How Do You Know When Someone is Dangerous?

 

If you want the answer to the question I posed as the title for my post, you've come to the wrong place.  I actually wanted to tell you a story from when I was a high school kid.  I hope you'll bear with me.  I wasn't a shrink then, and these weren't my patients, they were my friends, so there is no promise of confidentiality and the story is true.  For my own comfort level, I'm changing the names, but if you went to high school with me, you know the characters.  



When I was in high school, Jose sat next to me in Latin class.  I wasn't very interested in Latin, but I was there, in the back row, sitting with Jose.  Mrs. Massa was a most enthusiastic teacher.  Jose and I would talk, and one day he started telling me that he wanted to kill Sam and he had a plan.  Sam sat in the front of the room, he was silly, he made a lot of noise, and our Latin class had been together for years. We'd started in 8th grade and Mrs. Massa spent part of her day in the junior high school and part in the high school.  We'd gone to Rome and climbed Mt. Vesuvius and crawled around Etruscan tombs, there were Saturday morning ventures to different parts of the state for Junior Classical League meetings, and there was the time Sam threw grape juice on Mrs. Massa's freshly painted living room walls during a toga party and I first met baked ziti.  Okay, I wasn't running on the wild side back then.


So why would anyone want to kill Sam?  He was a sweet, goofy, well-liked kid who didn't really bother anyone.  He smiled and laughed a lot and hung out with a few girls.  

"He's the all American kid," Jose said.  Well, really?  Not really, but I guess I could see that.  Why did Jose want to kill him?  That's all he would say about why.  His plan: he'd put a knife in a folder and when they were walking in a crowded hallway, he jut out the folder and the knife would fly out and stab Sam in the back.  In terms of the physics, it didn't seem feasible. 

Was it a joke?  I didn't know.  Today, we'd take this very seriously, but I really didn't know what to do.  I seem to recall that I told my mother and I told a teacher, but I didn't know what to do.  Mainly I worried.  I don't think I worried a lot, but it was a long time ago and we didn't have memories of Columbine.  I don't recall that Jose was treated badly, and he had friends, other smart kids.  He was on the quiet side, but I went to a huge high school and we didn't think in terms of the details of every kids' personality.  There were kids who were really weird (Jose wasn't one of them),  and there were drugs everywhere, and there was a fair amount of violence.  It was a large, urban high school with police in the halls.  But Jose and I were in Latin class, we weren't in the stairwells smoking weed.


So we're sitting in Latin class and Jose takes out his calculus book, opens it, and there is a large butcher knife.  I left the classroom, called my mother, she called the principal, and maybe the police, and Jose was removed from school.  He was out for 6 weeks and I heard he'd undergone some psychological testing.  We never said another word to each other (ever) and Sam is alive today.  One of Jose's friends told me it was a joke, and at a high school reunion, Sam hugged me and said laughingly that I'd saved his life.  


Was Jose going to kill Sam?  I have no idea, still, but I never really thought so.  I didn't understand why Jose was doing this or what he hoped to achieve.  His plan couldn't have worked, though he was carrying a big knife, and I suppose he could have stabbed Sam.  As a teenage kid, I felt badly getting Jose tossed out of school, especially if he was just trying to yank on my chain or tease me, and I worried a little that people would ridicule the fact that I'd gotten Jose in trouble.  I also didn't see that I had any choice here but to tell someone that Jose was walking around with a knife talking about killing another kid.  Today, I have no doubt that Jose would have been permanently expelled from high school and his life would have come undone.


So Sam, the all-American boy, became a lawyer and last I heard, he still lived in his childhood home.  He never married.  Jose applied to 10 colleges, he got into 5, and graced the Ivy League with his presence.  He got an advanced degree in architecture and teaches college.  His online resume does not include any breaks long enough to include an incarceration, so I'm assuming he went on to live life as a model citizen.  I think it was a more forgiving world back then, because I'm not sure now how anyone would get around a 6 week suspension for possession of a deadly weapon and pick up with their life, much less get into one of the country's top universities.  I'm very glad his life turned out okay (at least Google-okay).  


Maybe Jose was joking and I caused a crinkle in his life.  That is what I've assumed.  It's not a story I think about very often at all.  After the event, it didn't crinkle my life.  Maybe he would have killed Sam and destroyed both their lives-- it would have been one of those stories where no one saw it coming.  Maybe he was a troubled kid and this event got him the help he needed.  Today, however, you do understand why I'm thinking about this story.

Weiner Diagnosis?

 

In Shrink Rapper world, we get a lot of email from publicists about books, TV spots, upcoming events.  This was in my spam box today:

Rep Anthony Weiner is expected to resign today after weeks of scandal surrounding his lewd text messages, tweets and photos.  Even in his tearful media conference, Weiner could not explain why he participated in such behavior.  According to NYU Medical Professor and Internist, Dr. Marc Siegel, the congressman’s behavior is systemic of a larger psychological problem, which must be addressed before fixing the addiction to online sexual activities.  

 

Dr. Siegel says, “This seems to be an example of extreme narcissism, inflated self image, depersonalization, loss of contact with reality, addiction, and the power of the Internet as a medium (like the Wizard of Oz you feel you are hiding behind the curtain)”.

 

To discuss the dangers of addiction and steps to overcome the serious illness, Dr. Siegel is available to offer is medical knowledge.  As a medical practitioner and FOX’s House Doctor, Dr. Siegel has spent years diagnosing and treating people in the national media spotlight.

 

If you are interested in speaking with Dr. Siegel, please contact me at .

 

Best,

Rena  

 

Rena Resnick

5W Public Relations

Oh my, I thought.  I read it twice. An internist is going to comment on Anthony Weiner's narcissism, motivations, sense of self, and contact with reality?   Sounds like a shrinky thing to me, but the Goldwater Rule prohibits psychiatrists from commenting on the mental state and diagnosis of someone they haven't personally examined.  Does that mean it's okay for other specialists to talk about the mental state of someone they don't know?  Hmmm...   I guess we'll see what he has to say, but I'm not so sure about this.

Just As I Was Thinking About You

I think I have ESP. Last week, I was thinking about a patient I hadn't seen in a couple of months, and he called, just as I was thinking about him. It's happened before with this patient. Today, I was walking to my car (where I'd left my cell phone, unsubmergered), and I started to think about a patient I haven't seen or thought about in some time. I've been treating her for over ten years, and issues of age and health have made it hard for her to get in to see me. It's been a year, maybe more, but every once in a while, she surfaces. So I'm thinking about her, wondering how she is, and I get to my car and there's a voicemail from her. Sort of eerie. I have ESP.

What I don't understand is the whole ShrinkRap with Bacon thing on our sidebar. I guess Roy did this. Why does anyone want bacon with our blog? It's just sort of weird. He couldn't have put ducks up?

And for a final thought: my husband is leaving on a jet plane. He texted to say there is a comfort dog in the next row. I can't wait to hear how the flight goes.

Thanks to everyone who's commented on our pre-draft of a chapter. I like the diversity of opinions. And to anyone who thinks their middle schooler might get something out of it, that would be wonderful!

I'll get a photo in later: let me know if you have any special requests....

What I Learned Part 3

ClinkShrink is blogging from AAPL meeting she is attending.
Click HERE for Part 1 (she'll even tell you what AAPL stands for).
Click Here for Part 2.

So, the clinical vampirism presentation taught me one main lesson: I'll never understanding how the program committee chooses which presentations to accept. The speaker presented an overview of the historical role of blood in ancient cultures and religions (remember our blog posts about Moche indian culture?), then he presented his own proposed typology of blood-seeking behaviors, then he presented two cases to illustrate that typology. The first case was your basic Goth who drank his girlfriend's blood (consensually) then beat her to death. The second case was a sad one about a psychotic killer who decapitated his mother, her bird and the family dog. (Note to future speakers: please warn your audience if you're going show autopsy photos during the time slot right before lunch.) I really don't think we need a new classification system to understand these behaviors, but there you are.

One of the next presentations was a nicely done study of violent female offenders in one Connecticut prison. These women essentially all had very early onset of conduct disordered and antisocial behavior with high levels of substance abuse and childhood trauma. I'm not sure it says as much about the women themselves as it does about the criminal justice system: in order for a woman to get sent to prison they have to be really really pathological, at least compared to men.

Next up was an update about human subject research in correctional psychiatry. The Institute of Medicine is in the process of reviewing the Code of Federal Regulations as it applies to prisoner research. As it stands now the regulations are restrictive to the point that inmates are being denied necessary research into the best practices for correctional health care. New IRB regulations will help ensure that projects are designed to give a clear risk-benefit analysis to proposals (as opposed to doing generic research on 'systems' issues or institutional issues).

Then I went to the Computers in Forensic Psychiatry presentation, an annual tradition that I as a geek always enjoy. Once again, computers don't always behave in public the way the geeks plan. After some fiddling and tweaking I saw some fun new gadgets, including a pen that electronically records everything you write and uploads it to organizing software through a USB port. Pretty wild. It can also record up to 100 hours of audio.

Last but not least, I went to an update on the US v Hamdan case. Hamdan was Osama Bin Laden's chaffeur, and was the subject of the landmark US Supreme Court case in which Sandra Day O'Connor declared that a "state of war is not a blank check for the President." In other words, that the President could not unilaterally create his own separate legal system. Hamdan has been a Guantanimo Bay detainee since shortly after start of the Afghanistan war (except for one month spent in a suspected secret CIA facility in northern Afghanistan). Anyway, two of Hamdan's lawyers spoke as well as the forensic psychiatrist who spent 120 hours evaluating him. While the legal issues were pretty egregious, in the back of my mind I kept wondering how I could testify, if placed in a similar position, that this person would not participate in future terrorism. I mean, what in psychiatric training would really qualify one to testify to that? If there was clear evidence that he was not a central conspirator, as they suggest, then why would they really need a mental health expert to testify to that fact? It seemed to be a situation where political ideology dragged mental health into a realm that it was never designed for. If AAPL feels strongly that mental health professionals should not assist or participate in interrogations (a position I agree with) then perhaps they should also encourage members not to express opinions about the future dangerousness of suspected terrorists---an area for which data is lacking, to say the least.

So that was my third day.