1. As of this point, we know nothing of the shooter, to my knowledge.
2. In any case, most anybody who would engage in a mass shooting, sans some other primary psychiatric diagnosis, would, by default, fit criteria for antisocial personality disorder.
3. What I'm more interested in is how we (as a society) keep blending axes I and II. In a way, we label APD as mental illness as if it lumps in with all other axis I diagnoses (again as a society and not specifically the field of mental health). A shooter who's manic or psychotic could feasibly be deemed 'mentally ill' in the public's eyes for how they understand that term. What I mean is that psychosis and mania, though can be chronic (psychosis), have acute exacerbations and the person does have an underlying problem that can be otherwise treated and/or managed to an extent. Not so for an antisocial. Do we perpetuate a very unreal expectation by focusing on mental health when we're dealing with axis II and ASPD? It's not like these guys have a different prognosis with a little treatment.
I think you make a good point in that the public isn't aware of the different types of mental illnesses and that we often think of them as being on a spectrum; although, the public does seem to have some sort of belief in an "inherent evil" when they talk about the 1000-yard stare, etc, and it seems to even have been popularized in movies lately where there are evil children in horror movies (I've only seen trailers so I"m not sure how accurate that is). I don't believe in the idea of inherent evil, but I'm saying that the public does seem to have a gut-level feeling about certain people and realize the difference between that and a mood disorder. But you're right in that you could confuse availability of treatment with the possibility of being able to treat someone. Still, I think society wants some sort of control of people even in lieu of good outpatient treatment options.
I was also under the impression that whether a disorder is mood or personality it's still considered being mentally ill.
Anyhow, even though I had been talking about personality disorders, I hadn't been thinking about ASPD until you mentioned that term, which people seem to automatically equate to psychopathy, even though ASPD is diagnosable without a person lacking the ability for empathy. So, it seems even there, there is the same divide you were mentioning in public perception: between ASPD where the diagnostician means to say psychopathy and one where that is not the intent but the criteria otherwise fit. I'm not even sure if the idea we have of a psychopath exists in reality, and if so, why isn't there a diagnosis for it? I'm not saying it doesn't exist, just that I don't know if it does.
I was curious myself what treatments are available for ASPD, and I'm not sure how relevant these are to a person who truly is psychopathic and lacks the ability for empathy (again, assuming that exists), but I found these articles, which were interesting to read:
http://en.wikipedia.org/wiki/Multisystemic_therapy
http://en.wikipedia.org/wiki/Schema_Therapy
The only thing I would challenge you on is the belief that there is no treatment available, which you seemed to imply. However true the belief is, it's a self-limiting belief. I ask this not as a challenge but with sincerity: is it known with certainty that lack of empathy is an incontrovertible state? Is it ever a defense mechanism? And if it is biological, shouldn't we assume it could be possible to treat in the future?
And is there a better present solution until then? That's why in my earlier posts I had been bringing up the idea of a residential one-on-one, intensive psychotherapy type solution; although, I had been thinking of personality disorders that are known to be treatable. I'm not as familiar with ASPD, but it seems like it's worth trying. I know right now there are currently legal and financial issues preventing such a system.
I think we need to believe there are solutions and create them, even if they don't exist with our current tools: medication, short-term hospitalization and returning the patient to the original environment, jail, family support, outpatient therapy.
Even with my anxiety disorder, it has put an enormous strain on my family, and I have no violent tendencies, etc. Families are the main support system for mentally ill people, I believe, but it really harms relationships, and as the mother in the article pointed out, it's not enough.
I'm in the system as a "consumer," and so I don't help really except as triage to friends who call me and I try to give them good advice and direct them to community resources, and so it might seem a bit unfair for me to give advice, but I really do think it's important to believe that something dramatically better, dramatically different could exist and could help. That massive amounts of research into mental illness, and not just into pharmacology but into all forms of therapies and new therapies can be done. And that if nothing else building up our ability to do palliative treatment for mental illness, to open up doors and residences where people can be helped without having to enter through the criminal justice system, would be a start.
I'm one of the people like most people in society today who talks to people after they've seen their psychiatrist on an out-patient basis for a crisis. Where they usually come away with Zyprexa. Or they've been to the ER with the same. And they're no better off except that they get some sleep.
I'm trying to write all this in a cohesive way, but I don't know the answer, and I know I probably sound offensive toward your profession, and I don't want to be. I guess I just want people to at least be able to imagine something much better.
