Mental Health and the Aurora Shooting

Tuesday, July 31, 2012

In the weeks before the Aurora, Colorado movie theater shooting, suspect James Holmes was seeing a psychiatrist specializing in schizophrenia. Columbia University Director of Law, Ethics, and Psychiatry Paul S. Appelbaum, explains how psychiatrists determine red flags with their patients and when behavior is concerning enough to warrant further action.


Dr. Paul Appelbaum

Comments [18]

Ed from Larchmont

Since he doesn't remember what happened, if he's telling the truth, there's a possibiity that he was possessed at the time of the shooting.

Aug. 01 2012 05:56 AM

I still haven't heard whether Holmes was taking selective serotonin reuptake inhibitors (SSRIs).
"Virtually all of the gun-related massacres that have made headlines over the past decade have had one thing in common:
Health and Healing: Tomorrow's Medicine Today
by Dr. Julian Whitaker, M.D.

Jul. 31 2012 11:42 AM
Dolores from Connecticut

Until the conversation regarding mass murders turns to the underlying mental disorders that inspire them, more and more people will fall victim -- singly as well as in public gatherings. The national media does not report on individuals who "snap" and attack and sometimes murder family members, but it is not uncommon. After every shooting spree, there are a handful of people who knew the shooter was a ticking time bomb. Neighbors and teachers had been watching the troubled young man who shot up Virginia Tech struggle with mental illness since he was a small child. The Arizona shooter had been expelled from college because of threatening behavior. Mental health care should not an optional luxury, but it is dispensed as such.

Having struggled to use the mental health care system on behalf of a family member in this country for ten years, I have found it baffling and inadequate -- and I am an educated English speaker who can pay professionals out of pocket when insurance falls short. With the latest baby boomlet age cohort turning 20 this year -- the typical age of onset for schizophrenia and other psychosis -- the world is poised for an up-tick in violence perpetrated by untreated young people whose symptoms are ignored, denied, or insufficiently treated.

Jul. 31 2012 10:38 AM
Katie from Huntington

I am not a psychiatrist, but I have a son, now in his 40s, who worries me. He has anger problems, and I recently found out he has guns. The family has tried to get him into anger management classes to no avail. He has deep resentment toward his sister, and I worry about her and her family, or even other people on whom he may someday take out his anger. He has committed no crime, his guns are legal, and he may never act out...but then again he may. And if he ever does act out, how do I live with myself for not getting him some kind of help? But what do I do?

Jul. 31 2012 10:35 AM
Doug from PA & NYC

Unfortunately you gave too little time to an issue that takes between a semester and two semesters for students to learn. He skipped over a lot if debate and info, and you, Brian, barely asked him any challenging questions. It was not a good service to your listeners


Jul. 31 2012 10:34 AM
BK from NJ

For the second time in 5 days WNYC and NPR have booked the same guest to discuss the same topics on back to back shows. I realize NPR and WNYC are different organizations, but considering WNYC broadcasts NPR content, you should do a better job of scheduling. In this case, is there a different person in te same arena of expertise who could comment on the issue and maybe bring a slightly different take? While very informative, we just heard Dr Applebaum's opinion 45 minutes ago on the Takeaway.

Jul. 31 2012 10:30 AM
Doug from PA & NYC

Your guest surprisingly forgets the tarasoff case where the killer of miss Tarasoff was in therapy and thinking of killing her. The therapist told campus safety but she still was killed. This case is a pillar of the ethics rule for psychologists to always report threats to others or to ones self. It is the duty of the psychologist to ascertain the likelihood and means of the patient first of course to determine an idle fantasy from a real plan.

This is a basic thing constantly drilled into us in school. We keep private everything of our client unless there is harm to another or to the patient (and for PA, any form of child maltreatment/abuse). While the patient may dislike us telling the police he is threatening to kill someone it would be worse if he did so and we knew about it.

Past crimes ate more of a grey area, but there are supervision levels to help out students as well as established psychologists iin most states and through the APA.

Your guest is simplifying and leaving some things out.

3rd year doctoral psychology student

Jul. 31 2012 10:28 AM
Amy from Manhattan

What if keeping a murder by a patient confidential endangers the life of an innocent who is arrested for the murder? What's the therapist's obligation in that case?

Jul. 31 2012 10:27 AM
RJ from prospect hts

Please don't move lightly over the possibility that someone else might be in prison for a past crime that someone confesses to. What is the docs responsibility to *those* people, whether patients or not?

Jul. 31 2012 10:26 AM
John A

I had a problem with a person incompetent to care for an elder and who used violence. What I did was call the Police "cold", what I got was a lesson in wasted time. The YWCA is now my go-to organization for dealing with dangerous persons - they seem to be quite specialized in these situations (typically 1 on 1; not the scale of Aurora, but perhaps the same mindsets)

Jul. 31 2012 10:25 AM

Slippery slope: Doctors and lawyers used to have the power to have people locked up - A case in point was Donna Eden, world renowned healer, married to an MD in the 60s - had no idea that not everybody could see energy, was talking about colors as did her mother before her - when she talked about energy she was seeing, he threatened to commit her to a mental institution! Years later when 5 top specialists told her to get her affairs in order, find a mother for her little girls - she got to work using the energy she can see, she healed herself. Part of that process was helped along by shamans in Tahiti, where the good doctor took the family. Now she is known the world over and mainly interested in teaching people how to work with their own energy, seen or unseen.

Clients didn't have to pay her fees if she didn't help her. Not one client was ever treated who didn't pay! Doctors tried to sue her for practicing medicine without a license - the testimony of clients inspired the judge t throw the case out - and the University of CA had her teaching!

Her favorite students are skeptics, and one MD offered her a head to toe MRI to prove that she really wasn't healed of MS - but it proved her healed. Her books are Energy Medicine, Energy Medicine for Women, The Promise of Energy Psychology, written with her 2nd husband, David Feinstein, who taught Psych. at Johns Hopkins Med School (Psychiatry dept) and other places.

Then artists could start getting locked up, too.

Jul. 31 2012 10:24 AM
Steve from NYC

Unfortunately, as with the Virginia Tech shooting, we are already turning away from the issue of gun control and seeking to blame mental health professionals for gun violence.

Jul. 31 2012 10:23 AM
Sopranos Fan from NJ

Although purely fiction, Dr. Melfi kept Patient Confidentiality on Tony Soprano.

Jul. 31 2012 10:23 AM
fuva from harlemworld

Please, exactly HOW does a person's psychiatric history affect a gun app in NY?

Jul. 31 2012 10:22 AM

I am a clinical psychologist who does a lot of anger management work and have done research in anger and aggression. I frequently work with court referred clients where aggression has been an issue.

This is a very difficult ethical issue at times in terms of measuring risk.

Could the guest address whether the Tarasoff case always applies to clinicians in New York?

Thank you,
J. Ryan Fuller, Ph.D.

Jul. 31 2012 10:22 AM
Birgitta from Highland Park, NJ

Ask guest about:

Tarasoff v. Regents of the University of California

I'm not sure if all the states have adopted a "duty to report"

Jul. 31 2012 10:18 AM
Dave from Washington, DC

I have a BA in Psychology...You're leveling too much emphasis on the patient-psychiatrist relationship and the actions of the psych professional. There is an issue in our country where the mentally ill aren't even seeking out appropriate. medical attention. It seems there is a lack of understanding of general psychology throughout our country. Imagine if high school students were required to enroll in psychology courses in high school, the same way high school students are required to enroll in health courses. The students would more easily be able to identify mental health issues they're facing. They would know who to seek out and how to treat them. Similar to the way high school students are taught to check themselves for testicular or breast cancer and seek medical attention after identifying an issue on their own. I'm sure there would be less school shootings, cinema shootings, etc.

Jul. 31 2012 10:17 AM
Janet from NYC

Certain professionals DO have a legal mandate to report certain kinds of information, which would include possible threat of harm to self or others, and/or child abuse or neglect. These professions include psychiatrists, psychologists, social workers, nurses, teachers.

Jul. 31 2012 10:14 AM

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