Mark Rubinstein's Blog, page 39
March 29, 2013
Crime, Criminals and the Insanity Defense
As a forensic psychiatrist writing crime novels, I'm often asked about criminal cases involving the insanity defense (Not Guilty by Reason of Insanity, or NGRI). These are usually controversial and the most infamous ones are covered extensively by the media -- John Hinckley; the Unabomber; and more recently, James Holmes, the Aurora, Colo., killer.
In reality, NGRI pleas are quite rare, involving less than one percent of criminal cases; and fewer than one quarter are successful.
At the heart of the NGRI defense is the claim the defendant either lacked the capacity to know right from wrong (was brain-damaged, intellectually impaired) or had a mental disorder when the crime was committed, causing an inability to act within the law's requirements. An example would be a paranoid man who fervently believes the FBI and CIA are following him, and because of this delusion, shoots someone walking behind him on the street.
When I was a psychiatric resident in a large hospital, the police brought in a man who was ranting wildly. He had stabbed his six-year-old daughter ten times in the heart. The prisoner, a paranoid schizophrenic, claimed he heard the devil's voice commanding him to do it. He believed his daughter was a child of Satan. Months later, I was asked by the defense to re-examine the patient, this time at a state facility. He was as psychotic as ever and steadfastly clung to the belief he had done the right thing by returning his daughter to the devil. At trial, he was found NGRI and remanded to a state hospital where he remains, nearly 30 years later.
Occasionally, we hear of a defendant claiming "temporary insanity" after committing what is commonly known as a crime of passion. The defense posits a temporary loss of ability to discern right from wrong because of an extreme mental state brought on by an unanticipated, shocking situation, the classic example being a man coming home to find his wife in bed with his best friend. Juries, for the most part, are unsympathetic to such claims, rejecting them because they expect adults to exercise more self-control, even in extremely trying situations that engender rage.
Because NGRI defenses are very difficult to prove, they rarely are brought by defendants. At trial, forensic psychiatrists testify about the defendant's presumed mental state at the time the crime was committed. The jury must make its decision based on that testimony. The current functioning, appearance and demeanor of the defendant is of no bearing. It is the competing expert testimony presented by the forensic psychiatrists, which must be evaluated by the jury, and form the basis for its determination.
The biggest misconception about NGRI pleas is the popular belief that, if found Not Guilty by Reason of Insanity, the defendant leaves court a free person. The thinking is, the defendant got away with it.
This is not true.
If a jury concludes a defendant is Not Guilty by Reason of Insanity, he or she is remanded to a state hospital for an indefinite period of time. That confinement is for treatment of the mental condition that allowed the crime to occur. The hospitalization is usually very long, and may exceed the time which would have been served in prison had the defendant been found guilty. The average stay in a locked mental hospital for an insanity acquittee is 42.6 years in Connecticut, Office of Legislative Research whereas the prison term for the same crime is about 7.5-10 years National Judicial Reporting Program.
In most states, psychiatric facilities for NGRI acquitees are under the aegis of the Department of Corrections. A review board meets annually to decide if the acquittee has been "restored to sanity." In most cases, "restoration of sanity" rarely occurs.
So, a successful NGRI plea doesn't mean the defendant got away with a single thing. In fact, it's often a life sentence.
Mark Rubinstein
Author, "Mad Dog House"
In reality, NGRI pleas are quite rare, involving less than one percent of criminal cases; and fewer than one quarter are successful.
At the heart of the NGRI defense is the claim the defendant either lacked the capacity to know right from wrong (was brain-damaged, intellectually impaired) or had a mental disorder when the crime was committed, causing an inability to act within the law's requirements. An example would be a paranoid man who fervently believes the FBI and CIA are following him, and because of this delusion, shoots someone walking behind him on the street.
When I was a psychiatric resident in a large hospital, the police brought in a man who was ranting wildly. He had stabbed his six-year-old daughter ten times in the heart. The prisoner, a paranoid schizophrenic, claimed he heard the devil's voice commanding him to do it. He believed his daughter was a child of Satan. Months later, I was asked by the defense to re-examine the patient, this time at a state facility. He was as psychotic as ever and steadfastly clung to the belief he had done the right thing by returning his daughter to the devil. At trial, he was found NGRI and remanded to a state hospital where he remains, nearly 30 years later.
Occasionally, we hear of a defendant claiming "temporary insanity" after committing what is commonly known as a crime of passion. The defense posits a temporary loss of ability to discern right from wrong because of an extreme mental state brought on by an unanticipated, shocking situation, the classic example being a man coming home to find his wife in bed with his best friend. Juries, for the most part, are unsympathetic to such claims, rejecting them because they expect adults to exercise more self-control, even in extremely trying situations that engender rage.
Because NGRI defenses are very difficult to prove, they rarely are brought by defendants. At trial, forensic psychiatrists testify about the defendant's presumed mental state at the time the crime was committed. The jury must make its decision based on that testimony. The current functioning, appearance and demeanor of the defendant is of no bearing. It is the competing expert testimony presented by the forensic psychiatrists, which must be evaluated by the jury, and form the basis for its determination.
The biggest misconception about NGRI pleas is the popular belief that, if found Not Guilty by Reason of Insanity, the defendant leaves court a free person. The thinking is, the defendant got away with it.
This is not true.
If a jury concludes a defendant is Not Guilty by Reason of Insanity, he or she is remanded to a state hospital for an indefinite period of time. That confinement is for treatment of the mental condition that allowed the crime to occur. The hospitalization is usually very long, and may exceed the time which would have been served in prison had the defendant been found guilty. The average stay in a locked mental hospital for an insanity acquittee is 42.6 years in Connecticut, Office of Legislative Research whereas the prison term for the same crime is about 7.5-10 years National Judicial Reporting Program.
In most states, psychiatric facilities for NGRI acquitees are under the aegis of the Department of Corrections. A review board meets annually to decide if the acquittee has been "restored to sanity." In most cases, "restoration of sanity" rarely occurs.
So, a successful NGRI plea doesn't mean the defendant got away with a single thing. In fact, it's often a life sentence.
Mark Rubinstein
Author, "Mad Dog House"
March 21, 2013
Post-traumatic Stress Disorder & the Courts: The Jodi Arias Case
Many of us are familiar with the case of Jodi Arias, who is on trial for murder.
She admits to shooting her boyfriend, Travis Alexander, stabbing him multiple times and slashing his throat from ear to ear. Arias claims to have little or no memory of the murder. A defense-retained psychologist testified Jodi was suffering from Post-Traumatic Stress Disorder which arose from the murder itself.
Although I have never examined Ms. Arias, nor reviewed any of the documents submitted as evidence in the trial, I am disturbed by this tactic.
This diagnostic assertion is ludicrous on face-value because PTSD and the claim of not remembering a traumatic event are mutually exclusive.
In fact, Post-Traumatic Stress Disorder applies when a person remembers too much of a trauma. Intrusive thoughts and recollections (flashbacks) of the incident are played over and over in the victim's mind. Recurrent nightmares awaken the person in a state of terror. In essence, the signs and symptoms of PTSD preclude the person from being unable to remember the trauma. The disorder involves "over-remembering" the event.
In addition, for PTSD to be properly diagnosed, the victim must experience the trauma with fear of imminent death or threat of severe harm to self or others. Stressors which may evoke the disorder include forcible rapes; violent muggings; wartime combat; witnessing others being killed, maimed or tortured; tsunamis; plane crashes; and similar horrific occurrences.
As a forensic psychiatrist, I have examined many patients who survived catastrophic incidents, including more than 300 survivors of the 9/11 attack at the World Trade Center. However, during other consultations, I've encountered some people claiming to suffer from PTSD following situations that would never evoke the disorder. Whether it was tripping and falling on a sidewalk, or a fender-bender car accident not even requiring a trip to the emergency room, the flagrant misuse of the diagnosis has earned it the dubious distinction of being the most abused and misapplied diagnosis in the psychiatric-legal lexicon.
The Arias case demonstrates a larger issue. The claim of PTSD seeps into courtroom proceedings far too frequently because the disorder primarily involves symptoms, with relatively few (if any) objective signs. And, the word stress is a loaded concept presented to juries, often in a distorted way that trivializes real PTSD.
Post-Traumatic Stress Disorder is a serious psychiatric condition caused by an overwhelming psychic stressor, rendering the victim unable to stop reliving the sense of helplessness, terror and impending annihilation. There is absolutely nothing about the Jodi Arias defense that even remotely approaches rendering an honest diagnosis of PTSD.
It's time for the courts to require rigorous criteria be applied to this diagnosis before allowing more specious psychiatric claims to be presented to juries.
She admits to shooting her boyfriend, Travis Alexander, stabbing him multiple times and slashing his throat from ear to ear. Arias claims to have little or no memory of the murder. A defense-retained psychologist testified Jodi was suffering from Post-Traumatic Stress Disorder which arose from the murder itself.
Although I have never examined Ms. Arias, nor reviewed any of the documents submitted as evidence in the trial, I am disturbed by this tactic.
This diagnostic assertion is ludicrous on face-value because PTSD and the claim of not remembering a traumatic event are mutually exclusive.
In fact, Post-Traumatic Stress Disorder applies when a person remembers too much of a trauma. Intrusive thoughts and recollections (flashbacks) of the incident are played over and over in the victim's mind. Recurrent nightmares awaken the person in a state of terror. In essence, the signs and symptoms of PTSD preclude the person from being unable to remember the trauma. The disorder involves "over-remembering" the event.
In addition, for PTSD to be properly diagnosed, the victim must experience the trauma with fear of imminent death or threat of severe harm to self or others. Stressors which may evoke the disorder include forcible rapes; violent muggings; wartime combat; witnessing others being killed, maimed or tortured; tsunamis; plane crashes; and similar horrific occurrences.
As a forensic psychiatrist, I have examined many patients who survived catastrophic incidents, including more than 300 survivors of the 9/11 attack at the World Trade Center. However, during other consultations, I've encountered some people claiming to suffer from PTSD following situations that would never evoke the disorder. Whether it was tripping and falling on a sidewalk, or a fender-bender car accident not even requiring a trip to the emergency room, the flagrant misuse of the diagnosis has earned it the dubious distinction of being the most abused and misapplied diagnosis in the psychiatric-legal lexicon.
The Arias case demonstrates a larger issue. The claim of PTSD seeps into courtroom proceedings far too frequently because the disorder primarily involves symptoms, with relatively few (if any) objective signs. And, the word stress is a loaded concept presented to juries, often in a distorted way that trivializes real PTSD.
Post-Traumatic Stress Disorder is a serious psychiatric condition caused by an overwhelming psychic stressor, rendering the victim unable to stop reliving the sense of helplessness, terror and impending annihilation. There is absolutely nothing about the Jodi Arias defense that even remotely approaches rendering an honest diagnosis of PTSD.
It's time for the courts to require rigorous criteria be applied to this diagnosis before allowing more specious psychiatric claims to be presented to juries.
March 3, 2013
The Prescription
The Prescription
Not Your Everyday Rx
Steve was a 52 year old successful executive who looked downtrodden entering my office. He’d come reluctantly, and only because his wife insisted he “see someone.”
“She says I’m not living my life anymore,” he told me.
When asked what was going on, Steve said two years earlier, his dog of 14 years had died. His two kids were now out of the house, living on their own. His wife began teaching history at a community college, and he felt lonely, isolated and demoralized. “I don’t look forward to much,” he said, and added, “And don’t even think of prescribing pills for me because I’m not a pill-taker.”
Steve talked about doctors being “pill pushers” saying, among other things, “You guys’re tied into the pharmaceutical industry. I know...know, everyone’s got to make a living, but I don’t want to be part of that whole pill dropping thing. Besides…I’m not depressed, I’m just unhappy.”
Steve was right about his condition. He didn’t fulfill the criteria for a clinical depression; he was simply miserable with the way his life was turning out. Though he was doing well at the office, he felt isolated and pushed aside with the kids gone and his wife now working. He’d reached a financially rewarding executive plateau, and felt there was little to look forward to in middle age
By the third session he still complained about feeling empty. His wife was taken up with her career and the kids were doing well on their own. They rarely visited.
“So what do you have to offer?” he asked. “An anti-depressant? I won’t take it.”
“I’m not sure you need pills,” I said. “You really need something more in your life…”
“Are you suggesting I have an affair?”
“Not at all. It sounds like you’ve been thinking of it.”
“Maybe…but I’m sure it’ll cause more problems than it’ll solve.”
“You’re right about that,” I said.
“So what can you do for me, other than prescribing a pill, which I won’t take?” he added, shaking his head.
It seemed clear: Steve was challenging me to do something to help him.
“Well…I can prescribe something for you, but you would have to commit to the treatment.”
“I told you, I don’t want any pills.”
I reached over to the side table and pulled out my prescription pad.
“ Pills aren’t the answer,” Steve said. “Besides, what can you possibly prescribe for me so I won’t feel unneeded…just extraneous…even superfluous?”
“I’m going to prescribe something. But you’ll have to make a commitment.”
“What kind of commitment?”
I wrote the prescription, ripped the sheet from the pad, and handed it to Steve.
Looking at the script in his hand, a huge smile erupted on his face. “You really think this will help?” he said, still grinning.
“Yes, I think that’s what you need…”
“Maybe…you could be right.”
“You’ve been in mourning long enough, Steve. It’s time.”
The prescription said, “Get a dog.”
Mark Rubinstein, M.D.
Author of “Mad Dog House”
Not Your Everyday Rx
Steve was a 52 year old successful executive who looked downtrodden entering my office. He’d come reluctantly, and only because his wife insisted he “see someone.”
“She says I’m not living my life anymore,” he told me.
When asked what was going on, Steve said two years earlier, his dog of 14 years had died. His two kids were now out of the house, living on their own. His wife began teaching history at a community college, and he felt lonely, isolated and demoralized. “I don’t look forward to much,” he said, and added, “And don’t even think of prescribing pills for me because I’m not a pill-taker.”
Steve talked about doctors being “pill pushers” saying, among other things, “You guys’re tied into the pharmaceutical industry. I know...know, everyone’s got to make a living, but I don’t want to be part of that whole pill dropping thing. Besides…I’m not depressed, I’m just unhappy.”
Steve was right about his condition. He didn’t fulfill the criteria for a clinical depression; he was simply miserable with the way his life was turning out. Though he was doing well at the office, he felt isolated and pushed aside with the kids gone and his wife now working. He’d reached a financially rewarding executive plateau, and felt there was little to look forward to in middle age
By the third session he still complained about feeling empty. His wife was taken up with her career and the kids were doing well on their own. They rarely visited.
“So what do you have to offer?” he asked. “An anti-depressant? I won’t take it.”
“I’m not sure you need pills,” I said. “You really need something more in your life…”
“Are you suggesting I have an affair?”
“Not at all. It sounds like you’ve been thinking of it.”
“Maybe…but I’m sure it’ll cause more problems than it’ll solve.”
“You’re right about that,” I said.
“So what can you do for me, other than prescribing a pill, which I won’t take?” he added, shaking his head.
It seemed clear: Steve was challenging me to do something to help him.
“Well…I can prescribe something for you, but you would have to commit to the treatment.”
“I told you, I don’t want any pills.”
I reached over to the side table and pulled out my prescription pad.
“ Pills aren’t the answer,” Steve said. “Besides, what can you possibly prescribe for me so I won’t feel unneeded…just extraneous…even superfluous?”
“I’m going to prescribe something. But you’ll have to make a commitment.”
“What kind of commitment?”
I wrote the prescription, ripped the sheet from the pad, and handed it to Steve.
Looking at the script in his hand, a huge smile erupted on his face. “You really think this will help?” he said, still grinning.
“Yes, I think that’s what you need…”
“Maybe…you could be right.”
“You’ve been in mourning long enough, Steve. It’s time.”
The prescription said, “Get a dog.”
Mark Rubinstein, M.D.
Author of “Mad Dog House”
February 7, 2013
The Gift
With Valentine's Day approaching, many of us think of love and relationships. While so much is written about these topics, my awareness of love's meaning -- at least for me -- has been heightened by something we all dread.
Last year, my wife of nearly 30 years was diagnosed with a rare and very aggressive form of uterine cancer. She's seven years my junior, has always been in excellent health, and never had a physical complaint in all the years I've known her. The diagnosis hit us like a bolt of lightning.
Before her surgery, still reeling from the impact of the diagnosis, I
was in a supermarket, picking up a can of plum tomatoes that Linda needed to make pasta sauce for that night's dinner. (Yes, she continued to cook and do everything else throughout the many months of her treatments.) Linda always reminded me to check the expiration date on products, and I did just that. As I read the September 2014 date on the can, I was seized by a terrible fear: What would Linda's expiration date be? Statistics for her rare kind of cancer give a 30 percent chance for five-year survival. Would my wife be fortunate enough to have caught this beast before it spread? Tears welled in my eyes as I stood in the aisle with can in hand.
Maybe I was getting a bit morbid, but who wouldn't under such circumstances? Your previously healthy and optimistic wife, someone living life to the fullest, is diagnosed with a disease so rare there's no specific treatment protocol for it. It's treated as if it's ovarian cancer, but that's a shotgun approach. It's seen so infrequently, doctors have to do something and hope for the best.
So maybe there was ample reason to feel morbid.
But Linda had a different view, and she made it very clear: "I'm not going to let cancer run my life or define who I am. I'm going to live every day, and keep doing what I always do."
We began dealing with the treatments together. First, there was the surgery, which involved the removal of so many internal organs, it's called a "debulking." Linda went through it with flying colors and, to the doctors' amazement, was out of bed and walking the hospital corridors the very next day. Two days after that, she was home and functioning, despite discomfort.
I cut back on my office schedule for the chemotherapy. Over a four-month period, Linda received toxic infusions every three weeks. She lost her hair and experienced various other side effects, but kept going. We persevered together.
Next came radiation. Although the sessions themselves were uncomfortable, there were only three, and she fared quite well.
We received encouraging news. It would appear the cancer was caught in its earliest stages, and Linda's prognosis is guardedly excellent. We're one year post-diagnosis, and her scans and tests are all normal.
To the outside world, it would appear our lives are back to normal, and we've resumed our usual routines; but they're not, and we have changed. Facing the challenges and fears of this past year has brought us closer. We see each day together as a gift. Our appreciation of the simple things of life is heightened, whether it's a moment shared watching our dogs play, or the enjoyment taken in a meal before the fireplace.
True, Linda was the patient and faced her situation with unwavering optimism and courage; but her cancer struck both of us. And it impacted our lives and relationship very deeply. It made us stop amid our nearly 30 years of married life, and recommit to each other in a way that would never have occurred, if not for illness.
As this Valentine's Day approaches, I think about these things more deeply than ever before.
In a way, looking back on it, cancer was a gift.
Last year, my wife of nearly 30 years was diagnosed with a rare and very aggressive form of uterine cancer. She's seven years my junior, has always been in excellent health, and never had a physical complaint in all the years I've known her. The diagnosis hit us like a bolt of lightning.
Before her surgery, still reeling from the impact of the diagnosis, I
was in a supermarket, picking up a can of plum tomatoes that Linda needed to make pasta sauce for that night's dinner. (Yes, she continued to cook and do everything else throughout the many months of her treatments.) Linda always reminded me to check the expiration date on products, and I did just that. As I read the September 2014 date on the can, I was seized by a terrible fear: What would Linda's expiration date be? Statistics for her rare kind of cancer give a 30 percent chance for five-year survival. Would my wife be fortunate enough to have caught this beast before it spread? Tears welled in my eyes as I stood in the aisle with can in hand.
Maybe I was getting a bit morbid, but who wouldn't under such circumstances? Your previously healthy and optimistic wife, someone living life to the fullest, is diagnosed with a disease so rare there's no specific treatment protocol for it. It's treated as if it's ovarian cancer, but that's a shotgun approach. It's seen so infrequently, doctors have to do something and hope for the best.
So maybe there was ample reason to feel morbid.
But Linda had a different view, and she made it very clear: "I'm not going to let cancer run my life or define who I am. I'm going to live every day, and keep doing what I always do."
We began dealing with the treatments together. First, there was the surgery, which involved the removal of so many internal organs, it's called a "debulking." Linda went through it with flying colors and, to the doctors' amazement, was out of bed and walking the hospital corridors the very next day. Two days after that, she was home and functioning, despite discomfort.
I cut back on my office schedule for the chemotherapy. Over a four-month period, Linda received toxic infusions every three weeks. She lost her hair and experienced various other side effects, but kept going. We persevered together.
Next came radiation. Although the sessions themselves were uncomfortable, there were only three, and she fared quite well.
We received encouraging news. It would appear the cancer was caught in its earliest stages, and Linda's prognosis is guardedly excellent. We're one year post-diagnosis, and her scans and tests are all normal.
To the outside world, it would appear our lives are back to normal, and we've resumed our usual routines; but they're not, and we have changed. Facing the challenges and fears of this past year has brought us closer. We see each day together as a gift. Our appreciation of the simple things of life is heightened, whether it's a moment shared watching our dogs play, or the enjoyment taken in a meal before the fireplace.
True, Linda was the patient and faced her situation with unwavering optimism and courage; but her cancer struck both of us. And it impacted our lives and relationship very deeply. It made us stop amid our nearly 30 years of married life, and recommit to each other in a way that would never have occurred, if not for illness.
As this Valentine's Day approaches, I think about these things more deeply than ever before.
In a way, looking back on it, cancer was a gift.
February 5, 2013
Living the Dream
I always had dreams.
It’s May 1956 at Ebbets Field, a bandbox of a baseball stadium, home of the Brooklyn Dodgers. My all-time hero, Gil Hodges, stands at first base. We’d snuck down to the first baseline box seats from our perch in the bleachers. In the blink of an eye, I’m standing next to Gil and talking with him. We’re teammates. A 14-year-old boy’s fantasy.
Baseball was in my DNA; I was a fine ballplayer. I had an uncle who, at 9, left home, heading for Vero Beach to try out for the Dodger...
February 4, 2013
My Day Behind Bars
It looked like something out of a nightmare—the Fishkill Correctional Facility in Beacon, New York. The first unit was built in 1886. Over the years, other buildings were added, and the original hospital for the criminally insane became the Fishkill prison complex as it now exists. A huge, rambling series of structures, the buildings stand on 246 acres near the Hudson River. Surrounded by chain link fences and concertina wire, the place exudes an eerie sense of foreboding and menace that’s di...
January 30, 2013
The Horror of Newtown--Part 2
In my first post, I made comments about what occurred in Newtown and gave an overview of the problem, primarily from a psychiatrist’s perspective. I do, however, have some specific comments that while difficult to implement, might help reduce the likelihood of such tragedies occurring with frequency.
We hear public service announcements about how heart attacks can kill, or that cancer can kill, along with advice that early diagnosis and intervention save lives. The public airwaves carry messages about childhood asthma, cystic fibrosis, obesity and diabetes. Yet, nothing is ever stated that severe mental illness (depression, some forms of schizophrenia) can kill as well. These are unmentionables in the media. We need public service announcements to help destigmatize these disorders because they can kill—the afflicted person as well as others.
Our culture and entertainment have changed drastically. There used to be one family TV with a limited number of stations. Today, a house may have three or more televisions (with 600 stations) and it’s typical for each kid to have a bedroom TV. Or to have a computer (or handheld device) on which music, videos, and the Internet can be streamed. There’s less entertainment today that’s life-affirming; there’s much more filled with anger, violence and a nihilistic world view. Parents must be more aware of their children’s entertainment fare in today’s, multi-modal, digitalized (and increasingly desensitizing) world. I’m not talking about banning or trampling freedom of speech. I’m simply saying we must stop supporting some entertainment by not buying into that which glorifies hatred and violence.
Parents should stop trying to be “friends” to their kids. Empathy with and understanding our children are fine, but they don’t mean we relinquish responsibility or authority. Too many parents seem to do just that.
Parents must band together to guide their children and promote a more positive world view. Parents of kids who are friendly must speak with each other and be aware of their kids’ activities and access to the Internet, video games, and music. Yes, parents are working and have full lives; but to ignore these issues is to invite trouble with possibly tragic consequences.
Kids should be encouraged to inform their parents or teachers about any “strange” behavior or verbal pronouncements by a friend or classmate. They should be dissuaded from feeling this is somehow “ratting out” another kid. Rather, it’s an obligation to everyone to report these things. After all, we’re all in this life together.
Parents should be exquisitely aware of any entertainment that debases authority figures or any group of people for any reason.
And from a psychiatric perspective, let’s face it: it’s a fact of life that some troubled people should never own or have access to a weapon of any kind. There should be strict mental health background checks of anyone wishing to purchase a weapon, for any reason. This certainly doesn’t infringe on any sane person’s right to bear arms.
I recently watched two films that powerfully depict the erosion of respect young people have for school, parents and authority. They depict the coarsening of our culture and its effects on young people. The first is Detachment which paints a bleak portrait of an inner city public school, and the burned out ennui affecting the teachers, along with the struggle of poor youngsters to find anything positive in their lives. There’s a scene in which not a single parent shows up for Open School Day.
The second film is Margaret, which takes place in a Manhattan private school. While the film dives into issues of right and wrong, it also depicts the students’ lack of respect for teachers and each other. And it tellingly portrays a mother’s preoccupation with her career to the extent whereby she doesn’t have a clue about what’s going on with her seventeen year old daughter.
We must also revisit HIPPA regulations about patients’ privacy rights. Today, the mother of a twenty year old Paranoid Schizophrenic whose behavior is erratic and deteriorating, cannot ask her son’s treating psychiatrist about his treatment, even though he lives under her roof and depends on her for everything—food, clothing, and shelter. It defies common sense.
Yes, there are laws, rules, regulations and the Constitution. But what we need as much as anything is common sense. Unless we use common sense in making adjustments to the scourge of mass killings that has spread across our country, we will all be victims, again and again.
Mark Rubinstein,
Author, “Mad Dog House”
We hear public service announcements about how heart attacks can kill, or that cancer can kill, along with advice that early diagnosis and intervention save lives. The public airwaves carry messages about childhood asthma, cystic fibrosis, obesity and diabetes. Yet, nothing is ever stated that severe mental illness (depression, some forms of schizophrenia) can kill as well. These are unmentionables in the media. We need public service announcements to help destigmatize these disorders because they can kill—the afflicted person as well as others.
Our culture and entertainment have changed drastically. There used to be one family TV with a limited number of stations. Today, a house may have three or more televisions (with 600 stations) and it’s typical for each kid to have a bedroom TV. Or to have a computer (or handheld device) on which music, videos, and the Internet can be streamed. There’s less entertainment today that’s life-affirming; there’s much more filled with anger, violence and a nihilistic world view. Parents must be more aware of their children’s entertainment fare in today’s, multi-modal, digitalized (and increasingly desensitizing) world. I’m not talking about banning or trampling freedom of speech. I’m simply saying we must stop supporting some entertainment by not buying into that which glorifies hatred and violence.
Parents should stop trying to be “friends” to their kids. Empathy with and understanding our children are fine, but they don’t mean we relinquish responsibility or authority. Too many parents seem to do just that.
Parents must band together to guide their children and promote a more positive world view. Parents of kids who are friendly must speak with each other and be aware of their kids’ activities and access to the Internet, video games, and music. Yes, parents are working and have full lives; but to ignore these issues is to invite trouble with possibly tragic consequences.
Kids should be encouraged to inform their parents or teachers about any “strange” behavior or verbal pronouncements by a friend or classmate. They should be dissuaded from feeling this is somehow “ratting out” another kid. Rather, it’s an obligation to everyone to report these things. After all, we’re all in this life together.
Parents should be exquisitely aware of any entertainment that debases authority figures or any group of people for any reason.
And from a psychiatric perspective, let’s face it: it’s a fact of life that some troubled people should never own or have access to a weapon of any kind. There should be strict mental health background checks of anyone wishing to purchase a weapon, for any reason. This certainly doesn’t infringe on any sane person’s right to bear arms.
I recently watched two films that powerfully depict the erosion of respect young people have for school, parents and authority. They depict the coarsening of our culture and its effects on young people. The first is Detachment which paints a bleak portrait of an inner city public school, and the burned out ennui affecting the teachers, along with the struggle of poor youngsters to find anything positive in their lives. There’s a scene in which not a single parent shows up for Open School Day.
The second film is Margaret, which takes place in a Manhattan private school. While the film dives into issues of right and wrong, it also depicts the students’ lack of respect for teachers and each other. And it tellingly portrays a mother’s preoccupation with her career to the extent whereby she doesn’t have a clue about what’s going on with her seventeen year old daughter.
We must also revisit HIPPA regulations about patients’ privacy rights. Today, the mother of a twenty year old Paranoid Schizophrenic whose behavior is erratic and deteriorating, cannot ask her son’s treating psychiatrist about his treatment, even though he lives under her roof and depends on her for everything—food, clothing, and shelter. It defies common sense.
Yes, there are laws, rules, regulations and the Constitution. But what we need as much as anything is common sense. Unless we use common sense in making adjustments to the scourge of mass killings that has spread across our country, we will all be victims, again and again.
Mark Rubinstein,
Author, “Mad Dog House”
The Horror of Newtown Part 2
In my first post, I made comments about what occurred in Newtown and gave an overview of the problem, primarily from a psychiatrist’s perspective. I do, however, have some specific comments that while difficult to implement, might help reduce the likelihood of such tragedies occurring with frequency.
We hear public service announcements about how heart attacks can kill, or that cancer can kill, along with advice that early diagnosis and intervention save lives. The public airwaves carry messag...
The Horror of Newtown
As a psychiatrist and human being, I understand the complicated swirl of emotions people felt and still feel about the horror of Newtown, Connecticut. This is especially true for those with young children, though I think most of us reel in revulsion when we think of that terror-filled day. It’s a natural human reaction.
One tries to comprehend the profound sorrow of those who lost children that day. The ripple effect spreads—widely and deeply. On the day it happened I was in a supermarket where many employees were from Newtown and the surrounding area. They were in a state of abject shock, and some ran home for fear their children were victims.
I’m asked frequently to provide insights about Newtown—how to understand that tragedy, and how to learn something from it. It’s impossible to provide some psychiatric nostrum or unitary explanation for what happened, but I do have some thoughts. And they don’t all relate to psychiatry.
The horror of Newtown calls into question who we are as a society and how we relate to our children. We must look more closely at our schools, the entertainment our kids watch, and at our very culture itself—who and what we are as a nation. And, we must examine our mental health delivery system.
It’s clear that the young man who committed these crimes was a disturbed and tortured soul whose inner demons exploded that day. I’m struck by the fact that in each of these mass killings—whether in Aurora, Colorado; Arizona; Virginia Tech; a shopping mall; a high school; an elementary school in Newtown; or wherever these killings occur—the shooter is always a young, loner male with deep-rooted mental problems that were either ignored or inadequately treated. And invariably, he gave many warning signs of his mental state before acting.
Usually, after a few weeks of media frenzy and renewed debates about gun control and mental illness, we go back to our daily lives and concerns. The horror of it all fades into the background.
But these terrible events are a cause for deep, probing soul searching about many issues, some not pleasant to examine: access to assault weapons; the depersonalizing effects of some video games and CGI action films; our music; and the coarsening of our culture with its desensitizing influences on those who are emotionally vulnerable. Looking into these worrisome concerns can make us feel uncomfortable.
But if we don’t address them, these tragedies will occur again and again.
Mark Rubinstein
author of MAD DOG HOUSE
One tries to comprehend the profound sorrow of those who lost children that day. The ripple effect spreads—widely and deeply. On the day it happened I was in a supermarket where many employees were from Newtown and the surrounding area. They were in a state of abject shock, and some ran home for fear their children were victims.
I’m asked frequently to provide insights about Newtown—how to understand that tragedy, and how to learn something from it. It’s impossible to provide some psychiatric nostrum or unitary explanation for what happened, but I do have some thoughts. And they don’t all relate to psychiatry.
The horror of Newtown calls into question who we are as a society and how we relate to our children. We must look more closely at our schools, the entertainment our kids watch, and at our very culture itself—who and what we are as a nation. And, we must examine our mental health delivery system.
It’s clear that the young man who committed these crimes was a disturbed and tortured soul whose inner demons exploded that day. I’m struck by the fact that in each of these mass killings—whether in Aurora, Colorado; Arizona; Virginia Tech; a shopping mall; a high school; an elementary school in Newtown; or wherever these killings occur—the shooter is always a young, loner male with deep-rooted mental problems that were either ignored or inadequately treated. And invariably, he gave many warning signs of his mental state before acting.
Usually, after a few weeks of media frenzy and renewed debates about gun control and mental illness, we go back to our daily lives and concerns. The horror of it all fades into the background.
But these terrible events are a cause for deep, probing soul searching about many issues, some not pleasant to examine: access to assault weapons; the depersonalizing effects of some video games and CGI action films; our music; and the coarsening of our culture with its desensitizing influences on those who are emotionally vulnerable. Looking into these worrisome concerns can make us feel uncomfortable.
But if we don’t address them, these tragedies will occur again and again.
Mark Rubinstein
author of MAD DOG HOUSE
The Horror of Newtown
As a psychiatrist and human being, I understand the complicated swirl of emotions people felt and still feel about the horror of Newtown, Connecticut. This is especially true for those with young children, though I think most of us reel in revulsion when we think of that terror-filled day. It’s a natural human reaction.
One tries to comprehend the profound sorrow of those who lost children that day. The ripple effect spreads—widely and deeply. On the day it happened I was in a supermarket wher...
