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Can a detailed psychiatric examination predict, and prevent, the sort of massacre that took place in Connecticut?
For a while, I worked in the forensic unit of a psychiatric hospital. I was required, among my other duties, to make a determination of how dangerous someone charged with a crime might be in the future. Here are some of the things I discovered:
1. The people who engaged in violent behavior sometimes, but not always, had a history of violent behavior. The same could be said of suicidal patients. People who kill themselves often have a history of prior suicide attempts. Of course, most people who make suicide attempts do not go on to make a successful attempt.
I saw a man in the army because he had physically attacked one of his comrades in a bathroom. He had a history of torturing small animals when he was a small boy, and torturing larger animals when he got bigger. He got into a physical altercation as an adult and was given the choice of jail or joining the army. Despite this history, the army, in its wisdom, wanted to retain him. “He’s a good rifleman,” his commander told me. I thought he was a good candidate to commit a violent act, but I could do nothing other than see to it he was discharged from the service.
2. Some of the people who attempted murder were psychotic, but the greater number were not. It is always possible to make a psychiatric diagnosis on everyone. An angry person might be said to suffer from a personality disorder. A diagnosis of a personality disorder might be made also on someone who procrastinates, or is clinging, or is withdrawn, or is devious, or is any of the myriad ways that people are, if we sketch their personalities out in broad strokes. These are descriptive terms only and do not reflect a mental disease.
3. Of course, most psychotic patients, even those who are paranoid, do not commit violent crimes — or, for that matter, any crimes.
4. Those who committed murder, or almost committed murder, were acting under a confluence of events that might not have happened under ordinary circumstances — and could not have been anticipated. These included: first of all, the availability of a weapon, usually a gun; an argument with a family member; participation in a lecture group of disenchanted and angry political partisans; the use of alcohol; and so on. Knowledge of this fact invites thoughts like, “If only somebody had been there for him to talk to…” or “If only school had not been cancelled that day…” or, certainly, “if only there was not a weapon close at hand…” It is being said on the airwaves today, “If only he had been in psychiatric treatment… (On drugs, in a hospital, or something similar.) Some of these people had, in fact, passed through the hands of a psychiatrist or therapist recently. Most of the time, there was no pronouncement made that that patient was dangerous, because the patient did not seem different in any way from many other such patients.
At different times, I saw two women who were in their 60s and who had become delusional. One woman thought someone was shooting rays of some sort at her from another building to get her sexually excited. I told her not to tell anyone else about the rays, and I was able to manage her as an outpatient. The second woman decided that a neighbor was having an affair with her husband, who was 70 years old and in a wheelchair. So she shot her neighbor, not quite killing her. Had I known this woman prior to this murderous attempt, I would not have been able to predict it. I would have thought the woman mentioned above was just as likely, or unlikely, to commit a violent act.
On the other hand, in some cases, such individuals were, indeed, seen to be dangerous, but there was no way of helping them against their wishes or preventing future violent acts. Even when such a patient is so flagrantly dangerous that they can be admitted involuntarily to a hospital, that hospital stay will inevitably be limited in time and leave the individual just as vulnerable in the future to committing murder, or some other awful act. There are no measures that can be taken to prevent future violent behavior.
(Illustrating the chancy quality of these crimes, see my blogs, “Heading off a Murder,” November 14, 2012 and “You Are Supposed to be Afraid of Certain Things,” June 10, 2012)
5. Some people who have committed murder never do so again, even though they have the opportunity. That suggests that there are very few people who can be said to be “murderous” by inclination. A number of people sent to psychiatric hospitals for lacking criminal responsibility for a murder that they committed have subsequently wandered away from the hospital and were found years later living peaceably in the community.
I testified once in a murder trial that was widely reported internationally. The murderer, “The Beast of Bayreuth,” was judged insane and spent years in a mental hospital. As far as I can discover, when he returned to the community, he never committed another such crime, even though it is now about forty years later.
Of course, there are individuals who commit violent acts over and over again and can readily be seen to be a continuing risk. That is the bottom line: Studies have shown that psychiatrists testifying to the possibility of a criminal committing further acts of violence are no better at predicting those acts than anyone else. Someone with a history, particularly a continuing history of violence, can be presumed to be dangerous. Would I prevent, if I could, the “Beast of Bayreuth” from possessing a gun? Sure, although the murder weapon he used was his own bare hands. For other people, if I tried to determine who is potentially violent, I would be guessing.
It is understandable that when confronting the horror of the mass murder reported a few days ago, we look to some kind of hope for preventing such attacks in the future. But the fact is, we do not know how to predict them, and I do not think we will ever know. We have to turn our attention to the availability of guns.
(c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog
