What to do about dangerous crazy people

[Keleynal]

I was reading a CNN article today by Ann O'Neill and Sara Weisfeldt (2015) regarding the trial of James Holmes, the so called Batman massacre killer. For anyone that missed it, he's the guy that opened fire in a crowded theater for the premier of Dark Knight Rises. He killed 12 and wounded 70. There's speculation that he was trying to emulate the Joker in some way. He failed miserably. The Joker is much better at not getting caught.

The main focus of the article is on the testimony of Holmes' psychiatrist, Dr Fenton. According to her, Holmes struggled with homicidal thoughts and talked about hating everyone and killing them. However, he never made specific threats or names targets, nor was she aware of him actually stockpiling weapons. Since he never crossed those lines with her, everything was kept confidential, and Dr Fenton tried to keep him in treatment and build trust with him. Unfortunately, he stopped his sessions. One month later, he committed his crimes.

So here's where I get conflicted. In hindsight, Holmes is a very dangerous person. This crime could have been prevented if he was in a treatment facility where he was forced to attend therapy and take medications until he reached some kind of breakthrough, if ever. However, patient/doctor confidentiality is very important. If people aren't comfortable talking with a professional about their issues or think they will be reported for having abnormal thoughts, then many will not seek the help that could prevent them from taking action. For every one like Holmes that isn't stopped, I do think there are others that benefit from having a confidante and never cross that line.

Maybe there's a middle ground. What if social service professionals were able to add individuals of concern to a confidential list? That list would be encrypted and not able to be read by anyone. If the individual were to try to purchase a weapon, it would send an alert to the provider that placed them on the list. If no hits occurred, they would be removed from the list automatically after three months. The provider could add them again if still needed.

I think this system could provide a good middle ground between protecting confidentiality and identifying problems before they turn into tragedies.

Article cited:

O'Neill, A. and Weisfeldt, S. (2015). Psychiatrist: Holmes thought 3-4 times a day about killing. CCN.com, online. Retrieved from http://www.cnn.com/2015/06/16/us/james-holmes-theater-shooting-fenton/index.html June 17, 2015.

 

[Baldoraxx]

Thanks for bringing this up Kel, this has been on my heart recently and was wondering if anyone else was thinking about it.

Since he never crossed those lines with her, everything was kept confidential, and Dr Fenton tried to keep him in treatment and build trust with him. Unfortunately, he stopped his sessions. One month later, he committed his crimes.

This part here, it seems like he wanted help. At some point the therapist should have discretion to contact authority to help get people in these situations more help. Or just help since he stopped coming. Did she clear him or did he just stop coming? That would throw some red flags for me if I was the therapist. hmm our last session he wanted to commit homicide....he should be fine...this could have been preventive.

Now back to the issue of privacy vs freedom. If there was a clause that stated "If at some point the patient becomes unstable and has criminal thoughts it can become the Dr's discretion to contact the correct authority to give the patient needed treatment"...I don't think many patients will be going to get therapy after something like this happens which could actually make things worse for those who are actually trying to get help. I'm borderline. I want there to be help but I know lawmakers will make a huge mess of things.

 

[dainjre]

Honestly, the doctor did nothing wrong. Even through the confidentiality stuff, she's still a mandatory reporter for any suspicious or dangerous activity. Nothing is going to stop people from doing stuff like this unless we go into a minority report type situation. Also if that guy had tried to do something like that here he would've been immediately shot by someone in the audience that's carrying.

 

[Keleynal]

Honestly, the doctor did nothing wrong. Even through the confidentiality stuff, she's still a mandatory reporter for any suspicious or dangerous activity. Nothing is going to stop people from doing stuff like this unless we go into a minority report type situation. Also if that guy had tried to do something like that here he would've been immediately shot by someone in the audience that's carrying.

People like this tend to be pretty cowardly, so they target places that prohibit firearms. If they had REAL balls and wanted to make a statement, they'd raid a police station.

This part here, it seems like he wanted help. At some point the therapist should have discretion to contact authority to help get people in these situations more help. Or just help since he stopped coming. Did she clear him or did he just stop coming? That would throw some red flags for me if I was the therapist. hmm our last session he wanted to commit homicide....he should be fine...this could have been preventive.

Now back to the issue of privacy vs freedom. If there was a clause that stated "If at some point the patient becomes unstable and has criminal thoughts it can become the Dr's discretion to contact the correct authority to give the patient needed treatment"...I don't think many patients will be going to get therapy after something like this happens which could actually make things worse for those who are actually trying to get help. I'm borderline. I want there to be help but I know lawmakers will make a huge mess of things.

It's not illegal to want to kill someone. Many of us feel like killing our bosses, children, or spouses (or at least seriously maiming them) at some point. The mandatory reporting is when there is some kind of specific threat or evidence of actual planning. Based on the limited information provided by that article, it looks like he his all actual intent until he did it.

Health providers won't stick their necks out too far. If I mentioned to my doctor that I was having homicidal thoughts and he reported me, I could then sue him for violating confidentiality. If doctors ran to law enforcement every time they heard a rumor, people would stop opening up to them. I think the result would be that even less cases would be prevented than they are now.

My idea would not have stopped this incident. Holmes used guns that he stole from his family (he shot his mom before going to the theater), so there would be no record of him trying to purchase anything. I'm just trying to think of more tools that we could use that would provide enough credible threat so providers could report it without being sued.

 

[Euchale]

Just throwing in my 52 cents:
Not giving guns to people has worked pretty well in Germany. The last shooting of a confirmed insane person was... um I can´t remember. We still get the occasional school shooting though.

 

[Keleynal]

Just throwing in my 52 cents:
Not giving guns to people has worked pretty well in Germany. The last shooting of a confirmed insane person was... um I can´t remember. We still get the occasional school shooting though.

It's nice to know that only sane people shoot each other in Germany.... actually, I'm not sure that's better.

 

[PsionicFox]

I think a vitally important step is education. So few people know what to look for when it comes to mental illness, to many people fly under the radar until its too late. Also, lets educate people on the proper causes, instead of blaming rap music, or movies, or videogames.

I listen to rap music - haven't killed anybody.

I watch lots of movies - haven't killed anybodt.

And I play violent video games daily - haven't killed anybody.

These things don't make people violent. The wrong kind of crazy person IS violent. And can have trouble figuring out reality from fiction.

 

[Cheese]

Stupid and Crazy are two forces that can not be stopped.
The only thing that can be done is to start early and give people a real education and an opportunity to experience empathy.

Thus begins the real problem, education cant be fixed by people who like the ideas of avoiding it.
Controllable masses does not mix well with education and empathetic thinking.
Thus we have this world.

Tracking, helping, anything we do to "those people" will not keep us safe or stop it in the long run.
To be honest, the harder we fight established crazy the more we encourage the escalation of it.
We must accept that this world we have established does not work, and no system can eradicate crazy, but we can strive to improve.
Now, to convince the people who have lots of money and power in this broken world to change...

 

[Keleynal]

Stupid and Crazy are two forces that can not be stopped.
The only thing that can be done is to start early and give people a real education and an opportunity to experience empathy.

Thus begins the real problem, education cant be fixed by people who like the ideas of avoiding it.
Controllable masses does not mix well with education and empathetic thinking.
Thus we have this world.

Tracking, helping, anything we do to "those people" will not keep us safe or stop it in the long run.
To be honest, the harder we fight established crazy the more we encourage the escalation of it.
We must accept that this world we have established does not work, and no system can eradicate crazy, but we can strive to improve.
Now, to convince the people who have lots of money and power in this broken world to change...

It's actually becoming frighteningly common in Dutch culture to euthanize those with mental deficiencies or health problems. In 2013, 650 babies born alive were euthanized. Most of them had painful or incurable medical issues, but others simply had Down Syndrome or something similar. Adult mental patients are also being euthanized, sometimes without their consent.

I don't think that this is the answer in any shape or form, and it's more about the inconvenience of having to care for the mentally ill or sick people rather than fear of violent behavior that is driving the euthanization. I think it does show that some are willing to go tot he extreme of killing off the crazy rather than try to deal with it at all.

Here's one article about it: http://www.lifenews.com/2015/01/02/...nder-assisted-suicide-law-in-the-netherlands/

 

[Passage]

Maybe there's a middle ground. What if social service professionals were able to add individuals of concern to a confidential list? That list would be encrypted and not able to be read by anyone. If the individual were to try to purchase a weapon, it would send an alert to the provider that placed them on the list. If no hits occurred, they would be removed from the list automatically after three months. The provider could add them again if still needed.

I could see something like this working out, though no list ever goes unread. On a tangent, it's ethically similar to the government screening calls & internet traffic & whatnot.

 

[Keleynal]

I could see something like this working out, though no list ever goes unread. On a tangent, it's ethically similar to the government screening calls & internet traffic & whatnot.

It would be encrypted, but if someone was just determined, I'm sure they could get at it eventually. Not sure what it would profit them, though.