Cognitive Daily

While the debate over guns and gun control has taken center stage on ScienceBlogs, ultimately there’s a human pulling the trigger. The New York Times has an interesting article about the problems getting troubled students to seek help before they harm themselves or others. The facts about college suicide are startlingly grim:

While shootings like the one at Virginia Tech are extremely rare, suicides, threats and serious mental-health problems are not. Last year, the American College Health Association’s National College Health Assessment, covering nearly 95,000 students at 117 campuses, found that 9 percent of students had seriously considered suicide in the previous year, and 1 in 100 had attempted it.

If their sample is accurate, that means that about 170,000 of the 17 million students enrolled in college or graduate school in the U.S. attempt suicide each year, and nine times that number consider suicide. Obviously, all these students need psychological or psychiatric help, but how do you determine which of them need to be removed from the classroom and/or forced into treatment? You certainly can’t justify removing 1.5 million students on the chance of stopping one Cho Seung-Hui.

NPR’s “Here and Now” had an interview with threat assessment expert Paul Dillon yesterday, where he explained how the University of Maryland system determined which students were serious threats to themselves or others.

Dillon explained that the vast majority of cases are only dangerous to themselves (this certainly corresponds with my own college experience: several students committed suicide, but nobody murdered anyone). Students can be referred to the counseling center, but in order to force them into treatment, direct threats must have been made. Maryland used a computer database to track troubled individuals and identify their relative levels of risk. In one case, they were able to take swift action when a student who had been expelled from school later threatened to return and physically harm a professor. The man was found to have a stockpile of illegal weapons; in this case the result was a conviction and a crisis averted.

But in many other cases, there simply isn’t enough evidence to remove someone from campus — and clearly, with as many 1.5 million students considering suicide each year, in nearly every case it would be wrong to do so. The Times article and NPR report offer additional insight into the extent of the problem.

Comments

#1 Fladvad
April 19, 2007

I am sorry as a foreigner to come in and point out something obvious, but the problem in the US with school shootings is not that people are crazy, depressed, angry or desperate. Students and people alike are that all over the world, and I would guess no more in the US than many other western countries.
No the problems is guns, their number at large and the easy access to guns of all sorts in the US. I, again as a foreigner, cannot see the need for a civilian population to have access to so much guns. And as a whole I think they do more harm than good. They will be used in robberys, threats, harrasment and murders much more than they will be used for protection.

I know it is impossible, but if I where in legislation I would even be so bold as to try to confiscate guns in my country. I actually believe them that harmful.
#2 Dave Munger
April 19, 2007

I don’t really want to weigh in on the gun control issue, but I should point out that many nations with gun control still have very high suicide rates. You might be able to prevent some of the mass killings using gun control (though the other side will argue that gun proliferation would also prevent them).

The problem of figuring out how and when to intervene still remains.
#3 Elia Diodati
April 19, 2007

It’s easy to find warning signs in retrospect, but a judge ruled that Cho was a danger to himself and the people around him. What more do you really need?
#4 Dave Munger
April 19, 2007

Putting someone in jail (or institutionalizing them) based on “warning signs” or even an attempted suicide is a dramatic step. It happened to one of our own sciencebloggers, and was a horrific experience for her.
#5 Elia Diodati
April 19, 2007

Here’s something from the Smoking Gun that might be worth looking at: Judge Paul Barnett concluded that Cho “presents an imminent danger to himself as a result of mental illness,” but that an involuntary hospitalization was deemed “unsuitable.”

http://www.thesmokinggun.com/archive/years/2007/0419071cho1.html
#6 sinned34
April 19, 2007

Guns don’t kill people, kids who play video games kill people.
#7 Dave Munger
April 19, 2007

Sinned34,

I’m guessing you’re not aware of Cognitive Daily’s long history of reporting on video game violence studies. We certainly don’t advocate banning the games, but we do think that exposure to certain types of media violence really is harmful. All joking aside, parents do need to decide what limits to place on the games their kids play.

It’s very unlikely that video games “caused” the Virginia Tech tragedy, but it’s too early to tell whether they may have played some role.

One thing is certain: banning video games probably wouldn’t have as much impact reducing suicides and violent behavior as working to improve our mental health infrastructure.
#8 Jenny
April 19, 2007

First and foremost: I think it’s a little inappropriate to try to start addressing the issues behind this incident without knowing what they are. We are just starting to learn the backstory, and are hearing bits and pieces of it at that. None of us are really in a position to say what caused this tragedy.

That said, I think we should distinguish between preventing suicides and preventing mass murder/suicides. In the case of a suicide bomber, for example, treatment for depression, etc., would not be effective. Someone who is truly suicidal is motivated by the desire to end their own life. A suicide bomber, on the other hand, is motivated by the desire to kill a whole bunch of other folks, and as it turns out, being a suicide bomber is a very effective way of doing this. I think the motivation is entirely different, and I think from what we’ve seen, Mr. Cho appears to be of the latter type. The motivation doesn’t appear to be suicide. The problem appears to be that he hated the people he went to school with, and wanted to take out as many of them as he could, much like a suicide bomber is not motivated to die per se, but rather to kill as many other people as possible (although, much like Cho, martyrdom appears to be a motivation).

So, no, 1 out of 100 students isn’t remotely potentially going to flip out and shoot up their school because they’re suicidal. However, it is interesting to note that Cho’s mentality is not unique – how many suicide bombers kill scores of people every day in Iraq?
#9 Dave Munger
April 19, 2007

Jenny,

I think your comparison of Cho to the suicide bombers in Iraq doesn’t work. I think the motivation of the terrorists has more to do with a Milgram-like obedience to authority rather than simple hatred of the people they are killing.

Clearly Cho had severe mental problems, and had they been addressed, the attack might have been prevented.

Stopping the suicide bombings in Iraq can’t be done by improving Iraq’s mental health infrastructure.
#10 Kurt
April 19, 2007

I’m speaking largely out of ignorance here, but… I had the impression that one reason it is so difficult to have someone involuntarily hospitalized is because of a history of abuses of the system, and poor standards of mental health care in general in decades past. However, given that our knowledge of mental illness and the range of treatment options has increased greatly, perhaps it’s time to tilt the balance somewhat back in the other direction.
#11 sinned34
April 19, 2007

Dave,

You’re correct in your assessment that I’m not too familiar with Cognitive Daily’s reporting on video game studies.

I was attempting to make a flippant remark (based on a t-shirt) that pokes fun at simplistic, knee-jerk reactions that many people give as a response to tragedies. We’ve already heard all the standard boogeymen that led to this mass murder: violent video games, movies, and television, lack of gun control, evolution, religion, heavy metal and/or rap music, etc.

My personal view is that these things tend to negatively affect only those who already have pre-existing personality or mental disorders. The trick is to treat the disorders, not try to get rid of anything that might finally trigger someone with a problem.

I’m not certain if my view is correct, and I acknowledge that I have incomplete information in this area, but I feel that my view is at least reasonable (even if it may be somewhat flawed).
#12 Alan Kellogg
April 19, 2007

The trick is to listen. To get to know the person. The problem with Mr. Cho is that nobody wanted to be bothered. It wasn’t their problem. Then you have people who are about as observant as a rock. Wouldn’t notice a fist rushing at their face.

It comes down to this, people didn’t want to take responsibility for him. Probably scared off by the possibility that some civil rights group would get on their case. Well I’ve got news for people, there is no right to be sick. And mental illness consists of a lot of diseases.

I have clinical depression, along with attendent anxiety disorder. Grrl Scientist also has clinical depression, and we’ve both attempted suicide. I don’t know about her, but I can tell you that being suicidal is a horrible thing. There’s not just the depression, but anger as well. A blood red rage that could as easily lash out against others as lash out against you. Every suicidal person out there is angry at the world, and just the right provocation could easily produce a bloodbath worse than Virginia Tech.

Being willing to listen, willing to take responsibility for taking any action deemed necessary to protect the subject and others. Learning the signs of suicidal behavior and knowing when to get the person the help he needs. Even hospitalization if that is the best course of action.

It also means we need to accept that mental illness is not a matter of choice. Nothing maladaptive ever is. A mental ill person cannot function in society, and needs help becoming functional. It is not a matter of civil rights but a matter of health.

Finally, we need to accept that mental illness is not a moral matter. Even the best of us can be mentally ill. That seeking help for a mental illness is the right thing to do.

If you’re feeling suicidal, get help. And be persistent about it, don’t let soem clueless ass belittle your feelings. You’re on medication and seeing a psychiatrist, keep taking your meds and keep seeing him. I know about the side effects of anti-depressants, better them than dead. (Besides, for the fellows a good chunk of beef can do wonder for the libido (testosterone is derived from cholesterol). And, many a survivor of testicular cancer has learned that inspiration can make up for the lack of hormones. )
#13 Jenny
April 19, 2007

Dave: My point was just that Cho’s goal – to kill lots of people – was similar to that of a suicide bomber, and that’s different than someone whose only goal is to kill him or herself. There’s no question that he was pretty seriously in need of help – that’s evidenced by him having these types of goals in the first place. But there was a lot more going on there than being “just” suicidal, to be coarse.

I think that Iraq’s mental health infrastructure (or lack thereof) will have its hands full for a while. This sort of thing happens there, on a bigger scale, every single day.
#14 Ellen
April 19, 2007

I am a PT Hokie prof, and want to share with all of you what one of our recent alums wrote:

Think of Virginia Tech as one body who just got attacked and we’re lying in the hospital bed. We need to use all the energy of our body to heal our wounds. What does a person go through who has just been maliciously attacked? Shock, vexation, confusion, anger, sadness, grief, disbelief, denial, etc. We’re trying to survive and make sense of what happed and gain clarity and perspective. Many questions are asked and some we will never have the answers to.

Some people are at our bedside asking us “shouldn’t have Tech done this or that? Why didn’t someone do their job?” I hope people are not intentionally trying to cause more distress but we need all white blood cells on the wound, we do not need to be wasting energy dealing with more confusion and second guessing.

We need love, healing, comfort, consolation, forgiveness, and service to each other.

The worst thing we can do as a Hokie Nation is to let the toxicity of the second-guessing and doubt to invade our own body and have our own community turn against itself. In a time like this where community members have confusion, vexation, and anger, it’s easy to mistakenly want to place blame. We cannot blame the administration or ourselves; Virginia Tech did NOT ask for this tragedy nor bring it upon herself, it’s not our fault. I believe our administration and police leadership did the best they could, but that is beside the point. Right now we need to band together and support EVERYONE in our Hokie Nation. Please encourage each other to serve one another and come together.

Right now my Hokie family needs me to be supportive and serve them. I need to support Dr. Steger and the entire leadership and not let anything divide us against one another.

Let’s not be remembered as the massacre university, but the university who embodied her to her motto, Ut Prosim and came together as community. I hope and pray we can serve one another in patience, kindness, goodness, forgiveness, and gentleness in our time of great need and agony.

Please feel free to pass along this message to anyone it might help.

God Bless and Ut Prosim,

Drew Lichtenberger

Virginia Tech, B.S. 2000
#15 tekel
April 19, 2007

You certainly can’t justify removing 1.5 million students on the chance of stopping one Cho Seung-Hui.

umm, why not? Seriously, why not?

Until Reagan de-funded state mental health programs, Cho wouldn’t have been able to kill all of those people, because he would have been living in a government-funded room with padded walls and eating only the softest of foods.
#16 Caledonian
April 19, 2007

Obviously, all these students need psychological or psychiatric help

Is it obvious? Or is it merely an unquestioned assumption on your part?
#17 Caledonian
April 19, 2007

However, given that our knowledge of mental illness and the range of treatment options has increased greatly, perhaps it’s time to tilt the balance somewhat back in the other direction.

Um, no. Our knowledge of mental disorders has increased only in the sense that we’re ruled out most of the old hypotheses on the subject. We still cannot diagnose disorders on examinations of physiology, define asymptomatic cases of disorder, or provide treatments that we know correct any underlying problem.

More to the point, the old abuses didn’t take place because of any knowledge (or lack thereof), but because the power to instantly strip a person of most of their civil rights was granted to individuals without also imposing controls and limits on that power.
#18 Victor
April 20, 2007

I think people naturally need to hold someone responsible for this and we see front page articles titled “outraged nation asks why”. This stance implicitly assumes it couldn’t have happened in “our town”. I think people at VT acted the way anyone else would have acted, and it could have easily happened anywhere else in the US.

As for possible prevention.. Forced hospitalization immediately raises a number of questions. Where is the line drawn and someone becomes a danger to society? Who would have the authority to diagnose that and therefore lock someone up? What are the legal requirements to do this?

I actually don’t think it could have been prevented. Someone pointed out that nobody wanted to bother to get to know the guy – it wasn’t their problem. I think this is the key point here. You’re responsible for yourself and I am responsible for myself – this is America. The principle works great for society, but it also has a dark side, which manifests itself in alienated people showing their worst – and in extreme cases, events like Columbine and VT.
#19 J Daley
April 20, 2007

Guns don’t kill people, pathological people with guns kill people.

Let’s face it, while one can’t justify discriminating against everyone who’s ever been clinically depressed, or otherwise (and more seriously) mentally ill, you could certainly make a compelling case for keeping them away from automatic pistols. If “a blood rage could easily lash out against others,” and you’ve been institutionalized because of your behavior, then I’m sorry, but you’ve waived your right to bear arms. Period.

We don’t allow felons – many of whom are arguably neither insane nor dangerous – to purchase guns. Why do we let the mentally ill?
#20 Kurt
April 21, 2007

This story on today’s NPR All Things Considered program is perhaps relevant to this discussion. Journalist and author Pete Earley talks about his own son’s mental illness while he was in college in Virginia, and the legal barriers to getting his son treated against his will.

Just some food for thought.
#21 Mark Frank
April 22, 2007

Until Reagan de-funded state mental health programs, Cho wouldn’t have been able to kill all of those people, because he would have been living in a government-funded room with padded walls and eating only the softest of foods.

We aren’t very good at predicting who is going to be violent and some of the most helpful variables are not mental illness at all, but things like substance abuse, employment problems and antisocial personality disorder (which is really just a fancy way of saying you are antisocial). So if you want to detect and detain a large proportion of those who would otherwise be violent you can only do it by setting the bar very low and detaining far more people who would never have been violent, have not done anything illegal, and and do not have a recognised mental illness. I think most Western societies would find this unacceptable.

Cho obviously behaved weirdly – but I am not aware that he was diagnosed with a specific disorder and I imagine there are many, many quite innocent people who behave just as weirdly.