Tuesday, April 24, 2007

THE SANITY SQUAD - Dangerous Behavior

This week the Sanity Squad takes up a controversial topic: Can dangerous behavior really be reliably predicted?

And, if so, what should be done about people judged dangerous when they haven’t yet committed a crime? What is the role of mental health professionals and involuntary commitment in balancing the need to protect society with the need to champion the liberty of the individual?

Psychiatry and psychiatrists have been given this "social control" role by society, and yet they are expected to be able to appropriately balance that function with the best interests, liberty and privacy concerns of their patients.

These questions take on a critical importance in the aftermath of the Virginia Tech murders, as every talking head in America pontificates knowingly about what could have and should have been done to prevent it.

Hindsight is always perfect, of course.

The consequences of what might have been are unrecordable. No one considers that every day in every state, the psychiatric profession involuntarily hospitalizes people who are imminently a danger to themself or others and very likely saves many lives and prevents many tragedies from occurring.

But the thing about preventing a really terrible thing from happening is that...it prevents a really terrible thing--or things-- from happening. So, nobody reads articles about how effectively the system works or how many lives were saved--because there is no way of calculating that metric.

Only when someone slips through the safety net, does it come to public awareness.

If the VA Tech shooter had been better diagnosed and treated.

If he had been locked up until he responded to treatment.

If he hadn't been allowed to obtain a gun.


Just as a point of interest, the people who argue these points and want MORE laws; MORE protection; MORE perfection from the psychiatric profession; and of course easier ways to lock up people who might commit violence; are the same ones who dismiss the idea that the actions that President Bush took after 9/11 have prevented another terrorist attack on our homeland. Bush, they insist had nothing whatsoever to do with it. Oh, and stop violating the civil rights of the terrorists in Guantanamo.

[Just as an aside: I am curious as a psychiatric professional--why do we appear to be more frightened of the mentally ill (who are not more violent than the general population but are 2.5 times more likely to be the victims of violence), but not of terrorists who were caught actively fighting and killing Americans and are now incarcerated at Guantanamo?]

Actually, this the conundrum associated with successful prevention: being successful operationally means never being able to prove--from a research data perspective-- that your preventive measures had anything to do with the success versus pure dumb luck.

My area of research when I worked at NASA was on the psychological aspects of space flight. I was involved in astronaut selection and in identifying the psychological stressors of space and developing countermeasures against them for operational use.

One of the issues connected to this research used to bother me a lot and it was this: preventing something from happening is a good thing (e.g., you obviously don't want astronauts manning a space station or on a 2+ year trip to Mars to become suicidally depressed and become a risk for the mission), but by the very act of preventing such a thing from occurring you can never then prove that it might have occurred in the first place. And from the opposite perspective, if something bad does happen (like the VA Tech shootings) how can you show that 95% of the time the procedures are working--it is the demand for perfection every single time that is unrealistic.
Assessing and predicting human behavior will never be perfect no matter how many laws are passed. The act of taking away someone's personal freedom for something they might do must always be balanced by the needs of and risk to society at large.

In other words, sometimes the needs of the many outweigh the needs of the few; and sometimes it is the reverse. All mental health professionals are right in the middle of this dialectic and must constantly search for a synthesis for each particular individual they treat.

Join Neo-neocon, Siggy, (Shrinkwrapped and me as we consider this dilemma--and of course, relate it to the politics and culture of the day.

All podcasts of The Sanity Squad can be found here; and you can also download them from iTunes. (search for Pajamas Media)

(The Sanity Squad cartoon is drawn by Eric Allie, whose collection of political cartoons can be found here and here).

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