Violent fantasy about homicide is not an uncommon experience, often triggered by the end of an intimate relationship or sometimes job loss. It is about control and the protection of what we perceive to be our personal boundaries or self interest. Fantasy is a defence mechanism. Children will often act impulsively and violently towards others in late infancy or early childhood until they integrate information from the world around them including the likely feelings of other people as they develop in maturity. While there might be a primary urge to lash out when we feel threatened, normally a secondary restrictive process around social convention or consideration of consequences prevents the primary process from being acted out in later years. You could call it growing up or getting a grip.
One definition of psychosis in an adult would be the abject failure of the secondary inhibiting processes – losing your grip if you like and leading to extreme states of mind. Losing it is what will be referred to in this article as a “breakdown”. Breakdowns can be isolated events as in the psychotic break, or repeated occurrences leading to diagnoses such as schizophrenia. To understand the phenomenon of mass social assassinations, we need to have some appreciation of the factors that can lead to the suspension of those protective developmental processes that are usually acquired through socialization as a child.
What exactly was going on in terms of neurotransmitter chemistry at the time when Holmes, Lanza, Breivik and the others opened fire will never be known, let alone what on Earth they were thinking or experiencing. So the proposition that mental health care through the right prescribed medicines might have prevented these killings is speculative at best, even if biological psychiatry has a firm foundation. None of those three had previous criminal records. It is even arguable that some prescribed drugs could promote this sort of incident through “side effects”. The SSRI antidepressants are known to promote anxiety sometimes and therefore suicidal or rarely homicidal ideation, especially in the early stages of prescribing. It is also most unlikely that patients would get involved with antipsychotic medication without previous mental health crises. While heavy sedation might repress impulses and postpone an event, in the longer term such medication also impedes the cognitive rationalization of inner turmoil through therapy. Jared Loughner who killed 19 people in a shopping centre in 2011 had been detained and medicated in a secure psychiatric facility previously. He was still free and able to buy his weapon. Perhaps when Obama talks about better mental health care or gun controls he means better reporting and sharing of information more than treatment?
Generally speaking better access to mental health care will mean better access to medicines rather than therapy anyway. Drugs are cheaper for a start and good therapists are hard to train and quantify. While the drugs might be supportive in many cases, to describe these medicines as a cure rather than a treatment is a logical leap too far. They treat the symptoms rather than the cause. There is a good body of evidence that suggests neurotransmitter changes do indeed influence thinking and behavior, but many of the causes for those fluctuations in dopamine, noradrenalin and serotonin remain biologically uncertain. Stress is however a widely acknowledged factor.
There are also alternative and robust models of how and why some people suffer breakdowns that are psychologically based rather than biological, one of which, discussed here, is Gregory Bateson’s Double Bind Theory. The Double Bind Theory is as follows. The individual is subject to diverse and compelling commands, and failure to comply with either will each result in some kind of punishment or negative consequence. The commands are so contrary that rationalization is not readily possible and expression of the internal conflict experienced by the person is prohibited by their family or social context, for whatever reasons. After a period of time, something has to give to release that emotional stress if the construct remains in place around him. [cont’d.]