by Ross Bishop

The Intersection of Social Failure

Airplanes they say, crash because of multiple systems failures. Columbine, Sandy Hook, Aurora and Virginia Tech all represent significant multiple failures in the ways we regulate weapons and in our approaches to troubled people. The sad thing is that these tragedies are only the tip of a rather large iceberg. These problems have been screaming for resolution for a long time, and as is so often the case in America, it takes a catastrophe to bring them to our attention.

Limiting the availability of assault weapons and high capacity magazines is an essential part of the solution, but it is not the total answer. There are actually five important areas that intersect to create mass shooting tragedies, and each adds an element that ultimately together leads to disaster. These areas are: the way we view and treat troubled people, the sad failure of our mental health system, restrictions in the law, the availability of assault weapons and the nature of the dysfunction that drives mass killers.

There are answers to each of these aspects. Some will be expensive and others will require changes in our way of thinking. But since most of the changes will have to come through the political process, we can expect the special interests to be busy protecting their private agendas. However, one thing is absolutely assured – unless we do something substantial and soon, we’ll be having funerals for more a lot more innocent schoolchildren.

This is a complicated matter that touches on personal privacy issues, the right to own firearms, the power of the state vs individual freedom – especially as it relates to the confinement of angry, but not mentally ill people, the limits of police power, unlawful search and seizure and of course, the right of children to go to school or the mall without the threat of being killed.

The underlying fabric to this dilemma is the way we view and treat troubled people. We shun them, we fear them. They are the pariahs of society and we treat them like they used to treat the lepers in the Old Testament. Even with our enlightened modern perspective, we still try to sweep troubled people under the rug – or into alleys and freeway underpasses. A big part of our resolving this issue will have to do with us finding compassion in our hearts for these suffering people.

When it comes to the allocation of social resources, the emotionally troubled are always at the bottom of the barrel and the first to have funding cut when money gets tight. Over the past three years, conservatives in Congress have cut $4.3 billion from the federal mental health budget.

Our present mental health system has failed for two primary reasons – a lack of funding for facilities and resources and the inability of psychology to meaningfully help troubled people.

There was a time when we had large state mental hospitals. They were truly awful places, expensive warehouses for the mentally ill that offered little prospect for patients to ever get better. It was found that smaller, community-based mental health facilities could produce some results, so Congress shut off funding for big state hospitals – and then never bothered to provide money for community based health care. Also, people didn’t want mental health clinics in their neighborhoods, so faced with tight budgets and local opposition, the politicians folded.

Troubled people were simply turned out into the street to fend for themselves. In the public brouhaha after the horrible Virginia Tech shootings, gaping holes were exposed in the state of Virginia’s mental health system. The conservative Virginia legislature, traditionally opposed to any public funding for health care, allocated $43 million toward the state’s mental health system. A year later, when the media had gone away, the same legislature cut the state’s mental health budget by $50 million.

Troubled people don’t have a political lobby. There is no one to protest when mental health budgets are slashed and resources are eliminated. Plus, as I said, mental health care is always one of the first targets of budget cutting conservatives who are concerned about the expansion of socialized medicine. Political conservatives seem to possess antipathy towards the treatment of troubled people. Psychologists are typically viewed as fuzzy thinking liberals who want to help troubled people by providing socialized medicine.

When you read expert opinions and media accounts of shooters, keep a few things in mind: Mental illness has fairly specific diagnoses. And taken as a group, mentally ill people are no more violent than you are. There are a lot of people walking around who you might call “nuts” in street vernacular, who do not fit into the defined categories of mental illness.

There is a small percentage of mentally ill people, and we are not talking about large numbers here – specifically those with severe and untreated symptoms of schizophrenia with psychosis, major depression or bi-polar disorder, who are about twice as likely to be violent. Psychiatrists have created a category of illness called Antisocial Personality Disorder, which is sort of a catch-all for antisocial behavior.

People who have schizophrenia and substance-use issues do pose an even greater risk. They have a nine times higher risk of being violent. The association is especially marked in regards to homicide. People with schizophrenia are nearly 20 times as likely to kill as people unaffected by the disease. But, these are largely individual killings. Mass shooters are rarely substance abusers. And we should carefully distinguish between typical murderers, (remembering that any murder is a horrible thing!) and the special category of mass killers, because there are important differences.

We make a serious error when we categorically label mass killers as mentally ill. Mental illness is certainly an important consideration, but the mentally ill account for less than half of all multiple victim shootings. Of the 60 most recent mass shooters, acute paranoia, delusions, and depression were rampant among them, but only 38 of them displayed signs of mental health problems (not necessarily mental illness), prior to the killings.

Actually, there are even far fewer mentally ill involved if we only consider the “big” events. The large group of shooters, and we are only talking about 60 men out of a population of 35,000,000 young men, consists of troubled people who are not technically mentally ill, but who pose a serious threat because of their towering rage. Of the three major and many smaller gun tragedies in the nation in 2012, only one of the perpetrators seems to have been mentally ill. The others were just angry, feeling that they were right and everybody else was wrong. They see other people as responsible for their problems. They externalize blame, scapegoating groups or individuals – family, co-workers, neighbors — for whatever is wrong in their lives.

Violence is neither a diagnosis nor is it a disease, and ours remains a violent society. If you read the news, people kill each other every day, by the hundreds – in Afghanistan, New York and East LA, and very few of these people are mentally ill. A military officer who kills masses of people with a Predator drone may be many things, but he is not mentally ill. A drug dealer seeking to avenge a bad drug deal is little different from the mass shooter who seeks revenge for the abuses he feels have been done to him. These killers have been profiled by Paul Mullen, an esteemed Australian forensic psychologist:

They’re almost all male, there is one exception. They’re young. They tend to be in their 20s. They are typically social isolates. They very rarely have close friends or confidants. They almost never have an intimate relationship, although they sometimes have had brief relationships, which have usually failed.(1)

Interestingly, they’re not like many offenders, they don’t tend to have problems with alcohol and drugs. They’re certainly not impulsive, quite the reverse. These are rather rigid, obsessional individuals who plan everything extremely carefully. And most of these massacres have been planned for days, weeks, sometimes months ahead.

The other thing about them is that they are angry and resentful at the world, they blame the world for not having recognised their qualities, for having mistreated them and misused them. Resentment is central to their personalities.

They spend their time ruminating on all those past slights and offences. And they begin to develop a hatred for the whole world.

Perhaps most important of all, these people are on a project to suicide. They go out there to die, and they go out to die literally in what they see as a blaze of glory. They are seeking a sort of personal vindication through fame or, more precisely, infamy.

To summarize: although direct research is somewhat limited because shooters usually commit suicide, they do operate from an almost stereotypical pattern. The shooter kills in public during the daytime, plans his offense well in advance and comes prepared with a powerful arsenal of weapons. He has no escape plan and expects to be killed during the incident. The killer is driven by strong feelings of anger and resentment, flowing from beliefs of being persecuted or grossly mistreated. He is driven by fantasies of revenge.

These killers are calculating and delusional, but most often not mentally ill. If you met one, you’d think they were odd, but their behavior would not alert you to what they were planning. They can be episodic, so people who spend time with them such as parents, friends and teachers will know that something is wrong, but that can be said for many people, and trying to pick out a potential shooter from the millions troubled, frustrated and disenfranchised people is a daunting task to say the least.

But what is a teacher or parent to do? Several of the recent crop of mass killers could easily have been helped by a residential facility, but even though their problems had been identified, there was simply no program or facility to help them, and no mechanism in place to allow them to be legally referred out for help. So the concerns of teachers, family members and even therapists fell into an abyss in the system with as we now know, tragic consequences!

Most often a teacher or parent’s only resource is to call the police, but the police can only respond to a direct, immanent, violent threat. This puts the subject, if he looses his rigid composure (which is uncommon), into a criminal justice system that is neither equipped or prepared to deal with him.

There are almost no resources to help troubled people – no housing, no supervision, no guidance, counseling or vocational training. A callous political calculation has been made that killings such as Columbine, Virginia Tech and Sandy Hook are a cheaper alternative than to create community based mental health clinics and the billions of dollars and large infrastructure that would require.

Shooters do not see themselves as troubled but rather as victims, so these angry young men vehemently resist taking medications, being confined or receiving treatment. Many of the drugs they are prescribed have truly awful side effects (including violent behavior), further complicating an already difficult situation. These men are smart but their dysfunction is likely to have already brought them up against teachers, the police and psychiatrists, and they will have learned how to play the system to avoid being confined.

The lack of community support makes the well-meaning teacher or parent who seeks help for a subject, a target for the subject’s smoldering rage. And as we have sadly seen, these men can lash out with incredibly destructive rage or in a most interesting modern twist, lawsuits! Most parents are also unwilling to see their sons as troubled because that reflects back on them as parenting failures.

A critical element in the discussion of mass shooters obviously involves guns and their accessibility. There is a group of people in our society who fear that the government might try and take away their freedoms. These are usually men who feel personally powerless. And for people who feel powerless, like a victimized shooter or an NRA member, an assault rifle can be the great equalizer.

The need of these men to defend themselves against a fantasied governmental incursion has led them to create an open market for assault style weapons that regrettably, can easily get into the wrong hands (either legally or illegally). The fear of these “Defenders of Freedom” puts the rest of us at grave risk. Eighty percent of the perpetrators of the 62 most recent mass shootings obtained their weapons legally.

Besides, home security can easily be accomplished by less aggressive weapons. And as far as protection from a governmental incursion is concerned, if you consider the premise of armed civilians going up against the might of the Army with its tanks, trained troops and helicopter gunships, the whole concept becomes pretty ridiculous. But, in one sense the NRA is right, guns are only the instruments of mayhem. But, the pivotal factor that the NRA conveniently chooses to ignore is that a rage filled person with a Bushmaster assault rifle is massively more deadly and dangerous than one without. Mass killers don’t use knives or baseball bats. Assault weapons have been perfected as instruments of death and they are incredibly effective at doing it! And that is why we must get them and high capacity magazines off the street!

The NRA, controlled and funded by gun manufacturers, purposefully and unconscionably, fuels their member’s fears, as it attempts to gain support for its private agenda, which is a society where everyone carries guns – essentially a throwback to the violent Wild West of the 1880′s.

The other aspect of the weapons discussion has to do with their sheer availability. There are over 350,000,000 guns in America and anyone who wants a gun can easily get one. You can go to any city in America and in 48 hours purchase enough guns and ammunition (including heavy weapons), to equip a small army.

America is violent country. Our homicide rates are SEVEN TIMES higher than rates in the other high-income countries. More than half of all murders are committed with guns. Our firearm homicide rates are TWENTY TIMES higher. For youths fifteen to twenty-four years old, firearm homicide rates in America are FORTY THREE TIMES higher than in other countries.(1)

Another issue in this discussion, and what has until now been a sacred cow, is the failure of psychotherapy to heal people. The simple truth is that psychotherapy and drugs just don’t work very well. But, since they have been the only game in town and they come from the esteemed medical profession, politicians give them approval because of the way the legal system esteems psychiatry, (which even amongst practicing psychotherapists is a standing joke!) The alternative is to warehouse troubled people like we do criminals – who we also don’t seem to know how to help.

Shamanism (and you must accept my bias here) has a remarkable record of helping emotionally troubled people to heal, but it is a foreign concept from “backward” tribal cultures, difficult to teach in university classrooms and is spiritually and not medically or “scientifically” based. Besides, there are relatively few really qualified shaman around. So, even though the psychotherapy car already has several flat tires, we continue to try and drive it down the road.

The law doesn’t help much in dealing with troubled people either. The courts are understandably, exceedingly touchy about confining someone against their will without a certification of mental illness. And as I said, most mass killers do not meet the the mental illness requirement. Acts of mass murder are so heinous that it is difficult to attribute them to normal people, but shooters are merely the extreme fringe of a culture that engages in deadly violence every day. In America hundreds of people are killed every single day. I don’t personally agree with the psychiatric categorizations of mental illness, but these are the rules that the law and the courts have chosen to adopt.

When a troubled person attracts attention, the police are usually called. But the only resource a police officer has is jail, and that’s only going to be for a short time. Sometimes they can pawn the troubled person off to a shelter. If a seriously troubled person comes for therapy, unless he or she represents an imminent and immediate threat to themselves or to others, the system effectively forbids the therapist from doing anything beyond counseling. Even if the subject is a ticking time bomb, unless he or she expresses an active desire to cause harm, therapists, the police, teachers, the clergy and even the courts are denied any real resource for intervention.

And when a person does present an active threat, they can only be hospitalized for 72 hours before being committed as mentally ill, if they actually happen to be so, and if there is a bed available, which these days is rare. A colleague of mine in Virginia had a potentially violent client, checked with the state and found 70 other violent people already waiting in line. By the end of the day, this violent and potentially explosive man was back on the street. The only consolation for mental health professionals is the miracle that more killings aren’t happening every day!

I would like to end by making a few suggestions. These are not complete answers, but they would go a very long way toward mitigating the current situation:

GUNS
Since an assault weapon cannot be used for hunting, and personal defense can be easily accomplished by other means, it is time that society took a stand and joined the rest of the civilized world to establish bans on assault weapons and large capacity magazines. Further, the purposefully designed loopholes in the present reporting system for weapons sales such as unregulated private and gun show sales must be closed. Unfortunately, having the government maintain a list of gun owners feeds right into the paranoia that makes NRA members want assault weapons in the first place!

IDENTIFYING POTENTIAL SHOOTERS
In a many cases, troubled people can be identified before things go bad. I have mentioned having a referral system based on observations from therapists, law enforcement officers, clergy, teachers and even family members. It would be simple to backstop these referrals with a qualified professional so that errors would be minimized.

There are tests that could help identify people who are likely to need help in the future. It would be possible to test all sixteen to twenty year olds for a host of issues. This could cull out most, but unfortunately not all, of the people likely to be future shooters.

But, there is no sense identifying these people if we are not going to provide the resources to help them. The names of people meeting critical criteria could be denied access to firearms. Civil libertarians will not like it, but under the circumstances, it would seem to be a reasonable limitation of personal freedom. Access to this list could be selectively given to parents, teachers, the clergy, therapists, the courts and law enforcement officers.

RESOURCES
There is a desperate need for community based, residential facilities for troubled people. These facilities must be sufficiently funded and staffed so that the needs of patients could be addressed and the reasonable concerns of neighbors mitigated. This would provide a badly needed resource for parents, therapists, law enforcement officers, the clergy, the courts and educators who, with some changes in the law, could refer out troubled people with protection from retribution and lawsuits. This represents a very large expenditure, probably the equivalent cost of an aircraft carrier or a few nuclear missiles.

PSYCHOTHERAPY
Psychotherapy has emphasized cognitive behavioral health for years. Cognitions and behaviors are measurable, observable. And to some extent, altering thoughts and behaviors does help MANAGE emotional issues. But in only rare cases does it HEAL them. This leaves open room for relapse when the person is subjected to challenging circumstances.

There are other healing methods like shamanism that have an established history of providing exactly the healing that troubled shooters require. These approaches can reach the cause of the underlying problems and address them. It is time to begin looking into some of these alternate approaches.

THE LAW
Confining someone against their will who is not mentally ill and who already feels victimized by the world is going to pose a nightmare for the courts and legislators. Where do you draw the line? What about errors in diagnosis? And there will be some. This matter is subjective and emotionally loaded, presenting land mines for the legal system.
As I said, this is a complex issue with many moving parts.

Solutions will require changes in the concerns some politicians have about socialized medicine and our present legal prohibitions around personal privacy. Creating community based mental health clinics will be expensive. But most importantly, what needs to change are the views, fear and ostracism we hold towards troubled people.We need to find our compassion for them. Societies do not die in a cataclysm, that is only the final event in a series of unresolved social issues that cause the social fabric to decay. To delay, to not provide care for the many troubled people who live amongst us, is to only invite more school shootings, and the painful thing about that is what it says about a society that is unwilling to respond to the cries of its neediest people. Perhaps the Mayans were right after all.

(1) To clarify Mullen’s point: Interviews tell us that mass shooters are not exactly loners. They do not seek isolation, and have “friends,” but their social experience is marked by a history of struggling to connect. They experience rejection by their peers or they draw back from potential friendships, assuming they’ll be rejected if they try. They believe they are perceived as unimportant and insignificant. Many mass shooters, rather than wanting to be alone, end up that way because they cannot maintain a connection.

(2) (http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/WhitePaper102512_CGPR.pdf)

 Copyright 2013 Ross Bishop