Friday, January 14, 2011

Peter Kramer on Slate.



While we're waiting on ClinkShrink, I'll steal a link to a Slate article on paranoia by Peter Kramer. He won't mind.

Fanning the flames of paranoia

A psychiatrist wonders how a culture of Birthers and Truthers feeds the delusions of people like Jared Loughner

Dr. Kramer writes:

The experience in my training years made me comfortable with paranoia. As a result, I have always had one or two paranoid patients on the roster in my private practice here in Providence, R.I. I should stress that no one I see resembles Jared Lee Loughner. I travel a good deal, and I can't leave the covering doctor with potentially violent patients. When my patients have schizophrenia or related conditions, they tend to be the most accomplished, most reliable, and nicest people to suffer these terrible afflictions. Their needs are serious enough.

Not much specific is known about how to treat paranoid patients. Generally, they don't come in hoping to lessen their delusions, which can be wholly convincing to them. They want relief from depression or insomnia -- or from an employer who has insisted they get help. Their mood symptoms may respond to medication, and they may even become less isolative, but generally the system of thought does not budge. After months of trials of different drugs, the patient will be less agitated and less pained but still solidly convinced that he is being watched and threatened. Always, too, there are prices to be paid in terms of medication side effects.

One thing we all seem to agree on with mental illness of this magnitude is that violence of this extreme and horrific nature is rare. It's all pretty horrible.

15 comments:

ClinkShrink said...

I'm going to pick a bone here. As I stated in my last post, violence of this magnitude, sadly, is NOT rare. What is rare is that this violence was committed by an apparently (by media accounts) psychotic person. There are over 300 multiple murders every year!! This one got attention because one of the victims was a U.S. congresswoman. Sadly, had she not been injured along with another "high profile" victim this story would have been dead in a couple days. Had the only dead victims been the 9 year old girl or other "nobodies", the story would have been dead in a couple days. Let's please not treat this crime as more horrific than other crimes that happen every day in our cities to average citizens.

moviedoc said...

Even one is too many, but 300 IS rare, compared to 400,000 tobacco related deaths in the US in one year, 25,000 smoking related fire deaths in a year, 50,000 deaths per year in motor vehicle accidents, etc.

Anonymous said...

I don't get it, moviedoc. People are not forced into a room and made to smoke themselves to death. MVAs are unfortunate but I am not clear on how you equate accidental death with murder. If you want to say that 300 is rare and then quote your stats, you might be better off just saying pfft, 300 is rare because, of the billions of people on the planet, not one will be alive 120 years from today.
LSD

moviedoc said...

Or just, "300 is rare because of the billions of people on the planet."

Anonymous said...

No moviedoc, then you would have to tally the total numbers of murders per year for the whole planet and the number would not be be 300.
I have to agree with Clink. I can open the paper and read about a man who killed his family and then himself and not be shocked because I have read of or heard of or know of so many variations on the same theme. if it were really rare, it would have shock value

Anonymous said...

"One thing we all seem to agree on with mental illness of this magnitude is that violence of this extreme and horrific nature is rare. It's all pretty horrible."


I thought it was clear that I meant that I meant that it's rare for a mentally ill person to shoot 19 strangers at one time in a public place.

I believe this event would have gotten a fair amount of attention even without the congresswoman there-- we heard about Columbine, Virginia Tech, and Oklahoma City even in the absence of famous people. I'm not sure what critical number of innocent bystanders are needed for these events to become news. Maybe 10? Certainly, if Jim Jones has gotten 4 people to drink poison Kool Aid it would not have gotten the attention that it did with hundreds dying.

I think the public is drawn to stories where the fear is "That could have been me. I go to the grocery store." -- for example, the Central Park jogger-- That's true of random single shootings, but they occur at a frequency that make large amounts of media coverage untenable.


All murder is horrific, I agree.

But many people have psychotic illnesses, and very few of them shoot 19 strangers in a public place.

And while "multiple murders" occur at a rate of 300/year, my best guess is that many of these are related to drug deals or family passions or vengeance and not that many are the by-product of psychotic thinking --if that's what the Tuscon tragedy was.

If the shooter's agenda was political and unrelated to psychosis, might we consider this a terrorist attack?

Dinah

moviedoc said...

I believe I read Loughner described himself as a terrorist. Does that make it so? Clink, splitting hairs, but is that 300 people murdered or 300 episodes in which more than one(?) person was murdered? We should also keep in mind this might have ended with a suicide whether it was planned or not. Agree with Dinah: It's the numbers and the "could've been me" as well as the famous victim.

ClinkShrink said...

Moviedoc: That's 300 incidents in which more than one person was murdered.

Anonymous said...

And there are 365 days in a year. It averages to just about one multiple murder per day. Is that really rare? The sun rises once a day, too and we don't see that as rare, we count on it.

Anonymous said...

Dinah said,

"If the shooter's agenda was political and unrelated to psychosis, might we consider this a terrorist attack?"

Move Doc said,

"I believe I read Loughner described himself as a terrorist. Does that make it so?"

Interestingly, on another board, someone pointed out that if Loughner was dark skinned and his name was Mohammed, he would be described as a terrorist. The issue of mental illness wouldn't even be in play.

I am not sure what my opinion is on this but I thought since the "T" issue was mentioned, I would throw it out there for discussion.

AA

Anonymous said...

AA

Nidal Hasan, Fort Hood army psychiatrist--check out his story from late 2009. The issue of mental illness was in play as was the T issue.

LSD

moviedoc said...

LSD: Same was true of Mr. Haq in Seattle.
I just wish we could figure out what constitutes "rare."

Anonymous said...

mdoc,
Rare is when your steak bleeds on your plate. Common are those rare side effects listed about whatever medication you happen to take for just about anything that ails you. Rare is relative to other things and, as such, a moving target. Rare is a word and words sometimes, often, fail.Occasionaly, or quite a lot, I wonder why we care that something is rare.
LSD

moviedoc said...

My steak is rare.
It's over there.
If I don't care,
It won't be fair.

I rode a mare
to find a bear
but my pear
got quite a tear

he had a chair
in his new lair
oh was it rare?
oh was it there?

Anonymous said...

To avoid those awkward stares
be sure to wear your underwear

Time to end this great debate
so off I go to meditate



LSD