Sunday, October 4, 2015

I have seen the enemy, and it is us.

Recap: A horrifying tragedy happened in my home state this past week, on a community college campus.  A shooter opened fire on campus leaving 9 others dead and many more injured\

Then more tragedy ensued when (predictably) everyone in Oregon (perhaps slight exaggeration) began nasty infighting which was unnecessarily rigid, refused to listen, and perplexingly, all seemingly focused on the idea that their one solution was correct.

What is really weird about that last part is that no suggestion I have heard is mutually exclusive toward other points of view.  I don't know why we have this idea that a problem this complex has a really simple solution, but it is crazy.

The polarized viewpoints lead to no solutions happening, no action being taken.  This is not like other political issues in which two sides actually want a different outcome.  If you read no other part of this post, please read the following line, as it is really important:

WE ALL WANT THE SAME THING WHICH IS FOR THE SCARY MASS SHOOTINGS TO STOP.

This will never happen until we decide it is worth working together with people we normally oppose.  Listen carefully to me: If you refuse to hear out your fellow man, I sure hope you are ok with having blood on your hands.  If we can't start working together, this trend will continue and get worse.

You will lose NOTHING if you stop one time to listen to someone else's ideas on this subject without spending that time formulating a response in your head.  You ONLY stand to gain.  What are you afraid of?  That they will change your mind?  If that's the case, you may want to re-think your position.

The rest of this post will be divided into three different major parts, all with sub-parts.  Here is an outline to help you avoid any boring parts you don't care about.
A. Discussion of major proposed solutions
  1. Gun control or not
  2. Improved mental health care
  3. Empathy/improved care for others/community
B. Factors Which Predict Violence, as understood by someone who works with a bunch of risk-focused psychologists (but is not personally a psychologist, so this is professionally absorbed and applied knowledge).
C. Concluding Statements.

Ok, buckle up because here we go.

A. Discussion of major proposed solutions
There seems to be a weird argument going on about gun control vs. improved mental health care, with a third party chiming in and saying it all boils down to loving each other more.  Spoiler alert: this is part of my conclusion, but why aren't we looking at MORE THAN ONE SOLUTION.  We could do them all.  At the same time.  Really, we could, America.  We're cool like that.

1. Gun Control vs. We Should All Have Guns
So, I had some opinions about this that were based on assumptions and hunches, and fully admitted that I knew little about how much access to guns contributed to violence.  The republicans and democrats will tell you different things but they each have agendas so I wasn't willing to listen to any of their statistics/spins on their statistics.  And I know Wikipedia isn't the #1 most reliable source ever, but it is a good place to find information that can't be polarized too far one way, plus it's a great place to get lots of stats.

I started out by comparing each state's or district's rate of gun murder to their rate of gun ownership.  I didn't do this in the most statistically illuminating way.  I scored each state/district (hereby just referred to as "state") by rate of gun murders, giving 51 to the state with the highest rate, 1 the state with the lowest rate.  Then I did the same thing with gun ownership.  I even made a super unsophisticated graph of it which may not make much sense to others (plus it's kind of clunky) but I'd be happy to show it to others if you're interested.

The results were disappointingly very inconclusive.  Supporting the side that controlling gun ownership increases gun violence was Washington DC.  DC ranked the highest among rate of gun murders, and lowest among gun ownership, and there was also Alaska which ranked very high in gun ownership and very low in gun murders.

On the flip side, we have Hawaii which is both low in gun ownership and gun murders, and Mississippi and Louisiana, which both rank high in gun ownership and high in gun murders.

Looking over the list of states, I'm noticing some regional trends.  In the south, there tends to be high gun ownership and high gun murder.  In very sparse states (Alaska, Wyoming, the Dakotas) there tends to be both high gun ownership and low gun murder.  In more laid-back places like Colorado, Washington, New Hampshire, Hawaii, there tends to be low gun ownership and low gun murder.  And in densely populated states with very busy and fast paced cities such as DC, Delaware, New York, Florida, Illinois, there tends to be low gun ownership but high gun murder.

What this suggests to me is that the answer to how we regulate gun ownership must be much more nuanced than "yes" or "no," and the answer needs to be localized to the local culture.  If you live in rural Alaska, you need a gun to protect yourself from wild animals--to suggest otherwise is honestly pretty crazy.  On the flip side, to suggest we need to bring more guns to Hawaii to make Hawaii safer is equally crazy. Do we need to encourage more gun ownership in places like DC, and less gun ownership in places like Louisiana?  Those suggestions don't really sound right to me either.  Am I proposing that we need to leave things how they are?  NO.  I'm proposing we need to bring in some cultural anthropologists/sociologists to look at how guns are part of local cultures and how people can own guns safely, because I do not believe there is a one size fits all answer here.

*I would be happy to talk about knife control when we face an epidemic of mass stabbings.  So far I haven't heard any.  If I'm just totally in the dark about this awful epidemic, please let me know.

2. Improve Mental Health Care

A MOST IMPORTANT POINT: Sufferers of mental illness are more likely to be victims of violence than they are to act violently.  Sometimes being mentally ill can lead to violent behavior, but in the vast majority of cases it does not.

I hear this usually thrown out as a real solution, but I do sometimes hear it as an attempt to deflect from needing to look at how we own guns.  I don't want to lump people together, but I do know lots of people who support gun rights who also do not typically support additional funding for this kind of thing.  As someone who expended thousands of dollars and several years of my life to become a mental health professional, I wonder sometimes if these people think I should be volunteering all my time instead of making a living ;).  Good mental health care comes with a monetary price, because it is something that has value for society at large, so I just want to be clear about that.

I usually hear 3 diagnoses discussed as possible reasons for violence, and though there are more, I am going to focus on short descriptions of each of these, as well as what it can take to treat them, just so we are aware of what it means to invest in better care for each. (To my fellow mental health professionals, I am trying to give cliffnotes versions here, so I am probably not going to elaborate a lot more, but if I have facts wrong, please chime in and help me out.)

a. Schizophrenia
Schizophrenia is characterized by psychotic symptoms.  They are usually categorized into positive (adding something to your presentation) and negative (taking something from you) symptoms.  Positive symptoms are things like hallucinations (perceiving something that isn't there) and delusions (beliefs that continue to be held despite lack of evidence/existence of evidence to the contrary).  Negative symptoms are things like withdrawl from social relationships, lack of talking.  An extreme example would be catatonia.  Some cases of schizophrenia can be treated fairly well by medications.  Some require heavier medications with worse side effects, so they require a lot of monitoring to ensure that the person stays healthy and complies with the medication.  Sometimes extreme, few cases never respond well enough to restore functioning, and the person requires care and may never be able to maintain in an independent living situation.  Most people with schizophrenia are not dangerous, but some hear malicious voices that tell them to do awful things, and threaten to harm the sufferer's loved ones if they do not comply.  In addition, sometimes street drugs can feel soothing to people with schizophrenia, but they exacerbate symptoms and risk for dangerousness.

For someone with a severe case of the illness, treatment likely comes at the tune of several thousand dollars per month.  If they are in the community, between housing in a group home plus medication and other treatments like CBT for Psychosis, I am going to hazard a guess of at least $4,000/month. If they are hospitalized at Oregon State Hospital, it is somewhere in the neighborhood of $25,000 per month.  Month, not year.   I am so in favor of better treatment for people with this illness, but if you are going to make this claim, I want you to look at the price tag.  That does not even include costs of researching better treatment.

b. Autism
Autism is a neurodevelopmental disorder.  It primarily effects social development, recognition of social cues, and understanding that other people have the same emotions that they do.  There are no cures and no medications that get at the heart of the disorder.  Care often involves skills training and lifelong support, though many higher-functioning cases of autism live independent and virtually undetected in society.

In several mass shootings in recent years, the shooter's actions have been attributed to autism (formerly known as asperger's, but the phrasology is changing).  I have yet to hear of a case where this was 100% confirmed.  People with autism may sometimes be prone to frustrated outbursts which can be violent, but it's not quite so planned and premeditated.

That said, it is absolutely possible that someone with autism may become obsessed with committing a violent act, especially after being subject to social rejection, and I totally support research efforts that move toward helping people with this disorder integrate better into society.  (P.S. research trials are not cheap. I don't know an exact price tag, and I have every faith that your google skills are as good as mine.)

c. "Being a psychopath" aka Psychopathy aka Antisocial Personality Disorder
Say it with me: "Being a psychopath is very different from experiencing psychosis."  We defined psychosis above as experiencing hallucinations and delusions.  Basically the only thing psychosis and psychopathy have in common is that they both start with the same 5 letters.

Psychopathy is the outstanding quality of someone with Antisocial Personality Disorder, now abbreviated to ASPD.  Research is increasingly demonstrating that there is something different about the brain of someone with ASPD, specifically the part that allows feelings of empathy.  They have dramatically fewer emotions than your neurotypical person, and are motivated by different things because consequences that deter most of us (feeling shame for one) do not deter someone with ASPD.  The disorder is more common than people realize, partially because many people with this disorder learn to act as if they do have an average amount of emotions.

For people with ASPD, life is a constant question of whether the methods of getting what one wants are worth the potential consequences.  They are masters of understanding risks, as defined by their own priorities.  Therefore, if someone decides that, say, notoriety, is worth the loss of their own life, then realizing that shooting up a school may cost them their life is a fair trade for them, on balance.

There are no medications known to treat this disorder.  The only treatment we know about is properly motivating someone with ASPD to behave in pro-social ways, and having safeguards to prevent them from acting in ways we don't want them to.  And, as with the other disorders, more research to see whether there is, indeed, more that we can do.  Bottom line, while research may eventually find an effective treatment for ASPD, right now "improving the mental health system" in hopes that people with ASPD will cease with their antisocial behavior is completely unrealistic.

One last note on this topic: Other mental health conditions can contribute to violence too, including PTSD, Bipolar Disorder, and others, and they are all also expensive and time intensive to treat.

3. Empathy
This line of reasoning suggests that we live in a very isolated society anymore and don't even know our neighbors.  That reaching out to others and connecting with them as humans can reduce their risk of violence.  That becoming involved with a high-risk kid can make him or her a low-risk kid.

This is all correct.  I don't really see how anyone could argue against it.  So...first of all...do it! :)  (I can do so much more in this area myself.)

Secondly, STOP decrying anti-bullying programs in schools!  And/OR, implement pro-empathy programs in schools!  Maybe we will never fully stop bullies, but we can make progress and we can change lives of at least a good portion of the bullied AND the bulliers.  Maybe kids learn from adversity, but many of the kids who are being bullied (and who are bullies) already experience significant adversity.  Plus, bullying is not the only type of adversity a kid could experience, but it could be one of the more impacting ones.

Thirdly, this can be done in conjunction with examining our use of guns and our mental health care system.

B. Factors Which Predict Violence
There are so many of these.  I work two jobs, and my husband, friends, and family like to spend time with me on occasion too, so I am not going to go through every one.  I am going to lump some into groups, and quite honestly, even then I'm not going to discuss each one.  For more information, I suggest using your local library.  Or Google.  There's Google.  (Just be sure to check the source; if it comes from a news site, it's probably got an agenda.  Anything that sounds psychology-ish is probably a better bet.)

1. As a child, difficulty meeting behavioral expectations in school.  Of note, having brought a weapon to school previously, though I am assuming this means intentionally with thoughts of harming others, not "I live in a rural area, go hunting on the weekends, and forgot to take my hunting rifle out of the bed of my truck."
2. Past violent behavior, including violent outbursts/tantrums, harming others, harming animals, bullying (oh goodness, can't we please stop writing off our modern kids as pansies and actually look at this?), a pattern of violent threats when angry, firesetting.
3. Recent experience of humiliation, loss, or rejection/poor peer relations/being socioeconomically disadvantaged (see the importance of using empathy??)
4. Past suicide attempts (see: supporting better mental health care)
5. Preoccupation with weapons or explosives (this is a researched risk factor for violence.  But we don't need to examine the ways in which we own guns? Guns count as weapons, right?  Look, I'm not saying that nobody should ever have them, but I just don't see how we get around examining this as a real issue.)
6. Low neighborhood attachment and community involvement (EMPATHY!!)
7. Access to guns or weapons.  In isolation, this is not so much of a risk factor.  BUT IT CONTRIBUTES.  This is supported by psychological research.  It's not really up for debate that this does contribute to risk, and we need to take a deeper look at how to proceed.
8. Poor home environment growing up. (Oh goodness...empathy...we need to re-discover community!!)

C. Concluding Statements
If you have good suggestions about how to reduce these horrifying, deadly attacks, please be prepared to discuss with the people around you in an intelligent and informed manner, and more importantly...

Remember that you have two ears but only one mouth.  So listen more than you speak.

AND...

The

solution

is

multifaceted.

This is not either/or, and it never will be.

Please engage in a civil manner.  If you cannot, step away from the keyboard, and come back after you have taken a time out.

If you cannot collaborate YOU ARE PART OF THE PROBLEM.