Wednesday, April 18, 2007

Cho ruled mentally ill and released

Cho was ruled mentally ill by the courts and released. This is quite typical, given the degree of deinstitutionalization in our country, it is a wonder we don't have more violent people. In my documentary, Six, about six teens who commit mass murder, some of them were mentally ill and the ringleader, Natasha Cornett was released after only 11 days in a mental hospital even though there were documents stating she was a danger to herself and others. There is very little liability in this country when it comes to releasing the mentally ill back into the community or not taking dangerousness seriously. I once was doing an evaluation of a man who told me he was going to kill himself years ago. I called the local mental health center and they told me to "drive the guy over in my car." The level of stupidity and incompetence in the area of mental health is staggering.

63 Comments:

Blogger Heavy B said...

Dr. Helen,
What is your take on the networks' broadcasting of Cho's videos sent to NBC? It seems reasonable to publish his writtent manifestos as cautionary evidence, or at least there is precedent, but if we are going to broadcast a murderer's rant via visual media, why not show Nick Berg's beheading or other grotesque mortal acts?

Doesn't this fully grant Cho his last wish by immortalizing him in front of hundreds of millions of TV viewers?

I can hope that VT will become a rallying cry for reform of our mental health care policies in this country. Do you know of any good resources that can be employed in lobbying my state (WA) lawmakers to begin needed reforms?

heavy.B

8:05 PM, April 18, 2007  
Blogger Helen said...

Heavy B,

I think it is a mistake to broadcast these videos, the copycat effect that might produce are not worth the coverage. This killer was a nobody who wanted to be somebody--and sitting at home is another similar mentally ill person who will just be watching and waiting....

I agree that there needs to be reform of mental health policies in this country. People who are dangerous need to be hospitalized and/or monitored on meds until they are no longer a danger to themselves and others, not released back into the community after a few days or no time at all. Perhaps this website is a place to start, it gives the mental health commitment statues for each state and gives suggestions on advocacy:

http://www.psychlaws.org/LegalResources/index.htm

8:37 PM, April 18, 2007  
Blogger Richard said...

I have no problem with the way Cho's mental health commitment was handled. He was properly evaluated and found to be a danger to himself (but not to others at that time), and was ordered to undergo outpatient treatment. Obviuosly the examining physician believed that such treatment offered the lease restrictive setting for his present mental condition. And, in fact, it turned out that Cho was not a danger himself or to others for almost 1 1/2 years. Surely a court or mental health examiner is not tasked with trying to extrapolate from present condition what will happen 18 months down the road. All of us might be committed under such an liberal standard.

8:47 PM, April 18, 2007  
Blogger Helen said...

Richard,

What happened once he left the facility? Was there any follow up to see if he was going to treatment? He was said to have been taking meds for depression at some point, did the physician who prescribed them follow up at all or just give him the pills and say good luck? There are a lot of questions that seem unanswered.

9:00 PM, April 18, 2007  
Blogger Bob R said...

Helen-

As information becomes available it seems to be chipping away at your prepackaged little narrative of an institution that "does nothing" in response to a mentally ill student. You've repeatedly libeled my university though your shoddy research and spreading of unsourced internet rumors. (Will the "fire in the dorm room" turn out to be an urban legend. Doesn't matter. Good enough for Helen to allege incompetence.) I watched the bodies being carried out of Norris and to see you use this tragedy to flog your pet issues without the professionalism to wait until you knew even part of the information dissapoints me greatly.

9:13 PM, April 18, 2007  
Blogger Helen said...

Bob R,

The fire in the dorm room you mentioned was found in media stories such as Newsday.com--if you are upset by that, contact them, not me. In addition, security and law enforcement mentioned themselves on NBC news that red flags had been raised that the university ignored. If you want to take up libel issues, go talk to them. How dare you get on my website and speak to me this way, it is uncalled for.

9:29 PM, April 18, 2007  
Anonymous Elizabeth said...

It is about impossible for the family of a mentally ill person to do anything to help that person or protect them from hurting themselves or others given current laws. Two years ago my husband's sister committed suicide- after three visits in as many days from the county mental health officer who determined each time that she was not a danger to herself or others. On a Monday she called her former mother-in-law raving about all the people out to get here and "when I'm gone," the former MIL called my husband, and he called the mental health authorities who said "call the police". The police officer who was sent to her apartment believed she needed to be committed and called the county mental health officer. He said, no, no danger. The next day, my S-I-L called the police herself and ranted to the victim's services advocate for over an hour. The victim services advocate called the county mental health officer and once he again he said, no, no danger. On Wednesday, another police officer went to her apartment (different from the first) and called the mental health officer yet again. He said (for the third time) no, no danger to herself or others. On Thursday, she shot herself. Family members, two different police officers and the police victim services advocate all believed that she needed to be committed, but because the county mental health officer didn't believe her condition rose to the standard of being a danger to herself or others, nothing was done. (Of course, she would have probably been released after three days anyway.) It's a terrible system.

9:42 PM, April 18, 2007  
Blogger Bob R said...

Sorry Helen, you called for criticism when you said the following this morning.

"Something about this guy was bothering people to the point where women were going to the police and he was obviously frightening people. His teachers felt uncomfortable--and he was stalking women who reported him to the authorites. Nothing was done then. Teachers brought him to the attention of school authorities, nothing was done and it has been reported that he started a fire in his dorm room, again nothing done. A mental health evaluation at that point with assessment might have teased out some of his problems and given a clearer picture of his violence potential but I assume that was not done."
[emphasis mine]

Certainly we didn't do enough. The results speak for themselves. But to say we did nothing is grossly unfair - especially since we did exactly what you recommend and it failed. It is a deep insult to the teachers, cops, administrators, and mental health pros who had to deal with this situation. For you to rush to judgment and malign these people based on the information was a serious mistake on your part. We will see in the days to come if the story of the fire plays out, it only appears in a few places and seem to be getting buried deeper and deeper. But for you to use the "I saw it on the internet. It has to be true." defense is pretty raw.

9:52 PM, April 18, 2007  
Anonymous Anonymous said...

Cho had shown recent signs of violent, aberrant behavior, according to an investigative source, including setting a fire in a dorm room and allegedly stalking some women. [Associated Press/Denver Post/Apr. 17]

We don't know all the facts, we may be misinformed but the first-hand witnesses make for compelling testimony.

"Professor Roy, from Battersea, South London, said that Cho was the most disturbed student she had encountered in her 22 years at Virginia Tech. She had pleaded repeatedly with the university to give him counselling. But because he had not threatened anybody directly, the authorities were powerless to help. ...She said that she went to university police and counsellors repeatedly and sent Cho’s writings, poetry and plays — full of violence and twisted sexuality — to the police “to alert them and share my worries with them”."
Times Online

The outrage, the concern, the leaping to conclusions, stems from knowledge that the inability to intervene with a young man who is signaling his descent into madness is occuring in communities across this country. Take the time to seek out a special education teacher in your public schools. This is not to malign Virginia Tech but to acknowledge we've placed a tremendous burden on our educational system and we haven't fully apprised the public of the risks.

10:02 PM, April 18, 2007  
Blogger Richard said...

Helen- I am an attorney in Pennsylvania and a couple times each month I represent mental health patients at their commitment hearings, so I have some first hand experience with these matters. I agree with you (above) that there are indeed unanswered questions, especially with regard to follow-up of Cho after he was ordered to outpatient. Did he get treatment? No one says. The news media however are making it out to look like "the system" let a cold blooded mass murderer out on the streets after fingering him as Big Trouble. I was only saying that the plan for him at the time, given the doctor's exam findings, seems entirely appropriate and reasonable. According to the examining doctor, Cho's judgment and insight at the time were not impaired and so outpatient treatment was deemed least restrictive for him. I should mention that where I practice law, mental health agencies are excellent at tracking these cases, and if a patient who has been ordered to outpatient treatment stops AMA, or is non-compliant with medications, the agencies quickly file for a modification to inpatient treatment to get the patient into a setting where they can be monitored more closely and stabilized.

I enjoy you blog.

10:06 PM, April 18, 2007  
Anonymous JKB said...

If this court ruling is true, the big question is why the adjudication didn't make it into the NICS. If it had, the check for the gun purchase would have come back denied.

ATF lists the following among those who cannot legally receive or possess firearms or ammunition:
"(4) Has been adjudicated as a mental defective or has been committed to a mental institution;"
http://www.atf.treas.gov/firearms/faq/faq2.htm#b5

The question seems to becoming, not the need for additional gun laws but why the ones we have aren't being properly administered? Not to mention why the mental health system seems to feel someone determined to be a threat to themselves and others don't need at least a call back?

10:13 PM, April 18, 2007  
Blogger Bob R said...

I realize that the report of the fire has appeared in several places, but I have never seen the source. It was buried in the reports this morning and is not included in more recent reports that I have read. The VT police have not included any report of the fire that they received. If I fire did occur and any official knew about it and failed to act, it would be a huge malfeasance by VT and in fact the lead story in any paper. It would be a clear act of violence of Cho's. Why isn't it in the lead paragraph of every paper? I understand that VT has a lot of criticism coming. I'd just rather have it for things we actually did.

10:15 PM, April 18, 2007  
Blogger Helen said...

Anonymous 10:02:

Thanks for your input. I have worked with the mental health system for over 20 years. It is unbelievably frustrating to see the lack of help and intervention that is available out there, especially for our young people. Elizabeth's story above is an example of what happens because our mental health is inadequate, our laws do not allow for families and others to get help and the result is sometimes tragedy and other times, just a miserable life for the mentally ill person and his or her family. Our country has a very large mentally ill population, yet few resources or ways to get them help and only if they want it--and then often for a short time. When someone is a danger to themselves and/or others, it seems fitting to have some ability to monitor them in some way.

10:19 PM, April 18, 2007  
Blogger Bob R said...

Instead of relying on Times Online's interpretation of Roy's words, you can listen to the full text of her interviews. According to her, the University responded quickly with police and councilor visits. I would call this "help" even if ultimately inadequate. More accurately, he could not be involuntarily hospitalized and had not violated our code of conduct (in the judgment of most everyone involved). The clearest thing is that he gave everyone the creeps. If anyone wants to suggest a "wisdom of crowds" dismissal policy, I'm all ears. Failing that I'd like to hear some serious suggestions for what we could have done. (If there was a reported fire I am certainly on board with dismissal at that time.)

10:32 PM, April 18, 2007  
Anonymous Anonymous said...

Just when I start thinking that Helen might actually offer something constructive here, BobR comes in and calls her bluff. How dare you speak to me this way???? Oh, please. Learn to take criticism gracefully, will you? You get in the way of decent discussion.

10:55 PM, April 18, 2007  
Anonymous Nom dePlume, Ph.D. said...

"The level of stupidity and incompetence in the area of mental health is staggering."

Sad but true, although I think the better term is probably "mediocrity," rather than "incompetence." I've observed elsewhere that most mental-health professionals are, unfortunately, about average. They are decent at dealing with the average problems of average people. Put someone in front of them whose problems are outside the scope of their experience, and they will probably fail.

The small number of extraordinary people who do exist can deal well with unusual situations. Alas, systems that rely on extraordinary people in order to function are inherently fragile, and do not scale well, while the "average" psychologist or psychiatrist does not, in my experience, handle non-ordinary situations well.

I wish I knew a solution to the problem, but I don't. I don't think there is one. Some people will always slip through the cracks, while some who are innocent of ill intent will be misjudged unfairly. We should strive for improvement, but perfect prevention is not possible.

Self-defense is another matter. While I don't believe it is possible even in principle to identify all the bad apples before they try to kill, I have no doubt that the perpetrator would have been stopped quickly if all of the students had been armed. Impossible you say? Perhaps, in political terms, but there is nothing inherent in human nature or law to make it so. Whether arming all the students in the US would solve more problems than it causes is a different debate, but in the narrow sense of dealing with would-be mass murderers, it would certainly make a difference.

11:13 PM, April 18, 2007  
Blogger Thomas said...

Helen,
I don't know if you've seen the video excepts on NBC. I don't know if you're going to. But if you do...
What's your take on this guy? Assuming that there's not a lot more that we aren't seeing, he seems, to use my technical layman's jargon, crazy as a sh*thouse mouse.
Any thoughts if this is going to lead to some big prohibition now on firearms to anyone with a mental health history?

11:25 PM, April 18, 2007  
Blogger Tearfree aka Reject the Koolaid said...

Everyone is talking about what people at the university did or didn't do but what about this guy's family? What responsibility do his parents and sister have?

Helen, is it possible for someone like this to coe out of a "normal" family?

11:31 PM, April 18, 2007  
Anonymous alcatholic said...

Bob R said...
Failing that I'd like to hear some serious suggestions for what we could have done.

Bob R you are acting honorably in defending your institution and I respect that. You are also engaging the hard questions which is so important not just for VT but the whole nation. I work at a large university in LA and I pray that what VT does in response to this tragedy is worthy to be a model for all universities across the nation. The mental health system failures that have been exposed are really tragic and heart breaking.

On a previous thread, "How on earth was this time bomb allowed to go on ticking for so long?", anon @ 1:04 PM wrote what I thought were straight forward suggestions:

Anonymous said...

It concerns me that VT thought that nothing could be done, that the right of the individual superseded the safety of the whole. I wonder if any 1 person/department had all the info re: what was going on with this individual: mental health admit, potential for suicidal ideation/behavior via parents, stalking, classmates & teachers fear him to the point of refusal to be in class with him, starting a fire in the dorm, and recent silence (escalating from minimal response to not talking). There needs to be a central place for information like this.
After the fact, the same students and teachers “knew” it was him. I wonder if colleges should have, on the conditions of admission, something to the effect that if you exhibit several behaviors correlating to a DSM IV diagnosis, that failure to address it on your part: not pursuing treatment once identified and no discernable improvement of symptoms/behaviors will lead to parental notification/involvement and possible removal from the educational environment until the behavior is resolved. The school should reserve the right to essentially remove potential threats from campus. This should also be a laborious multidisciplinary process, not to be used to dismiss mere irritants. I would think that this is within the scope of any university. By allowing it to continue, you imply that the behavior is acceptable. SherH

What do you think, bob r, would this help our institutions, student, faculty, and staff?

11:31 PM, April 18, 2007  
Blogger Russ said...

"This killer was a nobody who wanted to be somebody--and sitting at home is another similar mentally ill person who will just be watching and waiting...."

WOW! How ruthlessly dismissive!
Reflect for a moment, on what it would be like to be at the social-mercy of a heartless "professional" such as yourself!

Don't get me wrong - I completely agree:
-The Cold-Heartedness of people like you exists in a vacuum
-Most "sociopaths" are simply "corrupted"
-The System works
-You are an Empress, over-seeing a vast ant-farm of VERY interesting sub-species! ;)

11:33 PM, April 18, 2007  
Anonymous Anonymous said...

he could not be involuntarily hospitalized and had not violated our code of conduct

That's it in a nutshell, should we revisit the "code of conduct?"
Laws Limit Options When a Student Is Mentally Ill [NYT]

It's being reported that the "VTech spokesman said this afternoon they had no idea Cho was taken a mental hospital or investigated for stalking in 2005." Did the laws prevent this information from being shared with the university? Did the intake specialist at the hospital unaffiliated with the university contact the dean to ascertain if there was other unusual behavior? Or, does the law restrict these two institutions from sharing information not only with each other but with the student's family. And, are we okay with the laws as they are currently implemented?

BobR, I gather you are an alumni of Virginia Tech. One thing the photographs of victims clearly reflect was that this school draws exceptionally talented teaching staff and students. What has happened is heartbreaking.

11:42 PM, April 18, 2007  
Anonymous alcatholic said...

bob r,

I think it is important to connect this tragedy with the article from the San Franciso Chronicle linked to by anon@5:15 in the comments of the previous post:
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/04/18/MNG7EPAN5U1.DTL

We might see more and more medicated and thus high functioning mentally ill students in our universities.

Quote from the article:
Providing that support has become a significant issue for higher education as students with complicated and serious mental health histories are increasingly showing up at college campuses, in part the result of the stabilizing effects of prescription drugs.

"Modern medications have made it possible for students with rather severe psychological problems to be successful in high school and go to college," Harris said. "It's a tremendous challenge across the nation for universities to have sufficient staff and services available to meet the growing demand."

Every year, UC Santa Barbara's faculty and staff members are given a booklet called, "Responding to Distressed Students," which outlines behavior or other signs to look for in the individuals.

Phone numbers of administrators, counselors and a social worker are included.

11:45 PM, April 18, 2007  
Anonymous Anonymous said...

What responsibility does his family have?

Well, let's see. The guy wrote violent plays about pedophiles and abusive parents. Boy, I hate to jump to conclusions here but could it be....
well, leave it to your imagination.
It is hard for me to see how someone like this could have come from a non-dysfunctional family. But I'm no expert, just a casual observer who knows a lot of people with a peculiar obsession with pedaphiles....

11:45 PM, April 18, 2007  
Anonymous Sebastian said...

Dismissive of what? I think some of you folks are inferring stuff that isn't being said.

11:56 PM, April 18, 2007  
Anonymous brian said...

Helen - I find that I must disagree strenuously with your position on the release of the videos. The argument has the same basis that Jack Thompson uses in his efforts to ban video games.

I, for one, do not wish to live in a world where all available information and entertainment is first passed through a filter of "will this trigger a psychotic episode in a mentally-ill individual".

12:05 AM, April 19, 2007  
Anonymous Arcy said...

I've had some experience with mentally ill and Universities, and that is definately something to look at.

In one situation, my roommate attempted suicide with an overdose of Tylenol. It took the resident assistant, dorm director about 1 hour to call the head of residence life to decide if they should call an ambulance to preserve her privacy. (All offers to drive her to the hospital 3 miles away were rejected due to liability.) She was held for 24 hours and released. She remained in the dorms for the remainder of the semester seeing a therapist once a week so she could complete two classes -- foreign language and art. She wasn't a danger to others -- I never felt in danger living with her, but I wonder if that was the best way to care for her. (There were family and ex-boyfriend issues.)

In the other case, a bipolar guy who bragged about not taking meds and his desire to kill his perceived enemies was in love with one of my friends.

After she dumped him, he would threaten suicide to his resident assistant, who reported it to his dorm director instead of reporting it. The dorm director then called our resident assistant to convince her to talk to him. She would be cajoled into making the call. She would reject his next call, he'd threaten suicide and the cycle continued.

One of the things that I witnessed was that there are 19-22 year olds trying to cope with difficult psychiatric issues that would be challenging for psychologists. I wonder if the resident assistants in this situation had any way to escalate the issue.

Then again, the resident assistants would try to "intervene" with anyone who was not their idea of the "typical" college student (not active enough, not going out enough, too quiet, too studious, not studious enough, etc.). They had little judgment of how to deal with many situations.

I think there should a better system than having the entire dorm under the control of a bunch of college-age kids and grad students. (If you're remembering the days of dorm matrons and the like, those days are over -- the students run the dorms under minimal supervision by professional staff.)

12:52 AM, April 19, 2007  
Blogger tomcal said...

Hola Doctora:

I hope you have been well. I've been busy.

I would be very interested in hearing you elaborate on your response to Heavy B at the top of this thread.

NBC's decision to publish portions of the "Manifesto" probably will encourage copycats who are also looking for their moment of fame, so in a sense it could be deemed irresponsible.

On the other hand, it gives the public insight into the mind of a truly insane man. I find it interesting that some commentators, supposedly professional, seem angry because Cho made his statements from the grave, eliminating any possibility of responding to them - as though he would ultimately accept a reasoned response if you could just sit him down and debate with him.

A Dr. friend once told me, "You can't reason with the insane; if you could, they wouldn't be insane." It seems to me that he is right, but certain people are evidently able to hide the depths of their insanity to the point that the system lets its guard down. Clearly there needs to be more awareness among professionals as well as the public about what true insanity means, and how to respond when you sense danger.

I was also interested, but not surprised, to learn that Cho was a stalker, and that one of his stalking victims apparently had the opportunity, but chose not, to press charges.

I am not blaming for one minute the young woman who chose not to press charges; I understand exactly how she must have felt. I work with an associate who has a stalker. Last year, after two years of pleading with her, I finally convinced her to vigorously pursue the case, which resulted in a felony conviction and his incarceration for six months.

He got out of jail in March. He now has a 500 yard criminal stay away order but has already tested the perimeter on two occasions that we know of. It's a scary thing to always have to maintain a heightened state of vigilance, and it is maddening that the authorities don't do it for you, but those are the facts of life. There is no doubt in my mind that our stalker will soon cross the line and we will have him on video, which will send him to prison for 3 years. But unfortunately for the victim, she has to do 90% of the work, as well as endure the constant stress of being so vigilant. Again, it would be nice if the authorities would take that burden off of her, but it just isn’t going to happen – it’s up to her, her friends, and all of the community who we have kept informed of the situation to be the first responders.


I think that because Cho demonstrates his insanity so clearly in the tapes, that in this particular case if a responsible media can use it as an opportunity to educate the public (probably insane for me to expect), but if it can, then NBC has made the right decision. The resulting heightened awareness by everyone would ultimately save lives.

12:57 AM, April 19, 2007  
Blogger alcatholic said...

hear, hear, arcy and tomcal. Very well put.

tomcal, how encouraging in these dark days to hear how you and your whole community are protecting your friend.

I totally agree that public awareness, and student and parent awareness must be raised. And in the case of Universities changes really need to be considered.

I feel really sad for those RAs arcy talked about. It hits me that the investment Universities are going to have to make to deal with this issue would be pretty big. In my university we have the equivalent of 7-10 hotels on campus housing students. Thank god its not just student RAs and front desk people, but to be honest I am ignorant of how mental health issues are escalated.

I may have to ask around. Thanks for writing about this, arcy.

1:21 AM, April 19, 2007  
Blogger J. Peden said...

arcy:

"In one situation, my roommate attempted suicide with an overdose of Tylenol. It took the resident assistant, dorm director about 1 hour to call the head of residence life to decide if they should call an ambulance to preserve her privacy."

Sounds like it worked out o-k. But the rule would be that if you are in any doubt at all about the safety of the person, call the ambulance/911. Let the EMT's deal with it. They have their ways and are very experienced in this area.

Furthermore, what are you going to get prosecuted for: a] invading someone's "privacy" - which actually wasn't her privacy anymore, once someone else found out; vs, b] "assisted suicide" or possibly[?] some kind of "negligence" if you don't do anything.

Basically, you don't want a death on your hands, and your friend probably didn't want to die anyway, though she could have. She was probably making what's called a suicide "gesture", in which the person usually wants help via making the gesture, but might manage to kill themselves off anyway. "Gestures" are very common, but must be taken seriously, at the least until they play out medically.

People who really want to commit suicide make pretty sure no one knows about it. But if you do happen to come upon one of them, dont' worry about their "privacy", either.

1:52 AM, April 19, 2007  
Blogger J. Peden said...

Unless it's Cho's kind.

2:04 AM, April 19, 2007  
Blogger Heavy B said...

tomcal,

"...a responsible media can use it as an opportunity to educate the public (probably insane for me to expect)..."

mmmmm, Yeah, we gotta question their motives here. The educational motive surely wasn't a consideration. I posit my original position that this is no different than showing the Berg decapitation; It is sensnationalism, not journalism, nor education, and diminishes the dignity of Cho's victims.

bob r, thou dost protest too much and thy wrath is badly misplaced. Dr. Helen's clear focus of blame lays on systemic failures, not those of individuals. Clearly, most of the profs and MH pros involved understood the danger Cho posed, but had no legal or systemic remedy.


heavy.B

3:02 AM, April 19, 2007  
Anonymous Arcy said...

J. Peden,

I agree with you. I wanted to get my car (1.5 blocks) and drive her. The RAs physcially blocked me from leaving the building and said a) it was unsafe for me to walk 1.5 blocks to my car at midnight (parked across the street from the police station) and b) they wouldn't permit her into my car due to University liability procedure (which didn't apply because I wasn't an employee, but they felt that it would cause liability if they condoned it in any way).

The RAs were the ones who were concerned about her privacy -- they felt it would embarass her if others in the dorm found out via an ambulance siren. I suggested that the ambulance be asked to keep the sirens off until they got to a main street -- the RAs dismissed that possibility until ordered by the head of residence life to make the call.

No RA wanted to make the decision to call an ambulance -- I agree that it was a basic decsion that should have happened immediately. I think at one point I was pulled aside and told to stop giving suggestions.

It was a cry for help and she's doing well (10 years later). But I was shocked that there were no procedures to deal with a likely situation. The procedures dealt with basic roommate problems and diversity.

I picked up my master's a few years ago, worked on the newspaper staff, and dealt with students who live in the dorms -- situation has not improved.

3:42 AM, April 19, 2007  
Blogger Helen said...

Brian,

Please note that I did not say that the video should be banned, censored etc. NBC has the right to make the decision to show or not show this material. The responsible decision might have been not to show it, the copy cat effect is known to exist. What is NBC's motive in showing the video? If it is education, that is not what I saw as I watched the clips. If you saw something different, okay. I do agree that the public does need to be made aware of the problems of the mentally ill in this country and the fact that very little is being done to deal with them. Jails and prisons are overrun with the mentally ill who finally commit crimes to get some attention or some help.

Mentally ill students are in universities where little is done to monitor or help them--is this acceptable? Maybe it is and maybe it isn't but it is an important conversation that is needed in our country. Sensational videos depicting the killer's rampaging thoughts without significant input and education, in my mind strikes me as unhelpful.

7:36 AM, April 19, 2007  
Blogger Mindsteps said...

Mental Health in the U.S. has been gutted by special interests.

11:08 AM, April 19, 2007  
Anonymous SofaSleeper said...

Helen, is it possible for someone like this to coe out of a "normal" family?

I'm not Helen, but I'll suggest an answer anyway. There are strong indications that Cho was schizophrenic. If so, then his family are no more reponsible for his condition than if he had diabetes.

I doubt this will keep large numbers of folks from dumping on his family. But count me out. They are relatives of a mass murderer, but they may also be folks who just lost a relative to a notoriously intractable illness.

11:17 AM, April 19, 2007  
Anonymous Wally Bock said...

As I read through these posts I'm reminded that within my lifetime it would have been routine for someone like Cho to be institutionalized. Mental health reform movements in the last forty years have changed that dramatically till now the scales are heavily weighted on the side of individual "rights." This has been compounded by the elimination of many mental health beds and dramatically lowering institutional capacity.

The old system had different abuses. People were sent to mental institutions for "evaluation" which could last weeks for social protests. Family members got together to have a difficult brother or sister "put away."

The present system is so very difficult to work in because the judgement of experienced but non-mental-health professionals such as teachers and police officers has very little affect on what happens.

One last thing. What would have happened, I wonder, if the university had sent Cho home? Would he have snapped then? Would he have gone back to Centreville and committed suicide in the basement? Or what?

12:39 PM, April 19, 2007  
Blogger alcatholic said...

Just as a lay person, I agree that just sending Cho home might not be optimal. He could snap and simply plan his rampage at home before returning to the campus.

The only thing I could think of is that Cho needed followups by the mental institution that held him in 2005. The deterioration of his condition could(?) have been noticed and further measures taken, including medication(I would hope).

Universities should probably consider putting aside student privacy and inform parents of all counseling type events, and holding them partially responsible for continued observation, treatment, etc.

1:06 PM, April 19, 2007  
Anonymous Sofasleeper said...

Universities should probably consider putting aside student privacy and inform parents of all counseling type events, and holding them partially responsible for continued observation, treatment, etc.

It's called in loco parentis, and used to be quite accepted. It's rather gone out of fashion in the last few decades.

1:18 PM, April 19, 2007  
Anonymous Wally Bock said...

You can't just put aside student privacy. Cho was an adult. His parents have no legal standing to be told his confidential information.

1:24 PM, April 19, 2007  
Blogger alcatholic said...

BTW, it seems clear that the English dept contacted Campus counseling, but they didn't work with the county mental institute that held cho in 2005.

Also, it seems that the University did not even know that Cho was sent to a county facility in 2005. The campus police referred Cho to the courts, but it seems they didn't followup. They either didn't know he was eventually referred to a hospital, or knew but didn't report the fact to the campus administration. Of course, the county hospital didn't seem to follow up either.

So, I believe Cho takes the writing class in Fall 2006, the English Dept reports him to Campus Counseling, but Counseling has no record of Cho's 2005 court determination and hospitalization.

Does this breakdown sound important to anyone else?

I guess one difficulty is that either Campus Counseling must keep police type files on students, or Police must keep mental health type files on students.

Another is that court proceedings and county hospitalization records would be shared with Universities. It seems that the firewall between the two makes sense, so breaking it down should be a very careful decision.

1:31 PM, April 19, 2007  
Anonymous brian said...

Dr Helen -

I wasn't concerned that you particularly wanted to ban the video, but merely saying that it was a bad idea because of fear of copycats worries me.

It worries me because we are allowing a small minority of the population to dictate what communications are considered a "good idea". It's the same battle we are having with Islamist extremists. We don't want to publish anything that might trigger an adverse reaction.

At some level, yes, you are going to influence broken people. But for all we know the sun coming up this morning will be the trigger for the next one.

Declaring some media "unhelpful" or "unacceptable" leads to legal liabilities and restrictions on communication. Everyone loses when these restrictions are proposed as a way to assuage an unstable minority.

1:33 PM, April 19, 2007  
Blogger Helen said...

Brian,

I understand your concerns--but as the press has the right to say what they wish, I have the right to say that I think it is a bad idea to put too much emphasis on the videos etc. But... I will not take to the streets, I will not threaten others, etc. I accept that they have the right to do this. Just as I have the right to express my opinion.

2:07 PM, April 19, 2007  
Anonymous Anonymous said...

Helen:

Your comment at 7:36am is sober and reasoned. I know you are capable of this. You just don't do it very often.

I agree in large measure with richard and bobr. Some (here and elsewhere) have descried the use of this event as fodder for gun rights talk. In the same way, I chafe at our society's habit at such times of immediately looking for a party to blame. In your case, you appear to point the finger in many directions: the school, the mental health system, etc. It's fine and appropriate to try to look at such events and consider what may be learned. But your initial reaction was to blame. That's not helpful and I think it's just as offensive as those who attempt to use the event for political purposes (like increased support for gun control). Particularly when you combine your blame with the same tripe I commonly read from you on here (i.e. "those damned liberals/PC folk are to blame!").

It may sound simple-minded, but it is unfortunately true. Sometimes, shit happens. Surely you know that YOU can't control everything. And neither can a school administration, the mental health system, or parents even.

I think somebody pointed this out on another post here, but...I believe at such times, we are better served by keeping our thoughts on the victims and their families. It may be more psychologically comfortable to skip the mourning and go straight to strident anger and blame. But I don't think it's healthy. And it sure as shit ain't helpful.

2:09 PM, April 19, 2007  
Anonymous Bugs said...

anon 2:09 - Unfortunately human nature, like shit, happens as well.

Not saying I disagree with you about the ugly debate. I just don't know what anybody can do about it.

2:49 PM, April 19, 2007  
Anonymous Cousin Dave said...

bob_r: I've got several co-workers who are grads of VT's engineering program. They have all spent a lot of time in Norris Hall.

So here's the thing, as I see it: Virginia Tech is a university. It is not a treatment center for the dangerously mentally ill. That is not its purpose. Further, VT does not have the legal authority to commit a student to involuntary treatment. And, under the current HIPPA regulations, it probably is not allowed to know about any treatment that a student is taking (or has been ordered to take but isn't), even if that student poses a danger to the campus at large. So yes, I think that blaming VT for what happened is way out of line. At most, I would wonder why the dorm arson incident didn't raise more flags. However, even in that case, I assume it would be up to the state to prosecute it, not the university. And if VT didn't know about any of Cho's other problems because of information firewalls, well, Cho wouldn't be the first student who committed a major screwup at least once during his college career. Universities see that all the time; they expect it, and generally the person who commits a major screwup like that doesn't do it again. So I can see why they may not have taken further action.

(Also, I had previously assumed, like a lot of others, that the previous stalking incidents occurred on campus. But the reports I'm seeing now indicate that maybe they were off campus. Again, in that case, information firewalls would have protected Cho at the university's expense.)

But even more the point: I don't see the value in everyone running around trying to affix blame to some third party. The person who should be blamed for it is dead, of his own hand, because ultimately he was too cowardly to face up to his responsibilities. That's the sad truth. I'm more interested in trying to figure out how ws can fix an obviously broken system. Cho is far from being the only violent bully who has ever slipped out between the bars of the mental health system.

There was a time, as others here have pointed out, when people like Cho were confined to institutions. That was a good thing. The problem was, a lot of people who, unlike Cho, were not dangerous and were capable of functioning in society were also confined to those institutions. Totalitarian nations are notorious for redefining mental illness to mean "any opposition to the regime". The Soviet Union, for one, was infamous for using its mental health wards as political prisons and forced re-education camps. So the possibility of a return to those days is definitely something that should concern libertarians.

However, the pendulum has swung too far. The system now gives the dangerously unstable more rights than it grants to their victims. It encourages and rewards threatening behavior and malignant narcissism and punishes those who try to check it. There's a tricky balance that has to be maintained between the lives of those that are wrongfully incarcerated, and the lives that are taken by the wrongfully freed. The existing mental health system has decreed, in effect, that the former are worth infinitely more than the latter. How can they make that determination? Don't both deserve equal consideration, at least in the large scale? At least the wrongfully incarcerated are still alive and can attempt to fight for justice and possible release. They may wind up losing a portion of their lives, which is wrong, but at least they get some of it back. The dead at VT have no possibility of ever obtaining justice. They will never get any portion of their lives back.

We don't shut down the criminal justice system just because of the possibility of a person being wrongfully convicted. We sort the wheat from the chaff. We have developed a system that does a pretty good job of distinguishing the guilty from the innocent. It doesn't work perfectly. Sometimes we find out that a convicted person was actually innocent. When that happens, we don't just throw up our hands and give up -- we work to refine the system so the odds of that happening again are reduced. We have forensic DNA testing that we didn't have 15 years ago. It has revealed that some people were wrongfully convicted, and for that reason we mandate its use in a most cases now where it can be applied. It has also revealed that a whole lot of people who were convicted and have protested their innocence to high heaven ever since, are in fact guilty within a high probability.

For the mental health system to protest that it can't distinguish cases like Cho from ordinary socially awkward loners is like saying that flu and spinal meningitis are indistuingishable because they both cause fever. Yeah, if you just look at one symptom, they might look similar. But a good physician or internist doesn't look at one symptom in isolation. It's the total picture that leads to the diagnosis.

So why doesn't the mental health practitioner see the whole picture? I see two causes. (1) The way the system is set up prevents any one entity from being able to get all the data. Hospitals can't share information with police. Police can't share information with universities. Universities can't share information with counselors. (2) The psychology profession has a credulity problem. Not a credibility problem (well, maybe, but that's a different issue), but a credulity problem. Most psych examinations consist of the therapist talking to the patient. But in the case of many of the most dangerous disorders, the patient is highly motivated to lie. That's one thing the internist doesn't have to worry about -- the physical body may give confusing signals, but it doesn't intentionally lie. But the mind and the mouth do lie, and there's plenty of existing evidence that three of the most dangerous personality types -- narcissists, socoipaths, and borderlines -- are often expert liars. How many times do we see court-appointed psychologists, who are charged with evaluating dangerous crminials, get hoodwinked time and time again? And yet it seems inconceivable to a lot of practitioners that a patient would intentionally lie to them. To my non-expert eye, there seems to be little in their training that prepares them for the possibility of a patient who lies. And worse, because the touchy-feely PC faction of the profession disdains the concept of obeective truth, it insults and shuns practitioners who suspect a patient of being anything less than truthful. "Everyone has their own truth", etc.

So what's to be done? I'm not sure, but here's a few ideas. De-emphasize the role of talk therapies in diagnosing potentially dangerous persons. Move more to scenario-type testing or role-playing situations or writing therapies. Spend more time evaluating the patient's paper trail -- so many people participate in one form or another of Internet activity that nearly everyone under 30 or so has some kind of Internet presence that can be examined. A blog, a Myspace page, and so on. Another idea is to do what a lot of people do these days anyway: use video to document their lives. Put cameras in their residences and have them running continuously. Make them wear cameras in public to document their interactions with others. (And if they try to subvert these conditions, this should be regarded as prima facie evidence that the patient does not intend to be cooperative.)

Finally, I'd suggest something like a jury system for committment hearings. Maybe not quite like a "jury of peers"; I think it would need to include at least a few experts. But it also needs to include at least a few people from outside the mental health profession, as a check and balance. I really think it could be done, with reasonably good accuracy, if someone cared to try.

4:03 PM, April 19, 2007  
Blogger Purple Avenger said...

It is hard for me to see how someone like this could have come from a non-dysfunctional family.

In a country of 300M, there's going to be a small handful that simply aren't wired right at conception.

12:19 PM, April 20, 2007  
Anonymous Cousin Dave said...

I agree with you, purple. Some people are just bad from birth, it seems. I've seen people from families that I knew were good, solid, loving families turn out like Charles Manson. I've seen the opposite too: kids from absolute nuthouse situations who raised themselves and turned out great. Proper child rearing is important, but sometimes genetic variation beats even the best (or worst) circumstances.

1:19 PM, April 20, 2007  
Blogger alcatholic said...

Well said cousin dave. A lot to think about in your point of view.

4:46 PM, April 20, 2007  
Anonymous Anonymous said...

Whether NBC had a right to show the video or not, I found it incredibly vulgar to see the NBC logo on the footage while I watched the news on the local Fox station. And I greatly would have preferred that they not give the guy the attention he was apparently seeking. I don't think there's a particularly productive reason for it. And I think the idea of copying and distributing criminal evidence is a bit much. Even as a former journalism student.

8:35 PM, April 20, 2007  
Anonymous Bugs said...

Oh, you know how it is - the public's "right to know" trumps everything.

Somehow I find it hard to believe that the NBC guys did a lot of heavy soul-searching on our behalf despite what they said. More like they weighed the damage to their ratings vs. the boost to their ratings if they showed it. Like the sniper video from Iraq, if it bleeds it leads. I think newsies will put their money on the freak show every time. Present company excepted, of course.

10:21 PM, April 22, 2007  
Blogger alcatholic said...

Dr. Peter Breggin makes an argument against relying on the mental health profession to protect us from the Cho's of this world. Police intervention is needed, and after debating this issue for a few days, I think I agree. University Police need to be better trained to intervene in cases of aggressive/violent behavior even if mental health issues seems to be an exculpatory cause.

The more I learn about the role and limitations of psychiatrists, the less I'm convinced they could be relied upon to keep the public safe. The police and administrative enforcement of suspension or other punishments for unacceptable behavior seem much more powerful institutions for dealing with campus violence and hopefully preventing mass murder.

And I write this as an early believer that the University failed by not understanding and treating Cho's paranoid schizophrenia. As Cousin Dave wrote above, universities are not mental health treatment facilities. I now believe the best role they can play is to seriously confront and punish aggressive/violent behavior.


Dr. Peter Breggin writes:
http://www.huffingtonpost.com/dr-peter-breggin/the-real-mental-health-l_b_46327.html

The answer to vengeful, violent people is not more mental health screening or more potent mental health interventions. Reliance on the whole range of this system from counseling to involuntary treatment failed. There is not a shred of scientific evidence that locking people up against their will or otherwise "treating" them reduces violence. As we'll see, quite the opposite is true.

So what was needed? Police intervention. Almost certainly, the police were hampered in taking appropriate actions by being encouraged to view Cho as a potential psychiatric patient rather than as a perpetrator. It's not politically correct to bring criminal charges against someone who is "mentally ill" and it's not politically correct to prosecute him or to remove him from the campus. Yet that's what was needed to protect the students. Two known episodes of stalking, setting a fire, and his threatening behavior in class should have been more than enough for the university administration to bring charges against him and to send him off campus.

Police need to be encouraged and empowered to treat potentially dangerous people more as criminals than as patients. In particular, men stalking women should be handled as definitively as any perpetrator of hate crimes. Regardless of whether the victims want to press charges, the police should. Cho shouldn't have been allowed to get away with it a second time.

How would a police action have affected Cho? Would it have humiliated him and made him more violent? There's no way to have certainty about this, but anyone with experience dealing with threatening people knows that a good dose of "reality," a confrontation with the law, is much more of a wake up call and a deterrent than therapeutic coddling. Furthermore, involuntary psychiatric treatment is one of the more humiliating experiences in American society, and tends to make people more angry, not less.

Mental health interventions do not protect society because the person is almost always quickly discharged because his insurance coverage has run out or because mental health professionals, who as a group have no particular capacity to make such determinations, will decide that the patient is no longer a danger to himself or others. Indeed, in December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found "his insight and judgment are normal." Need I say more about the hazards of relying on mental health screening and evaluation to identify dangerous perpetrators--even after they have already been threatening people?

3:07 PM, April 23, 2007  
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2:23 AM, April 21, 2009  
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