Fall 2012

Mass Shootings

The news has been difficult to listen to, owing to the mass shootings this past summer. As is well known, these took place in organized settings; a theater, and a place of worship in Milwaukee.

As I listened to these accounts, with each occurrence, my personal feelings varied from sorrow to anger and rage to a faint sense of helplessness that occurred has I felt empathy for the victims and the surviving families.

As a psychologist, I attempted to sort through the variables, as they were made public by the press. It is always difficult to sort these things out, especially since the information released publicly, in a titrated form, only after certain legal issues are resolved.

So I spent some time reviewing what scholarship is available on these types of events; I have to say, that I found very little that helped with understanding these horrific occurrences.

However, I did find it helpful to review the work of two scholars; the work of Reid Meloy and the work of Ed Megargee. I have taken workshops from Dr. Meloy on psychopathy. I am familiar with Dr. Megargee’s work which he has published over the last 60 years in forensic psychology, and in particular, his model of understanding violence.

Dr. Meloy (Meloy, Hoffmann, Guldimann & James, 2012) discusses the Secret Service’s Exceptional Case Study Project which indicates that a high percentage of verbal or written threats to a targeted individual occurred before the assault. In psychiatric patients, violent fantasies which are specifically directed towards others, violent fantasies which escalate, and grandiose thinking tend to be associated with violent outcome. He found that 58% of school shooters made a threat before they actually carried out the shooting.

Research indicating another helpful approach that applies to aggression, and may help us understand mass shootings, is Megargee’s Algebra of Aggression (Megargee, 2011) and (Sewell, 1985).

In an article by Dr. James Sewall, Megargee’s model is applied to the case of Ted Bundy. It should be noted that serial killers are different from mass killers. A mass murderer kills at least 3 people in one incident, while serial killers kill a number of people over a period of time. Ted Bundy was a serial killer. Dr. Sewall indicates that the Algebra of Aggression model suggests that in “all behavior, including violent crime, an individual automatically weighs alternatives and chooses a response to a situation which maximizes his/her benefit and minimizes potential pain and distress.”

The algebraic equation goes like this: [A (t) + H +S (a)] – [I +S (i)]

A = Instigation to Aggression
t = victim or target
H = habit strength
I = individual’s inhibitions against violence

S (a) = unique situational factors encouraging violence
S (i) = unique situational factors inhibiting violence

In other words, when factors weighing in the direction more for the violent expression of behavior are stronger than factors weighing in the direction for the inhibition of such behavior or the discouragement of such behavior, the individual may proceed with the violent act. I think Dr. Sewall sums this up nicely by saying “during the determination of a behavioral response, a response competition occurs; an individual selects a response that produces the most satisfaction for the least cost.”

Dr. Megargee also indicates “there is often an unconscious internal bargaining process or ‘response competition’, the behavior that offers the most satisfaction or the least costs will be chosen.” (Megargee, 2011)

Inhibition can come from a number of sources both internal and external to the individual. For example, the individual may lose the desire to commit violence once a violent act is committed, so there is a kind of satiation process that occurs. In other words, the individual’s need has been met. Thus, an individual may not commit another crime for a period of time. The individual may commit further acts of violence once he/she is stimulated again or, to use Megargee’s words, when the individual becomes “re-aroused” and therefore is instigated. A number of things can deter individuals such as opportunity to commit the crime, the presence of law enforcement or the individual is planning a crime and so on.

Ted Bundy was inhibited by an instance, for example, when a female he was pursuing and then hit with a piece of wood, fell and screamed. According to Dr. Sewall, Bundy ran in a panic. Dr. Sewall also notes that Bundy was raised in the Methodist Church. Bundy may “have established his own parameters which serve to control or limit his aggressive actions” (Sewall, 1985). He never attacked men, for example. Bundy also drank alcohol, which apparently served to decrease his violent actions.

So, mass killers or serial killers may have “ethical prohibitions” that serve as deterrents. Think about the popular TV show Dexter. In Dexter, he has learned a “code” from his father, who trained him to be a serial killer from his early years. There are things he will do, things he will not do. The show becomes interesting, when Dexter has conflicts about the code, that is, seems to get confused which way he should go in terms of the Algebra of Aggression; should he inhibit himself from violence or express himself with violence. I think the show does a nice job of taking us through that type of balancing act in Dexter’s mind.

Additional factors such as empathy, psychotropic medication, physical disabilities, not being able to fire at someone who is not in range and other barriers such as victim access may be inhibiting factors. Habit strength is “previous reinforcement for aggressive behavior” (Sewall, 1985). In Bundy’s case, habit strength appears to have increased based on his own direct experience; according to Dr. Sewall, he was repeatedly successfully violent and this “seems to have spurred him on to perform more acts of aggression.” Dr. Sewall goes on to say “the number of crimes for which Bundy is actually responsible significantly magnifies his success rate and further increases his habit strength.”

If we are successful, there is a greater chance we will repeat an action – and this behavior has a greater chance of being an antisocial behavior if we are instigated to be hostile and violent.

Megargee (2011) indicates that intrinsic instigation is important to evaluate and he notes that this needs to be explored in order to prevent instigation from becoming actual behavior. For example, if frustration is the underlying cause of angry feelings, avoiding frustration that leads to instigation can be very helpful. He also discusses working on unrealistic expectations that have led to frustration. He believes that long-term educational and vocational training may even “lessen chronic frustration.” A person gets a job, and then they feel better and their self-esteem is increased, leading to improvement in self-control.

He notes that practitioners should evaluate the levels of intrinsic and extrinsic motivation and look at the situational and personal determinants.

Just as Dr. Megargee does not assign equal weight to every variable in determining a violent outcome, Dr. Meloy indicates that “not all risk factors have an equal value, and some may be accorded predominance.”

Dr. Meloy has studied various types of homicides over the years. He and his colleagues discuss “warning behaviors.” In risk assessment for violence, psychologists typically look at static (historical, unchanging) and dynamic (possibly current, changing or changeable) factors. The warning behaviors are dynamic and reflect “acute, fast-changing or accelerating risk” behaviors (Meloy, Hoffmann, Guldimann & James, 2012). Individuals can fix on a particular individual, such as a public figure.

What I found interesting is the use of grandiosity as a predictor in violent actions. In some cases, such as “a problematic approach toward” the British Royal family, grandiosity was the single best predictor. Grandiosity or delusions of grandeur are those beliefs and fantasies such as being a prophet carrying an important message, or feeling uniquely chosen for some kind of special destination. Some delusions of grandiosity include being familiar or intimate with people of celebrity. A more common minor example is when people “name drop” important people to impress others.

Usually, there is no delusion involved, but there may be some hint of grandiosity – that is, the individual who does this tends to be focused on the appearance of being important. Some people do this without any real awareness of their strong need to appear important. Challenging a grandiose person can result in a very strong reaction, sometimes leading to violence. I have long felt that such individuals can be quite fragile and may be prone to a kind of humiliation-based rage.

Dr. Meloy and his colleagues also talk about mass murderers. These individuals do have warning behaviors such as “leakage.” Though we do not know the full story of Holmes, the individual thought to be responsible for the theater shootings in Colorado, he did apparently leave a notebook with his psychiatrist before his mass shooting. What is in this notebook is unclear, because it has not been made public. We may learn about Holmes’ “leakage” when and if this is ever released.

Dr. Meloy and colleagues discuss other well-known figures who have given out warning signals or warning behavior. For example, Timothy McVeigh, who bombed the federal building in Oklahoma City in 1995, resulting in killing 168 people, communicated to his sister that he wanted to be the “first hero” of a 2nd American Revolution.

In more recent times, a shooter, alleged to be Jared Loughner, wounded 13 people and killed a federal judge and 5 other people in Tucson, Arizona in a shopping mall. Gabrielle Giffords was one of the wounded. She sustained a serious penetrating gun wound. She has worked hard, along with her family and support system, to make an amazing comeback. (Please see the end of this article for a link to the ABC interview she did with Diane Sawyer about her recovery process. It is simply amazing).

Warning behaviors included what Meloy and his colleagues call “an energy burst.” For example, the evening before, the alleged shooter dropped off a 35mm roll film at Walgreens, checked into a motel, picked up the photos at around 2 AM, posted something on MySpace around 4 AM, including a picture of a Glock 19 and the words “goodbye friends...” And later, after stopping other places, he ran a red light and was stopped by a police officer. His father confronted him about contents of a shopping bag and the alleged shooting rampage started at 10 the following morning. Meloy and his colleagues indicate “this case illustrates energy burst warning behavior in a period of 12 hours before the mass murder in that behavioral activity significantly and noticeably increased in relationship to the intended violence.”

Dr. Meloy and his colleagues indicate that warning behaviors are complex. For example, some of these behaviors may be outside the awareness of the individual. Some of the behaviors may be more conscious needs for narcissistic reasons.

Dr. Meloy reported in one of his interviews that individuals who are mass shooters seldom “snap” – a myth which has been probably perpetuated by media. As you can see, it is much more complex than this. I realize this early on in my growing up. An individual in our neighborhood, who was known to be quite hostile and abusive to his family, wound up shooting his entire family and himself. At the time of this, he had moved from the neighborhood and I had left the area to go to college. However, this serves as an example in my mind of how possible intervention at some level may have reduced this individual’s frustrations, helped him replace his aggressive behaviors with assertive, nonviolent behaviors, and taught his family about safety outlets or procedures and prevented the eventual outcome entirely.

Individuals working in the mental health field, criminal justice field, or related fields will likely find the work of Dr. Megargee and Dr. Meloy and his colleagues to be very helpful in working toward preventing violence before it happens, and (unfortunately) explaining violence such as mass shooting after it occurs.

References

Megargee, E. (2011). Using the algebra of aggression in forensic practice. British of Forensic Practice, 13(1), 4.

Meloy, J. R., Hoffmann, J., Guldimann, M. A., & James, D. (2012). The role of warning behaviors in threat assessment: An exploration and suggested typology. Behavioral Sciences and the Law, 30, 256-279.

Sewell, J. (1985). An application of Megargee’s algebra of aggression to the case of Theodore Bundy. The Journal of Police and Criminal Psychology, 1, 14-24.

ABC News link to Ms. Giffords’ recovery process.

Poverty and Stress

According to an article in the July 27th issue of Science, there are many recent studies showing how poverty negatively shapes learning and memory (Lempinen, 2012).

It is fair to assume that the stress that middle class people have in their daily lives is experienced much differently.

We were born with a much different brain than we wind up with as an adult. There are many changes that are made to the brain through experiences. Our brains form neural connections as a result of learning. Thus, rich environments produce richer connections in the brain and impoverished environments are likely to produce less rich connections. According to the article in Science, “by the time a child is three; the brain is 80% the size of an adults with 100 trillion neuron connections that will be critical to continuing development” (Lempinen, 2012). The article goes on to indicate “areas such as the prefrontal cortex that govern more complex functions – language, problem solving, self- regulation and social bonding – develop most rapidly from the ages of 11⁄2 to 4" (Lempinen, 2012). Children’s brains are vulnerable to stress; they are not completely developed. As an example of brain development, our frontal lobes are not fully developed until our mid- twenties!

But let’s back up; stress of course, can occur prenatally. In animal studies, it has been shown that there are long-term effects from maternal stress that occurs during the pregnancy. Stress leads to reduced volume in the hippocampus, a brain region thought to be involved in learning and memory. And stress impacts the amygdala, the part of our brain associated with anxiety.

Exposure to stress that occurs in adverse or threating conditions creates a physiological response, primarily stemming from the hypothalamic- pituitary-adrenal or HPA axis. The short of it is that this response leads to stress hormones called glucocorticoids. Prenatally, these are passed through the placenta during pregnancy. In rats exposed to stress, connections in the brain are reduced during the last week of pregnancy (Lupien, McEwen, Gunnar, & Heim, 2009).

According to research on children, less supportive care environments produced increased glucocorticol levels. This is especially so for children who have existing behavioral problems. We also know that the HPA axis system of infants is erratic during the first year.

Moms who are clinically depressed have problems being emotionally available for their infants. In poverty, depression rates in mothers are higher than with mothers who have robust resources. Not surprising, there are some findings that indicate increased HPA activity in infants with depressed moms. Researchers have also found that preschool children have diminished EEG activity in the frontal lobe region, so these children may have problems with empathy, since the frontal lobes support our ability to interpret other people’s actions (Lupien, et al, 2009).

According to a recent article, Blair and Raver (2012) indicate that there is no “easy fix” to the mental health problems poverty brings. Parental skill training with parents in poverty does improve children’s social and mental health. Children in foster care, with foster parents who have had training to be emotionally supportive, show greater morning cortisol levels, but decreased levels throughout the day.

We also know early intervention of children at risk can increase IQ. Dr. Alan Kaufman (2009) notes that the Carolina Abecedarian Project which is “unquestionably the best intervention study ever conducted” studied children who were high risk, based on family income, maternal education and other factors. An intervention was geared to promote “cognitive, language, perceptual, motor and social development” (Kaufman, 2009). What did this consist of? There was a childcare center, open 8 hours a day, five days a week, 50 weeks per year, with low teacher-student ratios and a focus of language development and pre- literacy skills with preschool children. Good science was involved. There was random assignment to a treatment or a control group.

The control group, who did not receive those treatment conditions as indicated above, did receive enhanced nutrition – until the infants were 15 months of age. The control group family also benefited from social work. This was a long- term study. IQ tests were administered to both the children in the treatment group and children in the no treatment/control group. As Dr. Kaufman indicates “the results are fantastic.” He indicates that during the preschool years, “the treatment group outscored the controls by 161⁄2 points at age 3, 121⁄2 points at age 4 and 71⁄2 points at age 5. There was still a gain, at age 21, of 41⁄2 points. Achievement testing (measures reading and math skills) showed even greater results with the treatment group.

On a macro level, it is also noteworthy that recent research on interventions, suggests that “Improvements in economic status go hand in hand with improvements in clinical symptoms, creating a virtuous cycle of increasing returns” (Lund, et al, 2011).

So, poverty certainly does play a role in children’s long term mental health and learning and memory outcome. We certainly can do better, and there is good research on how we should help.

References

• Blair, C., & Raver, C. (2012). Child development in the context of adversity; experiential canalization of brain and behavior. American Psychologist, 67(4), 309-318.
• Kaufman, A. (2009). IQ 101. New York: Springer Publishing Company.
• Lempinen, E. (2012, July 27). Poverty can harm early brain development, researchers say. Science, DOI: www.sciencemag.org
• Lund, C., Desilva, M., Plagerson, S., Cooper, S., & Chisholm, D. (2011). Global mental health 1: Poverty and mental disorders. The Lancet, 378(9801), 1502-14.
• Lupien, S., McEwen, B., Gunnar, M., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10(June), 434-445. Retrieved from www.nature.com/reviews/neuro

Psychopaths in Court

A recent article in Science magazine, report some interesting research regarding expert testimony in the area of psychopathy. Most of us are acquainted with the term psychopath, from its use in the media. It is generally used by laypeople as a means of communicating a disregard of others or a propensity toward destructive behavior without regard to consequences of that behavior. The term psychopath was made popular by Hervey Cleckley, a psychiatrist who published the book, The Mask of Sanity. It was originally published in 1941; the 5th edition was published in 1988, a bit after Dr. Cleckley’s death. One can certainly appreciate his devotion to his scholarship and continued interest in developing ideas about psychopathy for well over 40 years.

Cleckley came up with a list of 16 characteristics that he felt best described the psychopath. These include an absence of insight, superficial charm, unreliability, the lack of ability to love another person, antisocial behavior, and an absence of nervousness. He presented a number of cases that illustrated these features. Some of the cardinal features of psychopathy are both a superficial charm and grandiosity. Cleckley captures this with his case presentation of Max:

“He knew the names of a half-dozen Shakespearean plays, several catchpenny lines familiar to the man on the streets, a scattering of great names among the philosophers.

He was totally ignorant not only of the systems of thought for which his philosophers are famous but also even of superficial and general facts about their lives and times that any person, however unintellectual, could not fail to remember if he ever had the interest to read of such matters. Of Shakespeare he knew practically nothing beyond the titles that rolled eloquently from his tongue and a few vague and jumbled conceptions that have crept into the ideologies of bootblacks, peasants, and street gamins the world over.

Furthermore, he had no interest, as contrasted with knowledge, in any matter that could be called philosophic or poetic. He liked to rattle off his little round of fragmentary quotations, the connections and the connotations of which he realized only in the most superficial sense, to contribute a few pat and shallow saws of his own, believed by him to be highly original, iconoclastic, and profound, to boast generally of his wisdom, and then to go on to descriptions of his other attainments and experiences. 

To my surprise, he was several times taken by psychiatrists who studied him briefly and by social service workers as a man of some intellectual stature” (Cleckley, 1985).

Later, Dr. Robert Hare developed the Hare Psychopathy Checklist. It is not all that dissimilar from Cleckley’s original list, but has been commercially published and has appeared in reference journals since its development. There are studies using the PCL-R, and there is now an adolescent version. Retained are some items from Cleckley’s original list, though Dr. Hare has increased the list to 22 items.

According to a recent article in the Archives of General Psychiatry, (Gregory, et al, 2012) those with higher Psychopathy Checklist scores have smaller volumes in areas of the frontal lobe when compared to those who are normal and those who have Antisocial Personality Disorder. In fact, the antisocials and normals appear to have frontal brain volume similarities. As one commenter indicated, the sample sizes in the study were small, and we should also not confuse brain structure and brain related behavior.

Along these lines, I am reminded of a long term study of nuns in which behavioral data was collected into their elderly years and their brains were studied post mortem. Some of the brains showed Alzheimer's characteristics, but had not show Alzheimer’s symptoms. The lesson here is that caution should be used in reviewing the results of brain scans. We need clinical confirmation to determine if the function is, well, not functioning!

According to a recent article in Science, researchers revisit the question about the role of nature in behavioral disorders, and focus exclusively on psychopathy. Researchers wanted to test out whether or not “expert testimony concerning bio mechanisms of psychopathy increases or decreases punishment” in court cases. They surveyed US trial state judges by emailing them a hypothetical case that was based on a real case. According to the article, the case in the matter was a hybrid of a real case based on an individual who committed aggravated battery. When the judges in the case were told by an expert that the defendant had a biological basis or biomechanical explanation for the psychopathy, this tended to significantly “reduce the sentence and significantly reduce the degree to which the psychopathy was rated as aggravating.”

This study indicated that the judges were asked to rate free will, legal responsibility and moral responsibility as it pertained to their decisions. When they did this, the judges did not believe that it was a substantial factor in their decision process. In other words, they still felt the defendant was morally responsible, had free will and was legally responsible.

It is interesting, however, because “the presentation of a bio mechanism by the defense doubled the number of judges listing a mitigating factor” (Aspinwall, Brown, & Tabery, 2012). The most frequently listed mitigating factor was that the defendant was “mentally ill and lacked control over his actions, and thus was less legally culpable” (Aspinwall, et al, 2012). So a biological explanation of psychopathy means that the judges believed psychopathy to be a mental illness.

The article indicates that one of the judges indicated “the evidence that psychopaths do not have the necessary neural connections to feel empathy is significant. It makes possible an argument that psychopaths are, in a sense, morally “disabled” just as other people are physically disabled...” 

It should be noted that psychopathy is not a mental illness in the DSM-IV, nor is it a mental illness in the ICD 10.

So, the introduction of evidence by an expert giving testimony about the biological basis of psychopathy “significantly increased the number of judges invoking mitigating factors in the reasoning and balancing them with aggravating findings” (Aspinwall, Brown, & Tabery, 2012).

As with every study, there were limitations. One of the limitations was that the judges were told that rehabilitation was not a possibility. The experimenters told the judge this because “large- scale treatment has today been ineffective for adult psychopaths” (Aspinwall, Brown, & Tabery, 2012). Experimenters also reported that the use of a term that is inflammatory to begin with, such as psychopathy, probably increases the stigma.

If you find the issue of psychopathy interesting, you might want to check out the link listed below which discusses the Hare Psychopathy Checklist, including a review of the instrument and its current use by Dr. Hare himself.

References

• Aspinwall, L., Brown, T., & Tabery, J. (2012). The double-edged sword: Does Biomechanism Increase or Decrease Judges Sentencing of Psychopaths? Science, 337(August), 846-849.
• Bleckley, H. (1988). The Mask of Sanity: An Attempt to Clarify Some Issues about the So Called Psychopathic Personality. William A. Dolan (publisher)
• Gregory, S., Ffytche, D., Simmons, A., Kumari, V., Howard, M., Hodgins, S., & Blackwood, N. (2012). The antisocial brain: Psychopathy matters: A structural MRI investigation of antisocial male violent offenders. Archives of General Psychology, (69 ed., Vol. 9, pp. 962-972).
• Listen to this excellent description of the Hare Psychopathy Checklist. Dr. Hare discloses his worries about the use of the PCL. http://www.thisamericanlife.org/radio- archives/episode/436/the-psychopath-test.