James Holmes' Psychiatrist Knew He Was Dangerous

We have been discussing whether or not James Holmes’ psychiatrist could have or should have known how dangerous he was and what she could or should have done about it.

Yesterday, ABC News reported that the psychiatrist, Dr. Lynne Fenton was, in fact, very concerned about the threat that Holmes posed and reported him to her colleagues on the University of Colorado threat assessment committee.

This committee had been organized by the university to identify and help students who were presumed to be dangerous.

Dr. Fenton reported on Holmes in early June, but, before the committee could meet, Holmes dropped out of school.

Whatever the legal issues now swirling around this case—and there are many—the question we should now address is this: if the problem was sufficiently severe to be reported to a threat assessment committee, why was it not reported to competent law enforcement authorities?

Holmes was just as much of a threat after he dropped out of school. He might have been more of a threat.

We do not know whether Holmes saw Dr. Fenton after he dropped out of school, so, we will not speculate on that matter.

The larger question is: should academic institutions should take on law enforcement functions, and is it sufficient for a physician to report concerns to university authorities and not to the police.

Take another example: members of the coaching staff at Penn State were aware that Jerry Sandusky was a sexual predator. Was it sufficient for them to report to university authorities or should they have informed the police?

James Holmes Had Seen a Psychiatrist

Yesterday, we discovered that, prior to opening fire in a crowded movie theater in Aurora, Colorado James Holmes had consulted with a psychiatrist. Link here.

He had been a patient of Dr. Lynne Fenton, director of mental health services at the University of Colorado, and a specialist in schizophrenia.

Whatever the value of this information for Holmes’ defense attorneys, it tells us that Holmes was aware of what was happening to him and had sought help for his condition.

I suggested previously that his interest in cognitive neuroscience, especially his work on the biological causes of mental illness, suggested that he suspected, at the very least, that he was suffering from an organic brain disease.

Perhaps, his fellow students and teachers in the neuroscience program could not have known of his illness, but, shouldn’t we expect more from a credentialed professional?

As of now we have more questions than answers.

We assume that Holmes consulted with Dr. Fenton voluntarily, but we do not know how often. We do not know whether she had arrived at a diagnosis. We do not know whether she prescribed medication for him and whether or not he had taken it.

We are obliged to assume that if she had recognized the danger he posed she would have taken action, at least by reporting him to the proper authorities.

A specialist in schizophrenia should, in my view, easily be able to recognize someone who is undergoing a schizophrenic breakdown. If Holmes was seeking help voluntarily, he would have been less likely to be trying to hide what was happening to him. Since he had a research interest in organic brain disease he would have been likely to speak openly to someone he might have identified as a colleague.

Dr. Fenton might not have known that the breakdown would manifest itself in a massacre, but she should know that such a breakdown would very likely prove dangerous to the patient or others.

Now, we know that Holmes sent Dr. Fenton a "warning package" of materials describing what he was planning to do. He sent it a week before he opened fire.

Tragically, the package got lost in a mail room. If Holmes was trying to reach out to someone who might stop him… at a time when he knew he could not stop himself… he failed.

We do not know whether the package contained a record of what Holmes had told Dr. Fenton or what he had not told Dr. Fenton. If he had told Dr. Fenton of his plans and she had not taken them seriously, he might have wanted to send the package to convince her to do something. 

We must assume that Holmes did not consult with Fenton in the week leading up to the massacre.

Ironically, the University had in place a group of professionals whose job was to identify at risk mentally ill students.

The Washington Post reports that this group has had some success, but that it missed James Holmes.

It reports:

After the 2007 mass shooting that left 33 dead at Virginia Tech, the University of Colorado set up a special team to spot students who were suicidal or might pose a threat to others. There is no indication that the team — made up of mental-health professionals, campus police and others — had identified Holmes as a student in need of monitoring.

Dr. Charles Krauthammer on James Holmes' Psychosis

Last night on The O’Reilly Factor Dr. Charles Krauthammer addressed the question we were discussing on this blog yesterday.

Link here… Krauthammer’s remarks on James Holmes begin ataround 2:45.

Why is it so difficult to commit a psychotic individual to a mental hospital against his will?

A former head of the psychiatric emergency unit at Mass General Hospital Dr. Krauthammer points out that in the old days a psychiatrist had far more discretion when it came to committing people he thought were dangerous.

He mentions Holmes and the Tucson shooter, Jared Loughner.

The times have changed, Krauthammer continues, because lawyers have gotten involved in the process to protect the rights of psychotics to walk free. Now it is nearly impossible to do so, given the risk of lawsuits.

To which O’Reilly adds, that, for this, we can thank the ACLU.

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?

The Aurora Massacre: What Made James Holmes Do It?

Since I do not believe that life imitates art, I tend to agree with Anthony Lane’s judgment of the Aurora, Colorado massacre:

…no film makes you kill. Having a mind to kill, at least in any systematic fashion, means that your mind is ready-warped; that the warping may well have started long before, perhaps in childhood; and that you may perhaps seek out, or be drawn to, areas of sensation—notably those entailing sex or violence—which can encourage, inflame, or accelerate the warping.

As of now we do not know whether James Holmes was mentally ill or was suffering from a brain disease, like psychosis.

I assume that he was psychotic, but we await further information.

Even if he was severely disturbed, the anguish and the agony need not have expressed itself as it did.

Not all psychotics or even psychopaths become mass murderers.

Does the ambient culture have any role here? At the least, the culture tells you what you need to do to be noticed, to be taken seriously, even to get help.

If, for example, Holmes was seeking celebrity through infamy, he succeeded. Today, he and only he is monopolizing the news. His story has overtaken all other events.

If he is a psychotic with megalomaniacal tendencies he might have believed that this kind of media coverage would confirm the truth of his delusions. In the space of a few minutes Holmes has gone from anonymous to eternally infamous.

On another score, Lane was working with imperfect information.

Attempting to refute the notion that the film made Holmes do it, Lane wrote:

The film, which the killer most certainly will not have seen beforehand, presented him with an opportunity; it did not urge him on, or trigger him into homicide, but it was, nonetheless, the occasion that he sought. He would have known that people had been talking of “The Dark Knight Rises” for months; that the excitement was mounting; that they would flock, in a good communal mood, to the first available showing.

After Lane wrote these words, we learned that the trailer for The Dark Night Rises was, in many movie theaters, coupled with the trailer for a movie called: Gangster Squad.

At the end of that trailer a man opens fire in a crowded movie theater.

Even if, as I and Lane believe, life does not imitate art, some individuals will still try to imitate what they see in a work of art.