It happened again. A 26-year old man with an arsenal entered a community college classroom in Roseburg, Oregon killed nine people and wounded seven. According to this article http://bit.ly/1M84UQg, President Obama said, “It's impossible to identify mentally ill people likely to perpetrate mass shootings ahead of time. The only thing the U.S. can do is ensure they don't have an arsenal available "when something in them snaps."
Yesterday, Lee Jaffe the president of the American Psychoanalytic Association put out this statement to members “As psychoanalysts we know that understanding why people do what they do is essential to responding. We need to do what we can. Early detection and intervention is important so we can help educate parents and schools. We can try to get to the press so a deeper understanding goes public, given that many of these children and adolescents will never be seen in our offices.”
Gun control and understanding mental illness are the two most common suggestions for antidotes to mass shootings. Difficulty acquiring a weapon can be a deterrent, but a determined person will persist and many guns already exist in hands and homes. Understanding mental illness helps us predict and prevent but we do not have the legal right to hospitalize, treat or detain unless a person is a danger to themselves or others in the moment.
In other words, someone can be a ticking bomb and we cannot do anything. People running around with rage, righteousness, feelings of humiliation and paranoid revenge are free to roam. Copycat murders can be stimulated by media coverage and the wish to be noticed. Dis-inhibition and anonymity in social media forums allow support for violent rants with no consequence as apparently occurred in this Oregon case. It appears this shooter had other risk factors. This Harvard Health Letter http://bit.ly/1IN5mnh lists personality disorders, youth, being male, paranoid illness, stress, poverty, crisis, loss, early exposure to aggression as risk factors for violence.
In both my personal and professional life, I have been astounded by what smart people cannot or are unwilling to see as far as psychopathology is concerned. There are understandable reasons for this. If it is in your family, you want to love, protect, help, keep it within or deny a heartbreaking truth to hold on to hope. If it is a colleague, you want to give them the benefit of the doubt. So and so is a little off, but who isn’t and we all have bad moments. Besides, who can you call, if you think something is seriously wrong? What if you misread the situation? Maybe someone will lose a job and it will be your fault.
Greater awareness and knowing what not to do is a start. A magnanimous, (slightly egotistical) offer of gentle understanding can be a huge error as I learned first hand during residency. A violent guy’s restraints were taken off so he could eat. I thought he would talk to me, so I entered the room and he hurled a plate of eggs at my head and screamed, “Get the f--- out of here.” While big-hearted benevolence may be kindly impulse, understanding and managing the aggression is the best treatment. Get to the root of the problem. This is not about taking away rights but facilitating functionality. People can make many important contributions while on a medication that manages destructive thought processes. No judgment, no shame.
The afflicted person might be your sibling, parent, cousin, officemate, neighbor or spouse. It could someone you love or once loved. People change. Illness happens. Life hurts, humiliations mount, mistakes multiply, inherent biology is triggered by a stimulus. Identifying the warning signs and having the courage to step up is an empathic act. But we need to determine who we can call, where we can go to protect the afflicted and the potential victims simultaneously. There are huge issues with regard to violating confidentiality, pointing a finger, making a horrible mistake, feeling that we have betrayed someone. Still, somehow, something has to be done about that in-between place where we can see that someone may be headed for a disastrous act but it has not happened yet.