Saturday, November 10, 2018

The Thousand Oaks Mass Murder

11/8/18 CBS News:
Dean said his department had several previous contacts with Long, a former machine gunner and decorated veteran of the war in Afghanistan. Those included a disturbance call to his home in April, when deputies found him acting irate and irrationally. 
The sheriff said the department's mental health crisis team was called at that time and concluded that Long did not need to be taken into custody under a "5150" order, an evaluation that determines whether a person needs to be involuntarily held for up to 72 hours because they are a threat to themselves or others. The episode was thought to be possible post-traumatic stress disorder because of his military background.
 11/9/18 Wall Street Journal:
Facebook post published to his account around the time of the attack said, “I hope people call me insane... (laughing emojis).. wouldn’t that just be a big ball of irony? Yeah.. I’m insane, but the only thing you people do after these shootings is ‘hopes and prayers’.. or ‘keep you in my thoughts’... every time... and wonder why these keep happening…,” a spokeswoman for the company confirmed.
PTSD alone is not, nor it should be a basis for a 5150 hold; many PTSD sufferers are not dangerous to others, but before Lanterman-Petris-Short Act of 1967 created 5150, "acting irate and irrationally," would have been enough.  The victims' parents demanding gun control in one of the leading gun control states is bad enough;  failing to address the part that destroying the mental health system plays in this is of course ignored.

11 comments:

James Gibson said...

Just before the vote Beto here in Texas involved the 30,000 gun violence dead number of our gun control movement. And again it's a failure to note that 22,000 are not gun violence, but suicides. We, with all our guns have a suicide rate of 14/100,000. Australia, with virtually no gun suicides, has a rate of 12/100,000 and Canada is at 11. Both these other nations should have seen their suicide rates cut in half when they banned guns, but all they ever saw was textbook transition to another means.

bombloader80 said...

One thing that occurs to me is that someone who enlists at 18 and does one enlistment is still in his early to mid twenties when he gets out. Given that this is also a common age for schizophrenia to develop, I wonder how many veterans suffering from odd behaviors after separating are initially diagnosed as PTSD when they have something more serious.

Clayton Cramer said...

bombloader80: What makes this more interesting is that PTSD is more common among those with bipolar disorder, which shares genes with schizophrenia.

Unknown said...

There have also been reports this guy was displaying erratic behavior and mental issues before he enlisted while he was in high school.

BFR said...

Clayton,

"bipolar disorder,...shares "genes" with schizophrenia."

Are you saying that there is/are solid genetic research and consequent evidential markers for those two diagnoses?

(By evidential, I mean sufficient to perform laboratory testing and obtain a result that leads to a diagnosis.)

Clayton Cramer said...

BFR: International Schizophrenia Consortium, "Common polygenic variation contributes to risk of schizophrenia that overlaps with bipolar disorder,"
Nature. 2009 Aug 6; 460(7256): 748–752. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912837/

Both diseases run in my family. Bipolar actually marathons in my family, almost never sleeping.

BFR said...

"A highly polygenic model suggests that genetically influenced individual differences across domains of brain development and function may form a diathesis for major psychiatric illness, perhaps as multiple growth and metabolic pathways influence human height."

"suggests...may...perhaps" are less than definitive.

The final paragraph prior to "Summary" says: "The nature of this “missing heritability” is a general problem..." and ends with a "remains to be investigated".

I am not dismissing the research out of hand, but it falls far short of that which can be defined as definitive and diagnostic.

Clayton Cramer said...

BFR: Not diagnostic, but it explains why these diseases run in families and why both diseases seem to be influenced by exposure to intoxicants.

BFR said...

Yes, I know this horse is embalmed, but if it is not diagnostic, it explains nothing. It is still at the "well, we suppose" level of investigation.

With fairly simple metabolic or imaging results (based upon an accurate elicitation of signs and symptoms) a disease state can (mostly) be accurately diagnosed.

To date, there are virtually zero metabolic or imaging results that can support diagnostic evidence for the conditions in question. I am not saying that there are none to be discovered; I am saying that in the absence of hard science, in medicine all else is conjecture.

Clayton Cramer said...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812015/

The 193 peer reviewed MRI studies reported in the current review span the period from 1988 to August, 2000. This 12 year period has witnessed a burgeoning of MRI studies and has led to more definitive findings of brain abnormalities in schizophrenia than any other time period in the history of schizophrenia research. Such progress in defining the neuropathology of schizophrenia is largely due to advances in in vivo MRI techniques. These advances have now led to the identification of a number of brain abnormalities in schizophrenia. Some of these abnormalities confirm earlier post-mortem findings, and most are small and subtle, rather than large, thus necessitating more advanced and accurate measurement tools. These findings include ventricular enlargement (80% of studies reviewed) and third ventricle enlargement (73% of studies reviewed). There is also preferential involvement of medial temporal lobe structures (74% of studies reviewed), which include the amygdala, hippocampus, and parahippocampal gyrus, and neocortical temporal lobe regions (superior temporal gyrus) (100% of studies reviewed).

takirks said...

In my opinion, based on 25 years active service in the combat arms, the problem we have with PTSD stems more from poor recruiting, assessment, selection, and training than anything else. Just about every single case I know of personally, the guys who had the most problems with handling stress were all people whose supervisors had already identified them as potential problems, due to poor coping mechanisms and other personality/behavioral issues.

PTSD is pretty much something you're going to get, with enough trauma. What makes the difference is in how you cope with it, and how well you recover from the trauma. Poor coping mechanisms, bad support mechanisms in your personal life, and you're probably not going to come back to any real functionality. All of the people I knew who demonstrated PTSD symptoms after trauma, who recovered? All of them had "normal" family backgrounds, no history of substance abuse, no diagnosis of behavioral issues in childhood, and possessed strong family/community/church support systems in their lives. The ones who didn't? All of them were the opposite--Broken homes, bad family relationships, histories of substance abuse in those families and personal lives, childhood personality disorders treated with psychotropic medications, and lacked strong support systems in their personal lives.

It is my contention that many, if not all, of the factors that go into PTSD predisposition and failure to recover adequately are identifiable, and should be screened for during enlistment, assessment, and training. Prophylactic training should also be embedded in everything we do, as the Israelis do with their "Purity of Arms" doctrine.

One aspect of the problem is that the military is oddly reluctant to discuss or train the real facts of life for servicemen, which is that the whole point of the thing is killing people and breaking things. Along with the fact that, yes, mistakes are bound to be made, and you're probably going to kill some friends of yours, or people on your side--Not to mention, the odd civilian or two. That's just the facts of war, and since we don't bother to train people realistically or discuss these things, when cold, hard reality slaps them in the face, they tend not to be able to handle what happens or what they've done. Big surprise, that...

We have a Code of Conduct that we train everyone on that goes into excruciating detail about what to do when captured, but which is utterly silent about explicitly telling Private First Class Jones what the hell his moral obligations are when his sociopathic squad leader starts talking to him about killing Afghani civilians. Because of this, we wind up with things like the Maiwand killings, and wonder why we have entire squads going off the reservation and raping and killing civilians. Nearly every incident I can think of off the top of my head had clear precursory warning signs that we'd recruited and/or promoted the wrong people, yet nobody did anything concrete about the problem until it was too late.

It's a sad fact, but if you don't exercise extreme caution in selecting the people you send off to war, things like My Lai tend to happen, and the broken people you put in uniform tend to come back from war even more broken than they were. I'm not a proponent of doing that, in any way, shape, or form--We need to recruit, select, and train far more carefully and stringently than we are.