A discussion of VA Tech, mental illness, and searching for "answers" from a social worker's POV
ZOMG public post!
In response to a discussion ishantil and I had yesterday about the Virginia Tech shooter, I decided to write up my opinions on the subject, especially in light of the broadcast on NBC last night of the murderer’s “manifesto,” so it’s being called, which he apparently spent a significant amount of time creating and even took time between the first shootings and the second to mail to NBC News.
My thoughts on the subject are mostly based on professional experience with mental illness and the “system,” and partially based on my own personal opinions, which I believe are what ultimately guided me to work where I work. Feel free to discuss as you will, feel free to think I’m wrong on some issues…the only way we (“we” being American culture, which seems to be having quite the violence problem) can begin to find any sort of path toward improving things is to talk about it.
What happened at Virginia Tech is frightening and, ultimately, probably not logically explicable - at least not in a way that will give anyone any sort of closure. To me, perhaps the most frightening part of the incident is that it could, indeed, happen anywhere. This man is not unique. Although dangerous people (and by that I mean, individuals with the potential of harming others in this way) are the vast minority of all individuals with mental illness, but they’re also the most likely to slip under the radar of everyone: their friends, family, and the “system” put in place to spot people with the potential to be dangerous. Individuals with mental illness are NOT, as a whole, dangerous, despite the public perception…however, there are some that are dangerous. These are the people least likely to seek treatment, most likely to be isolated, and most likely to find destructive and even murderous outlets for their anger. And the worst part is that the dangerous ones usually aren’t recognized as being dangerous until they harm themselves or somebody else. That, tragically, is what happened at Virginia Tech.
But, you say, weren’t there numerous warning signs? Wasn’t this man even involuntarily hospitalized in December of 2005 (according to the mental health evaluation posted on the Washington Post website) for 24 hours? More recently, he was referred for counseling due to the content of his writing for classes, and was referred for disciplinary action for things that the university will not disclose. Weren’t these signs that something like this might happen?
In hindsight, yes, they were signs, and treatment was sought for him. But, and this is something that most people do not understand, involuntary hospitalization is not an easy thing to accomplish. And, although these signs do show that help was needed, they’re not enough to indicate that Cho was planning to do what he did. This man was generally creepy and people were frightened of him, but that is not enough to lock him in the hospital and throw away the key: the state must prove by a preponderance of the evidence that this man is an imminent threat of harm to himself or others. Many times, the only way to determine this is if the patient discloses such ideations…or actually harms himself or someone else. According to the mental health evaluation, Cho denied homicidal and suicidal ideations and was able to hold himself together enough during the evaluation that they had no legal grounds to hold him. They recommended counseling and all that, but such services are voluntary and he chose not to avail himself of them: again, there’s nothing that can be done from a legal standpoint to make him.
In cases like Cho’s, where the patient denies the ideations and refuses treatment, the only thing that the mental health community can do is wait for a reason to hospitalize him. The best we could have hoped for in Cho’s case was that someone noticed him doing something dangerous, but less horrific than the massacre that occurred, such as possibly killing/torturing an animal or attacking one person - not to say that those things aren’t terrible, but they would have been something less than killing 32 people and would have probably been enough to at least get him locked away in a hospital or prison. It’s horrible and, in this case, deadly, that it would take something like that to hospitalize such a sick person but…what’s the alternative? If the system starts locking up people who might possibly harm others, people will be getting locked up first and questions will be asked later, which is an infringement on civil liberties. You can’t prove a negative; you can’t prove something that didn’t happen. It’s just not legal or right to warehouse people because of what they have the potential to do. I mean, even I have the potential to kill if pushed far enough…I’d like to think that will not happen, but it is certainly not impossible. There’s no easy solution, here: either we err on the side of caution and take away people’s rights (which would involve changing so many laws and would generally be unfair to people who’ve done nothing wrong), or we err on the side of individual rights, like we are doing, and potentially let people like Cho out into the community.
This is an endlessly frustrating dichotomy for people in my profession. I have many clients that would be well served in a hospital or residential setting because I fear they might harm themselves or someone else if triggered in the right way…but I don’t have enough evidence to prove that my fears represent an imminent threat. And on the other hand, couldn’t these people be served just as well in the community with the right services? Overwhelmingly, the answer is yes…but it’s a matter of the right intervention - and what is offered and available is typically NOT the right intervention.
So could Cho have been helped by the correct intervention, or was he going to do what he did regardless of anything that might have been done? Obviously, we’ll never know - but it all comes back to the question of whether he could have, given whatever help was right for him, gotten treatment and not done this horrific thing? Was the “right” intervention available to him…does that “right” intervention even exist in the world?
I don’t know if it’s because of my profession or because of who I am, but I believe the answer is yes, that given the “right” treatment and help, this could have been avoided. I base my work on the theory that anyone can change: child abusers, molesters, even killers - and I want to believe that it was possible to change this outcome…if I don’t believe that, my work with my clients would be pointless because I would think it was impossible for them to change. I could very easily be wrong…if the story had been different, if Cho had been getting therapy and medication and such, the same result might still have occurred. But I’d venture to guess that in that case, the blame for this would be firmly planted in the lap of the mental health providers (and probably regardless of their professional competence), and I’m not sure that’s fair.
It’s human nature to want to find a reason for this - to want to blame someone. In cases like this, especially from my profession’s perspective, it’s so easy to blame the parents. So temptingly easy. And, I strongly suspect, that there were things that his parents could have done differently. But I firmly believe that the vast majority of all parents do the best they can with what they have at the time. I’m sure, with hindsight being what it is, that the parents are feeling horribly guilty about everything, and that if they had the opportunity to go back and change things, they would. I’m sure that they didn’t intend for this to happen- yes, they could have probably done more to see the signs and recognize that their son needed help, but what more could they have done?
Most people think, “well, if someone would have just done something, things would have been different.” No, not necessarily. It’s easy to go back now and point out what was missing, but at the time it’s not easy or obvious. I believe that the “right” intervention would have changed things, yes, but knowing what the right intervention is at the time is a shot in the dark. As a mental health professional, all I can do with clients is try what I know has been effective with other clients and try to get to know the client as much as possible to determine what I need to do to help. This takes training and experience, and even then I have as much a chance of being wrong as I do of being correct. The only saving grace I have is that typically, I get more than one chance with a client. Most clients’ violent and dangerous behavior escalates slowly, and I have a chance to see that my intervention is not working and try a different approach when I see them decompensating. It’s not easy to spot those signs or to know what to change - and I am trained in this area. How is it fair to blame the people in Cho’s life…his parents, the school, people who noticed his odd behavior…for not doing something? Even the mental health professionals who tried to hospitalize him and weren’t able to hold him - they did what they could with the information that they had at the time, and they did all they legally could. I feel like we’re asking people to predict the future and what might happen - even for trained professionals, it’s very difficult.
I don’t believe that this man was born with a destiny to become a mass murderer. Perhaps he was born with a biological problem in his brain that made him more likely to become dangerous - I’m not sure what his mental illness was, exactly, and I don’t have enough information to forage a guess. I do feel quite confident, though, when I say that if a mental health professional were given the opportunity to examine his life, medical history, and all of that in minute detail, they would find a trigger or combination of triggers that made him capable of carrying out a massacre.
But those “triggers” are not really a cause, they are simply a trigger. A trigger, as I define it here, is some influence, internal or external, that causes a person with a tendency toward violence to act on his or her impulses. Triggers can be anything - perception is everything in this instance. What is a trigger for one person could be a totally benign thing to the person next to him.
Let’s take, for example, the argument that so often gets tossed around is the argument that violent video games “cause” violent behavior - that school shootings and the like happen because the shooter played Doom after school and the game glorified violence. Well, I can tell you that that argument has a giant fallacy in it: if violent video games were the “cause” of violent behavior, then by that argument EVERYONE who plays these games would exhibit extremely violent behavior, and this is not the case. Plenty of people who play these games are not violent, are not dangerous, and are probably never going to intentionally harm anyone. To me, for something to “cause” something else, the result must occur more than incidentally, which in the case of video games it does not - the vast, vast minority of gamers become killers. The argument that video games cause violence is akin to saying that driving causes drunk driving deaths…it makes no sense. Driving is not the cause; it is the person who drinks and then chooses to drive home. Video games…or nearly anything else, for that matter…do not cause violence in most people - they might, however, possibly cause violence in people who already had the potential for it.
What is important is the trigger. Violent video games can certainly be a trigger - but so could hockey, Hollywood action movies, a bad grade in math class, a random dog walking down the street, or the way that the words rhyme in Green Eggs and Ham. When a person is mentally ill, a trigger can be ANYthing, even things that, to you and me, seem very innocuous.
The one thing that is proven to be a predictor of violent behavior is being a victim of violence. This is the only thing that has been proven to predict violence - but still, it does not apply to everyone. In my cases, where I deal with physical and sexual abuse of children - almost all of my clients who abuse their children were abused in some form or another during their life. However, many children who are my clients (and thus, have been victims of violence) will grow up to never harm a soul. Even violence does not beget violence in 100% of cases, and it’s the best predictor we have (which is why I do what I do - to intervene and try to stop the cycle).
What I’m trying to say, here, is that Cho’s extreme violent behavior and that of those like him does have a cause - it’s just a highly individual cause. What caused Cho to become violent is unique to him, and there’s no way to predict what that cause will be. So blaming his parents - or anyone who touched his life - is unfair.
So what, then, can be done to prevent this from happening again? The answer, sadly, is that all we can do is try to find that “right” intervention before the person does something dangerous…and often we have no way to know what will spark the change from violent thoughts to violent actions. All we can do is be as aware as we can be and try to catch it before it becomes something huge and dramatic like what happened. And that, my friends, is not easy. That’s why all that can really be done to avoid tragedies like this in the future is to be aware of the people around you and to not be afraid to speak up if something doesn’t feel right, and to then hope that someone - or better yet, the community - will come along and help the person in the “right” way before anything happens. I really wish there were something more, but there isn’t.
One thing is for sure, though: blame gets us nowhere. The discussion that needs to be had is about raising awareness of and reducing stigma about mental illness and receiving help - to encourage people who need help to get it before they snap. The discussion that needs to be had is about building communities that support each other and not being afraid to reach out or to offer help. The discussion that needs to be had is about coming together to help people and families who need it, rather than have them be isolated and alone and left to cope in their own.
Will these things eliminate violence? Nope, not by a longshot. But at least then, we can say “we really did do all that we could possibly do.”
Comments and discussion are encouraged. &hearts
In response to a discussion ishantil and I had yesterday about the Virginia Tech shooter, I decided to write up my opinions on the subject, especially in light of the broadcast on NBC last night of the murderer’s “manifesto,” so it’s being called, which he apparently spent a significant amount of time creating and even took time between the first shootings and the second to mail to NBC News.
My thoughts on the subject are mostly based on professional experience with mental illness and the “system,” and partially based on my own personal opinions, which I believe are what ultimately guided me to work where I work. Feel free to discuss as you will, feel free to think I’m wrong on some issues…the only way we (“we” being American culture, which seems to be having quite the violence problem) can begin to find any sort of path toward improving things is to talk about it.
What happened at Virginia Tech is frightening and, ultimately, probably not logically explicable - at least not in a way that will give anyone any sort of closure. To me, perhaps the most frightening part of the incident is that it could, indeed, happen anywhere. This man is not unique. Although dangerous people (and by that I mean, individuals with the potential of harming others in this way) are the vast minority of all individuals with mental illness, but they’re also the most likely to slip under the radar of everyone: their friends, family, and the “system” put in place to spot people with the potential to be dangerous. Individuals with mental illness are NOT, as a whole, dangerous, despite the public perception…however, there are some that are dangerous. These are the people least likely to seek treatment, most likely to be isolated, and most likely to find destructive and even murderous outlets for their anger. And the worst part is that the dangerous ones usually aren’t recognized as being dangerous until they harm themselves or somebody else. That, tragically, is what happened at Virginia Tech.
But, you say, weren’t there numerous warning signs? Wasn’t this man even involuntarily hospitalized in December of 2005 (according to the mental health evaluation posted on the Washington Post website) for 24 hours? More recently, he was referred for counseling due to the content of his writing for classes, and was referred for disciplinary action for things that the university will not disclose. Weren’t these signs that something like this might happen?
In hindsight, yes, they were signs, and treatment was sought for him. But, and this is something that most people do not understand, involuntary hospitalization is not an easy thing to accomplish. And, although these signs do show that help was needed, they’re not enough to indicate that Cho was planning to do what he did. This man was generally creepy and people were frightened of him, but that is not enough to lock him in the hospital and throw away the key: the state must prove by a preponderance of the evidence that this man is an imminent threat of harm to himself or others. Many times, the only way to determine this is if the patient discloses such ideations…or actually harms himself or someone else. According to the mental health evaluation, Cho denied homicidal and suicidal ideations and was able to hold himself together enough during the evaluation that they had no legal grounds to hold him. They recommended counseling and all that, but such services are voluntary and he chose not to avail himself of them: again, there’s nothing that can be done from a legal standpoint to make him.
In cases like Cho’s, where the patient denies the ideations and refuses treatment, the only thing that the mental health community can do is wait for a reason to hospitalize him. The best we could have hoped for in Cho’s case was that someone noticed him doing something dangerous, but less horrific than the massacre that occurred, such as possibly killing/torturing an animal or attacking one person - not to say that those things aren’t terrible, but they would have been something less than killing 32 people and would have probably been enough to at least get him locked away in a hospital or prison. It’s horrible and, in this case, deadly, that it would take something like that to hospitalize such a sick person but…what’s the alternative? If the system starts locking up people who might possibly harm others, people will be getting locked up first and questions will be asked later, which is an infringement on civil liberties. You can’t prove a negative; you can’t prove something that didn’t happen. It’s just not legal or right to warehouse people because of what they have the potential to do. I mean, even I have the potential to kill if pushed far enough…I’d like to think that will not happen, but it is certainly not impossible. There’s no easy solution, here: either we err on the side of caution and take away people’s rights (which would involve changing so many laws and would generally be unfair to people who’ve done nothing wrong), or we err on the side of individual rights, like we are doing, and potentially let people like Cho out into the community.
This is an endlessly frustrating dichotomy for people in my profession. I have many clients that would be well served in a hospital or residential setting because I fear they might harm themselves or someone else if triggered in the right way…but I don’t have enough evidence to prove that my fears represent an imminent threat. And on the other hand, couldn’t these people be served just as well in the community with the right services? Overwhelmingly, the answer is yes…but it’s a matter of the right intervention - and what is offered and available is typically NOT the right intervention.
So could Cho have been helped by the correct intervention, or was he going to do what he did regardless of anything that might have been done? Obviously, we’ll never know - but it all comes back to the question of whether he could have, given whatever help was right for him, gotten treatment and not done this horrific thing? Was the “right” intervention available to him…does that “right” intervention even exist in the world?
I don’t know if it’s because of my profession or because of who I am, but I believe the answer is yes, that given the “right” treatment and help, this could have been avoided. I base my work on the theory that anyone can change: child abusers, molesters, even killers - and I want to believe that it was possible to change this outcome…if I don’t believe that, my work with my clients would be pointless because I would think it was impossible for them to change. I could very easily be wrong…if the story had been different, if Cho had been getting therapy and medication and such, the same result might still have occurred. But I’d venture to guess that in that case, the blame for this would be firmly planted in the lap of the mental health providers (and probably regardless of their professional competence), and I’m not sure that’s fair.
It’s human nature to want to find a reason for this - to want to blame someone. In cases like this, especially from my profession’s perspective, it’s so easy to blame the parents. So temptingly easy. And, I strongly suspect, that there were things that his parents could have done differently. But I firmly believe that the vast majority of all parents do the best they can with what they have at the time. I’m sure, with hindsight being what it is, that the parents are feeling horribly guilty about everything, and that if they had the opportunity to go back and change things, they would. I’m sure that they didn’t intend for this to happen- yes, they could have probably done more to see the signs and recognize that their son needed help, but what more could they have done?
Most people think, “well, if someone would have just done something, things would have been different.” No, not necessarily. It’s easy to go back now and point out what was missing, but at the time it’s not easy or obvious. I believe that the “right” intervention would have changed things, yes, but knowing what the right intervention is at the time is a shot in the dark. As a mental health professional, all I can do with clients is try what I know has been effective with other clients and try to get to know the client as much as possible to determine what I need to do to help. This takes training and experience, and even then I have as much a chance of being wrong as I do of being correct. The only saving grace I have is that typically, I get more than one chance with a client. Most clients’ violent and dangerous behavior escalates slowly, and I have a chance to see that my intervention is not working and try a different approach when I see them decompensating. It’s not easy to spot those signs or to know what to change - and I am trained in this area. How is it fair to blame the people in Cho’s life…his parents, the school, people who noticed his odd behavior…for not doing something? Even the mental health professionals who tried to hospitalize him and weren’t able to hold him - they did what they could with the information that they had at the time, and they did all they legally could. I feel like we’re asking people to predict the future and what might happen - even for trained professionals, it’s very difficult.
I don’t believe that this man was born with a destiny to become a mass murderer. Perhaps he was born with a biological problem in his brain that made him more likely to become dangerous - I’m not sure what his mental illness was, exactly, and I don’t have enough information to forage a guess. I do feel quite confident, though, when I say that if a mental health professional were given the opportunity to examine his life, medical history, and all of that in minute detail, they would find a trigger or combination of triggers that made him capable of carrying out a massacre.
But those “triggers” are not really a cause, they are simply a trigger. A trigger, as I define it here, is some influence, internal or external, that causes a person with a tendency toward violence to act on his or her impulses. Triggers can be anything - perception is everything in this instance. What is a trigger for one person could be a totally benign thing to the person next to him.
Let’s take, for example, the argument that so often gets tossed around is the argument that violent video games “cause” violent behavior - that school shootings and the like happen because the shooter played Doom after school and the game glorified violence. Well, I can tell you that that argument has a giant fallacy in it: if violent video games were the “cause” of violent behavior, then by that argument EVERYONE who plays these games would exhibit extremely violent behavior, and this is not the case. Plenty of people who play these games are not violent, are not dangerous, and are probably never going to intentionally harm anyone. To me, for something to “cause” something else, the result must occur more than incidentally, which in the case of video games it does not - the vast, vast minority of gamers become killers. The argument that video games cause violence is akin to saying that driving causes drunk driving deaths…it makes no sense. Driving is not the cause; it is the person who drinks and then chooses to drive home. Video games…or nearly anything else, for that matter…do not cause violence in most people - they might, however, possibly cause violence in people who already had the potential for it.
What is important is the trigger. Violent video games can certainly be a trigger - but so could hockey, Hollywood action movies, a bad grade in math class, a random dog walking down the street, or the way that the words rhyme in Green Eggs and Ham. When a person is mentally ill, a trigger can be ANYthing, even things that, to you and me, seem very innocuous.
The one thing that is proven to be a predictor of violent behavior is being a victim of violence. This is the only thing that has been proven to predict violence - but still, it does not apply to everyone. In my cases, where I deal with physical and sexual abuse of children - almost all of my clients who abuse their children were abused in some form or another during their life. However, many children who are my clients (and thus, have been victims of violence) will grow up to never harm a soul. Even violence does not beget violence in 100% of cases, and it’s the best predictor we have (which is why I do what I do - to intervene and try to stop the cycle).
What I’m trying to say, here, is that Cho’s extreme violent behavior and that of those like him does have a cause - it’s just a highly individual cause. What caused Cho to become violent is unique to him, and there’s no way to predict what that cause will be. So blaming his parents - or anyone who touched his life - is unfair.
So what, then, can be done to prevent this from happening again? The answer, sadly, is that all we can do is try to find that “right” intervention before the person does something dangerous…and often we have no way to know what will spark the change from violent thoughts to violent actions. All we can do is be as aware as we can be and try to catch it before it becomes something huge and dramatic like what happened. And that, my friends, is not easy. That’s why all that can really be done to avoid tragedies like this in the future is to be aware of the people around you and to not be afraid to speak up if something doesn’t feel right, and to then hope that someone - or better yet, the community - will come along and help the person in the “right” way before anything happens. I really wish there were something more, but there isn’t.
One thing is for sure, though: blame gets us nowhere. The discussion that needs to be had is about raising awareness of and reducing stigma about mental illness and receiving help - to encourage people who need help to get it before they snap. The discussion that needs to be had is about building communities that support each other and not being afraid to reach out or to offer help. The discussion that needs to be had is about coming together to help people and families who need it, rather than have them be isolated and alone and left to cope in their own.
Will these things eliminate violence? Nope, not by a longshot. But at least then, we can say “we really did do all that we could possibly do.”
Comments and discussion are encouraged. &hearts