In the aftermath of mass shootings at schools, work sites, and commercial establishments, there has been a constant and understandable cry for improving mental health services so that people at risk can be identified and treated. On the face of it, who could object? It seems to be common sense to allocate more resources and move quickly in this direction.
There seems to be an underlying belief that perpetrators of these horrific crimes can be identified early, that there are tell-tale signs that can clue others in. Then there is a belief that treatment will prevent such individuals from turning violent. I have written a book about identifying forerunners of antisocial behavior (Before It’s Too Late: Why Some Kids Get Into Trouble and What Parents Can Do About It). This effort is not to tag little kids as “criminals,” but to spot troublesome, potentially dangerous, patterns of thinking and behavior that expand and intensify over time. Obviously, I favor efforts to identify at-risk children early. I also recognize and discuss in another book (The Myth of the Out of Character Crime) that some offenders do not readily provide early clues and that they elude early identification. We read about these people who seem to be model citizens, then perpetrate some horrific act. Two things are true. We need to do more to identify precursors of antisocial behavior. Secondly, even our best attempts may not be successful.
When it comes to treatment, any mental health practitioner who has dealt with youngsters diagnosed with a “conduct disorder” (e.g., oppositional defiant disorder) know that these boys and girls usually resist treatment. The same is true with adults with narcissistic, antisocial, and borderline personality disorders. They are dragged to counselors by others, sometimes ordered into counseling by courts. These individuals occupy a chair, if they show up at all, and do little more. They deploy a barrage of tactics which obstruct even the most skilled-therapist in his or her efforts to help. They conceal their thoughts and their intentions. Some seem to be very “good patients,” appearing to participate and comply. In reality, these secretive individuals case out the therapist and feed them what they think they want to know. Significant change rarely occurs. This does not mean we should abandon attempts to work therapeutically with such individuals. But it does mean that we need to be very realistic about the scope of the task and the obstacles we are likely to encounter.
The suspect in the Aurora shootings, according to the news, was under treatment by a psychiatrist. One can only imagine how that psychiatrist feels now. Isn’t it possible that no one could have successfully treated this man and thereby averted the tragedy? This well-educated individual could have appeared to be a compliant and cooperative patient but, in reality, one who, because of his personality makeup, would have eluded attempts to help him made by any highly skilled mental health professional. Some patients/clients resist anything and everything the mental health community has to offer.
We need to continue trying to identify, prevent, and treat. But the public needs to be realistic in its expectations.
