[humanser] Signs Of Violence: What To Do

[Susan Tabor]

Hi, listers:

Though the following is not exactly a scholarly article, I thought it would
be worth sharing and may be helpful for other people we know.  It was
forwarded to me from a mental health advocate whose work I respect.
Best Regards,
Susan Tabor, MSW


Warning signs of violence: What to do
By Dr. Charles Raison, Special to CNN
updated 7:30 AM EDT, Thu July 26, 2012
Accused Colorado theater shooter James Holmes makes his first court
appearance Tuesday.
Accused Colorado theater shooter James Holmes makes his first court
appearance Tuesday.
STORY HIGHLIGHTS
list of 4 items
Psychosis may play a role in mass shootings
Withdrawal, hallucinations and delusions may be warning signs
Any talk of violence or threats should be taken seriously, expert says
Hospitalizations can short-circuit the danger and get a person in treatment
list end

Editor's note: Dr. Charles Raison, CNNhealth's mental health expert, is an
associate professor of psychiatry at the University of Arizona in Tucson.

(CNN) -- Senseless mass murder is a thing unto itself, which is almost
certainly why it is so hard to identify perpetrators ahead of time and stop
the subsequent
carnage.

The vast bulk of serious crimes in the United States are committed for
reasons that we might not agree with, or might even abhor, but that we can
understand.
They are committed to get money, or to consolidate power.

Or they occur in the heat of an understandable passion such as anger in
response to situations like infidelity that might not lead the majority of
us to
violence, but that are at least understandable.

Because all these factors are understandable, they make the crimes somewhat
predictable. Often crimes occur in high-crime areas and are committed by
people
with a history of breaking the law. And many -- perhaps most -- murders
occur between people who know each other, and frequently know each other
well.

But how would you predict that a 
quiet young man with no past legal history 
would allegedly dress up as the Joker and go on one of the largest shooting
sprees in American history in Aurora, Colorado? Or that a young man with no
past history of violence would 
shoot a congresswoman and innocent bystanders in Tucson, Arizona?
How can we better guard ourselves against crimes that make no sense and come
with no warning?

Court appearance fuels theories about Colorado shooting suspect

I don't have an answer to this hugely important question, but one doesn't
have to share my experience as an emergency psychiatrist to recognize at
least
two factors that most of the recent mass murders share in common. First,
they have been conducted by young men. And second, they were conducted by
men
who may have become psychotic, although few details are currently known
regarding accused Colorado shooter James Holmes' mental condition.

Because we use the word "psychotic" loosely in common parlance it is worth
defining it more carefully here. To be psychotic is to have lost touch with
common
shared human reality. While this can and does occur in a variety of ways,
most people with psychosis struggle with two primary types of symptoms:
delusions
and hallucinations.

Crime scene tape surrounds the Century 16 movie theater where 12 people were
killed in Aurora, Colorado.
Crime scene tape surrounds the Century 16 movie theater where 12 people were
killed in Aurora, Colorado.

Delusions are fixed false beliefs. Sometimes delusions are wrong, but make
sense. But just as often, they are so bizarre that the people afflicted with
them cannot explain their ideas in a way that is comprehensible to anyone
else.

Hallucinations occur when someone experiences something that is not present,
or more technically, that is not experienced by others in the same
environment.
All the senses are vulnerable to hallucinations, but most hallucinations
involve either sight or sound. People see or hear things that aren't there.
Interestingly,
visual hallucinations are more common in older people with brain diseases
such as dementia, and auditory hallucinations are more common in younger
people
suffering from psychiatric illnesses such as schizophrenia or bipolar
disorder (manic depression).

We know from many studies that the vast majority of individuals afflicted
with a psychotic disorder do not commit violence. And I know from much
professional
experience that people with schizophrenia are, as a group, among the
sweetest and most dignified people on the planet. But it is also very clear
from studies
that people with psychotic disorders are far more likely than others to
commit violent acts.

And the great tragedy behind these acts is that they are typically committed
by people who may believe they are doing the right thing. Some of the most
harrowing experiences of my professional life have involved watching people
who had done something terrible when psychotic come to realize the horror of
their deeds as they regained their sense of reality through treatment.

Opinion: Looking into the minds of killers

So if we want to reduce the risk of mass murder, a good way to start would
be to pay more attention to people who show evidence that they are
developing
a psychotic disorder and intervene before delusions turn to destruction.

A memorial rests on a highway for six people who lost their lives in a
shooting last year in Tucson, Arizona.
A memorial rests on a highway for six people who lost their lives in a
shooting last year in Tucson, Arizona.

This is no easy task, or we'd be doing it already. But I do believe that
even a little public education about what to look for might have measurable
effects.

Sometimes it is obvious that someone has become psychotic because he or she
says and does things that are indisputably bizarre, such as talking to
themselves,
espousing clearly strange and untrue beliefs, or not making any sense at all
when talking.

But just as often the onset of psychosis is slower and more insidious. In
these cases what strikes one is that the person has changed in some
fundamental
way. This seems to have been the case with most of the recent psychotic mass
murderers in the United States.

Dispatch: We need rescue in theater 9
Meet the man behind the Aurora crosses 

A person perhaps became more isolated and withdrawn. They began to fall away
from their previous level of functioning, as evidenced by things such as
dropping
out of school. And as is very apparent from photographs, their appearances
may change, becoming stranger and more disturbing.

Warning signs from a troubled mind: what parents should do

Again, it is important to emphasize that most people who demonstrate these
types of changes will not go on to commit violent acts, but it is still true
that these changes are a fingerprint of risk for mass murder. Given this,
we'd do well to take them more seriously, as individuals, families and as a
society.

Because these people do not engage in behavior that results in psychiatric
hospitalization or arrest, they are currently ignored by the system. And
because
of basic American liberties, they are protected from detainment or
incarceration based on suspicion alone.

So if we are to become better at stopping tragedies such as the recent
shooting in Aurora, it falls to us as individuals to be more aware of
acquaintances,
friends and loved ones who begin showing signs of psychosis.

Spoken threats of violence, or indications that a person is preparing for
violence, should always be taken with utmost seriousness. But this is even
more
true for people who are showing signs of psychosis, because -- sadly --
their delusions may give them a sense of urgency and depth of commitment
that make
violence much more likely.

Police: Evidence of 'calculation,' 'deliberation' in Colorado shooting

Sometimes people who are planning violence for psychotic reasons are
secretive. But just as often, they will tell you what they are planning to
do if you
ask them. For this reason, it is well worth checking in with psychotic
individuals on a regular basis to ensure that their disease is not driving
them
into danger in this regard.

If we have a friend, loved one or family member who has become psychotic, it
is also well worth taking a quick peek into their current living
environments,
mostly to make sure they are adequately caring for themselves, but also
because very occasionally such an inspection will turn up signs of danger. A
quick
look through the belongings of any of recent psychotic shooters a day or two
before their killing sprees may have found ample evidence of impending
mayhem.

If we hear or see signs of danger, it is of utmost importance that we act.
Although the mental health system in the United States often fails both
patients
and society, it is still the case that in most states people can be
hospitalized against their will when there is clear evidence either from
their words
or deeds that they intend to commit violence.

In my experience, such hospitalizations can often short-circuit the danger
and get people into much-needed treatment. Of course, this is not always the
case. But it is the best we can do, and it is a lot better than nothing.

Hi, listers:

Though the following is not exactly a scholarly article, I thought it would
be worth sharing and may be helpful for other people we know.  It was
forwarded to me from a mental health advocate whose work I respect.
Best Regards,
Susan Tabor


Warning signs of violence: What to do
By Dr. Charles Raison, Special to CNN
updated 7:30 AM EDT, Thu July 26, 2012
Accused Colorado theater shooter James Holmes makes his first court
appearance Tuesday.
Accused Colorado theater shooter James Holmes makes his first court
appearance Tuesday.
STORY HIGHLIGHTS
list of 4 items
Psychosis may play a role in mass shootings
Withdrawal, hallucinations and delusions may be warning signs
Any talk of violence or threats should be taken seriously, expert says
Hospitalizations can short-circuit the danger and get a person in treatment
list end

Editor's note: Dr. Charles Raison, CNNhealth's mental health expert, is an
associate professor of psychiatry at the University of Arizona in Tucson.

(CNN) -- Senseless mass murder is a thing unto itself, which is almost
certainly why it is so hard to identify perpetrators ahead of time and stop
the subsequent
carnage.

The vast bulk of serious crimes in the United States are committed for
reasons that we might not agree with, or might even abhor, but that we can
understand.
They are committed to get money, or to consolidate power.

Or they occur in the heat of an understandable passion such as anger in
response to situations like infidelity that might not lead the majority of
us to
violence, but that are at least understandable.

Because all these factors are understandable, they make the crimes somewhat
predictable. Often crimes occur in high-crime areas and are committed by
people
with a history of breaking the law. And many -- perhaps most -- murders
occur between people who know each other, and frequently know each other
well.

But how would you predict that a 
quiet young man with no past legal history 
would allegedly dress up as the Joker and go on one of the largest shooting
sprees in American history in Aurora, Colorado? Or that a young man with no
past history of violence would 
shoot a congresswoman and innocent bystanders in Tucson, Arizona?
How can we better guard ourselves against crimes that make no sense and come
with no warning?

Court appearance fuels theories about Colorado shooting suspect

I don't have an answer to this hugely important question, but one doesn't
have to share my experience as an emergency psychiatrist to recognize at
least
two factors that most of the recent mass murders share in common. First,
they have been conducted by young men. And second, they were conducted by
men
who may have become psychotic, although few details are currently known
regarding accused Colorado shooter James Holmes' mental condition.

Because we use the word "psychotic" loosely in common parlance it is worth
defining it more carefully here. To be psychotic is to have lost touch with
common
shared human reality. While this can and does occur in a variety of ways,
most people with psychosis struggle with two primary types of symptoms:
delusions
and hallucinations.

Crime scene tape surrounds the Century 16 movie theater where 12 people were
killed in Aurora, Colorado.
Crime scene tape surrounds the Century 16 movie theater where 12 people were
killed in Aurora, Colorado.

Delusions are fixed false beliefs. Sometimes delusions are wrong, but make
sense. But just as often, they are so bizarre that the people afflicted with
them cannot explain their ideas in a way that is comprehensible to anyone
else.

Hallucinations occur when someone experiences something that is not present,
or more technically, that is not experienced by others in the same
environment.
All the senses are vulnerable to hallucinations, but most hallucinations
involve either sight or sound. People see or hear things that aren't there.
Interestingly,
visual hallucinations are more common in older people with brain diseases
such as dementia, and auditory hallucinations are more common in younger
people
suffering from psychiatric illnesses such as schizophrenia or bipolar
disorder (manic depression).

We know from many studies that the vast majority of individuals afflicted
with a psychotic disorder do not commit violence. And I know from much
professional
experience that people with schizophrenia are, as a group, among the
sweetest and most dignified people on the planet. But it is also very clear
from studies
that people with psychotic disorders are far more likely than others to
commit violent acts.

And the great tragedy behind these acts is that they are typically committed
by people who may believe they are doing the right thing. Some of the most
harrowing experiences of my professional life have involved watching people
who had done something terrible when psychotic come to realize the horror of
their deeds as they regained their sense of reality through treatment.

Opinion: Looking into the minds of killers

So if we want to reduce the risk of mass murder, a good way to start would
be to pay more attention to people who show evidence that they are
developing
a psychotic disorder and intervene before delusions turn to destruction.

A memorial rests on a highway for six people who lost their lives in a
shooting last year in Tucson, Arizona.
A memorial rests on a highway for six people who lost their lives in a
shooting last year in Tucson, Arizona.

This is no easy task, or we'd be doing it already. But I do believe that
even a little public education about what to look for might have measurable
effects.

Sometimes it is obvious that someone has become psychotic because he or she
says and does things that are indisputably bizarre, such as talking to
themselves,
espousing clearly strange and untrue beliefs, or not making any sense at all
when talking.

But just as often the onset of psychosis is slower and more insidious. In
these cases what strikes one is that the person has changed in some
fundamental
way. This seems to have been the case with most of the recent psychotic mass
murderers in the United States.

Dispatch: We need rescue in theater 9
Meet the man behind the Aurora crosses 

A person perhaps became more isolated and withdrawn. They began to fall away
from their previous level of functioning, as evidenced by things such as
dropping
out of school. And as is very apparent from photographs, their appearances
may change, becoming stranger and more disturbing.

Warning signs from a troubled mind: what parents should do

Again, it is important to emphasize that most people who demonstrate these
types of changes will not go on to commit violent acts, but it is still true
that these changes are a fingerprint of risk for mass murder. Given this,
we'd do well to take them more seriously, as individuals, families and as a
society.

Because these people do not engage in behavior that results in psychiatric
hospitalization or arrest, they are currently ignored by the system. And
because
of basic American liberties, they are protected from detainment or
incarceration based on suspicion alone.

So if we are to become better at stopping tragedies such as the recent
shooting in Aurora, it falls to us as individuals to be more aware of
acquaintances,
friends and loved ones who begin showing signs of psychosis.

Spoken threats of violence, or indications that a person is preparing for
violence, should always be taken with utmost seriousness. But this is even
more
true for people who are showing signs of psychosis, because -- sadly --
their delusions may give them a sense of urgency and depth of commitment
that make
violence much more likely.

Police: Evidence of 'calculation,' 'deliberation' in Colorado shooting

Sometimes people who are planning violence for psychotic reasons are
secretive. But just as often, they will tell you what they are planning to
do if you
ask them. For this reason, it is well worth checking in with psychotic
individuals on a regular basis to ensure that their disease is not driving
them
into danger in this regard.

If we have a friend, loved one or family member who has become psychotic, it
is also well worth taking a quick peek into their current living
environments,
mostly to make sure they are adequately caring for themselves, but also
because very occasionally such an inspection will turn up signs of danger. A
quick
look through the belongings of any of recent psychotic shooters a day or two
before their killing sprees may have found ample evidence of impending
mayhem.

If we hear or see signs of danger, it is of utmost importance that we act.
Although the mental health system in the United States often fails both
patients
and society, it is still the case that in most states people can be
hospitalized against their will when there is clear evidence either from
their words
or deeds that they intend to commit violence.