What was wrong with Elliot Rodger?

Elliot Rodger spoke at length on a YouTube video about his plan to enter a sorority house and execute a mass murder, retribution for peer rejection. Blonds would be special targets, but everyone would die. He killed seven people on Friday, including himself, wounding another twenty-two.

Watching the video, it is clear he suffered from depression. He speaks of his loneliness and peer rejection, and at first we wonder if perhaps he had a high functioning autism, what used to be called Asperger's disorder. We wonder, like we did with Adam Lanza, who entered an elementary school and killed 20 children, 6 adults (Sandy Hook, Connecticut), if the social correlates of Aspergers depressed him beyond rational thought, drove him to violence. Children reject other children who don't have social skills, who can't follow social cues, as is the case with Aspergers.

But a teacher interviewed speaks of a whiny complainer, an unlikable young man who thought he deserved more (mainly from blonds). Neighbors call him polite and courteous. He'd been arrested three times, prior to his final act, and police didn't feel he needed to be held in custody.

So we know he knew how to talk to people. That, or the police spoke with parents who convinced them to let him go. He was in all types of therapy, although never hospitalized.

Neighbors of his parents say they never heard any shouting in the home. His family was in the process of moving to Santa Barbara to be close to their son.

All of his weapons were registered. On the gun owner registration there is a question: "Have you ever been adjudicated mentally defective?" Elliot could say no, never having been hospitalized.

So one lesson we can take from this (and this is a correction from a previous draft of this post):

We have to take what people say seriously. When someone vocalizes plans to commit violence, someone should take steps to see that it never happens, whether the threat is a public proclamation on a blog, a vlog, on YouTube, or at a coffee shop.

Those steps should include an evaluation by a professional, and hospital emergency rooms should be considered, seriously. Medical professionals won't admit anyone involuntarily for merely joking or venting. Involuntary admissions to hospitals are exceedingly difficult, because frankly, we have rights in democratic countries.

But as a community, we shouldn't rely on hope that a potentially violent situation will just go away. Bring a child, a friend, to the hospital when in doubt. Let the professionals do what they do best. Help.

The conceit expressed in Elliot's selfie-video is typical of the conceit of someone with narcissistic personality disorder. But it is an antisocial act, unfeeling mass murder, more likely to be a function of an antisocial personality. Antisocial people (ironic, since his most sincere desire had been to connect, sexually, with women) are also narcissistic. They can be depressed, too.

And yet, here it is:

Antisocial Personality Disorder 301.7 (F60.2) is a pervasive pattern of disregard for and violation of the rights of other people. A diagnosis requires only three of the following features:

1    A failure to conform to social norms and the law

2    Repeatedly lying and conning for personal profit or pleasure

3    Impulsivity and failure to plan

4    Irritability, aggression in the form of physical fighting

5    Little regard for the safety of others or self

6    Failure to consistently work or honor financial obligations, irresponsibility

7  Lacking remorse, rationalizing behavior that hurts others.

8    The individual must be at least 18 years old

This type of conduct is evident under the age of fifteen, although not diagnosed as such. To meet the diagnosis, schizophrenia and bipolar disorder must be ruled out.

My first guess, even though Elliot Rodger suffered paranoia and features of a narcissistic personality disorder, too, is that he had a co-occurring antisocial personality disorder. It is always a compelling diagnosis, and we don't usually recognize it until a deed is done, until someone steals our life savings, or sets off a bomb. 

Regardless of the trigger, the supposed reason for disregarding the feelings of others, the lives of others, this is a tough one to treat. And most of us, frankly, are uncomfortable, just being in the same room, with those who have it. 

They are scary, the stuff, the creatures of movies and video games. It is sad and ironic that Elliot's father, Peter Roger, is in the film industry, worked as an assistant director of The Hunger Games, among other accomplishments.

This can't be easy for him or his wife. Their son's disorder has biological underpinnings. It isn't their fault (see Adrian Raines' book, The Anatomy of Violence). Despite the fact that he may have had blurred boundaries, identified with movie characters, or watched too many video games, this behavior is likely not a consequence of that.

We're sure to find out much more about his parents and his childhood. The downside of the media, the downside of fame, is that unlike the privacy the Rodger family might have been assured, had Eliot been hospitalized, the gloves will be off.

But maybe that's a good thing. We have to promote awareness, and one thing Elliot has now, if he never had enough before, is that.

therapydoc

Bullying and Suicide

Rebecca Sedwick, suicide victim of bullying

People are pretty disgusted by the news of twelve year-old Rebecca Ann Sedwick's suicide jump from a tower at an abandoned concrete plant in Florida last month.

On Monday, the county sheriff, Grady Judd took a hard stand and charged two Lakeland teenage girls, 12 and 14 (12 and 14!) with felony aggravated stalking. Bullying, technically, isn't a crime; it is something kids do. But aggravated stalking is an adult crime across the nation, and juveniles can be just as guilty as adults.

Who stalks? There are many reasons, and we'll discuss them below, but the behavior seems to be generated by either insecurity or sociopathy.  Those fearful of abandonment take matters into their own hands and punish the ones who try to leave. The sociopaths or almost sociopaths, are criminal-- they have no remorse, no guilt for the harm they cause. Sociopaths (legal determinations) are often diagnosed with personality disorders, antisocial personality disorder at the top of the list. Some are children.

Even after the suicide, the older of the two young adolescents continued to write cruel things about Rebecca on Facebook.

"Yes ik [I know] I bullied REBECCA nd she killed her self but IDGAF [I don't give a f***]"

That threw the sheriff over the top, determined the felony charges.

Heartless. How does a kid write such a thing!? Does this kid need therapy? Undoubtedly.

And to think I just told a mother of a bullied child last week, "I like working with kids like yours, with the victims. The kids seem to like therapy."

What I don't mention is that victims are easier than the perpetrators because they don't have the attitude, the resistance, the disdain for authority. So they are easier clients. Merely depressed as hell.

Now I feel bad for implying I don't even want to work with the bullies and cyber stalkers. It isn't all their fault. Aggression doesn't happen in a vacuum.  Bullies are usually victims, displacing their own anger, no matter the cause, often unconsciously, onto someone else.  Displacement is a psychological defense, protects our fragile egos. Being young, these kids have time to work on their identities.* It's what we do in therapy.

Most of the time, too, aggressive behavior is easy to reverse -- a little anger management and family therapy and the kids are giving workshops to their friends. That has to be woven into the new bullying laws, the family therapy part.

When it isn't displacement, aggression is likely to be transgenerational, passed down generation to generation under the guise of domestic violence or child abuse. It is usually learned, and in some families considered normal.  They all have tempers in our family.  Every therapist has heard that one.

There's research that tells us a predilection toward violence might be caused by a birth accident or the lack of the empathy gene.  Wonderful people have difficult kids, and their parenting doesn't necessarily pay off.  We need more specialists, more research to help them.

This new sociological darling, bullying, or cyber bullying, cyber stalking, concerns us because now, more than ever before, suicides are mounting. We don't know which causes are the most likely, but in Rebecca's case the lead tormentor apparently learned the behavior.

Caught on camera, Vivian Vosberg, the step-mother of the "bully ringleader," is pummeling a boy in her home. A group of children laugh, push. Chaos ensues, noise, a scuffle, and all the while, someone is manning the cell, the video cam.

She's been arrested on child abuse charges, sent to jail, and her daughter, the cyber stalker quoted above, is supposedly in state custody. Ms. Vosberg claims she was merely breaking up a fight.

She is only thirty years old, looks like a teenager herself, and her neighbors are talking about her as a bad role model, blaming her for her step-daughter's behavior, no matter what really happened or what triggered her behavior on tape. It would be nice if Ms. Vosberg would tell the press more about her stress, more about why she hit that kid, and more about her trouble with her step-daughter. As it is, she denies the child's role as a cyber stalker. She needs to become a part of the solution. We need one.

If she won't own her part, the lesson for her step-daughter is that old adage, See one, do one, teach one. Many children joined in the stalking but they didn't have the audacity to continue the abuse after Rebecca's death. This kid, Vosberg's step-daughter, needs more attention, more of an intervention than the rest.

Meanwhile, Rebecca's mother, Tricia Norman, knew there was a problem, tried to help, but laments that she couldn't do enough. She pulled her daughter out of school, home-school her, then arranged a transfer. Still she couldn't protect Rebecca.

Probably because cyber stalking is a crime without walls, and continues even after the stalker stops talking. What is written on the Internet is permanent. The tragedy is that Rebecca believed herself worthless. She believed what those young girls wrote on her wall.

Her mother told reporters:

"She would come home every day saying she's not worth anything, she was ugly and stupid," 

Rebecca heard it from ten or more children, was verbally taunted, physically abused, beat up. Repetition makes its mark. It's hypnotizing.

Her mother made her delete her Facebook account but after Rebecca's death found messages on the child's phone: "Nobody cares about you," "I hate u," "You seriously deserve to die."

Mother tells reporters:

Becca tried to brush it off by responding positively. But there are similar entries. "Can u die please," "Go die," "Nobody likes u."

The effect of such abuse?  She started cutting, left pics of cuts on her thighs, cuts her mother had never seen, and pictures of herself lying on the railroad tracks, waiting for the train. 
Tricia Norman blames herself for not doing more to help her daughter. I want to tell her not to, that the problem is epidemic. The violence in our culture defines our culture (see Saturday's WSJ, Are the Streets Really Paved with Gore). When kids witness violence in the home it reinforces what is seen in the movies and on television, YouTube, everywhere.

Therapy might have helped, for sure, but a socially isolated child is at risk, even while in therapy, when systematic, repeated, mental, verbal, and physical abuse has torn down, whittled away at the will to live. Without friends, at any age, we're miserable, feel we're better off dead.

Just one more jab will do the job.  And we can't control all of the jabbers.  Children, the old saying goes, are mean. They have their reasons.

What to do?  Identify them early. Intervene early. Call the parents of your kids' friends, the ones who hurt them. Programs in schools have work to do, and should include discussions of the media, the lessons learned watching.

We need to establish interventions for bullies-- suspensions, amends to the victim, group therapy in the school, family therapy at a local agency, and legal proceedings to add some teeth to the solution. Keep that therapy alive for at least a year, make that two.

Jared Lee Loughner

He didn't look like a particularly healthy guy, but they sold him an automatic in Tuscon. No mental status exam, apparently. Indigent, he bought a $500 gun. You have to wonder. How does that happen? 

Gabrielle Gifford is hurt and six others murdered, 19 injured.  Glock 9, an automatic weapon, in the hands of a "mentally unstable" person.  Holds a clip of 15.  The whole neighborhood knew he was "very troubled."

We're watching the morning news and my daughter asks me, Should the kids really be watching this? Vampires are okay, werewolves, fine. But reality is scary.

He left us notes:  I planned ahead.  My assassination.  Gifford.

Lest we give the credit to someone else. 

Assuming he suffers from Schizophrenia, Paranoid Type, the credit goes to the voices in his head that told him to do it. 

But voices don't buy anyone guns. Someone has to sell these. And the whole town knew he was a time bomb. They were afraid of him, he was so odd, so disturbed. Couldn't someone have reeled him in?

Supermarket parking lot, people there to meet their Congresswoman.  Nine year old, Christina Taylor-Green. Dorwan Stoddard.  Federal Judge, John M Roll, just leaving church.   Phyllis Schneck.  Gabe Zimmerman  Christina Taylor Green, Dorothy Morris.

And the Congresswoman, a gun owning Democrat who married an astronaut, loves motorcycles is clinging to life, a bullet through her head.   The Tuscon tragedy is associated with her politics, left of the tea party.  But the shooter was a liberal. 

Judy Clarke,  attorney of the indigent, including the Unabomber, Theodore Kaczynski,  and 1996 Olympic park bomber Eric Rudolph, and Susan Smith, the South Carolina mother convicted of drowning her two sons by allowing her car to roll into a lake with the two toddlers strapped in their car seats will be representing Loughner, who will likely be diagnosed as mentally ill. 

So far the assailant hasn't said anything.  That will be something, his statement, although it is unlikely he will make one. Maybe he doesn't suffer from Schizophrenia. The violence in this country isn't limited to people who have Schizophrenia, although these mass, public murders do seem to have that running theme.

If he has other reasons, we're all ears. Antisocial Personality Disorder, perhaps, associated with most criminals who feel no guilt. Or werewolf, maybe.

therapydoc

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