James Egan Holmes

Does he look like The Joker?  Does he think he's Batman's nemesis?

What is wrong with this guy?

What we have is a shy kid, a boy who didn't engage when others tried to talk to him.  Or so says a San Diego neighbor, a young man who played on the same soccer team in high school.  He never socialized, never had friends.

What we know is that James Holmes is a brilliant young man.  A neuroscientist, at the top of his university class, an honors student.  Then, after graduation, no jobs.  He flipped burgers.

Graduate school, obviously, a PhD should be the next step.  Why wouldn't that be taken for granted?  Why McDonalds?  McDonalds?????  Something's not tasting right with that.

So he started school in Colorado, but he quit in June.  Quit?  Why would a nerd, clearly destined for academia, quit graduate school?

Tempting to think--psychopath.  Or Anti-social Personality Disorder, Social Phobia, Schizoid Personality Disorder.  Even people with Asperger's can't handle the social pressure of college.  It isn't the academics, not usually.  It's the socialization, the expectations.  We live in a social world.  But violence isn't associated with Asperger's.

And psychopathy is diagnosed during childhood.  James didn't even have a traffic ticket, let alone an altercation, a fist fight, a stolen candy bar.  This 24 year old man didn't pick pockets.

It is likely we'll hear that he suffered from Schizophrenia.  Or another psychosis, even Bi-Polar Disorder (see how not romantic that one really is).  Paranoid Schizophrenia affects reasoning, patients hear voices, believe that God talks to them, tells them to do things.  Some think they are Jesus Christ.  And some think. . . they are the Joker.

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Slow Burn- Cho Seung-Hui-Differential Diagnosis

Yesterday I saw the morning news and posted all those questions, knowing full well that much would come to surface in the coming days. It didn't stop me, all day long, from forming an opinion.

I saw kids doing that on television, forming opinions, and I've read blogs with opinions. I mostly heard words like "evil" and "sociopath."

After 2 hours of ABC News (who can resist Diane Sawyer?)and spontaneous tears through the footage of kids hugging and crying, and those pictures of the dead, the young, the beautiful, the talented, I still hadn't heard from the therapy docs.

There was one forensic psychiatrist on t.v., a great looking guy with a really convincing manner, very animated and right-on in some respects, for sure. He said that Cho had contempt, vicious contempt and conceit, and was filled with hatred towards the people who had hurt him.

So knowing that, I feel you need more about Cho's condition. "Contempt" hardly cuts it for me as a diagnosis.

If he was paranoid, he either had a personality disorder, perhaps Paranoid Personality Disorder, or a biological axis I disorder such as Schizophrenia, Paranoid Type.

But that's all too easy, because there are premorbid disorders, conditions people have prior to the onset of say, a psychotic disorder like Schizophrenia Paranoid Type, 295.30. And generally, people with that disorder do not function throughout childhood to the degree that we think he functioned (although at this writing, we really don't have the details about his childhood).

You notice that nowhere am I using words like evil or sociopath. That's because they aren't diagnoses. Sociopathy is a symptom of Antisocial Personality Disorder, but I haven't read anything to indicate that Cho had that. He was considered quiet and detached, not openly defiant through out his life.

Until April 16, 2007, when he defied very openly.

That can happen if a person is hearing voices (delusions) that tell him to do that, to kill people (Schizophrenia, Paranoid Type).

It surely happens when people are psychotically depressed, meaning they are suffering from a mood disorder and they want to die and are at the point of suicide, but their anger (I told you it's bad to be angry) gets the better of them. Add to that the energy (a sequela to anger) to take everyone down with them.

The ticking time bomb thing. They noticed that on campus.

According to his friends, Cho had an imaginary girlfriend. He stalked 2-3 female students, and he told his roommates about a rejection, "I might as well kill myself."
The police say he didn't threaten the women he stalked, meaning he was obsessed with them, a feature of Borderline Personality Disorder and several anxiety disorders. He didn't go home for winter or spring break (detached socially). He slept with the lights on (anxious). He may have had voices speaking to him in the dark.

Here's what I think was going on, and maybe we'll find I'm wrong in a couple of hours (it's still good to go over the different possibilities for your edification).

I think Cho had a Social Phobia and a Schizoid Personality Disorder (DSM IV-TR 301.20) that was premorbid for either Schizophrenia Paranoid Type, or Mood Disorder with Psychotic Features (psychotic = murderous), the primary DX that he had before and during his very violent outburst. Schizoid Personality Disorder looks like this, credit to the DSM:

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:
(1) neither desires, nor enjoys close relationships, including family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others.
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder, or another medical condition.

Schizoid Personality Disorder is found premorbid to schizophrenia.

Anyway. If I think he either he always suffered from schizophrenia but he was highly functional, or

H was an abused person, abused from early childhood, either physically, verbally, emotionally or sexually. Or he lived with someone who beat or abused someone else, perhaps a sibling or a parent.

He developed severe, severe anxiety and a Social Phobia, and more damage, damage to the psyche and to the personality.

The personality is paralyzed in schizoid individuals and Cho didn't talk to people. He did speak through his plays, and he undoubtedly (in my guess-tim-ation) talked to himself about his anger at people who teased him for his inability to spit out words, and his anger at people for being rich, beautiful, whatever. He was his only friend.

One student at VTech said that they used to play games with Cho. "I'll give you ten dollars if you'll say, 'gimme five'."

That makes a shy person angry. It builds up. It's likely it went on throughout his childhood, derision for being socially unskilled, "weird." Socially detached people aren't understood by others, they're teased. But they have feelings and get angry. It can simmer through the years. The anxiety turns to anger. They're both symptoms of arousal.

That kind of psychotic anger is typical in Schizophrenia, Paranoid Type, too. We feel that stress triggers the genetic predisposition to schizophrenia. The stress of needing female companionship, the stress of grades, the stress of comparative poverty--these are triggers. People with schizophrenia are very sensitive. You don't want to upset them, criticize them (expressed emotion, discussed elsewhere in this blog). This is why I keep stressing Be Nice. We do have a societal obligation, among other things, to be nice. His room mates, by the way, are amazingly wonderful people. They were so patient with this boy who was so ill.

The therapy doc he saw didn't recognize the arousal, the potential for harm, because Cho was probably mute. He looked anxious, probably depressed. They'd call it "agitated depression" perhaps.

People did see him seething, however, and one teacher threatened to quit if he wasn't removed from his class, so he was clearly out of control of his emotions. He needed what we would call, Major Meds.

He was psychotic, of that there's not doubt, regardless the cause, and his teachers DID call the police, and students DID treat him with kid gloves. (Go to the CNN website and see that video with his roommates on 360.)

Sure, 20/20 hindsight, he needed to be forcibly hospitalized and treated. I won't hold by evil, or by sociopath, cold-blooded killer ala Sopranos.

The guy was mentally ill.

I have to go watch t.v.

P.S. I'm adding this to the post later. I chose schizoid personality disorder over childhood schizophrenia based upon his high functioning in academics, but indeed, his poor functioning socially, and perhaps inability to relate to anyone, including a therapist, might have indicated childhood schizophrenia. For all we know he was delusional all of his life, and it's possible that he had many incoherent, mind-jumbled days during his childhood.

TherapyDoc

You're Not Alone on a Bike

Have we talked at all about social ecosystems? I don’t think so.

Original running title for the academic paper reads:

Living the Cultural Ecosystem

A social ecosystem is your world. That includes the media and the world you are in right now.

1. There's you.

2. There's your immediate family, the one you live with, could be friends or just your cat. Could be just you and your partner, spouse or significant other.

3. There's the family of origin, the people who raised you and your siblings, it’s possible you don’t live with them any more.

4. There's extended family, includes all blood relatives.

5. There are your close friends, both near and far, some on the other side of the world, perhaps.

6. There are acquaintances you see in your neighborhood. This would include that little subculture that you see hanging around in Starbucks or Borders.

7. There are the people you know from work, school, or place of worship.

8. There are people from the bar, sports center, work-out club, church, local government. You might call them “acquaintances.”

9. There are the people you connect with directly via your computer or telephone.
Even telemarketers are a part of your ecosystem, as is the barking dog next door.

10. There's all of the information you get from television, newspaper, and radio. You might include books, too, since they expand your experience.

11. If you're an astronaut, then space might be part of your eco-system.

12. There your “higher power,” perhaps.

Maybe I left someone out, hope not. You get the idea. The ecosystem consists of all of the people and all of the information that has a direct influence on how you feel, think, and behave.

Sometimes people feel very alone, even when their entire world is very big. They don't feel connected to their ecosystem, not intimately.

OKAY, OKAY, THE STORY

FD and I make a big deal about riding our bikes. Getting around the city this way has worked for us on a lot of levels, but these days when I personally talk about my bike it's generally to complain about how people in cars seem to have to swear at me or blast me with their horns.

They act as if I should MOVE OFF THE (expletive) ROAD. Like roads are for cars, not transportation.

Truth is, I’d have given up riding my bicycle years ago were it not for F.D.'s nagging. I’d have succumbed to the lure of potato chips and television, effectively, perhaps permanently, locking the serotonin in my neurons forever, wondering if I should start Paxil or Zoloft, knowing I'd hate them both.

The bikes, our original bikes, are a common thread with us. They’re a link between us, one of those historical reminders reaching back to the first day we met. We were buying bus tickets at the student union to go home before a Jewish holiday.

“Come out with me for a Pre-pesach beer?” he asked. Beer has malt, so you can’t drink it on Passover, the fast-approaching eight-day holiday.

“I’m in.”

That day, or was it the next, he won his Raleigh ten-speed in a raffle for the North American Indians, I think that was the cause.

I didn’t have a bike at the time. My original red ten-speed, a bike I had used to explore my world throughout high school, had been stolen freshman year, first week of school, and I didn't have the money to replace it. 
The bike I ride today was our first "big" pre-marital purchase at a little under a hundred bucks. So you could say it’s a piece of our marital history.

He would say we keep the stupid bikes because we’re too cheap to get the newer more fancy ones with 36  thousand speeds. I would say we're sentimental. But the truth is we've kept them because they feel good and we don’t trust the new ones. And they remind us of a very romantic time. Keeping stuff like that alive is key in marriage, in case you're wondering.  Creating those kinds of things.

Oh, and the new generation, now an old generation, the mountain bikes, were always just plain silly for Chicago, a very flat town.

So before we even had children, we were that young couple that took out the bikes at the first sign of spring, shaking the lead out, feeling better about having had cheese cake or ice-cream when we got home.

But even during pregnancy F.D. would nag me to go out riding with him. “Come on,” he’d say. “You know you’ve never fallen off a bike in your life; let’s go, you need the exercise.” He needed the exercise.

Being a doc he was also afraid I’d throw an emboli and have a stroke during pregnancy. He was always afraid of things he wouldn’t tell me about but I could tell from that far away look in his eyes that he was thinking something scary.

So I’d go with him well into the pregnancies, nauseous, fat, get on the bike and tool around in the suburbs late at night when everyone else was tucked away in bed or watching a warm TV.

Because he felt the need to exercise. Face it. I could have done yoga if it was about emboli. There are simply some things one does for a relationship.

When my excuses started to mount (the seat feels too hard, the handle bars are too narrow, I’m bored, bored, bored and want to throw up) he’d work on my bike and make it friendlier. The wide seat, wide handle bars, the perfect high stem that gave me the leg length and stretch that I needed-- all thanks to F.D.

So he'd have someone to ride around with late at night.

But at the end of the day I got pretty addicted to the feeling I’d get from riding, much more than he did. I had the longer ride to work. The fresh air, the visuals, the sounds woke me up. I liked that it was me who knew the geese were back in the city in the early winter. Because we talked. “Yo geese.” “Yo back, watch what’s on the bike path. Don’t look up so much.”

Well, one day a group of dog people were out enjoying a summer evening and their dogs were off their leashes. The dogs saw me, a red speeding bullet flying through their park (they had marked it) and of the same mind this pack of dogs thought, “Deer.” They were off to the chase. A pack of dogs. Domestic dogs.

I saw them coming and got an adrenaline rush that helped me out-distance them in seconds. But it was thoroughly terrifying. I shook for days after thinking about it.

The next night, as I approached the park, I stopped, looked around, saw the dog people and their dogs way ahead of me. I slowed it down to a crawl until I was close enough to get their attention and explained that it wasn’t safe, letting their dogs run around unleashed. This wasn’t an official dog park.

What if I hadn’t been able to out-distance the dogs the night before? What then?

“It’s because you have that flashing light in the back of your bike,” I was told.

Thanks. In other words you’re not leashing them?

“No, turn off your light when you pass through.”

I don’t think so.

I wrote a letter to the Chicago Tribune and the editors published it! But still, the dogs sniffed and roamed and I was stuck slowing down to a halt whenever I passed through. Didn’t seem fair. It's at least a half-mile of park we're talking about.

Then one night I saw a police car parked at the very end of the park. I pulled over to him, casually mentioned the problem.

He cruised on in and fined them all $500 bucks a pop. That's what it'll cost you if you don't leash your dog in Chicago, unless you're in a designated "dog park".

Should I have felt bad that they were fined? I didn’t, still don’t. I worked that ecosystem to my advantage and in the end it worked well, even for the dogs who will never be impounded for eating the flesh of the bikers or pedestrians in their world. The dog people have leashed their dogs.

The interesting thing is that now when I see them? Things are different. The dogs have been on 30 foot leashes since that day, and when they see me they're very friendly. We have this strange genuine bond going. We smile and wave. Sometimes I’ll even stop and talk for a couple of minutes, just comment on construction or the weather.

It’s like I’m a Park Person, if not a Dog Person, I'm a part of the culture.

They must not know it was me who worked my ecosystem, right, to get them in trouble?

But I've become a part of their world, the person on the red bike. I’m ONE OF THEM.

People like familiarity, being in the same place at the same time with the same people. This is why I tell single people to become a part of a mini-culture, a system within the ecosystem. Become a regular at the library, or at a bookstore or a coffee shop. Go to a church or join a political organization. Meet people or not, if they see you they get comfortable at the thought of you, like you are comfortable with certain checkers or baggers at your local grocery store.

Being lonely is a state of mind, you know. You’re never really alone.


Copyright 2006, TherapyDoc
http://everyoneneedstherapy.blogspot.com/2006/12/biking-culture-and-working-environment.html

Confidence and Social Phobia

Once titled Confidence Game, this post is under revision for the book.

I'll repost it when it's ready, but it could take awhile, and I'm not sure if that's even a good idea. What do you do when you can't decide?

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