Dr. Henry Paul, MD

Psychiatrist, Author and Educator

PREDICTING THE NEXT SHOOTER

June 4th, 2014

The debate about gun control will undoubtedly be fueled by this latest shooting in California. But the dialogue that needs to happen is about recognizing the problem. The question we need to ask is “What do you do when you think someone is dangerous to others?”

For the parents of Elliott Rodger, and a psychiatrist who treated Denver shooter James Holmes, they did recognize something was wrong. In the case of Rodgers the parents tried to contact law enforcement, who, when they checked on Rodger, found him to be okay. The parents knew that not to be the case, so now we have to ask “What more could they have been done?”

The simple fact is that all of us have blind spots because some truths are too much to bear. This is especially true when we feel that a person is getting out of control. Rage, anger, violence and abuse are very frightening things to experience for all of us, and, as a result, we shy away from confrontation. We get scared and hope it passes. We try to rationalize away irrational rage. When we are frightened our judgment gets clouded and decisions we make are often made to allay our own discomfort.

Reporting about a family member or friend also brings all sorts of anxiety. First, we might fear becoming a target of the destructive rage if we confront the person or suggest intervention. Second, we don’t want to make the whole thing worse. We might picture a physical altercation where we become the victim. Thus, the whole subject evokes a good deal of anxiety.

As a psychiatrist, I have even seen this anxiety in professionals who work in the field, too. Unconsciously, professionals can also become scared dealing with a patient who talks about mass shootings and murder. In these cases, the therapist might unconsciously change the subject to suicide rather than talking about killing others. In these instances, because of the anxiety created around the discussion the therapist may give shallow advice such as suggesting increased exercise to calm someone down. Sadly, I have even seen angry patients dismissed from care because of therapist anxiety. The dismissal is usually rationalized in some way. At the very least, I have seen people with overt red flags who are not probed enough or who are sent on their way because the professional is reluctant to become more deeply involved in discussing the details of their fantasies for fear of going to an uncomfortable place. This is why continued clinical practice and training and peer support remain such necessary tools. There are also professional violence screening tools which help in the consultation room.

Professionals and lay people alike should always ask for help when confronted with such anxiety-inducing situations. We are all human and prone to anxiety. There is no shame in being anxious. Reaching out can sometimes save a life. We will never be able to predict and prevent all violence, but there is a room for improvement.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

NOT ONE MORE!

May 30th, 2014

Richard Martinez, whose son was killed in the Santa Barbara shootings last week, said, “Not one More.”

I believe that we could use better gun control laws in this country, but I don’t believe that those laws, necessarily, will prevent the gun violence that results in mass shootings like the one last week at UCSB. I do believe that more vigilance on our part, and more support for those suffering with mental illness will make a difference.

What we know about the California shooter, Elliott Rodgers, in particular, is that his family did have concerns so they did contact law enforcement. The outcome of that visit between law enforcement and Rodgers I’m sure will be debated for a long time to come, but what we can say is that the parents did try to make a difference.

It is up to us as a community — as family, friends, neighbors, teachers, doctors, clergy and others to observe changes in the people we know and love. That is the key. It has never been more important than now to start a dialogue about understanding mental illness, the signs and symptoms, and how you can help.

If you suspect mental illness in a friend or loved one you need to learn more about what is going on or what is troubling them. If you get too little cooperation you can call a mental health professional or even the legal authorities for help. I am not saying that any of this is easy. The reality is it is very difficult, and sometimes it comes at a high price – the loss of a friendship or even more. It is human nature to ignore the frightening truths that are sometimes right in front of us, but the only solution to ending the senseless violence is to reach out when you have concerns. While we cannot predict with total accuracy who will commit violence, we do have enough evidence to know when to act. If we have the courage, and trust ourselves about our observations we might make the world a bit safer and move just a bit closer to reaching Mr. Martinez goal of “not one more!”

Here is a short list of some behavioral changes that should be of concern:

  1. Increased anger, aggression, tantrums, irritability, and revenge episodes especially when you can’t make any sense of the situation and the person seems more depressed, isolated and unruly than usual.
  2. The appearance of strange ideas especially having to do with anti-government themes, conspiracy theories, and other paranoid trends especially if accompanied by hearing voices.
  3. Interest in and ownership of weapons that are a new or heightened twist for the individual.
  4. Overt or thinly veiled threats, writings, interest in and worship of lethal ideas towards self or others, including suicide.
  5. Increase in substance use by people with a history of violence and especially in those who have been treated for a severe psychiatric illness who have stopped their medication.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.