to give, and I think it’s time for the lawyer class to give back to society the common sense and moral sensibility it stole a long, long time ago.

What is wrong is that we have a soft society that is unable to say “NO.” That’s just the truth. Whether it’s because of Oprah or whatever else is debatable. But we’ve lost our facility with limitations, which includes “NO.” People who say “NO” are considered MEAN people. And mean people suck. So now the lunatics are running the asylum and shooting up country bars. It’s a problem, but it’s not caused by the adults in the room. It’s caused by the lofty, childish dreams of civil libertarians who speak of “victimless crimes” that leave us all living in a sort of civilized squalor. We all have to get along. And we cannot get along if emotionally disturbed people can go so far as to demand that we change bathroom culture to accommodate an INFINTESSIMALLY small bit of the population who can’t figure out what gender they are. It’s patently ridiculous. It’s imposing a moral, ethical and increasingly legal duty on everyone else based on how the aggrieved gender-transitioning victim FEELS. I assert that is a bridge too far. If I identify as a British person, does that mean everyone has to swerve out of the way as I drive on the wrong side of an American street? I think not. That would be considered ridiculous. Yet that is EXACTLY what we are doing in our lugubriously infantile, painfully-sincere culture of vomiting all over ourselves in a contest to show who is the most TOLERANT among us. It’s not going well.

Christopher B said...

Agree with Anon@2:30. I would be more supportive of Dr Schneiderman's proposals if it wasn't so likely that they would now be hijacked and weaponized by SJWs.

Dr. Irredeemable Dreg said...

You can tell that a cog slipped somewhere when the judicial system identifies a loon with a gun... and arrests the gun.

Anonymous said...

Ignatius Acton Chesterton OCD brilliantly puts in a nutshell: "...we have a soft society that is unable to say 'NO.' ...People who say “NO” are considered MEAN people."

In such an atmosphere, people who say "no" are mean merely by virtue of saying "no" instead of on the basis of the reasoning behind saying "no". Such an approach is a cheap shortcut to ascendency over another person, the real goal of discourse for people in a weak-minded state.

Sadly, in the public sphere, that kind of rhetorical attack is applauded as victory. How is it that these weak-minded people, who must be in the minority, have gained so much power over current social issues? I am at a loss.

It all boils down to sophistry. As part of policy of teaching critical thinking, if sophistry,, its 1st cousin rhetoric, and 2nd cousin logical fallacy were given serious treatment in schools, making them clearly recognizable, perhaps these tactics would lose their power in the face of a public well educated in how to articulate opposition to what are essentially dirty tricks.

A study of the Socratic dialogues would be a good start.

Linda Fox said...

Yeah. I've known those "health professionals". Some are so f***ing incompetent, they should be stripped of their license, and slapped into public stocks, to be exhibited for public ridicule and shame.

Several things that might help:
(1) Every practitioner must have some "skin" in the game. If they certify - against family/others statements, that a person is safe to be in the community, they have to put some money on the bet - say, at least $1,000 down, with yearly payments to a victim's fund, should that person "go off", as everyone else expects that he will. If he doesn't, for a period of 5 years or more, the shrink gets his money back.
(2) PUBLICLY available records of the bad decisions. Searchable and having a full description of the original diagnosis, the crimes committed by the patient before and after that diagnosis (you can disguise the name), and any consequence suffered/judgement imposed on the therapist.
(3) Years ago, Berke Breathed, in Bloom County, had a very funny story about a lawyer arguing that an ax murderer should be released on bail. The judge agreed, and made that lawyer take that client into his own home.
Maybe not a bad idea - you think he's safe to be around, YOU take him (no medicating him against his will), and own the risk yourself.