F0nzie

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I am seeing a lot if these headlines on the news. Why does it have to be just about homicide as a result of a mental illness? Yea there must be something wrong with someone who pulls out a gun and shoots a bunch of people but what the hell happened to bad guys?
 

Doctor Bagel

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Well, if you include narcissistic personality disorder, antisocial personality disorder and addictions, that might capture a good deal of the "bad guys." I agree, though, these media reports are tiresome, and it makes me feel a bit defensive of the people I treat because I don't want them lumped in with people who go on shooting sprees. We've used these mass shootings to try to increase funding for mental illness while also probably increasing the stigma of mental illness.
 

birchswing

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I would guess that people have always had some level of empathy for sickness or whatever you want to call it. Mental illness is culturally a huge thing now, so it makes sense to ascribe feelings of empathy into that box. I'm not a great student of history but maybe other times people would have empathetically said a mass murderer was taken by evil spirits--I'm sure people still say that actually. It's probably part of how we understand the world and how we deal with our own nature of being both human but also being animals that have instincts we are afraid of and that we would rather chose to believe are apart from us somehow.
 

birchswing

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Well, if you include narcissistic personality disorder, antisocial personality disorder and addictions, that might capture a good deal of the "bad guys." I agree, though, these media reports are tiresome, and it makes me feel a bit defensive of the people I treat because I don't want them lumped in with people who go on shooting sprees. We've used these mass shootings to try to increase funding for mental illness while also probably increasing the stigma of mental illness.
This was actually very similar to my original response, which I deleted. I have my own theory that personality disorders are not often diagnosed due to the rejection of psychoanalysis. Out of all mental disorders, personality disorders are the ones most explained by developmental issues, which has traditionally been the domain of psychoanalysis. I was going to write that psychiatry might in the past have been interested more in the human condition more generally, and that whether a murderer has a diagnosable mental illness or not, it seems like the question of why is not productive and happy would be of interest to a psychiatrist. I know that it's often said that people with personality disorders don't seek help or are untreatable, but in my experience, I've noticed a reluctance to diagnose or treat on the part of psychiatrists. I would guess that this has to do with the move to the biological model, which cannot account for personality disorders--which can't be treated with medicine.
 
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We have always had the criminal element and we tend to deal with that in various ways in our society through the legal system. The mass murderer is a different phenomenon altogether. Do we have more of these occurring than we have historically or is it an effect of media coverage? If more are occurring, then why is that? I see some pretty angry individuals everyday and I think the mental health and educational system can actually make it worse. Kindergartners are supposedly mentally ill and dangerous and treated as such. I'm not making that up, they are actual referrals. Makes me wonder what the heck is going on and how did they deal with these kids when I was a kid?
 
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Doctor Bagel

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This was actually very similar to my original response, which I deleted. I have my own theory that personality disorders are not often diagnosed due to the rejection of psychoanalysis. Out of all mental disorders, personality disorders are the ones most explained by developmental issues, which has traditionally been the domain of psychoanalysis. I was going to write that psychiatry might in the past have been interested more in the human condition more generally, and that whether a murderer has a diagnosable mental illness or not, it seems like the question of why is not productive and happy would be of interest to a psychiatrist. I know that it's often said that people with personality disorders don't seek help or are untreatable, but in my experience, I've noticed a reluctance to diagnose or treat on the part of psychiatrists. I would guess that this has to do with the move to the biological model, which cannot account for personality disorders--which can't be treated with medicine.
I think we (including me) are also worried that if we diagnose someone with a personality disorder that they'll be angry with us and that it will ruin therapeutic rapport. That's why don't tell patients with borderline personality disorder that that bipolar disorder that they received a few years ago might not be right. And yeah, if you're doing a pure medication management practice, we've got no meds for NPD and ASPD.
 

birchswing

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I think we (including me) are also worried that if we diagnose someone with a personality disorder that they'll be angry with us and that it will ruin therapeutic rapport. That's why don't tell patients with borderline personality disorder that that bipolar disorder that they received a few years ago might not be right. And yeah, if you're doing a pure medication management practice, we've got no meds for NPD and ASPD.
I suppose it depends on each individual and the severity. The two people I know who have a diagnosis of BPD were both frustrated that they didn't get a diagnosis for many years (in one case, the psychiatrist had diagnosed it but not told the patient and the patient found out through requesting records). One I'm very close to, my aunt, has been very mindful after getting the diagnosis. Maybe the diagnosis isn't accurate and she isn't what you typically see with BPD, but for her, she appreciates being able to see the patterns. I personally think that I have a personality disorder that hasn't been diagnosed (in my case I would guess it's NPD--although again maybe not as you expect it stereotypically), and I can't say with certainty that it would hurt my rapport with my therapist but I would like to think it wouldn't. He's not big into diagnoses with anything, though (his usual question is: What would it change if you had X diagnosis?). As far as my psychiatrist, I don't think she deal with personality disorders. I can't see how she would be able to given the way she has her work set up. From an outside point of view, I think that if you could see these ingrained patterns and realize what they were, it would be very helpful especially if you could find and resolve the root cause. Or at least make some internal progress.

As far as the person misdiagnosed with bipolar who actually has BPD, I think again that's a function of our system being set up for med-checks and assuming that everybody who walks in the door has a biological issue. Around where I live, it would not surprise me for someone with a personality disorder to see a psychiatrist and leave with a prescription for Xanax.

The interesting thing is that it's not just psychiatrists who seem reluctant to diagnose personality disorders, though. It seems that psychologists don't delve into that too much either, especially with the focus on CBT. I feel as if the people who were the most oriented to treat or at least recognize personality disorders don't exist much anymore (psychoanalytic psychiatrists). I don't know if they would be the best at treating it, but given the etiology of personality disorders, it seems that they would be the most receptive to the idea of personality disorders. The diagnoses are in the DSM which is always being tweaked, so somebody must be doing some research into these conditions. But who is treating them? That I don't know.
 

Doctor Bagel

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I suppose it depends on each individual and the severity. The two people I know who have a diagnosis of BPD were both frustrated that they didn't get a diagnosis for many years (in one case, the psychiatrist had diagnosed it but not told the patient and the patient found out through requesting records). One I'm very close to, my aunt, has been very mindful after getting the diagnosis. Maybe the diagnosis isn't accurate and she isn't what you typically see with BPD, but for her, she appreciates being able to see the patterns. I personally think that I have a personality disorder that hasn't been diagnosed (in my case I would guess it's NPD--although again maybe not as you expect it stereotypically), and I can't say with certainty that it would hurt my rapport with my therapist but I would like to think it wouldn't. He's not big into diagnoses with anything, though (his usual question is: What would it change if you had X diagnosis?). As far as my psychiatrist, I don't think she deal with personality disorders. I can't see how she would be able to given the way she has her work set up. From an outside point of view, I think that if you could see these ingrained patterns and realize what they were, it would be very helpful especially if you could find and resolve the root cause. Or at least make some internal progress.

As far as the person misdiagnosed with bipolar who actually has BPD, I think again that's a function of our system being set up for med-checks and assuming that everybody who walks in the door has a biological issue. Around where I live, it would not surprise me for someone with a personality disorder to see a psychiatrist and leave with a prescription for Xanax.

The interesting thing is that it's not just psychiatrists who seem reluctant to diagnose personality disorders, though. It seems that psychologists don't delve into that too much either, especially with the focus on CBT. I feel as if the people who were the most oriented to treat or at least recognize personality disorders don't exist much anymore (psychoanalytic psychiatrists). I don't know if they would be the best at treating it, but given the etiology of personality disorders, it seems that they would be the most receptive to the idea of personality disorders. The diagnoses are in the DSM which is always being tweaked, so somebody must be doing some research into these conditions. But who is treating them? That I don't know.
Yeah, I think to some extent our fears might be unfounded, and they might be based on our own negative perceptions of personality disorders. Hmm, not that we do treatment or diagnoses here, but I wonder if your anxiety might lead to worries that you have NPD. Not to say you do or don't have anything because I have no clue.
 

birchswing

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Yeah, I think to some extent our fears might be unfounded, and they might be based on our own negative perceptions of personality disorders. Hmm, not that we do treatment or diagnoses here, but I wonder if your anxiety might lead to worries that you have NPD. Not to say you do or don't have anything because I have no clue.
Not to worry—I don't take that as advice. NPD is actually something I had already been planning on asking my therapist about tomorrow. I actually came upon it after Googling "can't handle being criticized" and it was one of the first results. I have a really hard time with needing to be perfect, always have felt I have to beyond reproach, which is difficult in that obviously no one is.
Edit: I realize the connection between not being able to handle being criticized and NPD sounds naive, but there's more to it than that. I've had episodes where I can't back down when being accused of being wrong. I don't talk about everything on here obviously and probably should not discuss this further. I'm not even sure why I mentioned my own suspicions of NPD here except that it was very much on my mind.
 

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The link is the lack of morals and values which encourages people to behave like asshats.
 

birchswing

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The link is the lack of morals and values which encourages people to behave like asshats.
I don't think the study of ethics or embrace of virtue, no matter how steadfast, can curb human emotion entirely. It very likely affects it, though. Humans are a contradiction. We can be intentional in our efforts to deny our nature and purposeful in our actions toward destruction of construction, yet we are animals with drives we cannot entirely control. At any time in one place in the world that a musical performance is taking place, an act of violence is occurring somewhere else. If we observed humans the way we do other animals, we would say that this is simply how things are rather than saying the humans committing violence aren't trying hard enough not to be violent. Even if every human on earth strived as hard as they could toward non-violence, you can't change entirely that human behavior will occur. I do agree that it could change the trajectory. But I think violence is part of what makes humans humans, at least right now. Humans are interesting in how much they seem capable of massive changes over relatively short periods of times, though.
Edit: I have heard that to my last point, humans have become less and less violent over time.
 

hamstergang

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The mass murderer is a different phenomenon altogether. Do we have more of these occurring than we have historically or is it an effect of media coverage?
I've looked this up a few times, but not since some months ago, so I'm going off of memory here. We mostly had no increase in mass murder rate until several years ago. It seemed to go up sooner mostly due to media coverage, but recently it actually went up. However, does this make a meaningful trend? Too early to tell. If it keeps going up or holds steady in this elevated rate, that would be meaningful. But it might drop back down, which would suggest this is just some random variation.

If it's really going up, we certainly don't know why. You're free to make up reasons, but of course there are many possible made up reasons and none are supported by evidence as far as I know.
 

Ceke2002

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We have always had the criminal element and we tend to deal with that in various ways in our society through the legal system. The mass murderer is a different phenomenon altogether. Do we have more of these occurring than we have historically or is it an effect of media coverage? If more are occurring, then why is that? I see some pretty angry individuals everyday and I think the mental health and educational system can actually make it worse. Kindergartners are supposedly mentally ill and dangerous and treated as such. I'm not making that up, they are actual referrals. Makes me wonder what the heck is going on and how did they deal with these kids when I was a kid?
When I was growing up as a child in the 70s behavioural or emotional disturbances in children seemed to be largely ignored unless the behaviours or disturbed emotional states became disruptive enough to the home or class room environment, and even then treatment didn't really seem to be much more than instructing parents or teachers on how to correctly praise or discipline the child in a type of behaviour modification approach to the problem (which of course invariably failed because both parents and teachers, for the most part, aren't mental health professionals with training on when and how to implement such psychological measures - not to mention I'm fairly sure behaviour modification approaches eventually fell out of a favour when it was found they weren't that effective to begin with).

(edited for length and conciseness of detail)

More on point, I've already indicated a number of times on here that I grew up in an abusive situation - both at home, and at school. Whether I was eventually labelled as a so called 'gifted' child or not, it was pretty clear I had some emotional and development issues (trauma based or otherwise), that probably should have been addressed, but weren't (or at least not in an adequate enough manner). And yet I didn't grow up to become a mass murderer. Yes I fantasised about getting hold of a machine gun and jumping up on stage in the middle of assembly and opening fire on all of my bullies and tormentors, but that's all it ever was, a fantasy. And yes I chased one of my bullies around several classrooms with a pair of scissors trying to stab him when I was 7 years old, but that wasn't really done with any forethought of malice or murderous intent. So other kids who grow up with similar, or worse backgrounds, with similar, or worse, emotional/developmental issues, who do go from fantasy, to planning, to taking action and actually killing a bunch of people, what's different about them - is it something biological, or is it societal, or just something in there own personal psychological make up (all of the above, none of the above?). Plenty of people grow up in bad situations, and plenty of people struggle with a variety of emotional issues, but that doesn't mean they go and pick up a gun and start massacring people, so what's really going on with those who do? Has anyone done any actual longitudinal type studies of this? I mean where is the mental health system at right now in terms of understanding why these things happen?
 
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MacDonaldTriad

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On one end of the spectrum we have Amoc…

Here is a headline you will never see:
Perfectly sane man guns down entire family, film at 11:00.
 
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whopper

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Several problems
1-Many of these cases we do not get detailed information on the shooter.
2-There are severe mental illnesses where the person may not be at fault for shooting such as schizophrenia, but there's other psychiatric disorders where we are to hold the person responsible such as a cluster B PD.
3-Our ability to get the guns out of the hands of those that are mentally ill are extremely limited.

Some are trying to focus the shift on more treatment. I agree with this but again-if I got a mentally ill guy and I have a big suspicion he might do something bad and has a gun but I do not have more than that I can do very little.
 
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erg923

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This is only tangentially related, but I have often felt that, in attempts to auto correct prior misdeeds, in recent years psychiatry has inordinately minimized how violent and dangerous those with untreated/unaddressed mental illness can be- Schizophrenia in particular.

I believe Adrian Rain (USC) and his group have done alot of work in this area.
 

vistaril

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I think it's important to keep in mind that the right to bear arms is not just 'in the constitution'......its in the bill of rights. Which is a special place in the constitution many believe holds it to an even higher value.

In many ways I think we as gun proponents can become satisfied and content with what the status quo is, and what the status quo will be for our lives. But just because we will have the same freedoms we do now when we are in our 60s and 70s doesn't mean the work is over. What about when we are long dead and our great great grandchildren our in their 60s and 70s?
 

digitlnoize

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I think we (including me) are also worried that if we diagnose someone with a personality disorder that they'll be angry with us and that it will ruin therapeutic rapport. That's why don't tell patients with borderline personality disorder that that bipolar disorder that they received a few years ago might not be right. And yeah, if you're doing a pure medication management practice, we've got no meds for NPD and ASPD.
I've been saying for a while now that psychiatry has a PR problem with how we name things. We should just drop the word "personality". I can't think of many other diseases in which we include the supposed etiology in the name. How about "Schizophrenic Hyper-Dopamine Disorder". It's just stupid. We know (or think we know...modern research is pointing to more genetic and epigenetic BPD etiologies) the cause, do we really have to put it in the name?

I have zero qualms about telling my patients they have BPD, if they have it. But I have a whole speech prepared that includes, showing them the diagnostic criteria, pointing out that this fits you to a tee, a disclaimer that I think the name is stupid and not to get offended by it. I've never had someone get mad about it and most are happy to know it's very treatable, and wonder why no one ever told them about DBT before.

On topic: I think anyone who guns down fellow humans is, by definition, mentally ill in some way. It may be intermittent explosive disorder, or NPD, or Antisocial, Adjustment D/O, or something we don't have a clear box for, but mentally healthy people don't shoot each other. SOMETHING's off.
 

birchswing

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On topic: I think anyone who guns down fellow humans is, by definition, mentally ill in some way. It may be intermittent explosive disorder, or NPD, or Antisocial, Adjustment D/O, or something we don't have a clear box for, but mentally healthy people don't shoot each other. SOMETHING's off.
I've always had the exact same sentiment until I started considering that it is our human nature to believe there are legitimate and illegitimate forms of violence. Generally we think of governments as the only legitimate implementers of violence, and within that value system, a mass murderer is illegitimate in his use of violence. And I agree that something is off with that person--it is by definition off given a certain value framework. There's an inability to cope with the structure of society and what is acceptable. But when you consider that it is psychiatrists and psychologists who clear men and women to be healthy enough to participate in legitimate forms of violence, I think we have to consider that violence is part of our nature. It is more an issue of social rules and conditioning that dictates who has the authority to use violence, and ultimately the illegitimate use of violence is kept in check with the that of violence from a legitimate source. To some extent you could say we are violent and make many attempts to control our violence, including using violence.

This may only be true for humans right now. Humans change very quickly and have moved away from violence more and more; although, you could argue that this is because the sources of legitimate violence have become more centralized and more powerful, which means the threat of great violence may be greater while the reality of it lesser.
 

Shikima

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Whether or not it's human nature isn't the question, rather the impulsive behaviors which govern severe actions. Case in point, it's human nature to pick your nose but you're not doing it in public and can control yourself - same goes for self-pleasure. Certainly there are those on the fringes of the bell curve who'll always do things inappropriately and we can debate if they'd be SMI or not.

Point is, we have the capability to make choices, rationalize decisions and change behaviors. We also may lack the insight and knowledge to make those changes too.
 

whopper

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The overwhelming majority of gun owners and the mentally ill are not violent.

Anything done to "control" these people through restriction of access to guns will serve to take away access and the freedom to choose from a large amount of people before it leads to any real decrease in use of guns for illegitimate purposes.

Anything done to hold the mentally ill in a facility through involuntary means in response to mass shootings will only lead to many being held extra days with little effect on reducing this phenomenon.

Several responsible gun-owners during their late teens to late 20s could develop a mental illness that could make them too dangerous to responsibly use a gun. Again the odds are very rare to the point where if actions were taken to restrict gun use in people of that age demographic you'd be restricting 98 people before you saw 1 person fit into the real category of having a severe mental illness with a gun, and even those few people in that category are likely to not be violent.

So what to do?

IMHO a nation-wide adoption of Kendra's Law may help. This is a law only in NY where a person with severe mental illness such as schizophrenia that repeatedly comes back to an inpatient unit due to non-compliance and has been found to be dangerous (unable to care for self or violent) is forced treatment even in the community.

IMHO a legal resolution needs to be cemented by the APA and/or AAPL suggesting that those people who are severely mentally ill and show a pattern of danger related to it should either have their guns taken away or meet a criterion of needing to be in the hospital even if psychaitrically stable by usual standards until they either voluntarily get rid of their guns or agree to a safety plan in the community with those guns (e.g. the guns will be locked and someone else in the family outside the patient will have the key).

I had a patient that had a long history of noncompliance with meds literally brought to the hospital every 4-8 weeks that owned guns and was found 3x to have the gun in his mouth. The 4th time he was hospitalized and I had him at this time (other doctors had him on previous admissions) I told him I was not going to discharge him even if he was stable unless he gave me some type of plan he'd be safe with his guns caused he's already screwed up 3x in less than 6 months (gun involved each time). The pt got angry and told me I was violating his 2nd Amendment rights.

I told him that we'll let a judge see about that.

In doing so if the pt was to be discharged by the court then if he shoots himself or someone else it's the court's fault. They discharged him not me. I have enacted a legal bullet-proof vest for myself no pun intended.

What ended up happening was his court date was literally several weeks later and after being in the hospital for 5 days and not wanting to wait any longer he finally agreed to have a relative hold his guns and I discharged him.
 

whopper

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Also wanted to add that I was really following the law. In Ohio even if a person is mentally stable you still must hold them against their will if you believe there will be an "immediate danger" due to mental illness.

This patient had a repeat history of stopping his meds, then putting a gun in his mouth. Ohio law never specified what the time duration of "immediate danger" means (1 day after discharge, 1 week, 1 month?)
 
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F0nzie

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The overmedicalization of antisocial behaviors in this country is ridiculous. I see tons of antisocial patients on mood stabilizers and antipsychotics-- individual is agitated...must be mentally ill. It's a dangerous move because everyone is free of liability except the doctor and the patient. I can't do anything about someone with pure hatred who wants to hijack the clinic and gun everyone down. I recently received a threat from a patient who stated that she is planning on killing her case manager and murdering everyone on the clinical team. IMO bad guys are real, call them what you want but they don't belong in our clinics. Btw I'm really REALLY tired of feeling threatened at work.
 

birchswing

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The overmedicalization of antisocial behaviors in this country is ridiculous. I see tons of antisocial patients on mood stabilizers and antipsychotics-- individual is agitated...must be mentally ill. It's a dangerous move because everyone is free of liability except the doctor and the patient. I can't do anything about someone with pure hatred who wants to hijack the clinic and gun everyone down. I recently received a threat from a patient who stated that she is planning on killing her case manager and murdering everyone on the clinical team. IMO bad guys are real, call them what you want but they don't belong in our clinics. Btw I'm really REALLY tired of feeling threatened at work.
If psychiatry isn't the authority on these afflictions, who is?
 

whopper

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I see tons of antisocial patients on mood stabilizers and antipsychotics-- individual is agitated...must be mentally ill.
Completely agree. There's an unwritten rule to medicate everyone when there's something going on with the patient that the doctor doesn't understand. I don't think a lot of psychiatrists, coming from entitled backgrounds, truly understand antisocial PD. I remember first year residents seeing a person being in jail only once diagnosing the person with it based only on that bit of data alone.

That and medicating Conduct Disorder-a disorder where meds are not found to help. I wish I could get these psychiatrists that medicate that disorder into some type of Bill O'Rielly no-spin zone and scream at them while they were on TV (of course that gives Bill O'Rielly too much credit cause most of what he does is BS).

The problem with antisocial PD is that there is data recently published in the AJP that interventions after the age of 25 pretty much do nothing. Many antisocials become less violent with age but this is not because they actually really develop a sense of ethics and empathy, but because they are older and can no longer beat people up as well, or jump over a fence after they've robbed a store.
 
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If psychiatry isn't the authority on these afflictions, who is?
Somebody being violent and aggressive is not a mental illness. Calling it an affliction sounds like a complete abdication of personal responsibility. I work with the victims of violent people every day and I have also met the perpetrators both when I worked in a jail and a few times when I was a resident of these institutions. The violent offenders are very clear and calculating in their appraisals of what they at doing. In fact, to survive in that world, you damn well better be able to regulate your emotions, deal with high amounts of stress, and have effective problem solving strategies. All things which my patients struggle wih doing on a day to day basis.
 

birchswing

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We need a super hero...
I feel like there must be a path forward for the villain in any story. I believe every person should have a place in society.
Somebody being violent and aggressive is not a mental illness. Calling it an affliction sounds like a complete abdication of personal responsibility. I work with the victims of violent people every day and I have also met the perpetrators both when I worked in a jail and a few times when I was a resident of these institutions. The violent offenders are very clear and calculating in their appraisals of what they at doing. In fact, to survive in that world, you damn well better be able to regulate your emotions, deal with high amounts of stress, and have effective problem solving strategies. All things which my patients struggle wih doing on a day to day basis.
So those examples go back to legitimate vs illegitimate uses of violence. If we're talking about a mafia-like organization that has clear, rational goals and uses violence to further their interests, it's not terribly different than a state that invades another state for its resources. In that sense, the people are bad in that their interests don't align with the majority's, and possibly their values of attaining their interests don't either. The people committing violence may not even be able to see themselves as committing violence. They may even see themselves as heroes as colonists have throughout history. Or they may be conflicted, just as people have been who have served in state militaries.

I thought when Fonzie mentioned that there are simply "bad guys" he was saying that there are people who are simply violent, not for any particular purpose that furthers their interests, and who aren't mentally ill. Probably because it is closer to me, I've been thinking throughout this thread about the double-murder and suicide that happened in Roanoke. I was thinking that Fonzie was making the case that there are just "bad apples," and that possibly someone like that is. Within that set of people, it raises the question of whether people are bad because they choose to be so or are they just so by nature and nurture (either born that way or had such a horrific upbringing that they were made that way) in a way that is not classifiable as a mental illness? It was those afflictions I was speaking to. I thought he was saying there are just "bad' people who are wired wrong for lack of a better term and as such are simply disposable to society, perhaps in the same way that people believe there are good and evil forces in the world, such as angels and demons.

I'm not sure what to make of this. It's hard to think about it all and there are so many angles. I would say that all human actions are explainable, which isn't to make a huge assertion. Being able to explain them all is impossible, though. There are a lot of factors that influence violence and our perceptions of it. As a very basic example, think about the animals that we kill and eat. I think the fact that we do that and wouldn't even consider it violent makes a strong case that violence is largely about perception.
 
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I feel like there must be a path forward for the villain in any story. I believe every person should have a place in society.

So those examples go back to legitimate vs illegitimate uses of violence. If we're talking about a mafia-like organization that has clear, rational goals and uses violence to further their interests, it's not terribly different than a state that invades another state for its resources. In that sense, the people are bad in that their interests don't align with the majority's, and possibly their values of attaining their interests don't either. The people committing violence may not even be able to see themselves as committing violence. They may even see themselves as heroes as colonists have throughout history. Or they may be conflicted, just as people have been who have served in state militaries.

I thought when Fonzie mentioned that there are simply "bad guys" he was saying that there are people who are simply violent, not for any particular purpose that furthers their interests, and who aren't mentally ill. Probably because it is closer to me, I've been thinking throughout this thread about the double-murder and suicide that happened in Roanoke. I was thinking that Fonzie was making the case that there are just "bad apples," and that possibly someone like that is. Within that set of people, it raises the question of whether people are bad because they choose to be so or are they just so by nature and nurture (either born that way or had such a horrific upbringing that they were made that way) in a way that is not classifiable as a mental illness? It was those afflictions I was speaking to. I thought he was saying there are just "bad' people who are wired wrong for lack of a better term and as such are simply disposable to society, perhaps in the same way that people believe there are good and evil forces in the world, such as angels and demons.

I'm not sure what to make of this. It's hard to think about it all and there are so many angles. I would say that all human actions are explainable, which isn't to make a huge assertion. Being able to explain them all is impossible, though. There are a lot of factors that influence violence and our perceptions of it. As a very basic example, think about the animals that we kill and eat. I think the fact that we do that and wouldn't even consider it violent makes a strong case that violence is largely about perception.
I thought he was saying that some people are bad and I tend to agree. They aren't usually the ones that are making the news recently, but most violence is not carried out by people with disorganized thought processes. There will probably always be this based on my own observations of how cruel we can be even at a very young age. Just step onto any middle school playground and you will see it every day.

Why is there evil in the world? That is beyond the scope of science. The cultural context does influence the manifestation and expression of violence and we live in a fairly violent society. Not quite as warlike as many in past history though so we are making progress. I think that looking at the mental health system to "fix this" which is the way many think is completely wrong. Mental health focuses on the indivdual, but the individuals are reflections of the greater society. Much of what we are dealing with are legacies of the evil we as a culture have perpetrated in the past. Slavery and the genocide of native populations are the two big ones. Changing culture is a lot like turning a cargo ship except a ship can turn in minutes and culture takes many generations. Also the focus on mental health for many is a desire to control of others and that in itself is what leads to evil being perpetrated.
 

Ceke2002

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The overmedicalization of antisocial behaviors in this country is ridiculous. I see tons of antisocial patients on mood stabilizers and antipsychotics-- individual is agitated...must be mentally ill. It's a dangerous move because everyone is free of liability except the doctor and the patient. I can't do anything about someone with pure hatred who wants to hijack the clinic and gun everyone down. I recently received a threat from a patient who stated that she is planning on killing her case manager and murdering everyone on the clinical team. IMO bad guys are real, call them what you want but they don't belong in our clinics. Btw I'm really REALLY tired of feeling threatened at work.
Somebody being violent and aggressive is not a mental illness. Calling it an affliction sounds like a complete abdication of personal responsibility. I work with the victims of violent people every day and I have also met the perpetrators both when I worked in a jail and a few times when I was a resident of these institutions. The violent offenders are very clear and calculating in their appraisals of what they at doing. In fact, to survive in that world, you damn well better be able to regulate your emotions, deal with high amounts of stress, and have effective problem solving strategies. All things which my patients struggle wih doing on a day to day basis.
I feel like there must be a path forward for the villain in any story. I believe every person should have a place in society.

So those examples go back to legitimate vs illegitimate uses of violence. If we're talking about a mafia-like organization that has clear, rational goals and uses violence to further their interests, it's not terribly different than a state that invades another state for its resources. In that sense, the people are bad in that their interests don't align with the majority's, and possibly their values of attaining their interests don't either. The people committing violence may not even be able to see themselves as committing violence. They may even see themselves as heroes as colonists have throughout history. Or they may be conflicted, just as people have been who have served in state militaries.

I thought when Fonzie mentioned that there are simply "bad guys" he was saying that there are people who are simply violent, not for any particular purpose that furthers their interests, and who aren't mentally ill. Probably because it is closer to me, I've been thinking throughout this thread about the double-murder and suicide that happened in Roanoke. I was thinking that Fonzie was making the case that there are just "bad apples," and that possibly someone like that is. Within that set of people, it raises the question of whether people are bad because they choose to be so or are they just so by nature and nurture (either born that way or had such a horrific upbringing that they were made that way) in a way that is not classifiable as a mental illness? It was those afflictions I was speaking to. I thought he was saying there are just "bad' people who are wired wrong for lack of a better term and as such are simply disposable to society, perhaps in the same way that people believe there are good and evil forces in the world, such as angels and demons.

I'm not sure what to make of this. It's hard to think about it all and there are so many angles. I would say that all human actions are explainable, which isn't to make a huge assertion. Being able to explain them all is impossible, though. There are a lot of factors that influence violence and our perceptions of it. As a very basic example, think about the animals that we kill and eat. I think the fact that we do that and wouldn't even consider it violent makes a strong case that violence is largely about perception.
I thought he was saying that some people are bad and I tend to agree. They aren't usually the ones that are making the news recently, but most violence is not carried out by people with disorganized thought processes. There will probably always be this based on my own observations of how cruel we can be even at a very young age. Just step onto any middle school playground and you will see it every day.

Why is there evil in the world? That is beyond the scope of science. The cultural context does influence the manifestation and expression of violence and we live in a fairly violent society. Not quite as warlike as many in past history though so we are making progress. I think that looking at the mental health system to "fix this" which is the way many think is completely wrong. Mental health focuses on the indivdual, but the individuals are reflections of the greater society. Much of what we are dealing with are legacies of the evil we as a culture have perpetrated in the past. Slavery and the genocide of native populations are the two big ones. Changing culture is a lot like turning a cargo ship except a ship can turn in minutes and culture takes many generations. Also the focus on mental health for many is a desire to control of others and that in itself is what leads to evil being perpetrated.
Agree with all this. And @birchswing what you said about the nurture vs nature debate regarding violence, or violent tendencies, was kind of the point I was trying to make before in that rambling essay I wrote above (I am going to edit that to be more concise)...anyway the fact is there are plenty of people who grow up in bad situations, there are plenty of people who struggle with mental illness, and there are plenty of people who struggle with mental illness and who have managed to hit the double whammy of growing up in an abusive situation (and don't forget there are also plenty of people who receive little to no understanding or treatment for their mental health issues and/or past or present issues of trauma they might have experienced) - and yet how many of those people actually go ahead and pick up a gun and start killing people? The answer would be, not that many.

I do think some people are just bad, and we may never fully understand why that is. It's not always as easy as saying 'well X person just had a bad start in life', or 'Well of course X person was like that considering the societal environment they were raised in'. If you read that bunch of tl;dr I wrote above, before I edited it, that was just one small aspect of how I grew up. I've always refrained from detailing too much of my experiences of abuse on here, but suffice to say my childhood wasn't exactly a bed of roses. And yet, like I also said before, I've never picked up a gun and gone out and shot a bunch of people, and I know plenty of others who have grown up in far worse situations than I did and they've never gone on a shooting rampage either.
 

whopper

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Somebody being violent and aggressive is not a mental illness.
A problem with our language is that even though I agree with you the language even among the mental health professionals is not compatible. Anyone with a real legal and mental health understanding when it comes to antisocial PD and excusing someone for a criminal act knows that antisocial PD isn't something that offers the person in question an excuse or entitle them to treatment due to their criminal or otherwise unethical and damaging act. I only add that because in some cases what the antisocial PD person does is not illegal such as a soldier that's part of a dictator's regime brutally raping a woman where it's legal in the dictator's nation.

And despite this several professionals would call the antisocial PD'd person mentally ill because we haven't created a canon as to how to talk and write about this phenomenon.

Some psychiatrists and psychologists do not have a legal understanding and some even may think such callous antisocial PD could be treated medically by giving an SSRI despite that study after study after study shows nothing to support this notion. This is the type of idiot psychiatrist that sees psychiatry as an art and thinks that "oh I'm having a blue feeling with this patient so I'll give him Seroquel because it's a warm medication and I know because I'm an artist" bull****. I really have seen a psychiatrist that actually told me this and on a serious forensic patient no less that was found NGRI on Arson.

And let's not kid ourselves. There are psychiatrists like this.

But those aren't the people I'm referring to regarding my original assertion. I assert that the term mental illness has been made so broad that when we talk about the psychiatric/psychological disorders that clearly do not excuse a criminal act such as antisocial PD, some still call it mental illness, or a "sickness" or what have you that confuses people thinking that it's something to treat.

Here's another example. Several forensic psychiatrists have unofficially dubbed "severe mental illness" as the types of mental illnesses that can get you an NGRI such as schizophrenia, bipolar disorder, schizoaffective disorder. Yet no one has officially defined what "severe mental illness" is.

I've seen or heard from colleagues a few PTSD cases that IMHO deserved an NGRI defense (or perhaps irresistible impulse defense). E.g. a veteran of the Gulf War that was raped by fellow soldiers while handcuffed. She comes back to the states, has very bad PTSD, and during a flashback episode, a police officer, not knowing what was going on with her handcuffs her and she bites him because she's reliving the rape.

But since PTSD isn't a "severe mental illness" by this unofficial list of disorders that count for NGRI, the court pretty much tossed it out for consideration for a mental health defense.
 
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sunlioness

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Yeah. I agree that this is some sort of cultural phenomenon. Blaming this type of violence on either lack of gun control or mental illness is missing the mark. But those seem to be the only two explanations in the dialog.

However I think gun control is the issue with police being killed in the line of duty. An officer answering a domestic in rural Montana is far more likely to be killed than an officer patrolling a high crime inner city neighborhood in Jersey.


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Messerschmitts

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However I think gun control is the issue with police being killed in the line of duty. An officer answering a domestic in rural Montana is far more likely to be killed than an officer patrolling a high crime inner city neighborhood in Jersey.
What do you base that on? You have statistics to back that up? It seems to me rural Montana has a lot less crime than inner city in New Jersey. If I were a police, I'd much rather stop a driver in rural Montana than in urban New Jersey. People who legally own firearms are much less likely to commit a crime than a gangbanger who owns one illegally in the inner city.
 

thoffen

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We are falling prey to political & media interests on guns and mental illness here. These attitudes are not about recognition of a public mental health problem and wanting to address it.

After all, if that were the case, we'd be talking about suicide, which makes up > 2/3 of gun deaths.

Instead, this is about the public splitting off a societal problem into a stigmatized group with some magical thinking of how to solve it in order to feel safer without doing anything at all to address the actual problem, which, as above, is very hard to understand or at least generalize.

As psychiatrists, though, we'll probably get some extra resources to put toward the patients we actually treat as a result of this.
 
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sunlioness

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What do you base that on? You have statistics to back that up? It seems to me rural Montana has a lot less crime than inner city in New Jersey. If I were a police, I'd much rather stop a driver in rural Montana than in urban New Jersey. People who legally own firearms are much less likely to commit a crime than a gangbanger who owns one illegally in the inner city.
I did in September, but I don't remember where I saw it.

Not gonna look now. Apologies.
 

Shikima

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Until we address immaturity and entitlement coupled with addictions, broken homes, physical and sexual trauma, and peer influences there will be no headway gained in any kind of violence. Social media has made it more glamorized and is spreading the behavior characteristics like a communicable disease throughout the world.