Is this not enough for involuntary commitment during an epidemic of active mass shooting incidents? Like all the others, a lot would have been uncovered - like his "mission". What mission? Anders Breivik had a mission in Norway too. We're not dealing with ghostbusters these days. If no probable cause for involuntary detention here, then why have involuntary detention for emergency psychiatric examination anyways? Does a known crazy man have to squeeze the trigger before there is probable cause for preventive detention? If so, a lot of first responders and policemen are going to die.
"The white man accused of fatally shooting nine people during a Bible study at a black church had been arrested on a drug possession charge about four months ago after concerned workers reported he was acting erratically at a shopping mall.
A Columbia Police Department report from Feb. 28 says 21-year-old Dylann Roof was wearing all black in a shoe store and in Bath and Body Works, asking employees strange questions. The report says he asked how many people were working, when they closed and when they left their jobs.
The officer wrote that Roof appeared nervous and said he was being pressured by his parents to get a job, though he didn't ask either place for a job application. When the officer searched him, he found suboxone strips — typically used to treat addiction to heroin and other opiates."
Comments:
Scottsdale Psychiatrist, John A Liebert MD PC discusses UConn Grand Rounds on the Adam Lanza Sandy Hook Elementary School Suicidal Mass Murder
Video: 03/13/2015 UCONN Psychiatry Grand Rounds: Dr. Schwarz's Lecture on Adam Lanza.
http://mediasite.uchc.edu/mediasite41/Play/23d2fd090846463a888043159b5f17411d
I have studied and written about this case and did learn some new things here - primarily that of his serious eating disorder. That being said, as psychiatrists on a psychiatric board like this, we must communicate via language enabling us to understand each other. In that regard, I found myself thinking that the only diagnoses on Axis I were Eating Disorder - and possibly severe Adjustment Disorder of Adulthood with a loaded Axis II, including Narcissistic Personality Disorder and a somewhat controversial - although I believe in it - Socio-Emotional Learning Disability (SELD). Axis III could have been lit up by his eating disorder, but no medical problems have been reported other than an extremely rare sensitivity to touch hardly anyone in this country ever heard of until publicized in this case! And, although Dr Schwartz said several external factors on the screen were in play with Lanza for Axis IV, in fact only two were - namely social isolation and violent video games. The social isolation implies forced social isolation, as in the SHU Syndrome at Pelican Bay Prison, CA, but it was really extreme social withdrawal typical of either the negative psychopathology of Schizophrenia or defense from paranoia. Axis V, as stated, was severe enough for CPA to have been called in. Surprisingly, at the very beginning of the lecture, Dr Schwarz seemed to have ruled out "psychosis"; this seems highly risky, as, the same would have been the case with Loughner had he ended his life as he said he intended; Cho was involuntarily committed with the diagnosis of Depression NOS, because the hearing officer quite obviously did not go along with the psych work up at St Albans; Aaron Alexis was found "fit for duty" and honorable discharge delusional of a microchip in his brain etc.
This was more a behavioral science perspective that could apply to many dysfunctional people, but of note is the fact that there is no history of violence in Adam Lanza and no history of self harm - i.e. cutting typical of BPD.
I thought that Dr Schwarz made quite a strong case for the group of violent mentally ill he cited in the Q&A period - just like Holmes, Cho, Kazmierzcak, Alexis, Rodger, Breivik et al; that is DUP and the risk of allowing this ticking time bomb of progressive psychotic illness with Paranoia to simply go undetected, unidentified and untreated.
The obverse side of this coin would be, again, of course, clinical speculation. What would officialdom have done with him had he been removed from his home with these diagnoses other than treat his eating disorder and provide some undefined therapy to improve his social relatedness and empathy? There is a literature on the effectiveness of family therapy for conduct disorder in adolescence, likely heading for special offender status - possibly enlarging their Amygdala so that they sense the other person. I think Dr Schwarz, however, was pointing in a different direction in the Q&A period and hit it right on the head without naming names - i.e. Adam Lanza. That is early diagnosis, shortening DUP and treating with antipsychotics. Of course we are speculating, because a paranoid psychotic can be together enough, omnipotent enough and cunning enough to keep his motives secret. Afterall, Cho is still under investigation, because VT police are searching for his cell phone and hard drive for clues of motivation. (This also, unlike CT, Thank God!, keeps critical information out of the public realm and, perhaps, any ongoing civil litigation against the Commonwealth. In the case of Adam Lanza, the only living witness to answer these questions, Nancy Lanza, was his first victim.)
I thought there were 3 other clinical exams also besides the Yale exam. Do we know what the diagnoses were in these? Why wasn't a simple MMPI or SCL 90 done by the school psychologist or at the time of his dropping out of UConn, where a precocious student?
Comment:
5/04/15
John, Very nice summary – you asked the right questions. Fuller
