How Will Psychology Respond to the Virginia Tech Killings?

April 17, 2007

The nation’s reaction to yesterday’s mass murder at Virginia Tech University have been understandable and predictable: lots of speculation and lots of emotion.

One of the more predictable responses is coming from my industry. Already, I have heard therapists in the media warning us about the dangers of vicarious trauma, the trauma of anniversary dates (the eighth anniversary of the Columbine massacre is just three days away), and the trauma of compound traumas.

If the university where I teach is any indication, well-intentioned mental health professionals are coming out of the woodwork to help. In a campus-wide email, we were reassured that counselors were available to students, faculty, and staff in the event that we were “touched by today’s tragedy.”

I am most certainly touched by today’s tragedy. My heart aches for those who lost loved ones.

But in regard to my own mental health, I’d like to pause for a moment, take a breath, and assess the situation. Do I really need a counselor today? Probably not.

Don’t get me wrong. If I didn’t believe in mental health services, I would never have earned a doctorate in psychology. But my industry gets carried away sometimes. When we’re not careful, we can do more harm than good.

Shortly after the 9/11 attacks on the World Trade Center and Pentagon, 19 psychologists warned the American Psychological Association of our industry’s tendency to overreact:

“In times like these, it is imperative that we refrain from the urge to intervene in ways that – however well-intentioned – have the potential to make matters worse.... Unfortunately, this has not prevented certain therapists from descending on disaster scenes with well-intentioned but misguided efforts. Psychologists can be of most help by supporting the community structures that people naturally call upon in times of grief and suffering. Let us do whatever we can, while being careful not to get in the way” (quoted in Hoff-Summer & Satel, 2005).

Wise counsel. Since 9/11, (and before, actually) we have learned that the way in which mental health workers approach disasters is sometimes counter-productive. Critical Incident Stress Debriefing (CISD), a group-based intervention invoked after tragedies such as today’s, has come under particular fire for its lack of empirical support. In fact, it appears that it can actually increase the risk for adjustment and anxiety disorders for some people (see, for example, Devilly & Cotton, 2004, for a critical discussion of the debriefing industry).

One of the ways that mental health workers can make matters worse is by interfering with natural individual and group processes that contribute to healthy coping – for example, by pressuring people to talk to professionals rather than gathering with friends and family. Overly enthusiastic counselors can also stay mired in the details of a tragedy long after their clients are ready to move on, thereby standing in the way of recovery.

Mass interventions such as CISD operate under the assumption that people are generally ill-equipped to respond to tough times. Nothing is further from the truth. Most humans, most of the time, are resilient creatures with good coping skills and solid support systems. In a study of Israelis who had suffered at the hands of terrorists, Bleich, Gelkopf, & Solomon (2003) found that the majority were optimistic about their future and felt that they could function well during a terrorist attack. Only five percent reported the need for professional assistance with mental health issues.

And there’s nothing wrong with being in that five percent. The task of mental health professionals during crises is to assist people when they get off-track in the natural process of assessing, responding, grieving, and recovering.

Self-destructive responses such as drug or alcohol abuse are a sign that a person is getting off-track, as are intractable and overwhelming emotional reactions. When thoughts or emotions interfere with normal functioning for days on end, then it is time to seek help.

And, of course, being directly affected by an event might require more assistance than friends and family are equipped to offer. If any of this describes you, please find a professional to help you make sense of the situation and find your strength again.

But if you feel that you’re doing OK, you probably are. If a professional tries to convince you otherwise, tell them to bug off. It might be the best thing you can do for your mental health.

-IS

References:
Bleich, A., Gelkopf, M., & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Isreal. Journal of the American Medical Association, 290(5), 612-620.

Devilly, G.J. & Cotton, P. (2004). Caveat emptor, caveat venditor, and Critical Incident Stress Debriefing/Management. Australian Psychologist, 39(1), 35-40.

Hoff-Summer, C. & Satel, S. (2005). One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance. New York: St. Martin’s Press.

Virginia Tech Part 2: Pulp Nonfiction: Why "We" Didn't Stop the Virginia Tech Killings

April 25, 2007

Context matters.

Seung-Hui Cho’s violent and disturbing play, Richard McBeef, tells a disjointed story of a broken family and the murder of a 13-year-old boy. The writing is childish and unimaginative; the scene is surreal. How does this differ from movies like Saw or Reservoir Dogs? Context.

Many aspiring authors invent horrific scenes. Some progress to successful writing and directing careers. Most linger in obscurity. A minute number go on to commit violent acts. For those few, writing is less an act of creativity than an expression of anguish and rage. Knowing the difference before the fact is sometimes impossible. It’s a question that mental health professionals have wrestled with for decades.

Perhaps one of the distinguishing marks of writing-as-a-cry-for-help is the context in which it occurs. By all accounts, Cho was an isolated individual who behaved in a bizarre fashion. From an early age, he was described as uncommunicative and brooding, and his stalking behavior speaks of a young man who was baffled by the rules of normal social discourse.

So why didn’t someone stop him?

Sadly, they tried. In fact, several individuals correctly read the signs and tried to intervene. Professor Nikki Giovanni reportedly insisted that she would resign rather than continue to expose herself and her students to Cho’s threatening behavior. Giovanni’s department head, Lucinda Roy, was so troubled by Cho that she reached out to him, offering individual lessons and reporting his behavior to campus police. Another of Cho’s professors, Lisa Norris, is said to have approached her Dean regarding Cho’s behavior. Norris also reached out to Cho, referring him to the university counseling center.

Others did the right thing, too. After Cho was arrested for stalking, campus police took him to a psychiatric facility rather than the county jail, which might have been easier. Later, a judge recognized the signs of mental illness and ordered Cho to participate in outpatient treatment. Both the police and the judge could have let him slip through the cracks entirely.

These are cynical times for some people. In the American Psychological Association’s Monitor on Psychology, author Mary Pipher laments that, “we no longer live in a culture where we know most of the people we encounter.” The article was entitled, “America: A toxic lifestyle?” The cure, many assert, is a more collectivist mentality.

But many of the individuals who crossed paths with Cho responded appropriately – even compassionately – to a very troubled young man. If a finger of blame can be pointed in any direction, it is at the paradoxical notion of the collective “we.”

It is the collectivist’s willingness to trade individual liberty for the illusion of safety that has created gun-free zones that are so very attractive to killers like Cho. And, ironically, the same government that intrudes too far into our lives has withered in one of the few areas where one can make a strong case for government intervention in the lives of individuals: responding to the severely mentally ill.

Decades old mental health crisis

According to a 2004 study by New York University’s Michael Almog, mental health care is difficult to obtain for “a population that is disproportionately and increasingly male, younger and of non-white race-ethnicity…. Psychiatric inpatients are overwhelmingly discharged to ‘the community’ and with a diminishing probability of discharge to a long-term psychiatric care facility.” The parallels to Cho’s life are eerie.

In the 1960’s, our country began dismantling the state mental hospital system, along with the infrastructure that allowed for the assessment and care of the severely mentally ill. Most noticeable among this group are young men, similar in age to Cho, who are experiencing their first severe psychotic disturbance.

In 1963, President Kennedy signed the Community Mental Health Centers Construction Act. It promised new outpatient mental health centers meant to replace state hospitals. State hospitals subsequently discharged their patients, but few of the new centers actually materialized. Even if the 2000 centers recommended by the National Institute for Mental Health had been built, decades of harsh experience have shown us that they are not equipped to handle severe mental illness. One of the biggest problems is that these patients simply don’t show up for treatment.

One of the reasons the state hospital system was dismantled was the promise of new medical knowledge. Another causal factor came from civil rights activists who regarded institutionalization as cruel and inhumane. Some activists seemed to regard mental illness as a right that should not be tampered with. “We” were willing to trade the safety of patients and the public for a utopian vision of boundless civil liberty. Now, the most severely mentally ill – those who were meant to benefit from deinstitutionalization – frequently end up homeless or in prison. They are too often the victims or the perpetrators of crime.

Clearly, “we” are confused about violence and civil rights. We force the responsibility of self-care on those who cannot manage it, while denying ourselves personal liberty and the means of self defense. But while collective confusion helped set the tone for the events at Virginia Tech, the wisdom of the individual nearly triumphed.

It was individuals – not an illusory collective – who acted heroically around Cho, even if they were unable to stop him. And it is individuals who will have the power and the responsibility to recognize and respond to the next troubled soul. Isolation, powerlessness, hostility, and pain: these are the context in which fantasies of violence can sometimes become reality. They are also the indication that it is time to follow the example of those who did what they could to prevent the tragedy at Virginia Tech.

-IS

References:
Almog, M. (2004). Managing United States mental healthcare policy: Changing patterns and trends in New York city acute psychiatry use, 1983-2000. Dissertation Abstracts International Section A: Humanities and Social Sciences, 64(7-A), 2640.

DeAngelis, T. (2007). America: a toxic lifestyle? Monitor on Psychology, 38(4), 50-52.

Moynihan, D. P. (July 12, 1999). Deinstitutionalization of the Mentally Ill. 106th Congress. Downloaded April 23, 2007 from: http://www.psychlaws.org/GeneralResources/article22.htm.

Torrey, E.F. & Zdandowicz, J.D. (1999). Deinstitutionalization hasn’t worked. The Washington Post, July 9, 1999. Downloaded April 23, 2007 from: http://www.psychlaws.org/GeneralResources/article17.htm.