Part Two of Three – Losing it

Originally published in the Bat Country Word. Read part I here.

Would-be assassin Jared Lee Loughner

Violent fantasy about homicide is not an uncommon experience, often triggered by the end of an intimate relationship or sometimes job loss. It is about control and the protection of what we perceive to be our personal boundaries or self interest. Fantasy is a defence mechanism. Children will often act impulsively and violently towards others in late infancy or early childhood until they integrate information from the world around them including the likely feelings of other people as they develop in maturity. While there might be a primary urge to lash out when we feel threatened, normally a secondary restrictive process around social convention or consideration of consequences prevents the primary process from being acted out in later years. You could call it growing up or getting a grip.

One definition of psychosis in an adult would be the abject failure of the secondary inhibiting processes – losing your grip if you like and leading to extreme states of mind. Losing it is what will be referred to in this article as a “breakdown”. Breakdowns can be isolated events as in the psychotic break, or repeated occurrences leading to diagnoses such as schizophrenia. To understand the phenomenon of mass social assassinations, we need to have some appreciation of the factors that can lead to the suspension of those protective developmental processes that are usually acquired through socialization as a child.

What exactly was going on in terms of neurotransmitter chemistry at the time when Holmes, Lanza, Breivik and the others opened fire will never be known, let alone what on Earth they were thinking or experiencing. So the proposition that mental health care through the right prescribed medicines might have prevented these killings is speculative at best, even if biological psychiatry has a firm foundation. None of those three had previous criminal records. It is even arguable that some prescribed drugs could promote this sort of incident through “side effects”. The SSRI antidepressants are known to promote anxiety sometimes and therefore suicidal or rarely homicidal ideation, especially in the early stages of prescribing. It is also most unlikely that patients would get involved with antipsychotic medication without previous mental health crises. While heavy sedation might repress impulses and postpone an event, in the longer term such medication also impedes the cognitive rationalization of inner turmoil through therapy. Jared Loughner who killed 19 people in a shopping centre in 2011 had been detained and medicated in a secure psychiatric facility previously. He was still free and able to buy his weapon. Perhaps when Obama talks about better mental health care or gun controls he means better reporting and sharing of information more than treatment?

Generally speaking better access to mental health care will mean better access to medicines rather than therapy anyway. Drugs are cheaper for a start and good therapists are hard to train and quantify. While the drugs might be supportive in many cases, to describe these medicines as a cure rather than a treatment is a logical leap too far. They treat the symptoms rather than the cause. There is a good body of evidence that suggests neurotransmitter changes do indeed influence thinking and behavior, but many of the causes for those fluctuations in dopamine, noradrenalin and serotonin remain biologically uncertain. Stress is however a widely acknowledged factor.

There are also alternative and robust models of how and why some people suffer breakdowns that are psychologically based rather than biological, one of which, discussed here, is Gregory Bateson’s Double Bind Theory. The Double Bind Theory is as follows. The individual is subject to diverse and compelling commands, and failure to comply with either will each result in some kind of punishment or negative consequence. The commands are so contrary that rationalization is not readily possible and expression of the internal conflict experienced by the person is prohibited by their family or social context, for whatever reasons. After a period of time, something has to give to release that emotional stress if the construct remains in place around him.

Another way of conceptualizing the idea of internal angst is through the idea of cognitive dissonance. That is the perceived difference between what we think should be happening (our beliefs) and what is actually occurring –or to put it another way the reality gap between what we consciously want and what we manage to or think we can achieve. That incongruence manifests as anxiety and relief of that inner tension eventually becomes the most important drive in the person, often through dysfunctional behavior, often through hostile behavior, but usually directed towards the self rather than others. Commonly labeled the “flight or fight” response, anxiety is biologically hardwired and triggered by perception. Clearly it is the “fight” side of the arousal dilemma that is of interest here where action is taken to control the environment in order to lessen the threat of division to our internal sense of self and its overall well being. While anxiety as a physical state can be treated with drugs, prescribed or otherwise, clearly chemicals do not directly address underlying psychology or perception.

So if we apply double bind theory to a critical examination of the Western societies these men have been born into, what do we find? We see the POTUS as an individual who can sanction illegal killings through a drone war. We see NATO inventing bogus wars with many thousands of casualties to feather the nests of multinational corporations. We see state appointed assassins licensed to determine who deserves to die today, die another day or survive, and the interests of a few outweighing the rights of whole populations. The power and control are nearly Godlike, flying the Predator drone from a remote metal box. Even mistakes are tolerated and are dubbed collateral. At home social legislation becomes increasingly controlling as governments head towards fascism and the loss of individual freedoms. Governments implement austerity measures, repress civil disobedience, and lie to or deceive us. Other impositions of authority in a myriad of different forms also threaten us, including extended detentions without trial and controls over the internet.

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Originally published in the Bat Country Word. Look for Part Two on Monday.

Part One of Three – Introduction, a Few Truths, and Mental Health

Accused Aurora, CO shooter James Holmes. Could improved mental health screening really prevent future shootings?

This series sets out to examine some of the psychosocial factors that conspire to create public massacres like those at Sandy Hook and Aurora, Colorado. It’s about how the hot base metals of a society blend in the alchemist’s crucible to produce a cold mass-murderer. Also addressed will be some social changes that are hoped will promote safer societies, such as access to mental health care and gun controls. Both are likely worthy aims and of benefit to society, but will they make a difference to the mass killings?

A few other good ideas are thrown in for good measure, naive and romantic though they may be (see part 3). Also noted is that public massacres occur outside of America too. In the UK there was the Dunblane School incident in 1996 where 15 children died and two adults, counting his own suicide. Hungerford in 1987 and more recently the shootings in Cumbria in 2010 are other UK cases. All examples here are drawn from Europe and America. The article refers exclusively to the West and NATO, its dirty activities and the noxious consequences.

Much media speculation has arisen about the mental health of the predominantly white young men who become these mass murderers, perhaps because they are predominantly white and not Afro-Caribbean or from the Middle East. (Were they anything but Caucasian they’d more likely be “gangsters” or “Islamic terrorists”.) They must have all been mentally ill to target groups of vulnerable people in schools, colleges or cinemas and open fire, right?

Adam Lanza was reported by his brother to be on the autistic spectrum and by other family and friends to have a diagnosis of Asperser’s Syndrome. Mental health advocates rightly were quick to point out that autism is a psychological developmental issue, not a mental illness, and as a condition not commonly associated with homicidal behaviour. James Holmes’ mental health has also been debated, but he has yet to be confirmed as having any diagnosable mental illness at the time of the Aurora shootings. In Norway 2011 Anders Breivik killed 77 people and injured at least 319 people in two separate incidents on July 22nd. Initially diagnosed as a paranoid schizophrenic, he was later reassessed and found to be sane. Thomas Hamilton, the Dunblane killer had complaints made about him and his proximity to young boys, but had no criminal convictions or psychiatric history. Derrick Bird, the Cumbrian gunman who killed 12 and then himself was reported in the local paper to have approached mental health services but was turned away. He was not diagnosed and the weapons in these UK incidents were legally owned. Seung-Hui Cho who killed at 32 Virginia Tech in 2007 did have identified and treated mental health problems. We could continue to profile offenders. The reader can do the same. Some of them had no mental health history, and about 50% did. Even those that did were not prevented from later going on to commit acts of mass murder. None of them were identified by previous homicides. The overwhelming majority of the weapons used were legally obtained.

In the USA wider screening of school children for potential mental health difficulties is being suggested. Unfortunately however the professionals are not able to predict future dangerousness with any great accuracy. Even if they were, there is then a reporting and confidentiality issue. As it stands, unless someone has already hurt someone it is unlikely that they will be detained or medicated for fear of what they might do to another person. That is the realistic scope of any mental health service run with a reasonable ethical or humanitarian code. Sometimes in fear and ignorance society expects or wants more control to be exerted but that is neither pragmatic nor morally correct. So the notion that mental health services can identify future offenders and through treatment or control significantly reduce public massacres might make good politics but it is just not realistic – (Watch this great debate).

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