The Shooting and its Effects on Mental Health Treatment

[myPsychAlt]

Someone I went to medical school with now practices as a pediatrician in Florida. She told me recently that they're trying to pass a law there that would prohibit physicians from asking patients about their access to firearms. My mind boggled.

http://www.orlandosentinel.com/news...n-docs-011611-20110115,0,56050.column?Florida

"we do stupid like Nebraska does corn"

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[Sneezing]

Many of the posts in this thread are arguing in the wrong direction.

There should be more lenient gun ownership laws. Concealed carry permits should be abolished. There should be less restrictions in the process to abtain them. We should have a society where it is just assumed that everyone is carrying a gun. Think of it like a vaccination. If everyone were vaccinated (carrying a gun) then there would be less disease (shootings).

Laws and restrictions only make it burdensome for those who follow them. The shear number of guns in this world are uncontrollable. I consider this to be a good thing. More laws and regulations only shifts the possession differential in favor of degenerates.

The greatest murderers in the world are committed by politicians and religions. Why not license and ban them if using some of the logic on this board?

Had there been more guns... this guy probably would have only been able to get off a few shots before a law abiding citizen stepped in...

 

[digitlnoize]

If everyone were vaccinated (carrying a gun) then there would be less disease (shootings).

Because that works so well in Compton...

 

[myPsychAlt]

Had there been more guns... this guy probably would have only been able to get off a few shots before a law abiding citizen stepped in...

or bullets would start to fly in multiple directions... another fun possibility.

 

[whopper]

If everyone were vaccinated (carrying a gun) then there would be less disease (shootings).

Just like South Central L.A. where all the gangbangers have guns. They don't shoot the other gangmembers, oh no.

The dynamics of how guns operate will also depend on the environment. If 99% of the gunowners are law-abiding citizens that actually want to own a gun, train themselves in how to use it, you got a situation where your statement makes sense. You arm a bunch of antisocial people and/or these people have no sense of responsibility you got the road warrior minus the Australian accents.

But maybe I'm wrong. If "everyone" should have a gun to stop violence, let's arm everyone in a prison with guns, after all these are the most violent people. The violence would then stop.

 

[Sneezing]

Am I the only one who doesn't see it as much of a problem when gang members kill other gang members? That's one less criminal for society to worry about capital punishment for. You mention also that many people are irresponsible. This is true and the learning curve will be steep. Doing something irresponsible will get you killed in this hypothetical guns every where society or will educate one very quickly how to be responsible.

Gun basics are still gun basics. Don't draw your gun unless you are prepared to fire it. Don't point it at anything unless you are willing to shot it. You are responsible for the bullets you discharge.

The problem that I, and you and everyone else fear are innocent people getting shot. We want the same thing which is safety. That is why I advocate ubiquitous gun ownership and carrying to defend oneself. The police are seldom there at an acute incident. As you pointed out criminals are already antisocial and you can't reason with that - but a colt can. Initially there will be a spike in violence, but the dividends will come later with a decrease in shootings.

If you are being shot at you pretty much have one choice and that is to hide. As we recently saw in AZ, you don't always have some where or the time to hide. Therefore, level the power differential, be armed, and shoot.

The people in prison, once out, already have guns. That's part of the problem. Yes, they are felons and our laws state it is another felony to be a felon with a gun, but guess what? What's a felony to a felon? We have made them second class citizens. I, too, would carry a gun as a felon if relegated as a second class citizen, unable to find a job, and forced to live in slums.

Guns for everyone.

 

[whopper]

who doesn't see it as much of a problem when gang members kill other gang members?

Well let's leave the gang members killing gang members out of this. We could debate the ethics of allowing people to kill each other.

The problem is the gangbangers will shoot a lot of innocents. Remember, guns have ranges that could hit lots of innocent bystanders, whether or not they are armed. Shoot a gun, it could hit someone several hundred feet away just minding their own business.

Doing something irresponsible will get you killed in this hypothetical guns every where society or will educate one very quickly how to be responsible.

I double dog dare you to tell that to the developmentally disabled. People we are supposed to treat if need be. In fact why not publicly argue that they too should be armed?

 

[Sneezing]

There are vast differences in the spectrum of DD which makes this a loaded topic I'll only briefly touch. Many are quite responsible and I would be comfortable with their gun ownership. Others would be questionable, to debate that would be its own lengthy topic.

This will be my last post for this thread as I'm starting to just repeat things. I felt the need to speak up as it was very one sided towards slandering guns on this thread. In summary, these are hypothetical broad sweeping generalizations and like most things in life not perfect. On one extreme is my argument of more guns. On the other extreme which some have advocated here, all law abiding citizens would be disarmed and there wouldn't be a 2nd amendment (but criminals would still be armed). Both will have innocent deaths. The question is which would have less deaths and be safer?

Simply put I believe my model is safer. As we've discussed so far, it is debateable.

 

[235750]

physicians should promote safe usage and storage, as even the CDC doesn't buy the argument that gun control decreases crimes.*

You're not listening. I'll repeat it once again: I am not calling for increased gun control laws. I am saying that physicians (namely psychiatrists as this is the psychiatry forum) should discourage their ownership as having them increases negative outcomes. It is simple evidence based practice. Period.

You want to talk about political confounders: the NRA put pressure on congress to withdraw money from the CDC after its grants showed proof that guns are a danger. To this day, every CDC grant must meet this requirement: "None of the funds made available...may be used to advocate or promote gun control." So, if through proper scientific investigation you conclude that gun control is a good thing, you will get your funding revoked.

Apart from stem cell research, I have never heard of funding so tightly regulated. Considering the religious fevour surrounding both issues, it is not a surprise then that the CDC takes a neutral view, neither claiming nor denying that gun control works.

these studies have nothing to do with kellerman, nor do they in any way duplicate or even cover the same materials. for the sake of debate, we'll forego discussion of suicide as that is a rather complicated topic

At least in this forum on which you are posting, we cannot choose to simply ignore suicide. It's kind of a big deal in mental health.

Here's another JAMA article that found that guns are a risk factor for suicide.

"Based on criteria for judging whether an association is causal, the evidence from comparative observational studies appears consistent with the inference that owning a gun increases the risk of suicide. Most studies show a moderately strong association, the biological mechanism is plausible, the exposure precedes the outcome, the association has been replicated in several populations, and there is evidence of a dose response (greater risk with more or more available guns). "

I have posted...7 articles now from JAMA, NEJM, and APHA. Although I agree with you that prospective randomized studies would be best, none exist for either side of the debate. Instead, there are about a dozen case control or retrospective cohorts which all show guns to be a bad thing.

So while you are right that we can't ban guns just yet, we have at least met the requirement of seeing gun ownership as a risk factor. That is all I am claiming. Considering there is no peer reviewed evidence of the positive effects of owning a gun, it seems then that physicians should practice evidence based medicine and warn their patients of said risk factor.

what would you say of i said firearms have just as much data on their prevenitive or stopping of crime?Firearms are used many times to protect and save lives & property

As scientist, I am absolutely open to new data. If you show me proof that gun ownership is a good thing, ie increases positive outcomes, then I would absolutely change my view. And judging from your critiques on Kellermann et all, I would hope that you have a number of excellent randomized, prospective, high-quality journal articles to back up your views.

In all seriousness, if you have ANY peer reviewed articles that not just argue against other articles, but actually present novel findings, I would love to see it.

As Whopper said, it is poor taste to involve politics into a medical discussion, and for that I apologize for mentioning the constitution as that should have no bearing here.

 

[whopper]

Many are quite responsible and I would be comfortable with their gun ownership. Others would be questionable, to debate that would be its own lengthy topic.

I don't think the question is loaded because you mentioned in a prior quote "everyone." That includes well, ahem, "everyone." It seems from your statement above there is a line where some people should not have them. Now where you believe the line may be will differ from mine (but maybe actually not...) but if you dont mean "everyone" don't use that word. I've noticed that debate over the internet can become tedious and much more flaming than need be due to the frustrations with having to wait for a response and being able to read a statement several ways without seeing the behavioral context.

I mention "maybe actually not" because if we got together and discussed this over a better forum, in person, not over the internet, you and I may actually find more common ground than not. I don't own a gun, but I have looked into buying one several times and several good friends own guns.

This will be my last post for this thread as I'm starting to just repeat things. I felt the need to speak up as it was very one sided towards slandering guns on this thread.

I respect your courage to bring up something that you felt the majority was against. I actually think I am more to the "right" when it comes to gun issues than most people here (hey, an issue you and I are on common ground). I think I should follow your lead. Why? The issue of owning guns and the medical practice behind it are two different things. Yes, there's overlap, but we doctors in my opinion should not be inserting political beliefs into practice, especially given that owning guns is the cultural norm in several parts of the country.

If we are going to discuss politics, we need to draw a line that we're dicussing politics. I do believe that some of the arguments above were sound and based on medical evidence, but some were purely political.

 

[digitlnoize]

I didn't intend this thread to be a political argument anyways. My original post was meant to be more of a "call to arms" for the profession (haha) than a "call to endlessly debate gun ownership." I raised the question simply because it has been discussed in the mass media and it seems to me, despite the legal issues, that arming the mentally ill is not a good idea.

I simply intended to point out that this event has generated something of a public outcry for improvement of the services we provide (and by "we," I mean YOU and someday, hopefully, me). And, that we should use that outcry to improve funding of both treatment and research, which will help prevent this type of disaster in the future.

 

[Hernandez]

You're not listening. I'll repeat it once again: I am not calling for increased gun control laws. I am saying that physicians (namely psychiatrists as this is the psychiatry forum) should discourage their ownership as having them increases negative outcomes. It is simple evidence based practice. Period.

if thats all you meant, then you'll have to excuse my confusion as when you linked studies that had nothing to do with suicides and stated "None of it is positive. If these studies were about any other unsafe practice, you would conclude it should be discouraged. As physicians, you should advocate gun-free households to increase positive outcomes in your patients", you can see my confusion as to why i did not get that impression.*

NRA put pressure on congress[/URL] to withdraw money from the CDC after its grants showed proof that guns are a danger. To this day, every CDC grant must meet this requirement: "None of the funds made *available...may be used to advocate or promote gun control." So, if through proper scientific investigation you conclude that gun control is a good thing, you will get your funding revoked.

and there is reason for this, despite the fact your article offers no citatin that the NRA had anything to do with that regulation, and the fact that requirement has been done away with, but clearly you didn't finish reading your own article, or know who the author Don Kates is and what his political ideology is as the remained of the article does much to discredit the bias that is gun research in the medical literature.*

you didn't even bother to read your own article did you? *

"serious scholars have been criticizing the CDC's "public health" approach to gun research for years. In a presentation at the*American Society of Criminology's 1994 meeting, for example, University of Illinois sociologist David Bordua and epidemiologist David Cowan called the public health literature on guns "advocacy based on political beliefs rather than scientific fact." Bordua and Cowan noted that*The New England Journal of Medicine*and the*Journal of the American Medical Association, the main outlets for CDC-funded studies of firearms, are consistent supporters of strict gun control. They found that "reports with findings not supporting the position of the journal are rarely cited," "little is cited from the criminological or sociological field," and the articles that are cited "are almost always by medical or public health researchers.""

and on the CDC's ignoral or misuse of other scholarly articles.*

"As Bordua and Cowan noted, one hallmark of the public health literature on guns is a tendency to ignore contrary scholarship. Among criminologists, Gary Kleck's encyclopedic*Point Blank: Guns and Violence in America*(1991) is universally recognized as the starting point for further research. Kleck, a professor of criminology at*Florida State University, was initially a strong believer that gun ownership increased the incidence of homicide, but his research made him a skeptic. His book assembles strong evidence against the notion that reducing gun ownership is a good way to reduce violence. That may be why*Point Blank*is never cited in the CDC's own firearm publications or in articles reporting the results of CDC-funded gun studies.
Three Kleck studies, the first published in 1987, have found that guns are used in self- defense up to three times as often as they are used to commit crimes. These studies are so convincing that the doyen of American criminologists, Marvin Wolfgang, conceded in the Fall 1995 issue of*The Journal of Criminal Law and Criminology*that they pose a serious challenge to his own anti-gun views. "I am as strong a gun-control advocate as can be found among the criminologists in this country. What troubles me is the article by Gary Kleck and Mark Gertz. The reason I am troubled is that they have provided an almost clear- cut case of methodologically sound research in support of something I have theoretically opposed for years, namely, the use of a gun against a criminal perpetrator."

Yet Rosenberg and his CDC colleague James Mercy, writing in*Health Affairs*in 1993, present the question "How frequently are guns used to successfully ward off potentially violent attacks?" as not just open but completely unresearched. They cite neither Kleck nor the various works on which he drew.

When CDC sources do cite adverse studies, they often get them wrong. In 1987 the*National Institute of Justice*hired two sociologists, James D. Wright and Peter H. Rossi, to assess the scholarly literature and produce an agenda for gun control. Wright and Rossi found the literature so biased and shoddy that it provided no basis for concluding anything positive about gun laws. Like Kleck, they were forced to give up their own prior faith in gun control as they researched the issue."

At least in this forum on which you are posting, we cannot choose to simply ignore suicide. It's kind of a big deal in mental health.

Here's another JAMA article that found that guns are a risk factor for suicide.

i intentionally separate suicide from criminal firearm violence as they are different topics, iin the habit of doing this as those like the brady campaign and the VPC leave the suicide data intertwined to support their data. we can talk that topic, but i wont argue much on that data other than the correlation/causation points, but undoubtedly firearms make suicides easier to successfully complete.*

I have posted...7 articles now from JAMA, NEJM, and APHA. Although I agree with you that prospective randomized studies would be best, none exist for either side of the debate. Instead, there are about a dozen case control or retrospective cohorts which all show guns to be a bad thing.

So while you are right that we can't ban guns just yet, we have at least met the requirement of seeing gun ownership as a risk factor. That is all I am claiming. Considering there is no peer reviewed evidence of the positive effects of owning a gun, it seems then that physicians should practice evidence based medicine and warn their patients of said risk factor.

as your own article points out, there is plenty of contrariety data to the medical science data, such as a litnany of criminology data. *I've read many of Gary Klecks books (already mentioned by me, and then again by your article) and John lotts. Lott has an anti-gun agenda so no doubt his data is skewed that direct, but Klecks studies are well done, and the criminology data i steer, the medical world ignores it. i know longer have access to the primary articles (although it doesn't appear that you do anything other than badly speed read) to give you, but the second amendment foundation has copies and many articles by gary Kleck available.*

As scientist, I am absolutely open to new data. If you show me proof that gun ownership is a good thing, ie increases positive outcomes, then I would absolutely change my view. And judging from your critiques on Kellermann et all, I would hope that you have a number of excellent randomized, prospective, high-quality journal articles to back up your views.

In all seriousness, if you have ANY peer reviewed articles that not just argue against other articles, but actually present novel findings, I would love to see it

http://www.nap.edu/openbook.php?isbn=0309091241. National academies of sciences: firearms and violence did another peer review of the data and came to the same conclusion that the CDC did.*

 

[whopper]

I didn't intend this thread to be a political argument anyways

No problem. I wasn't trying to criticize anyone, even the political discussions. I didn't want to get too much into the political side of the discussion because I'm no gun expert. That's purely in reference to me and my own desire to discuss the issues on the thread.

I do think I know a lot more about guns than most doctors I know but that's no pat on my back because most doctor's don't know much at all.

 

[235750]

http://www.nap.edu/openbook.php?isbn=0309091241. National academies of sciences: firearms and violence did another peer review of the data and came to the same conclusion that the CDC did.*

That's not peer reviewed (it was made by a committee), nor is it an journal article with original data.

If you do find an original published article that shows a positive outcome associated with gun ownership, let me know. It is fascinating that Swizerland, a country with very high gun ownership, has a fairly low homicide rate. England's is lower, but still, I think that does show that you may be right (or was it 'sneezing' or 'whopper'?) regarding the importance of firearms training

And as soon as i get my prospective gun ownership study going (not CDC funded obviously), I'll let you all know

 

[Ibid]

Switzerland has compulsory military service for everyone at the age of 20 for approx two years. Everyone is trained to use a gun. They have a very low homicide rate but lead Europe for suicide using a gun. approx 26 percent of suicides compared to the UK at 2 percent. Compared to the US at nearly 60 percent of suicides using a gun.

Occasionally a debate breaks out in the UK. "Should the police have guns". The answer has always been no. Even the majority of police don't want them.

The logic of guns for all is like saying nuclear weapons for all countries then nobody would go to war, after all it kept the peace in Europe for 50+ years. MAD mutually assured destruction theory works, we have the evidence so NUKEs for all? I think not.

 

[whopper]

Okay, now I am jumping into the political.

The logic of guns for all is like saying nuclear weapons for all countries then nobody would go to war, after all it kept the peace in Europe for 50+ years. MAD mutually assured destruction theory works, we have the evidence so NUKEs for all?

This logic works if everyone is sane. You give the UK, US, Canada, and France weapons fine. You're entering grey territory with India and Pakistan. You give North Korea, Iran, Libya, and Tunisia that's another story.

Likewise, IMHO you have 100 people, 30 of are law-biding citizens and responsible, and they want to own a gun--fine, I think it'll work. 40 are law-biding but they don't want a gun and don't want that responsibility, then you're going to have problems. Then the other problem, what about the 20 that are not law-biding?

The argument of course is not a perfect analogy. Several criminals can get guns illegally, and many of the law-biding will get the gun legally. IMHO, putting further walls to prevent the law-biding from getting guns if not very carefully done will just prevent them from getting it while not hampering access to the bad guys. The anti-gun people who don't understand this, unfortunately, will push for laws that make that happen.

 

[Ibid]

Whooper

I love the fact that you left China out of that little list with its implicit hierarchy of “sanity”. Unless one clarifies what one means by sane when it comes to populations of billions of ordinary people, who are as I am sure you will agree are just like us in the west, then the argument rather descends into ethnocentric stereotyping bordering on racism. (obviously I am just high lighting that risk)

Clearly I’m not in favour of nuclear proliferation, I hope that was obvious, but only on the grounds that the weapons are bad things and backed up with some moral authority rather than quaint notions of western superiority. You could say our moral authority in the west is slipping away as fast as our economic muscle. To continue the point though the people of Iran/Persia are no less responsible than North Americans or Europeans. Worried about the command and control systems in Pakistan and India, well…how good are ours?
http://www.independent.co.uk/news/w...after-nuclear-bombs-flown-over-us-397456.html

http://news.bbc.co.uk/1/hi/8107908.stm

One thing this thread clarifies is that being free is not the same thing as being civilised. Another high light has been the demonstration yet again of how the use of so called academic evidence in a moral vacuum leads to ethically repugnant argument being given credence by juxtaposing them against civilised counter point. That is why lampooning “the guns for all” with the nuclear example is apposite. Nuclear weapons were developed by scientists in a moral vacuum as all good science is done. One goes where the evidence takes one as we both know. Medicine and most importantly psychiatry should not be practiced nor its ideals expounded in a moral vacuum where relativism rules the day with one argument being as good as the other. The idea that a gang members life is worth less than any other is fairly abhorrent to me anyway.
In my opinion psychiatrists should be erudite, and above all politically aware and engaged, just as comfortable discussing broader political issues and notions of distributive justice as well as pharmacology.

Getting back more to the point.

IMHO, putting further walls to prevent the law-biding from getting guns if not very carefully done will just prevent them from getting it while not hampering access to the bad guys. The anti-gun people who don't understand this, unfortunately, will push for laws that make that happen

You could also say that the progun lobby does not understand that complex problems have complex solutions and yes it would be nice if one could solve all problems by giving every one guns but its not that simple. Nothing ever is. Its always interesting that it is the extremists who posit simple solutions to complex problems. The extreme left and the extreme right are both guilty of this sort of cruelty to people. Offering false hope to the most vulnerable. Politics and psychiatry or psychology mixing yet again.

 

[whopper]

No disagreement from me. As for China, no opinion. They are certainly more stable than China (edit: meant Pakistan) and India, but as for their recognition of human rights, that leaves much to be desired.

WWIII was prevented thanks to nuclear weapons. A cold war is certainly better than a hot one. But again, the mutually assured destruction argument only works if the people don't want to die and can handle the responsibility. Give a terrorist wanting to die a nuke? Doesn't work. Give someone who doesn't want to die but is not responsible? They'll accidently set it off sooner or later.

I also agree with your retort

You could also say that the progun lobby does not understand that complex problems have complex solutions

(if it can be called that because I don't disagree with it.)

In fact several of the antigun laws that years ago that lobby opposed, several from it now use those laws and "evidence" that no further law needs to be put into place because a great law already exists.

E.g. the Brady Bill has a provision that someone with mental illness not be given quick access to a gun. Wasn't that bill opposed by the gun lobby years ago? Now some gun proponents mention that no new laws are needed because the mental illness provision is already there but the same guy years ago opposed the bill.

I hope that was obvious, but only on the grounds that the weapons are bad things and backed up with some moral authority rather than quaint notions of western superiority.

Agree. Power requires responsibility and in the hands of the responsible it's a good thing. Not everyone is responsible and to deny that is ridiculous. As for the irresponsible deserving getting shot for being so? Everyone's been that at one time in their life. In that regard everyone deserves to have been hit by a bullet fired from a gun under the argument to literally arm everyone and if you happen to die because you're not smart and responsible enough too bad. I've heard that argument from several.

 

[Ibid]

Whooper

So many interesting lines here but to address what I believe is the common position we share on proliferation, namely nukes have averted a third world war and war in Europe and thirdly that nukes should only be held by responsible countries:

Fine, but look at the mental gymnastics and inherent absurdity in what we are saying. Namely that if we didn't have the nukes then presumably we would still be tearing lumps out of each other in Europe and elsewhere like the dumb apes we are. No evidence then that we are any more responsible than anyone else.

MAD only also only works if everyone believes that there is no advantage to be gained from a pre-emptive first strike. That's unknowable so ultimately it boils down to trust and not MAD after all.

True the cold war didn't boil hot but it was hardly freezing either if you happened to live in one of the countries where it was fought by proxy.

To be really honest the thing that has kept the peace in Europe is most likely the EU and the closer economic and political ties in the European Economic Community as much as anything else. What I am saying is I don't always believe my own b.s. even when I am not playing Devils advocate.

Side note: Didn't Eisenhower go through a phase when he was actively sharing nuclear technology with the Soviets? I don't think that plan worked out as expected though....

 

[whopper]

Don't agree with you but at the same time the disagreement is philosophical, not empirical. The only thing I can say is that when you crack open history books, countries pretty much went to war throughout history except for the countries that attained nuclear capability against other nations with the same.

Has humanity gained enlightened wisdom to avoid war? Yes and no. I think the enlightened wisdom is in part out from cultural changes due to nuclear weapons and the increased value of a human life. IMHO, it's been human nature for up until the nuclear age to want to go to war. E.g. during the Civil war, right at the outset, people were clamoring for war thinking it was going to be noble and even an adventure. People lost that enthusiasm later on, but with years of no war, nations start clamoring for it again.

From an evolutionary perspective, going to war gets rid of the weaker genes so to speak.

I will say that the disagreement I have is at a point I don't find effective debating in detail only because the conclusion is not hard science but more a matter of personal interpretation and perspective. I don't disrepect your difference of opinion.

 

[OldPsychDoc]

Forgive me for pulling this thread back on-topic.

 

[Ibid]

Fair enough whooper. The subject has changed from using nukes as a proxy for guns to a conversation about war.

However as you have introduced something new I will comment before moving on as well.

posted by whooper
The only thing I can say is that when you crack open history books, countries pretty much went to war throughout history except for the countries that attained nuclear capability against other nations with the same.

I will just say that I think the correct analysis is that countries that have aligned economic interests and trading relationships don't go to war. No two countries that have a McDonalds in them have been to war conventional or otherwise. (poss some exceptions here but the point remains) Nukes and guns are not the solution to a problem, they are a problem.

by whooper
during the Civil war, right at the outset, people were clamoring for war thinking it was going to be noble and even an adventure.

Nothing has changed; people sign up for the same reasons today e.g. Iraq Afghanistan

posted by whooper
From an evolutionary perspective, going to war gets rid of the weaker genes so to speak.

Now this I can't let go. Tell that to the Afghan girl blown apart by a predator drone that she just died because of her weak genes.

Secondly "strong genes" do not always survive. It's just a particular fantasy of the right because they think it supports their argument. 30,000 years ago when resources were stretched the group rose up against the greedy "strong". The group slaughtered them so that everyone could eat by sharing rather than competing. That is how morality was born in the human mind.

The message for the right is clear. People who can share and co-operate and behave in a moral manner will trump the competing individualists in the long run.

 

[whopper]

OPD, I'll make this the last post from me OT on this thread. I'm just going to respond to this and then let it go.

Now this I can't let go. Tell that to the Afghan girl blown apart by a predator drone that she just died because of her weak genes.

Nope, not what I meant. Let me clarify. I'm not advocating war. There are, however, several behavioral traits in the human population (not necessarily in me as an individual) that suggest a desire to go to war.

E.g. if someone with an appearance that identifies them as an outsider attacks someone identified as an insider, there's a heck of a lot of behavioral science data that such an attack will make the insiders of the group want to attack the outsiders. E.g. gang member colors, someone merely looking middle-eastern getting run off a road by bunch of hicks, the reaction of the white community if a black man were to rape a white woman, etc. In the context of a nation, that translates into wanting to go to war.

From an evolutionary psychology perspective, and this has been postulated by several in that field, this may be a reason why humans evolved so quickly in comparison with other species. The continual killing of other humans accelerated the evolutionary process.

The theory is there are triggers in the human genes that will make us want to go to war. That is not an argument that we should always go to war.

But taken a step further, some argue that the triggers to go to war may be sensitized when things are "going well" for the insider group. E.g. in studies, when America has not been in war for years, the sales of war movies increases. When war actually does happen, it sobers people up, there's plenty of people's family members getting killed, and then sales of war movies drop. Hence what happened in the Civil War. It was popular until people realized thousands of soldiers were dying.

IMHO the same triggers were being pushed when the U.S. went to war in Iraq. I think that war was a mistake.

To be able to state there's triggers in the human psychology is not an advocation that we should always act on them.

Of course, an Afghan girl getting blown to bits by a mine is a terrible thing, but the ethics and morality behind that has no direct connection with what I wrote.

By the way, if you are not familiar with the theories I mentioned, I recommend you read up on Stephen Jay Gould because evolutionary psychology IMHO is an important facet of understanding human behavior and will pay off in psychiatry.

From an evolutionary perspective, going to war gets rid of the weaker genes so to speak.

That was not written as an advocation for war for that reason. Many evolutionary psychologists opine that war may have been the drive that accelarated our evolution, but in today's atmosphere of possible mutually assured destruction, it can no longer work but the drive is there nonetheless as a product of hundreds of thousands of years of primate troop vs primate troop fighting. It's in the genes but we have to overcome that drive.

IMHO the drive is still there and one of the reasons (among several) why I think mutually assured destruction did prevent WWIII.

 

[digitlnoize]

Interesting take...

http://www.kevinmd.com/blog/2011/02/mass-shootings-symptom-nations-broken-health-care-system.html

 

[sarahjay]

Sigh. Collectively this whole conversation is causing me to visualize a scenario in which someone who may or may not have a mental illness does something violent. He isn't prosecuted because he's "ill", but the psychiatrist whose crystal ball wasn't clear enough to predict this behavior is.

agreed.

 

[whopper]

Forgot to mention this but in Arizona, the insanity defense is severely limited in it's scope. The court case of Clark v. Arizona made it tougher for one to use an insanity defense in that state.

According to the news, he is using the not guilty defense. I don't know if it's because the insanity defense in Arizona has a tougher standard than more states.

I have encountered several cases where the person met the criteria for an insanity defense, and I actually believed they should've gone for it, but the person, out of pride and wanting to deny they were mentally ill refused to do so.

 

[whopper]

The law and psychiatry are not a perfect fit. It's much better than it was a few decades ago but it's got a long way to go. The problem with advancing it is this problematic area is one politicians don't want to touch, and usually when an advance happens, it's only because of a court case that sets a precedent.

Several examples: Should antisocial patients be prosecuted if they commit crimes on a psychiatric unit? Often times the police will not show up and arrest the person. Doctors don't know if they are supposed to involve the authorities in these situations. Are doctors supposed to expose patients as malingering? Technically it is a form of fraud unless the person is willing to completely pay for all their bills on their own with no assistance from insurance or the government. To allow malingering to continue unabated could lead to the person's mental health issues getting worse, but reporting the person could be considered an attack on the person's character. No one has answered these questions and they're in legal limbo.

Judge Bazelon, a federal court judge in the Washington D.C. area (no longer practicing), was very interested in the area of the law and how psychiatry should fit in. He had a psychiatrist he consulted on cases that involved psychiatry and several of his decisions became landmark cases. I didn't agree with all of them, but I believe he tried to make the best decisions possible given the limited amount of knowledge at time (he practiced several decades ago.)

It's unfortunate, but the very thing that often addresses legal-limbo cases are situations where a lawsuit or other court case is brought up and a decision is eventually made that sets a precedent. In several of these cases, the mentally ill person could not advance their case but an outside group such as the ACLU may have gotten involved and they took it over. Politicians aren't interested in making laws that aren't grabbing the headlines, not much money is involved, and/or it's not affecting the day-to-day lives of a significant portion of the population, especially on a mysterious subject to laymen like psychiatry. That makes the situation only then addressable in court cases.

 

[digitlnoize]

Bump.

I have to wonder about this Batman guy. Reports are that his mom instantly recognized him as the perpetrator. If true, it would seem she had recognized some degree of maladaptive behavior in him...which, from what we know now, was untreated.

I think this just underscores the fact that we need better public awareness and willingness to seek and refer for mental health evaluation and treatment when a problem is suspected or recognized.

 

[OldPsychDoc]

Bump.

I have to wonder about this Batman guy. Reports are that his mom instantly recognized him as the perpetrator. If true, it would seem she had recognized some degree of maladaptive behavior in him...which, from what we know now, was untreated.

I think this just underscores the fact that we need better public awareness and willingness to seek and refer for mental health evaluation and treatment when a problem is suspected or recognized.

And once again, what can we do?

Here's how I've seen it play out: A troubled person is brought in eval because mother says "he needs help", he lies about his access to weapons, maybe acknowledges "venting" in some written statements, has no history of harming self or others, comes across as fairly functional except maybe recently dropped school or lost job or isn't doing much...you suggest an antidepressant or counselling, he declines. Family feels helpless, we have no a priori reason to hold... We can document our concerns or suspicions, but his rights, including his 2nd amendment* rights, take precedence.

*Having visions of the Founding Fathers looking down from Mt Rushmore or wherever, shaking their big stone heads and saying "You know, that really wasn't what we had in mind..."

 

[whopper]

We don't have enough to judge on this James Holmes. This is like being told a guy is x # of years, did a crime, did some spooky things. That's not enough.

There certainly is something going on with him but it might not be on the order of an Axis I illness.

I've got theories, but that's it. IMHO to start to giving conclusions and evaluations on what happened, even giving theories could be damaging and go against the spirit of the APA's Goldwater rule.

You know, that really wasn't what we had in mind..."

A problem here is that several do not address is that the Founding Fathers (didn't-edit, this word shouldn't be here) agreed on hardly anything. The Constitution is IMHO as great as all the Constitutional Libertarians make it out to be but it wasn't mystical or a type of thing where they wanted us to be bound by it as if it's a divine mandate.

 

[OldPsychDoc]

The ONION gets it right--again

 

[digitlnoize]

I'm not trying to imply a dx. But, his mom clearly knew something was very wrong, as she was not surprised he did this and able to ID him as the right person, if reports are to be believed.

I would like to see better systems in place for community follow ups with new dx and patients at risk for stopping medications.

 

[freaker]

perhaps it is time to reexamine the gun clause of the constitution. I wouldn't say that we should ban all guns, but perhaps tighter restrictions on the purchase would be warranted, given the amount of gun violence in our society. It's gotten to the point where the freedom to bear arms is infringing on our other freedoms. IMO, guns should be regulated at least as tightly as Percocet. Besides, the US military is far too well armed for the US population to be able to mount a real revolt against govt tyranny. So it seems to me that the purpose if the "right to bear arms" is largely mute at this point.

Unless you're talking about a Constitutional amendment, there is no revisiting the second amendment. It is what it is, and it serves a useful utility. You don't regulate guns the way you regulate Percocet because the Consitution quite clearly limits the federal government's ability to do such.

You could also argue that the right to bear automobiles infringes upon the rights of others (bicyclists moan about this all day long), but I wouldn't give you the time of day about it. It's interesting that one man acts and injures/kills a lot of people, and the first thing that happens is that the rights of millions go on the chopping block. Chicken Little politics prevails, per usual.

It should be noted that Colorado is not an open-carry state, and no one could defend themselves in that movie theatre legally (how a state like Colorado isn't open carry blows my mind given the location in the mountains). Guns were also banned at Virginia Tech. They're also banned in Mexico. How's that working out for them?

I do think you make a point that we could do more to interface between the psychiatric side of things and the legal side of things. Or at the very least bring awareness to the public where they start insisting/encouraging others to get help when it's becoming obvious that they need it.

It will be interesting what the defendant's mother has to say as this story unfolds.

I did find it somewhat disheartening when a newscastor asked a psychiatrist what could be done in a scenario where he believed the alleged perpetrator might be seen as a threat to others, and the psychiatrist stumbled all over the idea of psychiatric commitment without explaining it clearly or even the use of a Treatment Review Committee and forced medications / psychiatric court if need be. Granted, this varies from state-to-state greatly.

 

[Ibid]

As if we needed more proof that you're a raving socialist!

All socialist are raving by default surely....it explains why left wing women are better in bed...

Involuntary committment isn't going swimmingly I hear for psychopaths in the UK. Do a pubmed search on DSPD (Dangerous and Severe Personality Disorder) and take a look at their trends. Really arose because of sensationalized episodes just like this one, leading to a public outcry and the government passing laws to hospitalized someone for a potentially indefinite period of time. Maybe it would violate the constitution, maybe with the current supreme court it wouldn't...

In the UK no matter how people vote nearly everyone ultimately wants the government to solve/resolve the ethical dilemmas of society at large and more or less believes that is the whole point of having a government. The DSPD project/experiment is an example of that as well as the general expectation that mental health services should solve all sorts of things....

BTW the Mental Health Act has been recently revised so that people can be detained not for treatment but for a reasonable intervention because as you point out the treatments so far have not met with any success although the risks remain.

It will be interesting what the defendant's mother has to say as this story unfolds.

Im on the edge of my seat....

 

[whopper]

asked a psychiatrist what could be done in a scenario where he believed the alleged perpetrator might be seen as a threat to others, and the psychiatrist stumbled all over the idea of psychiatric commitment without explaining it clearly or even the use of a Treatment Review Committee and forced medications / psychiatric court if need be. Granted, this varies from state-to-state greatly.

I've seen more than one psychiatrist jump at the opportunity to be on the news when in reality they don't have anything useful to say.

When all that hoopla came out several months ago that SSRIs don't work, a bunch of psychiatrists were on the new for their 15 minutes of fame not even having read the article and commenting on it...and since they didn't even read it, their comments were binter-banter-useless. "Hmm, well yes, this is interesting." But nothing else.

The place where I used to do private practice, well I was asked by the local news a few times to talk about a few things and I refused, telling them it was on the order of inappropriate. Well guess what? I told my boss, and then all of a sudden he shows up on the news doing the same exact soundbite I refused to do. That was one of the first signs I had that perhaps I should be looking elsewhere to work.

 

[Iwillheal]

The ONION gets it right--again

Lol. Sadly true. And let me be one of those Americans...

From a practical standpoint, obviously once we have more information about this case, we need to consider the potential causes, and then do a cost/benefit analysis of the potential solutions. There are no guarantees in life and we may conclude that we would accept the risk of such a tragedy happening again because the chances are slim and that the benefits of no solutions offered outweigh its costs.

We may reconsider gun laws because everything else being equal, it's much harder to kill millions with bare hands than with a nuclear bomb. The killer in this case seems to have been a bright motivated person and I have no doubt he could have still caused quite a bit of damage even without access to any weapons but it's a simple fact that he could not have done exactly what he did in that short time without weapons and explosives. Most importantly, it should not be so easy for a person to purchase explosive online.

Moving back a step from the actual committing of the act, what are possible motivations for committing a crime? Unemployment? Mental illness? Meaninglessness in a materialistic world? Violence in the media? Watching violent movies and playing violent games does lead to violence. This is one of the few research areas where there is actual convergence of studies, of several thousands of studies. Of course, movies and video games are also a multi-billion dollar industry. I've certainly noticed a trend towards darker and more violence films and games in the last decade. And it is quite frightening that in the previous batman film Heath Ledger, the Joker, took his own life, and this tragedy in this one.

Of course there are other solutions. Since 9/11, security businesses have been blooming like no other time. Let's tighten up the security in movie theaters. Why not, let's put a body scanner in there too. Because let's face it, the gun laws are not changing, media violence is not changing, economy is not getting better, the only thing you can count on is security business. How is that for practical?

 

[Hernandez]

.

We may reconsider gun laws

Unless you have some exciting new evidence that gun control has any impact on crime control, you will have a large number like myself that will tell you, from my cold dead hands

 

[Hernandez]

, the only thing you can count on is security business. How is that for practical?

Considering even the movie theaters security was prohibited from carrying a gun, what could would they have been?

 

[Ibid]

. I've certainly noticed a trend towards darker and more violence films and games in the last decade. And it is quite frightening that in the previous batman film Heath Ledger, the Joker, took his own life, and this tragedy in this one.

Not sure....have you seen Titus Andronicus?

http://en.wikipedia.org/wiki/Titus_Andronicus

Some of the best bits of the plot....

During a royal hunt the following day, Aaron persuades Demetrius and Chiron to kill Bassianus, so they may rape Lavinia. They do so, throwing Bassianus' body into a pit, and dragging Lavinia deep into the forest before violently raping her. To keep her from revealing what has happened, they cut out her tongue and cut off her hands. Meanwhile, Aaron frames Titus's sons Martius and Quintus for the murder of Bassianus with a forged letter. Horrified at the death of his brother, Saturninus arrests Martius and Quintus and sentences them to death.

Some time later, Marcus discovers the mutilated Lavinia and takes her to her father, who is still shocked at the accusations levelled at his sons, and upon seeing Lavinia, is overcome with grief. Aaron then visits Titus, falsely telling him that Saturninus will spare Martius and Quintus if either Titus, Marcus or, Titus's remaining son, Lucius, cuts off one of their hands and sends it to him. Titus has Aaron cut off his hand and send it to the emperor, but in return, a messenger brings Titus Martius and Quintus' severed heads, along with Titus's severed left hand. Desperate for revenge, Titus orders Lucius to flee Rome and raise an army among their former enemy, the Goths.

Titus agrees and sends Marcus to invite Lucius to a reconciliatory feast. Revenge then offers to invite the Emperor and Tamora as well, and is about to leave when Titus insists that Rape and Murder (Chiron and Demetrius) stay with him. When Tamora is gone, Titus cuts their throats and drains their blood into a basin held by Lavinia. Titus morbidly tells Lavinia that he plans to "play the cook" and grind the bones of Demetrius and Chiron into powder and bake their heads.

When Saturninus answers that he should, Titus kills Lavinia, telling Saturninus of the rape. When the Emperor calls for Chiron and Demetrius, Titus reveals that they have been baked in the pie Tamora has just been eating. Titus then kills Tamora, and is immediately killed by Saturninus, who is subsequently killed by Lucius to avenge his father's death. Lucius is then proclaimed Emperor. He orders that Saturninus be given a state burial, that Tamora's body be thrown to the wild beasts outside the city, and that Aaron be buried chest-deep and left to die of thirst and starvation. Aaron, however, is unrepentant to the end, regretting only that he had not done more evil in his life

Shakespear would be a lot more popular in schools imo if they concentrated on the good stuff rather than Romeo and Juliet and all that clobber....

 

[Jorje286]

And once again, what can we do?

Here's how I've seen it play out: A troubled person is brought in eval because mother says "he needs help", he lies about his access to weapons, maybe acknowledges "venting" in some written statements, has no history of harming self or others, comes across as fairly functional except maybe recently dropped school or lost job or isn't doing much...you suggest an antidepressant or counselling, he declines. Family feels helpless, we have no a priori reason to hold... We can document our concerns or suspicions, but his rights, including his 2nd amendment* rights, take precedence.

*Having visions of the Founding Fathers looking down from Mt Rushmore or wherever, shaking their big stone heads and saying "You know, that really wasn't what we had in mind..."

But at least you'd give a chance for intervention. It might not always work out, but it's certainly better than nothing, especially if he was referred before he actually set up his mind and had everything planned out. I think this is a very good case of something horrible that happened because of "negligence" of mental issues cases. The signs were there. The fact that he was doing very badly in his school despite his former academic achievements should have raised the alarm. With better school oversight, maybe he should have been advised for help and psychiatric consult? There's no doubt that mental issues are still overly stigmatized; if we were a little more accepting and open about a visit to the psychiatrist we might have been able to avoid this tragedy.

 

[freaker]

We may reconsider gun laws because everything else being equal, it's much harder to kill millions with bare hands than with a nuclear bomb. The killer in this case seems to have been a bright motivated person and I have no doubt he could have still caused quite a bit of damage even without access to any weapons but it's a simple fact that he could not have done exactly what he did in that short time without weapons and explosives.

Or if you had enabled a few veterans, offduty police officers, or general citizenry who hold a permit who were actually enabled to defend themselves or others in the theatre, you might have had what you had here or at Virginia Tech. Instead, Colorado doesn't allow open carry.

 

[AnnoyedByFreud]

Or if you had enabled a few veterans, offduty police officers, or general citizenry who hold a permit who were actually enabled to defend themselves or others in the theatre, you might have had what you had here or at Virginia Tech. Instead, Colorado doesn't allow open carry.

Were there any veterans or off duty cops in this theater? The general citizenry? Really? Oh yeah, because in a dark, crowded theater filled with smoke and confusion, what you really want are untrained people (ie: general citizenry) pulling out their guns and shooting.

 

[whopper]

I've certainly noticed a trend towards darker and more violence films and games in the last decade

A theory proposed by several is that 9-11 caused a darker sentiment. I can tell you as a Batman fan for years that this type of story had been going on since the late 80s. Batman: The Cult a comic that came out in the late 80s had a similar storyline to Dark Knight Rises with all the tragedy and darkness. There's one particular part of comic where Batman tries to retake Gotham in a tank-like Batmobile and sees a woman screaming for help being torn apart literally and slowly by the bad guys--and he can't do anything about it other than watch or else he's dead and his mission will fail.

A personal theory of mine is that the fanboy is now the critical customer because it's the fanboy that'll go to the movie several times, buy a t-shirt, blu-ray, toys, and other merchandise, and dark gritty storylines in comics were the thing since the late 80s, and now, finally, what fanboys want to see is in the movie theaters. You will not see the same type of customer cash going into a chick flick or slow drama, unless there's some type of Ulee's Gold fanbase that's buying the novel, t-shirts, toys, and DVDs, and the Ulee's Gold video game that I dont' know about. (Hmm, what are you going to do in that game, make honey?)

 

[Iwillheal]

Whopper, yeah I can see 9/11 (or the two wars after, or even the anti-WTO riots starting in 99) contributing to this trend towards darker and more violent movies and games on the consumer side, not to mention the other side of the coin, things like "militainment," etc. Of course the bad economy and unemployment and resultant repressed anger could also create a demand for cathartic experiences that movies and games could offer.

I agree with your fanboy theory. In this economy (I sound like a politician) going to movies every couple of weeks is a luxury not everyone can afford. So the loyal customers are targeted and who else but fanboys. And what they want, they shall get. Something somewhat similar is happening in the music industry with little girls and their Bieber fantasies. Or Taylor Swift, or hundreds of other teen singers and actors who seemingly became famous over night and are making money like it's nobody's business. What happened to adult entertainment? But I digress....

Speaking of Batman, I used to absolutely love Batman: The Animated Series. It was dark, frightening, and pure awesomeness.

 

[surftheiop]

Im almost never the song lyric quoting type, but this always as struck me as surprisingly insightful (given the source )

http://www.youtube.com/watch?v=66jpwLSxZrw

...
"It wasn't me", says the boy with the gun
"Sure I pulled the trigger but it needed to be done
Cause life's been killing me ever since it begun
You cant blame me cause I'm too young"

"You can't blame me sure the killer was my son
But I didn't teach him to pull the trigger of the gun
It's the killing on this TV screen
You cant blame me its those images he seen"

Well "You can't blame me", says the media man
Well "I wasn't the one who came up with the plan
I just point my camera at what the people want to see
Man it's a two way mirror and you cant blame me"

"You can't blame me", says the singer of the song
Or the maker of the movie which he based his life on
"It's only entertainment and as anyone can see
The smoke machines and makeup and you cant fool me"

It was you it was me it was every man
We've all got the blood on our hands
We only receive what we demand
And if we want hell then hells what well have
...

 

[nitemagi]

I'll paraphrase Chris Rock on the topic (can't find original quote)--

I love how everyone talks about [video games and] violent movies and TV causing violence.

WTF was hitler watching?

 

[surftheiop]

I'll paraphrase Chris Rock on the topic (can't find original quote)--

I love how everyone talks about [video games and] violent movies and TV causing violence.

WTF was hitler watching [reading]?

WW1 Propaganda?

But obviously point is well taken that violence is not a new thing

 

[Iwillheal]

WTF was hitler watching?

I know this is a joke but I passionately dislike all references to Nazi Germany and Hitler. Not only there are more "evil" people than Hitler presently in the world out there (people overlook time and place and many other environmental factors when judging how "evil" he was) but simply don't have the means to cause the kind of damage he did, but more importantly, correlations with how Hitler lived his life are often overused and abused.

Case in point, I was discussing gun control with someone and after a bit of debate he accused me of twisting facts and I said we're having an "intelligent and civilized" discussion to which he replied: "Yes, but Hitler was also very intelligent." My father-in-law smoked a pack of cigarettes every day of his life, since his early 20s, and passed away last month, at the ripe age of 94. No cancer, no major illness aside from some respiratory problems last few years. Maybe I should pick up smoking.

 

[digitlnoize]

It will be interesting what the defendant's mother has to say as this story unfolds.

Apparently, she issued a statement today explaining that her comment had been interpreted incorrectly. She wasn't saying that she knew her son was "the right person." She was answering the phone and responding to the "is the this the mother of what's-his-name?" question with "yes, You have the right person."...meaning, herself.

To me, this makes it more unclear whether his parents knew of any mental instability.

Interesting images coming out of the courtroom proceedings today. Everyone is making a big deal of his "emotionless" face, and many are interpreting this as him being medicated...supposedly not seeking NGRI though...

I'm actually NOT in favor of taking away guns. Just better restrictions, tighter control, better background checks...more checks and balances. Someone ordering an arsenal in a 6 month time period should set off some alarms somewhere.

 

[nitemagi]

Maybe I should pick up smoking.

You should definitely get right on that.