Can We Predict Who Will Be Violent?
Lately, the news has been filled with reports of violence towards others. Earlier this autumn, a man went on a shooting rampage at the Washington Navy Yard. We have witnessed school shootings and horrible violence at a movie theatre. After these events, we wonder—why couldn’t we anticipate these individuals would become dangerous?
Hindsight, sadly, has perfect 20-20 vision. Afterwards, it seems so obvious that Aaron Alexis, who went on the shooting spree at the Navy Yard, posed a threat long before the attack. Why is it, then, so difficult to predict that these individuals will become violent?
In an article in the New York Times (September 18, 2013) by Denise Grady, the author, explored these issues. Jeffrey Swanson, a professor of psychiatry at Duke University, noted; “I can tell you the common characteristics of people who engage in mass shootings: It’s a picture of troubled, isolated young men that matches the picture of tens of thousands of other young men who will never do this.”
Therein lies the problem. The overwhelming majority of individuals with similar symptoms and characteristics of an Aaron Alexis (Navy Yard) or an Adam Lanza (Newton school shooting) will never hurt a soul. And because violence towards others is a relatively rare event (fortunately), it makes it even more difficult to discern a pattern of characteristics that will result in a violent act.
Not surprisingly, Dr. Swanson cites several studies that found psychiatrists and psychologists were not able to make accurate predictions of aggressive behavior. Some studies showed that these mental health experts were good at predicting who wouldn’t become violent, but poor at recognizing who would.
Dr. Michael Stone, a clinical professor of psychiatry at Columbia University, analyzed 298 mass murderers. In fact, only 22% suffered from psychotic or delusional symptoms. Many of the violent acts were from angry, jealous, or disgruntled workers who wanted to punish their bosses.
In the early 1980’s, I directed a crisis intervention program in a community of 200,000 people. I was responsible for evaluating both children and adults who might be at risk of harming themselves or others. I personally interviewed 100’s of at-risk individuals. To a large degree, mental health professionals are dependent on what people tell us. We can’t read their minds. Many distressed kids and adults are fearful or wary of telling us what they are really thinking and feeling. And they frequently leave out important information that would help us make a reasonable decision about what to do. Without these important facts, we are in the dark.
Clearly, there is a great need to provide better care for troubled children who are likely to become even more disturbed adults. Just last week, President Obama ordered that all insurance plans would treat mental health conditions in the same way (parity) that other medical concerns are handled. For many years, there were restrictions on mental health care for both children and adults. This is an important step towards providing help to those that need it.
Despite varying opinions on the Affordable Care Act of 2008, it will make available mental health services to individuals who are currently unable to afford health insurance starting in 2014. This is a step in the right direction.
In an article in the New York Times (November 9, 2013) Lee Gutkind, looks back at two children with psychiatric problems he described over twenty years ago. He notes that there are 15 million children in the United States that suffer from some kind of mental health disorder, but that the overall spending on these conditions have declined since the 1980’s.
All of the research on treatment effectiveness show that the combination of medication and psychotherapy provide the best outcomes for children. Yet there is a shortage of child psychiatric prescribers and child mental health specialists in our country. And, it is often less expensive for families to simply seek medication for their children than to participate in therapy, which is more costly.
I am not confident that we will have any “crystal balls” in the near future that will help us predict the future behavior of anyone. But I do know that we need to have improved access to mental health care for kids and adults that need it.
What do you think?