Mental illness and massacres

Is the day coming when a psychologist or psychiatrist will have a button under his desk to call the SWAT team if a patient appears homicidal?

After the Sandy Hook shootings, mental health got more attention than gun control.

The London Daily Telegraph provides a list of 30 mass shootings in the US since Columbine, April 20, 1999. In virtually every case the shooter had serious mental problems and in many cases had been previously reported to authorities.

James Holmes, the University of Colorado student accused of killing 12 in an Aurora theater and wounding 58 others, was reported to campus police by his psychiatrist.

Cuts in federal mental care under President Ronald Reagan, who believed families were responsible for taking care of their members, is getting much attention. Hundreds of thousands of institutionalized people were put out on the street. Insurance companies have rigidly enforced the number of times patients visit psychologists.

Reagan was only reflecting the attitude of the nation and companies trying to complete with overseas manufacturers. In most cases those competitors didn’t have to provide health care; their governments did it.

Before exploring the role of mental health care, or lack of it, in these shootings, one thing must be made clear.

Dr. Richard A. Friedman, in an op-ed piece in the New York Times, wrote: “…there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness. … Only certain serious psychiatric illnesses are linked to an increased risk of violence.”

A national study of nearly 18,000 people found records of violence in 16 percent of those diagnosed with schizophrenia and bipolar disorder, compared with 7 percent of those without any known mental illness. Friedman said alcohol and drug use “are far more likely to result in violent behavior than mental illness by itself.”

The doctor acknowledges treatment could reduce the number of mass killings, but would have no major impact on the 30,000-plus firearms deaths annually. In 2009, the last year figures for which figures are available, indicated nearly 32,000 died, roughly the number killed in Syria’s civil war. About 17,000 were suicides.

Can the potential for mass murder be reliably detected?

The general opinion is no. Even the Army has found it difficult to stop deadly rages by returning soldiers.

Edward P. Mulvey, professor of psychiatry and director of the law and psychiatry program at the University of Pittsburgh School of Medicine, says it is nearly impossible to detect likely homicidal behavior in most cases.

“Hindsight is not foresight. The picture is much more complex than simply developing ‘profiles.’ Knowing this young man's profile wouldn't have told us how likely he was going to walk into a classroom and open fire,” said Mulvey. He compared it to looking for a needle in a haystack.

Once discovered, what to do? The issue of patient-physician confidentiality arises. Different states treat the issue differently. Many allow a patient to be put on a 72-hour hold, but barring any signs of violence, potential violence, or hints of a plan to do a self-harm, the patient must be released.

In Carl Jung’s “"The Undiscovered Self" he wrote: “For every manifest case of insanity there are, in my estimation, at least 10 latent cases who seldom get to the point of breaking out openly…”

RESOURCES:

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/9414540/A-history-of-mass-shootings-in-the-US-since-Columbine.html

http://www.sociology.org/content/vol003.004/thomas.html

http://www.jsonline.com/news/opinion/a-misguided-focus-on-mental-illness-0n82n86-183966741.html

http://www.cnn.com/2012/12/18/opinion/mulvey-mental-disorder/index.html