Tahlequah Daily Press

February 19, 2014

Linking violence, illness can foster bias

Final in a three-part series on mental health

Staff Writer

TAHLEQUAH — After a 20-year-old man entered a Connecticut school Dec. 14, 2012, and went on a killing spree before committing suicide, a number of national debates arose surrounding gun legislation and mental health issues.

Gun control discussions were familiar in the wake of mass killing incidents. But until Sandy Hook, mental health had not been discussed as often.

Since the incident at Sandy Hook Elementary School, in Newtown, Conn., in which 20 children and six adults were killed, 44 school shootings have been reported across 24 states - more than three per month. The shootings have killed 28 and injured 37.

Eight school shootings occurred in a three-week span during January 2014.

Dr. Melinda Shaver, a Tahlequah psychologist, said mental illness is a possible, but hardly definitive, warning sign for potentially violent behavior. Other factors include aggression, withdrawal, violence in the home or being bullied.

“It is very difficult to predict violent behavior, but extra attention should be paid to individuals with warning signs,” Shaver said. “Teachers, counselors and parents should be made aware of indicators, and if a child or adolescent shows them, they should seek mental health treatment and be carefully supervised.”

Shootings at schools and elsewhere have Congress, state legislatures and school boards asking whether better access to mental health care might reduce the number of incidents.

But there is risk to assuming mental illness leads to mass shootings. The condition of Adam Lanza, the Newtown shooter, prompted a mental health debate, but Lanza reportedly received diagnoses of Asperger syndrome and sensory processing disorder. Neither are mental illnesses. Speculation also suggested  Lanza’s behavior indicated obsessive-compulsive disorder, but he was never diagnosed.

After James Eagan Holmes killed 12 people in an Aurora, Colo., theater in 2012, his attorneys entered the plea many expected: not guilty by reason of insanity. Holmes’ trial has not yet begun.

Mental health experts worry that such assumptions and pleas will worsen public opinion of afflicted persons already dealing with stigmas.

Groups such as the American Psychiatric Association cite many studies that indicate no link between mental illness and violence.

The overwhelming majority of Americans with mental disorders are not violent. But advocacy groups cite widespread refusal by the public to associate with, rent to, or employ those with mental illnesses, particularly those with schizophrenia and other severe disorders. The groups further cite ostracism as leading to shame, embarrassment, and hesitancy or refusal to seek treatment.

Shaver said determining whether a patient has violent impulses can be a difficult balancing act. Mental health professionals want to protect their patients, who sometimes are uncooperative.

“Obviously, there needs to be trust between a therapist and patient, which can make diagnosis a tricky situation to maneuver,” she said. “However, if a patient understands the therapist has their best interest in mind and realizes the therapist cares about them, the situation can be easier to navigate. Unfortunately, this is not always the case, and there might not be a therapeutic relationship. Ultimately, a therapist is legally required to notify the authorities if a threat has been made against someone.”

Studies indicate mental disorders are as common in teens as in adults, with figures of 20-25 percent at any given time. The most common mental problems faced by teens - depression, eating disorders and anxiety disorders – include no predisposition to violence.

Mental health studies also often link certain outcomes to better care, such as lower incidence of substance addiction and suicide, and an analysis by The New York Times suggested that most perpetrators of recent mass shootings suffered from mental illness.

Conversely, an international study found that those with schizophrenia – a disorder often accompanied by violent incidents – have a 1-in-140,000 chance of killing a stranger, suggesting schizophrenia is no greater an indicator than age or gender.

Most disorders are treatable with a combination of psychotherapy and medication, but Shaver said mental illness is a spectrum of curable, treatable and incurable conditions.

“Some disorders, such as depression and anxiety, can be situational or biological,” Shaver said. “Situational disorders can often be treated and will not recur. If the disorder is biological, the depression or anxiety may persists, or come and go.”

Shaver said biological disorders may always need treatment, sometimes with an antidepressant.

“Bipolar disorders and schizophrenia usually must be treated with medication,” she said. “Symptoms can be controlled but are never likely to subside. There are also personality disorders, which are not considered curable, and many insurance companies will not pay for their treatment.”