![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 57. Go back in thread:
Posted by Tomatheus on October 5, 2015, at 22:10:21
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 5, 2015, at 21:19:02
> "If only 3 to 5 percent are carrying out violent acts, that means a person with mental illness is one-third less likely to be a perpetrator of violence!"
>
> If this guy is saying that 3 to 5 percent of the 18.5 percent of mentally ill in america are committing violent crimes, and that this adds up to a mentally ill person being 1/3 less likely to commit a violent crime. Then if one were to look at the numbers, they'd see this is simply a false statement.I suppose that we'd need to look at the numbers to know for sure. Who knows, perhaps you might be right.
Tomatheus
Posted by hello321 on October 5, 2015, at 23:28:33
In reply to Re: Shooters and Psychiatry, posted by SLS on October 5, 2015, at 19:44:39
> 1. Bartholomew was born without any genes that would predispose him to mental illness.
>
> 2. Bartholomew had a childhood predominated by physical and emotional abuse, neglect, and exposure to domestic violence.
>
> 3. Bartholomew grew up feeling inferior because his family didn't have as much money as his peers did. He was teased and bullied. He swore that he would one day have money.
>
> 4. Now out of high school, Bartholomew continued to feel poor and inferior. He couldn't find a job. College was out of the question.
>
> 5. Bartholomew's mother noticed that her son's behavior had become erratic and that he was often quiet and uncommunicative. He was ruminating in his anger and indignation. She thinks that his quietness is depression, and convinces him to go to the family doctor. She would accompany him.
>
> 6. The doctor of internal medicine hears the word "depression". This is enough to convinces the doctor to prescribe Lexapro.
>
> 7. After six months, nothing changes.
>
> 8. 18 years previously, a law abiding citizen bought a hand gun legally.
>
> 9. This law abiding citizen had his house robbed while he was out at the cinema watching a mediocre remake of "King Kong". The gun was stolen along with a box of Fruit Loops.
>
> 10. The gun eventually found its way into Bartholomew's hands. He now felt empowered. He could use it to get the money and respect that he never had growing up. Society owed it to him.
>
> 11. Bartholomew was still angry. He decided to rob a convenience store. On impulse and filled with anxiety, he burst through the door and ran up to the counter waving his gun around and screaming for everyone to get down on the floor. He just happened to notice a box of Fruit Loops on the shelf. He was not distracted, though.
>
> 12. Bartholomew demands that the clerk give him all the money in the cash register. When the clerk raised his hands in the air to show Bartholomew that he was unarmed, Bartholomew panicked and shot him. Several patrons got up off the floor and began to run for the door. Bartholomew shot them all.
>
> 13. Realizing what he had done, Bartholomew felt trapped. He would surely be executed - or worse. There was no way out except by suicide. Suicide was not an unfamiliar thought. He used the gun one more time.
>
> 14. The coroner determined that Bartholomew's body contained Lexapro and Fruit Loops.
>
> 15. Upon investigation, Bartholomew's mother and doctor corroborated this finding and described that Bartholomew was taking Lexapro for depression.
>
> 16. In the media and on official public records, Bartholomew was taking an antidepressant for a mental illness and committed mass murder.
>
> 17. Bartholomew was not mentally ill.
>
> 18. Strange, though. Bartholomew didn't even like Fruit Loops.
>
>Scott, I find this confusing. There is no precise way to diagnose major depressive disorder. But it is mentioned in psychiatric literature and occasionally talked about on this board that chronic stress can result in one developing Major Depressive Disorder. That looks to be what Bartholomew experienced. Chronicle negative circumstances led to him developing lasting symptoms of what is recognized as clinical depression with today's limited ability to diagnose it as effectively as we can diagnose high blood pressure. True, many different situations can cause a person to rob and murder someone. But a situation like what you described is what just about any psychiatrist would diagnose as depression, isn't it? If not, then should only a chronic, negative mood accompanied by low energy along with other depression symptoms that are caused by efficiently diagnosed physical medical conditions be diagnosed as clinical depression? Am I missing something?
True, this guy had what are described as symptoms of depression that look to have been induced by life circumstances. But even when one perceives a situation like this as nearly hopeless. And they develop lasting feelings of worthlessness and become withdrawn, this doesn't have to happen. With the right brain function, one is more capable of being positive through experiences like his. They become less bothered by things in life and are just more able to see life from a better perspective. Because of this, they are more likely to make better decisions.
This is what can happen if a certain antidepressant we works well for someone. I've experienced this myself. Cyproheptadine (not exactly an antidepressant) brought me from not being able to leave my house because of severe feelings of inferiority and anxiety, to being able to go anywhere, anytime I wanted without putting a second thought into it. I also would notice what I thought of severe flaws in my appearance that made me feel terribly self-conscious. Cyproheptadine made those flaws unnoticeable to me. It became like they never existed. And basically I felt like my world became bigger and I became able to see the bigger picture thanks to cyproheptadine. I became less irritable and more positive about every aspect of life. Relationships became better as well. I could go on and on about how amazing this med was for me.
But first and foremost, I'd say Bartholemews situation became the way it did because of the perspective he viewed things from. Why did he view it the way be did? If not with any of today's treatments, maybe one day through medical advances, a treatment might come out that could turn a guy like Bartholomew into a more positive person that wouldn't consider such extreme actions like robbing a store for money, in hopes of being made happier by the money. Maybe even just seeing a therapist could have helped him to see life in a better way.
But then again, maybe if he had tried the wrong treatment, he might have ended up feeling even more negative and hopeless than he already did. He could have even been made unable to see any amount of money creating a bright future, and wouldn't even feel like robbing a store could make anything better, even if he had gotten away with it.
http://news.berkeley.edu/2014/02/11/chronic-stress-predisposes-brain-to-mental-illness/
Posted by SLS on October 6, 2015, at 0:53:21
In reply to Re: Shooters and Psychiatry » SLS, posted by Tomatheus on October 5, 2015, at 21:57:11
Sometimes, violent people try antidepressants in the hopes that they will relieve them of their inner pain and struggles. They don't. They are not truly depressed. When they are arrested for a violent crime, they report taking an antidepressant. What shall be the possible conclusions?
- Scott
Posted by SLS on October 6, 2015, at 9:35:32
In reply to Re: Shooters and Psychiatry » SLS, posted by hello321 on October 5, 2015, at 23:28:33
> > 1. Bartholomew was born without any genes that would predispose him to mental illness.
> >
> > 2. Bartholomew had a childhood predominated by physical and emotional abuse, neglect, and exposure to domestic violence.
> >
> > 3. Bartholomew grew up feeling inferior because his family didn't have as much money as his peers did. He was teased and bullied. He swore that he would one day have money.
> >
> > 4. Now out of high school, Bartholomew continued to feel poor and inferior. He couldn't find a job. College was out of the question.
> >
> > 5. Bartholomew's mother noticed that her son's behavior had become erratic and that he was often quiet and uncommunicative. He was ruminating in his anger and indignation. She thinks that his quietness is depression, and convinces him to go to the family doctor. She would accompany him.
> >
> > 6. The doctor of internal medicine hears the word "depression". This is enough to convinces the doctor to prescribe Lexapro.
> >
> > 7. After six months, nothing changes.
> >
> > 8. 18 years previously, a law abiding citizen bought a hand gun legally.
> >
> > 9. This law abiding citizen had his house robbed while he was out at the cinema watching a mediocre remake of "King Kong". The gun was stolen along with a box of Fruit Loops.
> >
> > 10. The gun eventually found its way into Bartholomew's hands. He now felt empowered. He could use it to get the money and respect that he never had growing up. Society owed it to him.
> >
> > 11. Bartholomew was still angry. He decided to rob a convenience store. On impulse and filled with anxiety, he burst through the door and ran up to the counter waving his gun around and screaming for everyone to get down on the floor. He just happened to notice a box of Fruit Loops on the shelf. He was not distracted, though.
> >
> > 12. Bartholomew demands that the clerk give him all the money in the cash register. When the clerk raised his hands in the air to show Bartholomew that he was unarmed, Bartholomew panicked and shot him. Several patrons got up off the floor and began to run for the door. Bartholomew shot them all.
> >
> > 13. Realizing what he had done, Bartholomew felt trapped. He would surely be executed - or worse. There was no way out except by suicide. Suicide was not an unfamiliar thought. He used the gun one more time.
> >
> > 14. The coroner determined that Bartholomew's body contained Lexapro and Fruit Loops.
> >
> > 15. Upon investigation, Bartholomew's mother and doctor corroborated this finding and described that Bartholomew was taking Lexapro for depression.
> >
> > 16. In the media and on official public records, Bartholomew was taking an antidepressant for a mental illness and committed mass murder.
> >
> > 17. Bartholomew was not mentally ill.
> >
> > 18. Strange, though. Bartholomew didn't even like Fruit Loops.
> >
> >
>
> Scott, I find this confusing.It really isn't so confusing if you take the story at face value. In this scenario, Bartholomew does not have a predisposition to mental illness as a reaction to psychosocial stress #1. He is, what scientists call, "resilient".
> There is no precise way to diagnose major depressive disorder.
They can get pretty close. What is your point? Bartholomew is not depressed. Nature has determined this. #1
> But it is mentioned in psychiatric literature and occasionally talked about on this board that chronic stress can result in one developing Major Depressive Disorder.
I talk about this a lot. It is not news.
> That looks to be what Bartholomew experienced.
Exactly. That's what it looks like, that's why a doctor prescribed for him the antidepressant, Lexapro. #5; #6 However, he is not depressed. #1 He is angry, ruminative, and withdrawn. #5
> Chronicle negative circumstances led to him developing lasting symptoms of what is recognized as clinical depression
No. Bartholemew is not depressed. #1
My question to you is: If you line up 100 people who are exposed to the same psychosocial stresses, how many will get depressed? The remainder will be resilient. Depression seems to be a product of an interaction between nature and nurture. What is the percentage of people who will get depressed from the environment Bartholomew found himself? Do you know? I don't. However, my guess is that fewer people will suffer a persistent psychobiologically driven case of MDD or BD depression than will remain resilient.
> True, many different situations can cause a person to rob and murder someone.
Yes.
> Am I missing something?
Yes. Please see above.
> True, this guy had what are described as symptoms of depression that look to have been induced by life circumstances.
What symptoms?
> But even when one perceives a situation like this as nearly hopeless. And they develop lasting feelings of worthlessness and become withdrawn, this doesn't have to happen. With the right brain function, one is more capable of being positive through experiences like his. They become less bothered by things in life and are just more able to see life from a better perspective. Because of this, they are more likely to make better decisions.
We are in agreement here.
> This is what can happen if a certain antidepressant we works well for someone.
For Bartholomew, antidepressants did not change his situation because he is not depressed. #7 What should have happened is that the family doctor should have made a follow up appointment during the first few weeks, and then monthly for awhile. After 6 months, the doctor should have sent Bartholomew to a psychiatrist. A psychiatrist would assess his psyche along with screening for major mental illness. A good psyshiatrist would have seen the need for psychotherapy. Psychotherapy would have had a more positive effect than antidepressants.
> I've experienced this myself. Cyproheptadine (not exactly an antidepressant) brought me from not being able to leave my house because of severe feelings of inferiority and anxiety, to being able to go anywhere, anytime I wanted without putting a second thought into it. I also would notice what I thought of severe flaws in my appearance that made me feel terribly self-conscious. Cyproheptadine made those flaws unnoticeable to me. It became like they never existed. And basically I felt like my world became bigger and I became able to see the bigger picture thanks to cyproheptadine. I became less irritable and more positive about every aspect of life. Relationships became better as well. I could go on and on about how amazing this med was for me.
I'll have to keep cyproheptadine in mind. Does it sedate you? How many times a day to you need to take it? How long did it take to work? I will be EXTREMELY pissed at myself if cyprohelptadine worked. On my last visit with Baron Shopsin, MD in 1986, he told me to try cyproheptadine. It was a weird idea, and I didn't follow up on it.
Did you try any of the following? How did you respond to them?
amitriptyine or nortriptyline
Remeron
atypical antipsychoticsLike cyproheptadine, these drugs all have the property of serotonin 5-HT2a antagonism.
- Scott
Posted by Tomatheus on October 6, 2015, at 15:09:00
In reply to Re: Shooters and Psychiatry, posted by SLS on October 6, 2015, at 0:53:21
> Sometimes, violent people try antidepressants in the hopes that they will relieve them of their inner pain and struggles. They don't. They are not truly depressed. When they are arrested for a violent crime, they report taking an antidepressant. What shall be the possible conclusions?
>Well, one could conclude that the antidepressant had something to do with the violent crime, or one could conclude that it had nothing to do with the violent crime. As far as whether a depressive illness might be involved, I think that I'd have to ask how the person ended up getting an antidepressant medication in his or her possession. If the medication was prescribed by a doctor who properly diagnosed the person with a depressive disorder, then I'd have to argue that the person was actually depressed (although you'd probably argue that the person wasn't properly diagnosed if he or she had violent tendencies without being what you'd call "truly depressed").
I don't doubt the idea that there are individuals out there taking antidepressants, even though the individuals don't have a depressive disorder or any of the conditions for which antidepressants are indicated. Perhaps there are some individuals with, say, antisocial personality disorder, who take antidepressants for their antisocial personality characteristics, even though they don't meet the criteria for any depressive disorder and are hence not "truly depressed." But as I was saying before, I think that all of the facts need to be examined when looking at whether a violent crime might be tied to a mental illness and/or the medications used to treat mental illnesses. Did the person have a history of violence? If a medication was involved, did others notice personality changes after the perpetrator started taking the medication? Even if a medication wasn't involved, did the perpetrator act in ways that were out of character in the days and weeks leading up to the incident? Was the perpetrator acting on delusions that the perpetrator might not have ordinarily accepted as true if he or she didn't have a mental illness? These are some of the first questions that I would ask if I were trying to evaluate the extent to which mental illness and/or psychiatric medications might have played a role in the carrying out of a violent crime. The answers to these questions might not always be straightforward, but I think that questions like these should be asked when looking at cases of violent crime where mental illness and/of psychiatric medications are thought to possibly be implicated.
Tomatheus
Posted by hello321 on October 6, 2015, at 16:53:01
In reply to Re: Shooters and Psychiatry, posted by SLS on October 6, 2015, at 9:35:32
> >
> > Scott, I find this confusing.
>
> It really isn't so confusing if you take the story at face value. In this scenario, Bartholomew does not have a predisposition to mental illness as a reaction to psychosocial stress #1. He is, what scientists call, "resilient".The guy grew up under very stressful circumstances. This is recognized to result in depression in some cases, particularly if someone isn't resilient to the stress. He became unable to deal with this stress in a healthy way and it had major effects on his thoughts and emotions. You see this because he grew up feeling inferior because of his situation and experiences. And he became withdrawn and began to behave erratically. You also see this because he eventually resorted to such a dangerous decision that could have obviously (and did) resulted in worsened circumstances. All of his reaction to the stress he experienced suggest he isn't all that resilient. I can only see someone like Bartholomew resorting to this either if they saw no way out of a terrible situation in life that they can't emotionally tolerate. Or if they just wanted/needed the money, recognized it could end badly, with death being a possibility, and figured death would still be better than continuing his life if he didn't succeed in his goal.... the guy is feeling so much emotional stress that he resorts to such an extreme decision. But I'm still expected to take at face value the idea of him being resilient to the kind of depression his life experiences could easily result in. He felt inferior to the people around him (sign of depression). Became withdrawn and began behaving erratically (more classic signs of depression) and basically ended up saying F it and resorted to a very dangerous decision that could result in his death. The guy might have been resilient to depression being induced by lesser circumstances. But what he went through made him a very depressrd pperson. To take idea that depression played no role in him attempting to rob a store would be unwise. It is like concluding the cause of death in someone who had their head cut off was when their body hit the ground after their head was removed. And then insisting this conclusion be taken at face value.
>> > That looks to be what Bartholomew experienced.
>
> Exactly. That's what it looks like, that's why a doctor prescribed for him the antidepressant, Lexapro. #5; #6 However, he is not depressed. #1 He is angry, ruminative, and withdrawn. #5
>
> > Chronic negative circumstances led to him developing lasting symptoms of what is recognized as clinical depression
>
> No. Bartholemew is not depressed. #1
>Scott, the guy experienced depressing events in his life and reacted in a way a depressed person would. But he's not depressed? He even took an antidepressant in hopes it would help... help what?
His social withdrawal, feelings of inferiority, and his rumination his thoughts of anger and indignation. The antidepressant was prescribed and he took it on his own free will in an attempt to help emotional problems causing significant distress in his life.> My question to you is: If you line up 100 people who are exposed to the same psychosocial stresses, how many will get depressed? The remainder will be resilient. Depression seems to be a product of an interaction between nature and nurture. What is the percentage of people who will get depressed from the environment Bartholomew found himself? Do you know? I don't. However, my guess is that fewer people will suffer a persistent psychobiologically driven case of MDD or BD depression than will remain resilient.
>
I don't know.>
> > Am I missing something?
>
> Y
> > True, this guy had what are described as symptoms>
>
> > But even when one perceives a situation like this as nearly hopeless. And they develop lasting feelings of worthlessness and become withdrawn, this doesn't have to happen. With the right brain function, one is more capable of being positive through experiences like his. They become less bothered by things in life and are just more able to see life from a better perspective. Because of this, they are more likely to make better decisions.
>
> We are in agreement here.But sadly, for what ever reason, Bartholomew Bartholomew developed a very unhealthy mindset and experienced many negative emotions that stayed with him. But it's not depression?
>
> > This is what can happen if a certain antidepressant works well for someone.
>
> For Bartholomew, antidepressants did not change his situation because he is not depressed. #7 What should have happened is that the family doctor should have made a follow up appointment during the first few weeks, and then monthly for awhile. After 6 months, the doctor should have sent Bartholomew to a psychiatrist. A psychiatrist would assess his psyche along with screening for major mental illness. A good psyshiatrist would have seen the need for psychotherapy. Psychotherapy would have had a more positive effect than antidepressants.Maybe so. But I will reiterate, one does not react to depressing experiences in such depressing ways that lead up to such an extreme decision unless they have been made depressed. If the suggesting that He simply was not depressed should wisely be taken at face value. Then any suggestion that any time someone commits a crime while taking an antidepressant, that the antidepressant played a causative role in the crime should be taken at face value. That would be just as wise.
> > I've experienced this myself. Cyproheptadine (not exactly an antidepressant) brought me from not being able to leave my house because of severe feelings of inferiority and anxiety, to being able to go anywhere, anytime I wanted without putting a second thought into it. I also would notice what I thought of severe flaws in my appearance that made me feel terribly self-conscious. Cyproheptadine made those flaws unnoticeable to me. It became like they never existed. And basically I felt like my world became bigger and I became able to see the bigger picture thanks to cyproheptadine. I became less irritable and more positive about every aspect of life. Relationships became better as well. I could go on and on about how amazing this med was for me.
>
> I'll have to keep cyproheptadine in mind. Does it sedate you? How many times a day to you need to take it? How long did it take to work? I will be EXTREMELY pissed at myself if cyprohelptadine worked. On my last visit with Baron Shopsin, MD in 1986, he told me to try cyproheptadine. It was a weird idea, and I didn't follow up on it.
>
> Did you try any of the following? How did you respond to them?
>
> amitriptyine or nortriptyline
> Remeron
> atypical antipsychotics
>
> Like cyproheptadine, these drugs all have the property of serotonin 5-HT2a antagonism.
>
>
> - ScottI took it twice a day. It began working on day 1 with a very modest effect that built up over time. My experience is complicated, though. I've mentioned it throughout the time I've used psychobabble. But I've been thinking it's inverse agonist at the 5ht2c receptor is how I mainly benefited from it.
Posted by hello321 on October 6, 2015, at 17:21:54
In reply to Re: Shooters and Psychiatry » SLS, posted by Tomatheus on October 6, 2015, at 15:09:00
Here are the numbers for violent crime committed each year since 1960. I only looked at recent years and compared the numbers with the percent of mentally ill people that are believed to be committing violent crimes. I did this last night and I believe, at least with the numbers for 2014, I even used the lowest percent of 3% given for the ratio of violent to non violent mentally ill people. The numbers I came up with are at home, and I'm not home at the moment. But I have a general memory of the numbers for 2014. If I remember correctly, there were about 59 million mentally ill people in America for 2014, if 3% of them committed 1 violent crime in that year, that added up to over 2 million crimes. Then if only 3% of the population not deemed to be mentally ill committed 1 crime that year, that added up to a number that, when added to the amount of crimes committed by the mentally ill, then these numbers added together would have resulted in more crimes than are listed in the statistics. I can't remember how many more exactly, but it was significant.
But basically, it shows there is no way a mentally ill person is 1/3, or even any less likely to commit a violent crime. If the lowest number given, 3% of mentally ill people committed a crime, the numbers showed they are still more likely to commit a violent crime than a non mentally ill person to commit a violent crime.
Posted by Tomatheus on October 6, 2015, at 18:14:54
In reply to Re: Shooters and Psychiatry » Tomatheus, posted by hello321 on October 6, 2015, at 17:21:54
Well, perhaps Dr. Grohol was incorrect in what he said about people with mental illness being less likely to be perpetrators of violence. As I've said, I do think that mental illness can sometimes play a role in the carrying out of violent acts, and a quote in Dr. Grohol's blog entry seemed to state essentially the same thing. However, the quote also pointed out that there are other factors (some of which the media and policymakers have placed little emphasis on) that are much more likely to contribute to violent behaviors than mental illness. Here's the quote (from a Vox.com interview): "[W]hile mental illness can be a contributor to some violent behaviors, other factors - such as substance abuse, poverty, history of violence, and access to guns - are much stronger predictors of violence and shootings."
Tomatheus
Posted by hello321 on October 6, 2015, at 19:48:07
In reply to Re: Shooters and Psychiatry » hello321, posted by Tomatheus on October 6, 2015, at 18:14:54
Oops, I meant to post this webpage link in my last post:http://www.disastercenter.com/crime/uscrime.htm
I posted it earlier in this thread, but figured I'd post it again.
Also, considering that guys quote, it is a vicious cycle between substance abuse and poverty and mental illness. Those 2 factors can increase the likelihood of someone developing a mental illness. And mental illness can also increase the chances someone will live in poverty or develop a problem with substance abuse. With a result of these situations being that these people have a higher chance of being involved in violent crime.
But I believe even the wealthy are regularly committing crimes. though with their crimes more likely falling into the category of crimes against humanity. An example being when a drug company covers up information about severe adverse effects their products can have on those who take their product. Or an auto company ignoring/hiding defects in their vehicles that result in the injury or death of many. But often they simply pay a fine when they are found out, and just go on about their business. Yet the amount of harm their actions/inaction often cause end up making any mass shooting look like a tiny speck in the statistics.
Posted by baseball55 on October 6, 2015, at 20:41:47
In reply to Re: Shooters and Psychiatry » Tomatheus, posted by hello321 on October 6, 2015, at 19:48:07
Studies show consistently that people with power or high status, even when that power or high status are given arbitrarily in psych experiments (think the Stanford Prison Experiment), are less compassionate and significantly less generous. Some studies find that people with power and wealth exhibit the characteristics of anti-socal personality disorder. The sociopathic nature of economic crimes is enabled by the cutthroat corporate culture where profits are valued above all and the tendency of high-level executives to "just follow orders" and take no individual responsibility for the human consequences of their actions.
I agree that corporate crime (or sometimes it's not crime, because corporations lobby Congress to not deem things "crimes") probably cause more death and misery than gun violence. In the US, we don't think of corporations as outright killing people, but those same corporations in developing countries will hire security forces to kill union organizers and community organizers who oppose the social and environmental impacts of mining or drilling.
As Marx wrote, capitalism entered this world drenched in blood.
> But I believe even the wealthy are regularly committing crimes. though with their crimes more likely falling into the category of crimes against humanity. An example being when a drug company covers up information about severe adverse effects their products can have on those who take their product. Or an auto company ignoring/hiding defects in their vehicles that result in the injury or death of many. But often they simply pay a fine when they are found out, and just go on about their business. Yet the amount of harm their actions/inaction often cause end up making any mass shooting look like a tiny speck in the statistics.
>
Posted by alexandra_k on October 6, 2015, at 20:50:50
In reply to Re: Shooters and Psychiatry, posted by baseball55 on October 6, 2015, at 20:41:47
> Studies show consistently that people with power or high status, even when that power or high status are given arbitrarily in psych experiments (think the Stanford Prison Experiment), are less compassionate and significantly less generous. Some studies find that people with power and wealth exhibit the characteristics of anti-socal personality disorder. The sociopathic nature of economic crimes is enabled by the cutthroat corporate culture where profits are valued above all and the tendency of high-level executives to "just follow orders" and take no individual responsibility for the human consequences of their actions.
With those studies... I do understand that 'most' people abused their power. But some of them didn't. Some of the Milgram experiment people didn't just follow orders, either.
I don't understand why we don't all actively promote those people (aka the good people) as leaders. Instead of promoting those who we think will further our interests (who will only turn on us when their interests come apart from our own).
Posted by baseball55 on October 6, 2015, at 21:04:14
In reply to Re: Shooters and Psychiatry » Tomatheus, posted by hello321 on October 6, 2015, at 19:48:07
To me, the point of Scott's story is that mental illness is incredibly complex. Psychiatrist Glen Gabbard, in his textbooks for psychiatric residents, writes that mental illness is a bio-psycho-social problem. The experience of mental illness, despite people meeting certain DSM criteria, is highly individual. When people suffer symptoms of depression or anxiety or psychosis, there are broad similarities, but the content of their ruminations and delusions is strongly affected by their psychological and social experiences.
Using myself as an example, I grew up in an abused and neglected. I was resilient and achieved a lot. In my 40s, I became depressed, but a lot of my depression was driven by the circumscribed nature of the life I had created to overcome despair about my youth. I believe there is a strong biological COMPONENT to my depression, but that the biology doesn't explain the intensity of the SI I experience when depressed. Many people are very depressed or anxious and never have overpowering SI. I, on the other had, have been hospitalized 10 times, following two suicide attempts and voluntarily committing myself to be safe from suicide. I believe the SI comes from a weak grip on life due to my history and from a tendency, due to my history to fall into despair that I will never be cared for.
I got help. But most people whose ruminations are about violence toward others do not get help. They may go to a doctor about getting on a drug to deal with their out-of-control feelings, but they don't do therapy and commit to trying to change. Instead, they ruminate on violent acts. I doubt this has much to do with meds and more to do with their psycho-social history which determines the nature of their ruminations.
This complexity and individuality is why I again recommend Patrick Gilligan's book, Violence. The case studies draw a complex picture of violent men (all the subjects are men, as are all the "shooters" and most perpetrators of violent crime).
Posted by SLS on October 7, 2015, at 0:42:56
In reply to Re: Shooters and Psychiatry, posted by baseball55 on October 6, 2015, at 21:04:14
> I, on the other had, have been hospitalized 10 times, following two suicide attempts and voluntarily committing myself to be safe from suicide.
I am so sorry.
:-(
- Scott
Posted by SLS on October 7, 2015, at 0:54:17
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 6, 2015, at 16:53:01
How rude of me.
I neglected to thank you for replying to my questions about cyproheptadine. I will look into its 5-HT2c activity.
What are your reasons for focusing on 5-HTc receptors?
Thanks again.
- Scott
Posted by pontormo on October 7, 2015, at 13:44:12
In reply to Re: Shooters and Psychiatry, posted by baseball55 on October 6, 2015, at 21:04:14
The statistics about violent crime are not terribly relevant to the question of mass shootings, which are a small category within that huge dataset. The thing that draws attention about mass shootings is that one person in a relatively brief outburst of violence stalks and kills a lot of people who have no relationship to him (or her).
The real common factor in these crimes is not the psychopathology of the shooters, although I'm sure they're disturbed people -- although in different ways in different cases-- but the availability and use of guns, in society and in the family of the killer.
Generally, this person has amassed an arsenal of weapons, and been suffering from resentment and a desire for revenge for real or imagined wrongs for a long time. Some of the killers have taken psychiatric drugs and even been known to therapists who've tried to report their threats to authorities. But generally, they lapse from their meds as in this case, where the killers mother said she only had trouble with him when he stopped his medication. Which unfortunately he had a tendency to do. Others seem not to have had much contact with the social service sector, or to have a medication regimen.
They all also seem to have different types of mental illuness. More importantly, there are millions of people with mental illnesses, on and off their medications, who have no propensity to commit violent.acts. There's no evidence basically that mental illness predisposes one to commit these crimes.
The point is that such crimes are very rare-- and the number of mentally ill people who are not violent far far outnumbers those who commit crimes.
If there's any correlation, it's between the gun culture and the rise of these crimes. It's not just the availability of guns and ease of getting them-- it's the glamorizing of gun ownership and the feeling of pride and being "strong" that comes with having a gun (eg I'm no a wimp--- or as this killers mother referred to "lame people" who didn't keep their home guns full of ammunition at all times)--
There's been a huge push to spread guns into every home-- and to defeat any limits on possessing and carrying a gun-- even into bars, and on campuses. Even elementary school teachers should have a gun at all times-- some people argue-- to defend the children in the case of an attack. (again, a very very rare occurrence-- while people, including young children, accidentally or purposefully shooting one another is anything but rare, when guns are present).
So maybe we shouldn't expect better psychiatric care to solve these problems. And maybe we shouldn't blame mental illness for these actions--
Posted by hello321 on October 8, 2015, at 16:21:53
In reply to Re: Shooters and Psychiatry » hello321, posted by SLS on October 7, 2015, at 0:54:17
>
> What are your reasons for focusing on 5-HTc receptors?
>
>
> - ScottBasically I've been pretty certain my fundamental problem is with a deficit in dopamine. Severe anhedonia seems to be my core symptom. But I haven't been responding at all, good or bad, to the typical dopamine increasing meds. nor have I gotten any effect from Haldol. Tho I haven't been responding to the many other psych meds I've tried the past few years either. You that pretty well described my thoughts on why I've not responded to meds in a post you wrote: "Brains such a these are more apt to respond to current treatments than one that have more profound abnormalities in function or morphology." In the thread about placebo response.But theres a lot to my situation that's a bit complicated to describe.
But before I tried cyproheptadine, I had tried a few atypical antipsychotics that antagonize the 2a receptor, along with their other effects, and receiveed no benefit. These meds were also antagonists at the 2c receptor. But when I tried cyproheptadine, I just benefited hugely. And when I read into its effects and how it might have helped me, I read the 2c receptor has "constitutive" control over dopamine release in the brain. Basically that receptor just existing puts a damper on dopamine. And it requires an inverse agonist to fully inhibit its constitutive activity. So then dopamine is more free to be released in response to pleasure. Rather than an increase of dopamine being forced by something like adderall.
After writing this I think I do recall the 2a receptor also having contitutive control over dopamine. And I don't think I've ever tried a 2a inverse agonist. not sure if I've looked specifically into 2a agonists in the past, or not, so maybe would be a good idea for me to look into.
Posted by SLS on October 8, 2015, at 17:24:00
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 8, 2015, at 16:21:53
> >
> > What are your reasons for focusing on 5-HTc receptors?
> >
> >
> > - Scott
>
> Basically I've been pretty certain my fundamental problem is with a deficit in dopamine. Severe anhedonia seems to be my core symptom. But I haven't been responding at all, good or bad, to the typical dopamine increasing meds. nor have I gotten any effect from Haldol. Tho I haven't been responding to the many other psych meds I've tried the past few years either. You that pretty well described my thoughts on why I've not responded to meds in a post you wrote: "Brains such a these are more apt to respond to current treatments than one that have more profound abnormalities in function or morphology." In the thread about placebo response.But theres a lot to my situation that's a bit complicated to describe.
>
> But before I tried cyproheptadine, I had tried a few atypical antipsychotics that antagonize the 2a receptor, along with their other effects, and receiveed no benefit. These meds were also antagonists at the 2c receptor. But when I tried cyproheptadine, I just benefited hugely. And when I read into its effects and how it might have helped me, I read the 2c receptor has "constitutive" control over dopamine release in the brain. Basically that receptor just existing puts a damper on dopamine. And it requires an inverse agonist to fully inhibit its constitutive activity. So then dopamine is more free to be released in response to pleasure. Rather than an increase of dopamine being forced by something like adderall.
>
> After writing this I think I do recall the 2a receptor also having contitutive control over dopamine. And I don't think I've ever tried a 2a inverse agonist. not sure if I've looked specifically into 2a agonists in the past, or not, so maybe would be a good idea for me to look into.Thanks for taking the time to reply to my question. You have provided valuable information and perspective.
What do you make of this?:
https://en.wikipedia.org/wiki/5-HT2C_receptor#Ligands
It doesn't seem right to me. What do you think?
- Scott
Posted by hello321 on October 9, 2015, at 14:40:49
In reply to Re: Shooters and Psychiatry » hello321, posted by SLS on October 8, 2015, at 17:24:00
What doesn't seem right?
Posted by SLS on October 9, 2015, at 15:33:10
In reply to Re: Shooters and Psychiatry » SLS, posted by hello321 on October 9, 2015, at 14:40:49
> What doesn't seem right?
Do you think the list of 5-HT2c inverse agonists is accurate?
- Scott
Posted by hello321 on October 10, 2015, at 15:35:24
In reply to Re: Shooters and Psychiatry » hello321, posted by SLS on October 9, 2015, at 15:33:10
>
> Do you think the list of 5-HT2c inverse agonists is accurate?
>
>I really couldn't tell you. What do you see that seems wrong about it? Do you think it is missing some? Has some that aren't actually 5ht2c inverse agonists? Any time I want a more reliable source on how a med works, I try finding a good research article on it.
Posted by hello321 on October 10, 2015, at 18:16:16
In reply to Re: Shooters and Psychiatry » hello321, posted by SLS on October 9, 2015, at 15:33:10
Also Scott, do you happen to know of any 5ht2c inverse agonists that lack any significant antihistamine, dopamine blocking or direct neurotransmitter increasing effect, such as by reuptake inhibition? Basically, I'd love to find a med like Cyproheptadine minus the antihistamine effect.
Posted by SLS on October 10, 2015, at 22:38:01
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 10, 2015, at 15:35:24
> >
> > Do you think the list of 5-HT2c inverse agonists is accurate?
> >
> >
>
> I really couldn't tell you. What do you see that seems wrong about it? Do you think it is missing some? Has some that aren't actually 5ht2c inverse agonists? Any time I want a more reliable source on how a med works, I try finding a good research article on it.
>
>I find it hard to believe that there are so many 5-HT2c inverse agonists. All of the tricyclics? All of the antipsychotics? I am sometimes suspect of Wiki.
- Scott
Posted by SLS on October 10, 2015, at 22:46:37
In reply to Re: Shooters and Psychiatry » SLS, posted by hello321 on October 10, 2015, at 18:16:16
> Also Scott, do you happen to know of any 5ht2c inverse agonists that lack any significant antihistamine, dopamine blocking or direct neurotransmitter increasing effect, such as by reuptake inhibition? Basically, I'd love to find a med like Cyproheptadine minus the antihistamine effect.
At this point, I don't know of any.
Sorry.
Have you ever tried low-dose Prozac? It should act as a 5-HT2c antagonist without significant reuptake inhibition at very low dosages.
- Scott
Posted by phidippus on October 16, 2015, at 1:05:15
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
> It angers me that psychiatric patients get such inadequate care.
The problem is these shooters go unnoticed and aren't recognized to be disturbed before its too late. James Holmes was recognized too late.
Also, a large part of these shooter's persona can be descibed as anti-social which adds a complex dimension to the therapist's couch; to the psychiatrists couch. Anti-social personalities don't respond well to care. Or medications.n
James Holmes had an anti-social personality. Eric Harris and Dylan Klebold were sociopaths. Dylann Roof was just a psychopath.Unless we learn to treat anti-social behaavior there will be no stop to these senseles shootings.
> Mass shooting seem to have two things in common:
> 1) The shooter has a poorly managed psychiatric history.The shooter is likely to be non-compliant with therapy. I mean, what's funner than therapy? planning the death of dozens. These guys have deep seated problems-they can only be rewired. Perhaps in the future.
> 2) They choose gun-free zones for their targets.
Well, they're usually pretty smart.
> What can be done to get all patients greatly improved care?For those at risk, mandatory testing should be done and if a person is found to rank high on sociopathic tendencies that individual should be institutionalized. Just my dystopian future.
> what can we do to get patients much better care?
Provide free access to mental health care.
> Most of the meds are not very good.I've had many drugs that worked well.
>What can we do?
Put our head between our knees and pray.
Posted by Hugh on October 18, 2015, at 18:40:55
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
School shootings are a modern phenomenon. There were scattered instances of gunmen or bombers attacking schools in the years before Barry Loukaitis, but they were lower profile. School shootings mostly involve young white men. And, not surprisingly, given the ready availability of firearms in the United States, the phenomenon is overwhelmingly American. But, beyond those facts, the great puzzle is how little school shooters fit any kind of pattern.
Complete article:
http://www.newyorker.com/magazine/2015/10/19/thresholds-of-violence
This is the end of the thread.
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