Mental Illness and Mass Violence

On May 23rd, Elliot Rodger went on a killing spree in Isla Vista, California. Unlike many of America’s growing number of mass killers, Rodger not only used a gun, but also a knife.

Why do mass shootings/stabbings occur? 

Can anyone answer the question of why? The mass killers have several things in common. They are angry loners, usually isolated, usually paranoid (they detect some kind of personal meaning in the actions of others). However, many people with the same characteristics don’t go on killing sprees.

Some people say guns are the reason why massing killings occur. But Elliot also used a knife. Others say mental health funding is the reason. But Elliot was actively receiving mental health services.

I cannot dispute that a madman with an automatic weapon is a very dangerous thing. I cannot dispute that funding mental health clinics is important and necessary. These things are true.

But as a professional, treating some of the potentially dangerous individuals, I see another side. The truth of the recent killer in California was that he was showing signs of dangerousness, and people were concerned. His family, mental health professionals, and law enforcement took action. They tried to do something. The police went out to check on him. And here’s what I know that the general public does not: everyone did their job. They followed all the rules.

When the police went out to his residence on April 30th, they would have spent time observing Elliot Rodger. They would have looked for signs of dangerousness and mental illness that might impair his ability to take care of himself or make him a risk to others. Elliot held himself together long enough to reassure the officers. The officers left, and Elliot continued plotting until he carried out his plans on May 23rd, less than one month after the officers visited his apartment.

So why did this happen? Why didn’t they take Elliot into custody? Put him in a hospital? Protect the public?

The law requires officers personally to observe concerning behavior before taking an allegedly mentally ill person into custody. If they do not observe bizarre or threatening behavior first hand, officers cannot take a person in.

To understand why this is necessary, let us consider the scenario from another angle. What if my loved one could call law enforcement and have me taken into custody for mental illness, simply because my loved-one asserted that I was dangerous? What if my therapist could do the same? It would be a set-up for serious abuses of power. For example: what if my spouse could declare me mentally ill and have me hospitalized to prevent me from getting custody of our children in a divorce? Or what if my concerned loved one was paranoid, seeing mental illness in me instead if realizing he or she needed help?

Elliot’s parents did the right thing by asking police to go out and perform a safety check. The officers followed the law when they checked on Elliot but didn’t take him into custody because they found him to be calm, pleasant, and cooperative. 

I sit down with a family at least once a month and explain why I may not be able do anything to help their mentally ill or disturbed loved-one. The reason is this: in America, above all else, a person has the constitutional right to freedom. If a person with mental illness has not committed a crime or made a very clear threat, he or she has a constitutionally protected right to be free from incarceration. Even those with severe mental illness, if they are not hurting anyone, have this right to freedom.

America used to lock away the mentally ill in institutions, not so many years ago, in fact. And then lawmakers decided than institutionalization was expensive, most often unnecessary, and (most importantly) a violation of the civil rights of mentally ill people.

But we need a better system. 

Motherjones.com has published a timeline of mass shootings/killings in America over the past 32 years. It is apparent from viewing the timeline that these types of horrific events are increasing in frequency. The result, in addition to the tragic loss of life, is that mental illness is further stigmatized. Patients fear a diagnosis like Schizophrenia or even Autism will evoke fear and discrimination. They shy away from treatment.

To end the epidemic of mass violence in America, we need to reduce stigma (without overlabeling normal life as mental illness.) We need treatment for the severely mentally ill. We need research to guide us, training for law enforcement and mental health personnel for reporting and treating potentially dangerous individuals, qualified professionals to assess for signs of dangerousness, and funding to provide people like Elliot Rodger with the treatment programs they need.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

Defining A Parent’s Role After A Child Leaves Home

There are tons of books and articles offering advice on how to parent. They span (almost) every stage: Train your baby to sleep restfully through the night; Teach your toddler manners; Get your kids to eat their vegetables; Talk to kids about sex; Improve your relationship with your teen; Help your kid go to the best possible college. But what about books or articles advising when and how to stop parenting? Where are those?

Letting go after finishing the parenting job is perhaps the biggest lesson of all. Parents wonder: What is the parents’ role when a child leaves home?

The stage between childhood and adulthood can last through the college years, into the mid twenties, and sometimes into the late twenties, thirties, and beyond. Without a clear line between childhood and adulthood these days, how are parents to know their role? But, there is an answer: each family must define the process for letting go of each child.

Defining the parent’s role depends on what path a child takes. If a child is going off to college, parents may be helping pay tuition and living expenses. In some respects, parental support extends childhood for a few years. College students are often not expected to be fully accountable for paying all of their own bills or even for making all of their own decisions. A college student is usually more independent than he was at younger stages of childhood, but he is still more dependent on parents than the average thirty-year-old.

In fact, a parent’s level of involvement may determine whether the child will remain in a dependent child role, or be released into the world as an independent adult. When parents continue to pay the bills, offer sage advice, and oversee young adult offspring, then young adults behave and function much more like adolescents than like bona fide adults. With active parental oversight, why would they act like adults? Why not defer to the “real” adults?

If a child is leaving home for the Army, a parent can hug her and write her lots of letters, and essentially let her go. Other than checking-in by phone or email, leaving home for the armed services doesn’t require much parental oversight. The same applies for the Peace Corps, a job on a cruise ship, or an adult child starting a career away from home. In these cases, parents might have in mind some guidelines for how to help if the need arises.

Will you pitch in funds if your kid has trouble starting out? How much? Under what circumstances?

What if she is making a big purchase, like a car or a home? Will you offer financial assistance?

Aside from money, do you intend to offer other types of support? Advice? Resources, like use of your lake house?

Can your child move back home if life out on her own is too difficult?

Just as parents have done throughout the stages of childhood, parents must dial-back involvement as adult children gradually move toward full independence. And then at some point, parents must lovingly let go. The endpoint of parenting is releasing a child, ready, into adulthood. Trusting adult children to manage their own lives is the ultimate goal.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

How Families Can Re-Group After College Withdrawal

20-year-old Penny came home from college during the middle of her fourth semester, defeated after feeling overwhelmed for months. Unable to keep pace with full time college, she failed every class her third semester and withdrew halfway through the fourth. On Tuesday, Penny was sobbing in my office about returning home to her childhood bedroom. She feared she might get stuck back in childhood and never return to her path to adulthood.

On Thursday, Penny’s parents sat in the same spot in the office, without Penny. They were fuming. Their daughter had not held up her end of the bargain at college. Parents paid tuition and rent for two years, and she only produced credits for the first year. They knew their daughter suffered from anxiety and so they had provided her with every available resource to support her in college. They were shocked to learn she had stopped attending classes during two consecutive semesters. After years of saving for college, Penny was throwing away her opportunity. In addition to missing classes, her parents felt she was overspending. They feared she would continue excessive spending and never act like a responsible adult.

Both Penny and her parents shared the same desire: for Penny to regroup, figure out what had gone wrong, learn necessary skills, and return to college as soon as possible. Penny wanted freedom and opportunity; her parents wanted to see responsibility and accountability. The end point would be an independent adult. The problem was, none of them knew how to move out of frustration and defeat and toward a new start.

During the first week home, Penny spent most of her time in her room crying. When she came out, her parents asked her when she planned to get her act together.

The family needed a plan to move forward, so we sat down and wrote a simple list:

Make A Specific Plan/Agreement

            Spell out the details of what you want Penny to do now that she is home.

            Type up the agreement. Give everyone a copy or post it on the wall.

            Keep your rules as simple as possible

Hold Her Accountable

Resist giving advice. If she is required to work, tell her. But don’t tell her where to apply.

            Make her find her own solutions

            Leave her to operate within the rules.

Be Clear About Rules and Consequences

On the written plan, note how you plan to hold her accountable for the rules. Tell her in advance, in writing, what she can expect to happen if she violates part of the agreement.

            Review it together.

Stay Calm and Mindful

No shouting, name-calling, boundary violations. If you’re upset, take a walk. Talk to a friend or counselor.

            Parents vow not to make financial concessions under pressure.

            Parents discuss decisions with the co-parent.

            If you lose your cool, your message may not be heard.

Follow Through

Require a formal meeting with both parents and a formal request in writing to get any extra money.

            Decide in advance what you plan to do if the whole deal fails.

Do everything as you set out in the beginning. If something comes up you had not planned for, make a plan for the new issue and discuss it before handling it.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.  

Effectively Parenting Older Teens

Parents of older teens and young adults often ask how they can help kids become responsible and mature. After parents spend years teaching moral values and helping kids practice skills for adult life, the final stages of “parenting” can leave parents feeling daunted. Is there anything more a parent can contribute once a child is grown physically but not yet grown-up behaviorally?

Consider the following two high school seniors:

Hunter was a high school senior in the honor’s program at a local public school. Almost overnight he seemed to lose his energy, interest in school, and sense of responsibility. His parents were worried. Frustrated and anxious, his parents yelled at him and called him lazy. They had heated arguments about his lack of motivation for school and asked him if he was stupid enough to throw away his future. They harassed him to get work done, and when he didn’t, on several occasions his parents completed assignments for him. Doing work for him made them angrier and the situation worsened. His grades were failing. His parents were disappointed. They made him an appointment with me because he seemed depressed and they wondered if there was a medication he could take to improve his mood or his academic performance.

Taylor was also a high school senior. He attended the same school as Hunter and took many of the same honor’s classes. Almost overnight he too seemed to lose his energy, interest in school, and sense of responsibility. His parents were worried. He wasn’t studying for exams, so his grades were poor, and within the first month of the school year he was failing three classes. Taylor’s parents had been through a similar experience with an older daughter and were ready with a plan. Taylor was a debate team champion and a basketball star. His parents responded by cancelling all his extracurriculars until further notice and telling him he had to put his grades first. Taylor was upset, but then got to work. He turned his grades around in about three weeks.

The key differences in the parents’ approaches:

1.     Stay Calm. The effective parents maintained their composure. The ineffective parents lost their cool. Staying calm when dealing with a teen can be difficult. Research proves that when teens have trouble keeping calm, parents can get triggered. Mastering your calm takes practice.

2.     Be Confident. The effective parents were confident and in-control. The ineffective parents felt powerless, lacked confidence, and used anger to feel stronger. Remember, you’re the parent and you’re in charge! You may feel overwhelmed, but it’s important to appear strong. If you appear uncertain you may get more pushback.

3.     Plan Ahead. The effective parents had a plan for this situation well in advance. The ineffective parents were caught off guard when their son’s enthusiasm for academics plummeted. High school seniors sometimes suffer a drop in enthusiasm (as do teens and young adults at other stages). Expect predictable bumps in the road and be ready with a plan to head them off. Make your plan before you get irritated or angry.

4.     Teach Accountability. The effective parents’ plan made their son accountable for catching up on his work. The ineffective parents took-on accountability for schoolwork to protect their son’s GPA- depriving their son of the opportunity to practice solving his own problem. When your child makes a mistake or has a lapse in his work ethic, it should be his job to clean up the mess with his grades. Make certain your plan has him doing his own work.

5.     Stay Positive. The effective parents stayed positive. The ineffective parents resorted to yelling and name-calling. Studies show that anxiety lowers test scores. It might seem natural to guilt your child for his failures, but it only helps to push your child as far as it takes so he regrets his mistake. Focusing on his duty to rectify the situation is more effective than reiterating his shortcomings.

6.     Teach Valuable Skills. The teen with ineffective parenting ultimately developed mental health symptoms as a direct result of his low motivation and his parents’ response. The teen with effective parents learned a valuable lesson, practiced skills for accountability he will use in adulthood, and felt proud of his achievement. Teaching adult skills is the primary role of the parents during the last few years at home and in the first few years after young adults leave the nest. Fill their toolboxes to ensure they are equipped.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.