From Sandy Hook to Santa Barbara — Asperger’s Syndrome And Violence

I don’t think we plan what our real specialties are going to be.

I frequently tell patients I am an expert on getting through menopause now that I have been able to come through my own relatively unscathed.

I became somewhat of an expert on Asperger’s because I diagnosed many elements of it in my father and just about all criteria in my brother.

They both carried additional diagnoses of bipolar (a.k.a. ‘manic-depressive’) illness.  Neither one was in any way typical.

Both surely had their problems in life.  My father was assisted considerably by his domineering mother who gave him lots — I mean lots — of direction.  She even helped him choose a wife — my mother — who took care of the things in life that were difficult or even impossible for him.

Me, I did the best I could by my mother and him both.  A preceptor in my psychiatry at the University of Kansas once visited my family in Boston, when he went there for a national meeting.  On returning to Kansas, he told me that my family was a lot crazier than I had described them (I was still in a fair amount of denial) and that my mother had managed to “infantilize” my father a bit and my brother a lot.

My father’s mother had prepared him for an easy transfer of authority when it went from her to his wife.

My brother was still “infantilized” at the death of my mother.  My husband, who is a saint in many ways, picked up the slack on that one.

Brother Harry and my father were both childlike in their own ways — may their memories (and my mother’s and grandmother’s) be blessed.

Neither one could have knowingly inflicted violence on anyone. No way and not ever.

This article about a recent tendency to blame autism/Asperger’s for violence blindsided me a bit.

Two people who seem to have allegedly been responsible for mass murders — at Sandy Hook Elementary School and now the University of California, Santa Barbara, have a history of having been diagnosed as having Asperger’s syndrome.

I totally missed what the author of this piece describes as a slow change in the reporting of the crime and reactions to it after the fact as slipping toward blaming the act on autism.

This is wrong in a plethora of ways.  We can’t marginalize the mentally ill just because all too few in the general public understand what is going on, and we have minimized care for them because it seems expensive.

The mentally ill are not monsters. They are people who go through their days with open wounds for which we, all too often, have no real healing, soothing balm.

What I need to do is avoid the kind of argument that my patients (and my readers) often make in response to what I say.  Making inferences from single (or in this case, double) personal experiences is dangerous at best.

This is simply not Scientific. In a world where observations and inferences simply need to be described by statistics, maybe even inferences of possible mechanisms of causality, based on the experiences of many patients, evaluated as precisely as possible.

I can say as a fact that I have seen and cared for more patients with Asperger’s Syndrome than I can count.  I can also say that none of them have been violent by history prior to visiting with me, and that I had no reason to fear violence from them either.

I am driven to get back to basics and to figure out what is going on here.

I think that one person who may have had more worries and tears learning about Asperger’s than I did was none other than Hans Asperger. Every account of him I can find anyplace of Asperger’s own youth and development basically describes his symptoms of poor social skills, which are pretty characteristic of this syndrome.

For completeness, I must include Dr. Kanner, who described what looks to me like the same syndrome.

Both docs published in 1943.  Neither seems to have been the first to observe this syndrome. Dr. Itard, a Frenchman — who must be mentioned since his nationality makes him one of my “peeps” — an obvious genius who showed up and presented himself as a surgeon to Napoleon’s army for the revolution, even though he did not bother going to medical school, and seems to have succeeded brilliantly at both that and his later studies of intelligence.
Oy! If it was that easy, why did I work so hard for so long?

Although perhaps a bit superficial, here is a decent summary of what Asperger’s tends to look like in a child.

It is generally seen as part of the “autistic spectrum” and always seems to be viewed as a “developmental” disorder.

I never much appreciated classification systems.  The more experienced I have become, the more I want to look at treatment.

This one may be more “accessible,” and links to resources for diagnosis and treatment.

There is a tremendous amount of research and lots of things that have actually been shown to help. For those who are unafraid, the place to go is outside the dramatically bogged down mainstream medical system.  I personally favor elements of the Defeat Autism Now protocol.

I have used natural treatments and am especially impressed with EMpowerPlus, a chelated multivitamin and micro-nutrient compound that crosses the blood-brain barrier.  I have seen socialization happen before my eyes.

In fact, I was the American investigator for an international study (an FDA-approved clinical trial) of this compound in treatment of bipolar disorder, and have informally found it helpful in my private practice in a great many conditions as a viable alternative to pharmaceuticals.

I always regretted my failure to get EMPowerPlus into my own afflicted family members, for a plethora of reasons.

Not everyone embraces what society has determined to be an “alternative” treatment.

This is a regrettable state of affairs since insurance does not generally cover this sort of treatment. It seems expensive, inaccessible, and is often proscribed by narrower minded doctors.

Oy!

Back to the question of violence and how it is associated with this syndrome.

I have been looking into the professional literature on this one for a long time and things have evolved a lot in the last 25 years or so.

I mean, when I was still just a trainee, about the only useful thing to say about a given patient’s propensity for violence was, well, if he or she had done it before, they were likely to do it again.

Mental illness is simply not the most significant predictor of violence. As far as I am concerned, it does not look as if it is any kind of a significant predictor of violence.

As a matter of fact, I remember learning not too long ago that the best predictors of violence were things happening in the last year like divorce or job loss or abuse.

Our government actually presents a pretty good distillation, as far as the younger patient is concerned, of risk factors and protective factors taken from the literature.

There are tons of “risk assessment instruments.” There are a couple of problems, though.

First, there is no way, in most of the county mental health agency jobs I have had, that anybody has time to run patients through this kind of assessment.

Second, most of the people on the front lines have never heard of this stuff, anyway. I have worked where the front line people think their job is something like personal friendship for those who have no friends. Caring and well-meaning but of little therapeutic value.

Even psychiatrists need some training to do this one correctly.

From the tragedy of the school shootings, a plethora of websites and programs have arisen.

I just have no way of telling which, if any, of these are good and work.

But wait, there’s more. There are limits to what you can do if you are convinced someone is at a high risk for committing a crime, but have not yet actually done anything.

Take this too seriously, and we end up with a situation like the Tom Cruise movie, Minority Report.

This is a frightening situation, if anyone of my education and experience is making reference to a Tom cruise movie.

Oy!

It seems to me as if a lot of my adult psychiatric patients are no stranger to violence.  It is not hard to believe this is a major factor in all kinds of psychopathology.

(NOTE: This link will download or open a PDF file.  You must have the free Adobe Acrobat reader to access the content.)

The developmentally disordered are all too easy to victimize.

It took years for my family (and me) to realize that my Brother-Of-Blessed-Memory had been beaten, regularly, at school by a headmistress, reputed to be excellent at managing folks like my brother, and smart enough not to leave scars.

He just thought the whole world was like that, so he never thought to tell us.

Our family never protested to school authorities – we just transferred him to another school.

Frankly, I have now seen enough articles on violence and the developmentally disabled that I am convinced subjugation is a far greater risk than violence initiated by the developmentally disabled.

These people are generally the victims – not the instigators.

I am so happy someone else figured this out.

These articles brought back a vivid memory of my work in the California state prison system where I spent more hours than I can count doing paperwork to get a developmentally disabled inmate (who had time for a more precise diagnosis?  I thought the other guys were going to kill him) into protective custody to prevent his being physically and violently attacked by his alleged peers.

More Oy!

Violence prevention is a tough row to hoe at best.

Me, I give points to New York State.

I love the first paragraph, where they preface the list of risk factors by saying that no individual should be stigmatized because of the presence of risk factors.

This is good — no “Minority Report” danger here.

There are lots of resources for this.  Lots of hardworking, well meaning people trying to prevent violence.

I can’t say much about exactly what works; we need to stay tuned and keep trying.

Teachers have enough to do, I know, but loners might be Asperger’s syndromes who are low in social skills.  People can and are trained in social skills.  There is some evidence that Asperger’s, which is far and away the least socially (and communicative) form of autism, gets better with adulthood, or at least somewhat “compensated.”

Try a movie starring John Turturro called “The Luzhin Defense” about an eccentric and tragic chess grandmaster.

This was based on a novel by Vladimir Nabokov. (Of “Lolita” fame) but has also been referred to as similar to real-life grandmaster Bobby Fischer.

I have seen Asperger’s syndrome folks loved and married.

But typically, with a deficit in social skills, relations with the opposite sex are challenging at best.

I actually once “fixed up” my brother on a date where I went along.  His date was a woman I knew from the staff of the hospital I worked at who was paid poorly and appreciated the dinner and had good people skills and promised not to act strangely no matter what my brother said.

It was worth it to me that he could no longer say “I never had a date.”

Somehow the young man blamed for the carnage at U.C. Santa Barbara thought lack of response from local girls he approached justified the killing spree that resulted.

Another – my brother — did not.  He was literally the person who would never harm a fly.

There are complex individual factors here that differed these two Asperger’s patients.

“Comorbidity” is just a way of saying asperger’s patients sometimes have other things wrong with them,too.

Sometimes they do wrong things and simply do not meet criteria for responsibility for their actions.

I am not anywhere near pretentious enough to think that the difference between my Brother-Of-Blessed-Memory and other Asperger’s patients was just me.

The “we need more research“ conclusion is like an old friend.

Barriers to psychiatric care are as plentiful as the misconceptions about what it can do.

We have to try harder.

We have to try harder to see individuals — not as patients, but as people.