Sunday, July 29, 2012

The Difference Between Going Postal and Suffering Paranoid Schizophrenia

On Friday I tweeted (a little smug, sorry),

"Don't listen to me :). Holmes suffered from schizophrenia. Treated by a doc at U of Co, head of the department."

Apparently James Holmes had been treated by the director of student mental-health services at the University of Colorado Anschutz Medical Campus.

Dr. Lynne Fenton is a researcher in schizophrenia and bipolar disorder, as well. Days after the shooting she received a package from Holmes, drawings depicting stick figures and a man with a rifle-- a mass shooting spree. Perhaps she had asked him to draw what he saw in his head.

Nobody would want to be in Dr. Fenton's position right now. It is the reason that one of my best friends got out of treating mental illness, turned academic full time, never looked back. Psychiatrists can prescribe medication, so they are the ones who see the most violent patients. Although most patients who suffer psychotic disorders are not violent, some are.

Only the strong have the stomach for this. As much as we hear about violence, we're all a little afraid that a threatening patient will turn on us, or will turn on someone else, and we will be responsible.

At lunch today the discussion turned to Holmes and someone brought out the evil card. Yours truly couldn't handle it, had to lecture about mental illness and the difference between vengeful, angry people, and those who are terrified to the core, hear demanding voices in their heads, eventually surrender to them, give in, act out.

Once I was riding my bike. Approaching a woman on the sidewalk dressed in a bright summer outfit (it wasn't summer) we locked eyes. She had an odd look and I knew, at that moment just knew, that she suffered from some psychosis, probably schizophrenia. She spat at me, missed by only a few inches, too, and I sped away. Maybe a voice in her head said,
"She's dangerous, she's on to you, she knows about you. Get her first."
A reverse empath.

Some people suffering from psychoses like schizophrenia and bi-polar disorder are so confused, their boundaries so poor, that they believe that they are not only the agents of God or The Devil, but that they have been endowed as super figures, omnipotent beings, biblical prophets, Jesus, or the nemesis of all that is good,
The Joker.

I say all of this at lunch and someone logically opines. "I think he just went postal. He'd been marginalized so many years, he had enough, wanted to punish the world." Postal, if you recall, is a reference to an actual postal worker who, fired from his job, returned and attacked his co-workers.

Could be. But most kids who show up at a university counseling center are not seen by the director who happens to have a research background in psychosis. They are seen by staff clinicians. We can all do anger management.

Then today we hear about the first copycat. He's a joker and has been fired from his job. He has an arsenal.
. . . a Maryland man who called himself "a joker" and had an arsenal of semiautomatic rifles threatened to shoot up the business in Palmer Park from which he was being fired, and was wearing a T-shirt reading, "Guns don't kill people. I do," when confronted by officers . .

The man, identified in a search warrant as Neil Prescott, 28 years old, made multiple threats in phone calls this week. The shooting in Colorado, coupled with the "joker" reference, gave the comments extra urgency, officials said.
The difference between Holmes and Prescott?

Holmes is a brilliant young man who graduated at the top of his class, then seems to have gradually declined following graduation from University of California. His mental health deteriorated to the degree that he failed his neuroscience exam in June and dropped out. It appears that his sense of identity merged with a movie character, a villain, the Joker. He did what the Joker is supposed to do, set out to slaughter his "enemies." He did so with precision, planning, deliberation, joy. The Batman movie is all about slaughtering enemies, the perversity of killing. Great stuff, must be.

Neil Prescott, on the other hand, has no problem with his identity. "Guns don't kill people, I do." Prescott knows who he is and what he is doing.
Neil Prescott (ABC news)

He is a man known for his sense of humor, who plays jokes, and who seems to be something of a neighborhood watch kind of guy.  A gentle giant.  He has a huge arms collection.

He is fired from his job. He makes several calls threatening revenge. But he doesn't carry out his plan. Calls for help, maybe? Or attention? Someone stop me, 
I want to kill these people who have ruined my life by firing me. 
Someone pay attention, here!

They both planned an attack, but only Holmes carried his through; the pain, or at least the depths of the illness, greater than that of his copycat.



Charles Phillips said...

my friend and room mate is a schizophrenic who takes meds and have known him for 8 years .I have had to call police twice when he stopped meds (the voices Came back0 He is high functioning and attends university with A average .I am a little concerned about him because he sleeps a lot during the day now that school is finished .in fact he sleeps unless he has a specific commitment like work, dates,dr appointments .I suspect that he is not informing medical staff about sleep habits . I realize the side effects of high medication( 8oomg syroquill)are onerous but wonder if he will be able to function when he gets a real job after graduating next year .what can i do to help him .

therapydoc said...

He's got a therapist, correct? If you are really invested, you could see if you could become a part of that team, meet with him and his therapist. That would be a nice systems intervention.

If you have your own, you can discuss the effects of feeling so powerless, and if there are more ways to intervene. Being an online blogger, not a person giving advice online, I can't really advise much more than this. But the standard thinking is that if someone isn't getting enough help for himself, and you are a part of that person's life, then get it for yourself.

Anonymous said...

I've sure thought of Holmes' psychiatrist. I've thought of how terrible it must be for her that Holmes did what he did, how responsible she may feel. I would think that's a pretty tough call, knowing who will act on delusional thinking, who will not. I hope the psychiatrist has someone really good to talk to. If I were in her shoes I would find it almost unbearable that a patient of mine had done what Holmes has done.

Mound Builder said...

Oops. I meant to put my name on the remark I just posted. The remark about feeling for the psychiatrist is from Mound Builder. I just hit send at the wrong point.

Mound Builder said...

One other thing, and pardon me for multiple postings...It occurred to me this morning that there are often efforts to educate teens/young people about drugs and alcohol, about unsafe sex, about birth control... but to the best of my knowledge, there's no effort, or relatively little, about educating teens about when they should be concerned about a friend or just an acquaintance who may be in the early stages of psychosis. Maybe there ought to be more effort to educate young people, since they are the ones most likely to see things changing with someone, yet may not know how to interpret it or what to do if they thing something is really wrong. When I was a teen, I had a friend who was brilliant, possibly the smartest person I knew. He got full scholarships at major universities, scored a perfect score on his SAT. I could tell, toward the end of our senior year, that something was wrong. I didn't know what to call it. He would call me on the phone and talk to me for huge amounts of time. I can't really tell you the content anymore, just that at the time, even though it seemed interesting, it just seemed like too much. Not too much for me to hear, just that he seemed to have inexhaustible energy, talking and talking and talking, very exuberant. Sometime in the months after we graduated, he decided to hitchhike across the country. I heard later that something had happened, some sort of mental break, that he was bipolar. I think now, looking back, that it must have been mania I was hearing. But I didn't know what to call it, just knew that something seemed wrong. He's lived his life in group homes, the person I knew, never was able to take advantage of any of his brilliance, the scholarships offered to him. I couldn't have changed his biology, I do understand that, but what if the form his mania had taken was something darker than what I heard when he talked to me? Maybe there is some way to teach younger people what to notice and what to do. Clearly, this country isn't yet ready for things like gun control or more restrictions on access to ammunition. I'd like to think there might be some other way to address it , that some people will become psychotic and that some small number of those has the potential for doing harm.

Unknown said...

Thanks for this post - I think psychosis & in particular schizophrenia is such a misunderstood form of mental illness in America. When watching news coverage of Holmes first day in court I kept getting more and more upset each time the reporter said something akin to "We'll have to see if they use the insanity defense but they'll have to prove his just a complete crazy not someone evil" Why she kept having to use the terms crazy, insane, and nuts rather than saying perhaps the poor guy is MENTALLY ILL is beyond me. But part of that culture is what prevents people like Holmes from getting appropriate care and from others in society helping them get appropriate care before something like this happens. Does being mentally ill excuse what he did? No. But, if his mental illness was better recognized for what it is and what it causes in a person then others in his environment would have had a better shot at taking action before Holmes did.

therapydoc said...

Mound Builder, I'm going to quote you on that, 'Maybe there ought to be more effort to educate young people, since they are the ones most likely to see things changing with someone, yet may not know how to interpret it or what to do if they thing something is really wrong."
Yup, we have to start with the kids.

And Unknown, you are so right. It is astounding the lack of sophistication in this country about mental illness. But I think TV has helped, and the self-help books never quit.

And honestly, it is an excuse. Although it won't win a person any friends, being someone who massacres under the influence of psychosis. So we try to treat it, reel it in.

My grandson, talking about the homeless, innocently asked, "Why don't their relatives give them a place to stay?" In a sense, this is the same situation. Although it is hard for the family to recognize mental illness sometimes, even living with it, it is our job (and that of friends or roommates) to make sure there's someone minding the strange one, the one with the "crazy" ideas, making sure he has the right place to stay.

Better Things-- Seeing Ghosts