This week’s Sanity Squad podcast at PJ deals with the question of how therapists figure out who is likely to be dangerous, and what to do about it. Listen to Dr. Sanity, Shrink, Siggy, and me wrestle with this knotty and topical problem.
“Your words are killing us”: note to Harry Reid
Here’s Naval officer Jason Nichols’s letter to Harry Reid on the subject of Reid’s recent declaration of defeat in Iraq. He makes the excellent point that statements such as Reid’s strike fear into the hearts of any Iraqis who might be thinking about cooperating with the US by reporting on terrorists and insurgents.
If Reid wants less violence rather than more, he should think more deeply before he speaks.
Feeling too much of your pain: therapists and clients
Are clients best served by therapists who’ve had life experiences and backgrounds similar to theirs? Clients certainly often seen to want this, but do they need it for the most effective therapy to take place? And, in fact, can such similarity of experience sometimes be counterproductive?
Ann Althouse discusses an article on the subject by psychiatrist Richard A. Friedman that appears in today’s NY Times. Friedman says similarity of background is not necessary, and that empathy and understanding are not limited to those who’ve shared a certain experience, but are products of imagination. Althouse asks how a patient is supposed to know how good an imagination a therapist has.
Therapy is a funny thing—funny-strange, that is, not funny ha-ha. Although it’s an experience that’s morphed from something exotic and only for the rich and leisured into something relatively mainstream, the process is still poorly understood by some clients (and even some therapists, as well). From an endeavor that initially focused on the psychoanalytic, it has branched out into so many schools and approaches and theories of personal change that the bewildered client can be forgiven for not knowing where to turn or whom to call.
There’s a school of thought that gay patients are best served by gay therapists, abused women need counselors who’ve been there too, alcoholics require those who’ve been through a twelve-step program themselves, and so on and so forth.
But I think this idea springs from an oversimplification and misunderstanding of the process of therapy. And I think Dr. Friedman’s emphasis on empathy and imagination is simplistic, as well.
It’s not that those traits aren’t important: they most definitely are. And anything that helps a client to trust a therapist enough to speak freely is a good thing—and that trust can often be fostered by having a therapist who seems to share a similar life experience and background.
But therapy is a great deal more than empathy and understanding, or being able to give good advice because one has walked in the same shoes. Therapy requires a peculiar set of traits on the part of the therapist: an ability to understand through leaps of intuition and empathy, as well as an ability to distance and to look with an objective and evaluative eye on the situation.
Therapists are human—all too human, I’m afraid—with the full complement of humanity’s foibles and emotions. And yet, in order to be effective, they must develop the ability not only to look at their patients in that dual intuitive/objective way, but also at themselves.
Two of the pitfalls all therapists must traverse, no matter what school they belong to, were recognized by Freud early on, and are known as transference and countertransference. These terms relate to the sometimes very powerful emotions the therapeutic relationship can foster in both parties, “transference” being the feelings a client brings from his/her earlier relationships (such as, typically, his/her parents) and redirects towards the therapist while in therapy. “Countertransference” is a similar phenomenon a therapist feels towards the patient.
There are special perils inherent in dealing with clients whose experiences are too close to the therapist’s own. Both transference and countertransference can be enhanced in such a situation.
This can make for a great feeling of bonding (especially if the transference and countertransference are mostly positive rather than negative). But it can also lead a therapist down false paths, imagining he/she knows more than he/she actually does about this patient, using the therapist’s own experience as a guide when it is inappropriate.
Unless the therapist has done an exceptional amount of working through of his/her own related issues, the emotions that still remain can cloud judgment. For example, a therapist can think that the way he/she worked through a similar issue is the best way, the way a client should follow, and fail to pay attention to the unique characteristics of that client that would dictate otherwise.
So, paradoxically, it’s often best to have a therapist who hasn’t had an experience too close to one’s own. Therapists aren’t just glorified friends or hairdressers who listen well—although, again, that’s certainly a skill they need to have. They are understanding listeners who can also detect a client’s patterns of behaviors and reactions; and can suggest to that client other ways of perceiving, feeling, and acting, in the interests of fostering desired change in that client’s life.
One of the most fascinating and moving aspects of therapy for some clients is the growing realization that, despite the fact that the therapist does not share the exact (or even similar) life experiences, that therapist can still understand deeply and listen with compassion to the client’s story. Many people who come to therapy (and many who don’t) have the idea that “no one can understand me,” and whatever expands their idea of the universality of their experience and the ability of even the “other” to understand them is a good thing.
Althouse asks how a patient can know that a therapist is sufficiently imaginative to empathize well. My answer is that, surprisingly enough, that’s one of the things most patients ordinarily can tell about a therapist, although not from the yellow pages or a recommendation. The only way to sense this is to have an initial consult, and usually the feeling of being understood or not understood will come through very quickly, on a gut level. Not all therapists are alike, and not all therapists are good matches for certain patients, but the patient is the one who has the final say in the matter, and should leave the therapist if there isn’t that feeling of basic rapport.
As referenced in the Friedman article, patients often come with pre-existing prejudices and preferences about what they want in a therapist. Some of these are considered therapeutically valid, such as a woman who’s been severely abused by men being more comfortable with a woman therapist. Some are arguably less so, such as a request for a therapist of the same race. I disagree with Friedman that the latter request should be refused; if a client is that uncomfortable with someone of a different race, whether it be a black person uncomfortable with someone white or vice versa, than the therapy can and should deal with the issue. But it’s not best dealt with by placing the client with a therapist who makes him/her acutely uncomfortable at the outset.
A lesser-known issue is that of therapist discomfort with certain clients. Theoretically, therapists can work with anyone, but in actuality they tend to specialize and refer out those patients who press their buttons (such as, for example, child molesters).
And, although this sounds like some sort of bad joke, I know quite a few therapists who say they would have difficulty treating a client whom they know to be a Republican. So it’s not just clients who want therapists who are as much like themselves as possible—some therapists return the favor.
The break-away fence
While I was away there was another “storm of the century”—the third, by my count, since this century has begun.
I was overjoyed to have been safely away when it happened; my neighbors, hearty New Englanders all, report cowering in their beds without electricity or heat, listening to gale-force winds and the CRACK! of huge evergreens dropping with the regularity of metronomes throughout the night.
The arborists are still so overworked that they are doing emergency service only—“emergency” as in “a gaping hole in your roof.” My tree doesn’t quite qualify, since my house is intact, but only by a fraction of an inch.
The tree resembles a huge lance pointing at—but not quite spearing—the house. Here’s a trunk’s eye view:
The thousands of broken branches that littered every inch of the front, side, and back yards have mostly been cleared away. And it’s an extraordinarily beautiful day today, seventy and sunny and June-like, making the fallen tree seem like the relatively minor noncrisis that it is.
I have a fence on the side of the backyard, a rickety thing that doesn’t do a bit of good keeping anything in or out but serves as a sort of rustic scenic boundary marker. After the storm, it lay littered on the ground, covered with tree limbs and debris, and looking for all the world as though it were irreparably broken.
But no. It turns out that the fence’s design allows it to disassemble itself at the first hint of trouble, the posts leaping out of their holes in the ground and the rails jumping out of their nests in those poles. And then, like a tinker toy, it can be easily reassembled when the storm is over and ends up looking as good as new. Or, that is, as good as old: 
There’s some sort of moral to the story, I know. It’s not Frost’s “Good fences make good neighbors,” but something about flexibility and rigidity, and the ability of the former to bounce back from adversity whereas the latter would break.
And hey, the crocuses are out.
French elections: a choice, not an echo
The first round of the elections in France have produced the two candidates for the runoff: Sarkozy and Royal. It turns out after all that most people were not lying to the polls because they were ashamed to say they were voting for Le Pen: in fact, they weren’t voting for Le Pen, who came in a distant fourth.
So now France faces a real choice, between a candidate somewhat to the right (for France, at least) and one to the left, a man and a woman, an idea-focused candidate with a track record of action and another who specializes in vague generalizations and has never held a senior ministry post, a pro-American who actually (sacre bleu!) visited President Bush, and one who is following the recent French tradition of America-bashing and going it one better, thanking Hezbollah legislator Ali Ammar for:
“being so frank” when he described U.S. foreign policy in the Middle East as “unlimited American insanity.”
Royal is banking on an “anyone but Sarkozy” syndrome to help her in her fight for the Presidency. And Sarkozy is banking on the fact that she will continue to put her foot firmly in her mouth as she already has done on almost every foreign policy issue she’s mentioned so far.
I wrote earlier that Sarkozy reminds me a bit of Rudy Giuliani. Royal reminds me a little bit of a French, female, and much more abrasive Barak Obama: relatively inexperienced; and counting on her personality, platitudes, and the voters’ dislike/fear of the other candidate to attract voters.
Harry Reid’s failure—to appreciate the larger consequences of his own words
Democratic Senate Majority Leader Harry Reid has called the war in Iraq a failure.
How does he know this? Because of the “extreme violence in Iraq this week.” And what did that violence consist of? A series of terrorist bombings that killed around 200 Iraqi civilians.
Originally, Reid voiced his “failure” viewpoint to the President at a White House meeting. I have no problem with that. But to make such a declaration publicly shows a narrow focus on politics as usual that is almost breathtaking in its self-absorption and its ignorance (or dismissal) of the consequences of his words.
So now it appears that the enemy can win a war simply by killing enough civilians to demoralize the Democrats. Their own civilians, that is; not ours.
That may seem like an odd definition of victory—I certainly find it so—but it’s the inescapable conclusion to draw. As such, I think it not only odd but unique in the annals of warfare.
Make no mistake about it, it’s very easy for our enemies to kill their own civilians. Not all that much is needed, really. You don’t need the support of many people in the country involved. You don’t need an army. You don’t need an enormous amount of money or a functioning state apparatus.
You don’t need, in fact, to be actually winning under any traditional (or even rational) definition of winning.
What do you need? You need a supply of high-powered explosives, and not an exhaustive one as that (Iran and others will foot the bill nicely). You need a small number of people willing to die in the process: check, no problem, in a society raised on the otherworldly rewards of suicide bombing. You need a group (once again, not that huge) able to plan and organize such bombings, which isn’t all that difficult either.
If Reid’s motive for his statement is the laudable and humanitarian one of aiming to stop the killing of civilians in Iraq, it would be hard to make the argument that an American withdrawal will aid that cause, either. It’s hard to escape the idea that he is cynically using concern for those citizens as a pawn in his own political game.
Reid’s new definition of success/failure in war paradoxically makes it even more necessary and desirable for the enemy to go on killing their own civilians in just such a manner. After all, whatever else could give such a huge payoff at so little cost? It is “victory” on the cheap.
[NOTE: When I say the enemy is killing its own, I’m well aware that not all the killers here are Iraqis. But virtually all the killers are either Arabs or Iranians, Muslims in neighboring countries with an interest in American defeat, and willing to murder other members of the so-called umma in order to achieve it.
On a related note, you might be interested in listening to a recent podcast in which I participated, a very relevant Blog Week in Review discussion of the attractiveness of defeat in Iraq.]
Decision time for France: will it break for a pro-American?
The first round of French elections are coming this Sunday, followed by another (and deciding) one two weeks later.
The field is unusual for France. As Jane Kramer points out in the New Yorker, all three leading candidates are relative outsiders, and all are in agreement that France is broken and needs fixing, quick. This in and of itself is somewhat unusual; the French are not especially known for self-criticism.
The candidate who interests me the most is Nicholas Sarkozy, the leader in the polls. But the situation is very fluid, because the large undecided group—in some polls, half of the electorate, a truly formidable figure—makes predictions impossible.
According to Kramer, Sarkozy makes many French people uneasy, for reasons they can’t articulate very well. I think it’s because he isn’t quintessentially French–his father was Hungarian, his maternal grandfather a Greek Jew. He is a blunt speaker in a world exquisitely sensitive to PC circumlocations, an action-oriented candidate focused on results, an extoller of the value of work in a welfare state, and an Americaphile in a country steeped in anti-Americanism.
One of Sarkozy’s rivals, the geriatric Le Pen (78), is capitalizing on the perception of Sarkozy as a foreigner, calling himself the candidate of “the native soil” as opposed to Sarkozy. Le Pen also points out that his own standing is probably higher than polls reflect because people are ashamed to say they’re voting for him—a strange thing for a candidate to say about himself, but Le Pen is probably correct.
There’s an even more basic disconnect from French perspective in Sarkozy, and it’s his attitude towards equality:
We’re in a crisis that comes from a very false idea of solidarity—the idea that you have to give as much to the person who doesn’t work as to the one who does. The élites have been wrong about this for decades. They have betrayed the idea of equality and given us egalitarianism.
If I understand Sarkozy correctly, he is coming down on the side of equality of opportunity over equality of results, something that makes him more akin to conservatives in this country than to liberals. But France’s “liberte, egalite, fraternite” has always seemed to have the accent more on the “fraternity” part (as in “brotherhood,” socialist style) than on the “liberty” part (as in “libertarian belief in individual freedom”).
In line with this idea, Sarkozy is quoted in this article in American.com as saying that the French do not value those who are successful:
This attitude is explained by the French desire for egalitarianism, the fascination with leveling out, and, frankly, jealousy… Success is more often criticized than presented as a model.
When I was in Paris last fall for the France2 trial, this was an idea I heard voiced many times—that somehow, in French society, it’s not good to stick out in such a vulgar fashion. This is in marked contrast to the US, where the veneration of the successful is probably at least partly responsible for Europe’s disapproval of this supposedly crass and brash country.
The next few weeks in France promise to be “interesting.”
A two-podcast week
Along with Jeff Goldstein of Protein Wisdom, I’m a guest on this week’s Blog Week in Review. So, if you haven’t had enough of my voice lately on the Sanity Squad, you can listen to more here.
Sanity Squad podcast: Virginia Tech
Join me, Siggy, and Dr. Sanity, as the Sanity Squad discusses the killings at Virginia Tech. (Shrink was on vacation this week; he’s due back next time).
“Like talking to a hole”
As more details emerge on the background of the Virginia Tech shooter, it turns out that his history was one long, loud warning sign that something extremely bad was about to happen.
So how is it that this young man—who was known to have set fires and stalked women; who barely spoke, never made eye contact, and seemed profoundly depressed; who was friendless and expressionless; and whose writings so alarmed his classmates that they were afraid to come to class—how did he slip so readily through the cracks?
The answer is that the cracks can probably never be sufficiently filled without sacrificing more of our individual freedoms than we are willing to give up.
It’s not as though the alarms hadn’t been sounded in the case of Cho. His teachers, for example, found his behavior so profoundly disturbing that school authorities were alerted. But their hands, those authorities reported, were tied, because he had made no threats.
Or rather, he hadn’t made the right kind of threats. Lucinda Roy, who him tutored him separately because his presence in a classroom had become too disturbing to the other students, alerted everyone she could think of: the administration, the counseling office, and the campus police. It’s unclear whether Cho had much (or any) counseling—but law enforcement could do nothing about him, apparently, since his threats were “veiled” rather than “something explicit.”
What about involuntary commitment? Virgina, like most states, has procedures in place, but they are stringent. Usually the commitment process is quite temporary, anyway, and designed merely to get a patient’s meds under control. The days of state mental hospitals warehousing large numbers of potentially dangerous people who have committed no serious crime are over–and that’s a good thing, since that system was widely abused. And it’s fairly clear that by the standards we now use, Cho could not have been committed against his will.
From the descriptions of Cho’s disordered personality, it appears that he was the sort of individual who is so deeply disturbed in so many areas of human interaction, and so resistant to even the idea of counseling, that talk therapy would not have been of much help, anyway. So, short of commitment for an indefinite period of time, the mental health community probably could not have helped him.
But what of the school? The school probably could have dismissed him, and given the severity of his behavior it would have been well within its rights to have done so. Instead, it bent over backwards to accommodate him (the private teacher, for example) and hoped for the best, while his fellow students chillingly speculated on whether he would become a serial shooter.
But a school dismissal would most definitely not have done away with the problem. In fact, it could have exacerbated it by increasing his anger and desire for revenge (not that that would have been a good argument for not dismissing him; it’s simply a fact).
Would a more stringent background check have prevented Cho from purchasing the gun, at least? Perhaps. But he easily could have gotten one illegally; it’s really not all that difficult, if one is determined to do so. And my guess is that Cho was extremely determined.
What else? Well, it’s not something that proponents of gun control like to hear, but the evidence from research indicates that the only factor demonstrated to be effective against serial shootings is the carrying of concealed weapons by trained and certified portions of the population. Researchers John R. Lott Jr. and William M. Landes from the State University of New York and the University of Chicago Law School, respectively, have come to this conclusion in a paper entitled “Multiple Victim Public Shootings, Bombings, and Right-to-Carry Concealed Handgun Laws: Contrasting Private and Public Law Enforcement .”
They evaluated all sorts of factors relating to gun control in particular. The conclusion: the only one that mattered was the carrying of concealed weapons by law-abiding citizens. This worked both to discourage the number of attacks—perhaps because potential mass murderers knew that their likelihood of carrying off such killings would be reduced by the presence of another gunman/woman—as well as the severity of whatever such attacks did occur.
Remedies may be difficult to come by, but one thing is clear: when a person is described as “like talking to a hole” (as tutor Lucinda Roy memorably stated about Cho), watch out. That is the single most common characteristic of those who murder (see this, about Mohammed Atta’s eyes): dead eyes from which the soul appears to have been scooped out.
“Dead eyes” can’t be a criterion for involuntary commitment, I suppose—but if I were to design one, that would be it.
Profiles in the Virginia Tech massacre: the young and the hero
As more of the story emerges, we begin to learn something about the dead and their lives (see here and here for some heartbreaking photos, as well).
Most were so young that their tales were cut off before they could really be written; as college students, they were just emerging from promising youths into adulthood. Their parents and families have been plunged into a grief that is unfathomable, and is just beginning.
I don’t like to use the word “victim” here (although it’s hard to avoid it), because it gives a certain triumph to the shooter, a power I want to deny him even though it’s probably absurd of me to play these semantic games.
One person in particular to whom I refuse to give the title “victim” was Professor Liviu Librescu, whose web page at the university remains blissfully unaware of its owner’s untimely and violent demise. A Holocaust survivor who emigrated from Romania to Israel in 1978, Librescu arrived in this country twenty years ago to teach at VT and has been there ever since. He is reported to have blocked the door of his classroom after hearing the shots, in order to keep the shooter at bay while many of his students were able to escape.
Librescu will be buried in Israel. Not so professor P.V. Loganathan, a hydrology professor whose grieving Indian relatives will be coming here for his funeral, since he expressed a wish to be interred in Virginia.
The international flavor of the incident is a minor and side issue, of course, but an interesting one nevertheless in indicating how interconnected the world is these days. In the list so far one can also find a student from Peru, one from Puerto Rico (the latter, I know, is part of this country), and girl of Lebanese descent, all united by this horrific event.
Profiles in the Virginia Tech massacre: the shooter
Loser. Loner. Kept to himself. Set fires. Wrote disturbing papers that caught the eye of teachers and got him referred to counseling. On antidepressants. Woke up one day (yesterday) and blasted away thirty-two other people.
Shooter Cho Seung-hui, a 23-year-old South Korean national who has resided in this country since he was eight years old, has his own Wikipedia entry. And that’s as it should be, because he’s a celebrity now that he’s dead and took so many with him.
Perhaps such notoriety was part of his motivation, although we’ll probably never be certain, as we may never learn what the cryptic words “Ismail Ax,” written in red ink on one of his arms, signified.
The shooter’s profile could have been written by almost anyone beforehand, so precisely does it fit what we’ve come to expect of people who end up as mass murderers. And if he did in fact go to counselors for some therapy sessions, I’d hate to be one of those counselors today. Evaluating potentially violent patients and deciding when to alert authorities about their dangerousness is one of the especially knotty and heavy responsibilities of therapists, and an almost impossible task.
Not every loner with a beef, an oeuvre of angry essays, and a love of guns wids up blasting away thirty-two people—or even one, himself. But many of those who do so were loners with just those characteristics. To differentiate the first group from the second is fiendishly difficult, although in our desire to protect ourselves we like to think we can predict better than we can.
However, if this young man had voiced specific and credible threats against others, his counselor would have had a duty to seriously consider voluntary or even involuntary commitment, a controversial and imprecise instrument for attempting to evaluate and treat such an individual and prevent him (and it’s almost always a “him”) from exploding into murder.
The details will emerge with time. But so far, no real surprises on that score.