Health Features
Inside the Mind of James Holmes and Mass Murderers
By Dr. Reef Karim Jul 25, 2012, 20:21 GMT
In the world of psychiatric medicine, we often have to play the role of emotional detective.
As a psychiatrist, my job is to understand the intricacies of the human mind.
The purpose may be to help strengthen a relationship, assess why someone is self-destructive, diagnose a mental health problem or understand how someone could be dysfunctional enough to commit a mass murder. I've worked with individuals who are neurotic, emotional, impulsive, psychotic, self-destructive, suicidal, homicidal and even serial killer mass murderers.
At this very moment, everyone is asking the same question of James Holmes. WHY?
In the world of psychiatric medicine, we often have to play the role of emotional detective.
So let's go through what kind of questions need to be asked to gain a better understanding of who we're dealing with and why they may have committed such a tragic and terrible act.
Background Questions:
1) Do they have a history of violence?
2) Do they have a history of mental health impairment? Seen a professional? On medications? Received a diagnosis?
3) What is the family unit like? Abuse history? Violence history? Mental health dysfunction?
4) What was the individual like as a child? Oppositional? Fire setting? Cruelty to animals? Were they violent? FIghts?
5) Is there a criminal record? Terrorist affiliations?
6) Were they loners? How did they interact with others? Did they have intimate relationships?
7) Did they have any obsessions? Pop Culture references? Videogames obsessions? Specific people? Dark figures?
8) Did they abuse drugs/alcohol/pills?
9) Was their behavior erratic? With family? School? Work? Do they isolate? Are they a loner?
10) Were they ever lost in fantasy? With a difficult time assessing reality from fantasy?
The Act:
1) Was it pre-meditated or did it seem impulsive?
2) Was kind of preparation was there? Weaponry? Explosives? What was the plan?
3) Was there any evidence of communication beforehand? With others? A note? Family?
4) Was there any odd presentation during the act? Clothing? Statements? Costumes?
5) Was there any reference to society, police, authority figures, family members, specific individuals?
Now let's focus on what we know and don't know about the deadly mass shooting and James Holmes.
WE DON'T KNOW if he had a mental health history. We don't know if he's ever seen a psychiatrist or been in a psychiatric facility or was on psychotropic medications. We don't know if he acutely stopped any medications and we don't know if he has a history of violence or intent to hurt others prior to thursday night. We do know that people describe him as a loner type, quiet and "standoffish."
WE DO KNOW he has no criminal record, no terrorist affiliations and he was able to complete his undergraduate degree and at least start a PhD program in Neuroscience.
We know that, thus far, nobody has stated (counselors, teachers, parents, friends) that he has a history of violence or mental health disorder or a plan to hurt others. We also know he painted his hair red and claimed to be like the Joker from the Batman series. And he bought an assault rifle, Remington shotgun and two handguns along with explosives found in his car and apartment.
Conclusions:
In most cases of extreme violence and erratic behavior, there is an underlying mental health problem. The most common mental health problems seen are: a psychotic disorder from drugs, bipolar mania with or without psychotic features, schizophrenia or schizoaffective disorder with command auditory hallucinations, an individual suffering from difficulties interpreting reality and fantasy and lastly, the anti-social personality. Most people with mental health disorders are not violent but when there is violence, it's often an individual with an untreated mental health disorder.
This tragedy raises many societal questions. Is the family accountable for the actions of their kids? How did our schooling system fail to recognize the mental health dysfunction? Should there be more mental health screening done? What was the role of pop culture and fantasy based movies/brands in this? Should there be stronger gun control laws? How do we further de-stigmatize mental health diagnosis and treatment?
It's likely we'll find out that James Holmes either suffered from a mental health disorder or was in the process of having a first break of a mental health disorder (recent onset) as many disorders reveal themselves around 17-25 years of age or he had some history of anti-social personality disorder. There really can't be any other explanation as we are not programmed, as human beings, to kill others. Particularly like this.
I plead with any family members who are concerned about someone they know and love. PLEASE get your loved ones evaluated by a mental health professional. There is nothing wrong with seeking help. Nothing good can come of this tragedy. Only more awareness of mental health treatment.
A frequent contributor to Monsters and Critics, Dr. Reef Karim, M.D., is a board-certified psychiatrist and a pioneer in the fields of addiction behavior and intersection of pop culture and psychological disorders. Dr. Reef Karim is an assistant clinical professor at the UCLA Semel Institute for Neuroscience, and the CEO and medical director of The Control Center, a private practice in Beverly Hills, and is widely published on the subject of addictive behavior.
Twitter @DrReef
