CPRC in the New York Post: Why psychiatrists fail in stopping mass killers

Jun 2, 2014 | op-ed

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CPRC board academic board member Arthur Berg and CPRC president John Lott had a new piece in the New York Post on the limits of psychiatrists in stopping mass killers. Their new piece starts this way:

More money for mental health won’t stop these mass murderers.

With the Santa Barbara killings, mental health is again the central focus. Sen. Richard Blumenthal (D-Conn.) is pushing for more resources on mental health “to make sure that these kinds of horrific, insane, mad occurrences are stopped and the Congress will be complicit if we fail to act.”

But the killer, Elliot Rodger, had already been receiving top-quality mental-health counseling for years. One of his psychiatrists, Dr. Charles Sophy, is nationally known and medical director for the LA County Department of Children and Family Services.

Rodger had, in fact, been seeing multiple psychiatrists. Some blame the sheriff’s deputies for not doing more to investigate an initial complaint, but Rodger’s psychiatrists ultimately had the responsibility to ensure he had the proper treatment. It’s not obvious how more money would have helped.

It’s very common for mass killers to be seeing psychiatrists before their attacks, including Ivan Lopez (the recent Fort Hood shooter), Adam Lanza (Sandy Hook elementary), James Holmes (“Batman” movie theater) and Seung-Hui Cho (Virginia Tech).

For Lopez, the Army psychiatrist who last saw him found no “sign of likely violence, either to himself or to others.” In Holmes’ case, while his psychiatrist warned University of Colorado officials about his violent fantasies, she “rejected the idea” that the threat was sufficiently serious for him to be taken into custody.

Seung-Hui Cho was deemed “an imminent danger to himself as a result of mental illness.”

Yet he was determined not to be “an imminent danger to others as a result of mental illness.” The judge stated it was not necessary to have him involuntarily committed.

Again, these prominent mass killers certainly didn’t lack mental health care. The problem was that even top psychiatrists failed to identify real threats.

Yet psychiatrists have strong incentives to get the diagnosis right. Besides their own professional pride and desire to help, they have legal obligations to inform authorities of a threat. Families of those killed by Holmes sued his psychiatrist for not recommending that Holmes be confined. Similar legal action may face Rodger’s psychiatrists.

The psychiatric profession is aware that it is very difficult for mental-health professionals to accept that a patient could pose a serious violent threat. They tend to deny it to themselves. In other words, psychiatrists frequently underestimate threats to safety.

The problem is severe enough that a whole academic literature is devoted to it. Explanations include psychiatrists trying to prove their fearlessness and becoming desensitized to the dangers. It’s possible that added training to understand these unusual cases may help improve their diagnoses.

Yet it’s also simply hard to predict these extremely rare outcomes.

Monday morning quarterbacking is always easy. What seem like obvious telltale signs in retrospect are not so obvious before the attack, even to the experts.

Nor is there much benefit to overly stigmatizing mental illness generally. Extremely few of those with mental illness go on to become killers. Even among schizophrenics, we’re talking about a rate that is much less than one person out of every 100,000.

Renée Binder, the president-elect of the American Psychiatric Association, advocates “a Gun Violence Restraining Order, a mechanism that would allow those closest to a troubled individual to act when there are warning signs or indications that person is at risk for violence.”

Sorry, that won’t really help. Set aside the fact that half of Rodger’s killings were stabbings; it’s just not hard to get guns illegally in this country — especially if you’re willing to spend months or years planning your attack, as virtually all of these killers do.

There are no cheap or easy answers. If someone poses a true danger to others, why not lock them up? Or provide outpatient care-givers to monitor them?

The rest of the piece is available here.

UPDATE: Elliot Rodger was apparently taking Xanax for six months before his attack, something that had been presumably prescribed by his psychiatrists, but it should be noted that he was planning this attack in detail over a year-and-a-half before it occurred.

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johnrlott

2 Comments

  1. James R Berger

    The mentally ill are more likely to be the victims or crime than the cause, because MOST MENTALLY ILL ARE NOT VIOLENT! How will just spreading more of the stigma of mental illness help society, or even prevent these tragedies? And, yes, we need to invest more money into mental illness, not to prevent violence, but because it is the decent, humane thing to do. Here, if you don’t believe me: http://depts.washington.edu/mhreport/facts_violence.php

    • johnrlott

      Virtually all the mentally ill are not violent.

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