The prosecution seeks to bend the jury to a theory of the facts—a strange phrase, “theory of the facts”—that will lead to a guilty verdict. The defense offers an alternative theory that it hopes will create reasonable doubt about the State’s allegations. The rule of law makes the playing field as level as it can be, given the government’s huge resource advantage over individual defendants, with things like presumption of innocence, the right to a public jury trial, a guarantee of competent counsel regardless of ability to pay, a prosecution burden of beyond reasonable doubt, and dozens of other rights of the accused. In the end, the case is decided, the book is closed, legally at least, and life goes on without the why.
But when the topic is something as terrible and frightening as mass murder, our search for the why isn’t satisfied by a jury verdict and a judicial sentence. Things get complicated; they don’t really get resolved.
Not resolving the why can be very unsettling. We want our world to be orderly, predictable, and safe, not frightening. We don’t want the person next door to be able to turn homicidal all of a sudden, especially without some good reason. We don’t want danger to lurk in theaters or nightclubs or schools or workplaces, but if it occasionally does, we want that danger to somehow be logical, not to be so random that we get nervous every time we sit down in an auditorium and feel the lights dim. More broadly, we want to feel settled, comfortable with some explanation that fits the way we go through life.
We also look for something concrete, something outside ourselves, to blame. Ancient humans thought up all sorts of blameworthy creations for whatever troubled them or piqued their curiosity. They gave their creations—gods, magic, totems—names; naming the beast always makes it less fearful, more settling. Modern folks like to do that, too. Some things have good, valid, reliable explanations, and some don’t, but we still like to have things resolved, to feel settled.
It’s very tempting to resolve the enigma of things like Holmes’s killings and maimings, to increase our comfort, by creating an easy why, one that sounds good to enough people on Internet comment forums, Facebook or Twitter, at cocktail parties or over a beer, that they reflect our own views back to us as if in an echo chamber. Such a why doesn’t have to be accurate or tell the whole story; it just needs a few articulate voices to tell us, or agree with us, that the matter is settled. We nod confidently. No matter that the voices say the same thing over and over without real critique, that they silence other views with pat answers and disapproval.
We want simple; sometimes we need simple. That’s where things like a sertraline (Zoloft) hypothesis come in for crimes such as Holmes’s, or a government frame-up hypothesis, a spurned-lover hypothesis, a graduate school failure hypothesis, a “he’s pure evil” hypothesis, or even a psychiatric one. The search is worthwhile, but a trial doesn’t end it, nor is there likely to be a valid answer from writers or commentators who stand to gain from publicizing their pet theories, much less from Internet trolls and others with quick, simple (or conspiracy theory) answers.
Most of the so-called explanations for Holmes’s behavior that we’re drawn to aren’t so much explanations as resolutions. They’re ways to resolve the unsettling questions that poke at our frustration with the enigma, our fears, and often some of the unconscious feelings that lie deep within us.
No current explanation of Holmes’s tragic behavior withstands routine scientific tests of replicability and predictability. Examining people with his diagnosis, with his family and social background, his medications, his culture, or his race doesn’t work. Every effort to tease out a group from which we can recognize perpetrators and prevent incidents like the one in Aurora fails. Each creates a scenario in which hundreds of thousands, sometimes millions of people with the same characteristics don’t shoot at anyone, much less four hundred people in a theater.
The answer—and this really is the answer, but it’s not very satisfying—lies in an unimaginably detailed and complex confluence that we can’t replicate because we can’t see all of it. It’s an almost unique condition that arises in only one person among millions, and the few people who have it don’t wear big asterisks on their foreheads so that we can recognize them. That means that predicting or preventing the handful of James Holmeses in North America or the world isn’t primarily an issue of mental health care or better law enforcement, as some suggest. Such killings are not, in any realistic sense, “the system’s” fault.
Better access to mental health care, if applied adequately and nationwide, is likely to reduce mass killings and other crimes, but we’ll never know which two or three out of millions of patients was kept from killing because of the heightened treatment opportunity. More liberal US civil commitment laws—laws that allow hospitalization against a patient’s will—would help tens of thousands of patients every year and prevent a few crimes (and many suicides), but the societal tradeoffs among need for clinical intervention, protection against harming oneself or others, and a person’s right to refuse hospitalization and medication are complicated indeed. Decades ago, Dr. Alan Stone, a Harvard professor of psychiatry and of law, foresaw situations in which many severely mentally ill patients, whom the law increasingly allowed to refuse much-needed psychiatric care in the name of their civil rights, would “die with their rights on.” His prediction has come to pass.
Just how important is mental illness to our prevention conundrum? For reducing the murder rate or violent crime in general, not very. For individual cases, almost always viewed after the fact and clouded by social outrage, finger-pointing, and political posturing, the topic is worth discussing, but our greater aim should be primarily to advance care, and access to care, for the millions of patients who aren’t destined to be violent.
The point is that although some mass murderers (but not all; perhaps not even most) have a treatable mental disorder, the equation doesn’t work the other way. Think of the old adage that all heroin addicts started by drinking milk, but most milk drinkers don’t become heroin addicts. It would be silly to try to prevent heroin use by monitoring milk drinkers or trying to modify milk consumption. It’s just as silly, and blatantly unfair and unconstitutional, to treat everyone with a mental illness, even a serious one, as if he or she were doomed to be violent.
Dozens of studies, some very large, have shown that mental illness, either in general or by specific diagnosis, is not a significant factor in rates of crime, violent crime, or killing in general.1 Every major crime category, and every violent crime category, is either more common in the general population than in mental patients or occurs at about the same rate. The only exception is substance abuse, which may or may not be considered a “mental illness” by some. Drunks, crackheads, heroin addicts, and amphetamine abusers are a much greater threat to the public than are people with schizophrenia or bipolar disorder.
I am not suggesting that we ignore danger signals in psychiatric patients. Indications of danger to others should be taken seriously whether the person is mentally ill or not. Fortunately, once the immediate risk is contained, good treatment (and cooperating with that treatment once it is offered) almost always decreases the risk from those few people with mental illness who are significantly dangerous.
That’s not the case, by the way, for the far greater number of criminals who aren’t mentally ill. They don’t particularly want our help, and they rarely benefit from it. With due respect for caring therapists, social workers, and other counselors who try valiantly to change the purely antisocial people among us, psychiatry and psychology rarely ameliorate the danger and violence that can arise from simple criminality, amorality, or greed.
Mental health is a low priority for legislators. Funding and new programs don’t usually get much attention from the general population, and there’s little immediate bang-for-the-buck to encourage votes in the next election. Mental patients, though better organized today than ever before, are often unable to advocate articulately for themselves. In spite of fine groups such as the National Allian
ce on Mental Illness (NAMI), Mental Health America (MHA), and the Depression and Bipolar Support Alliance (DBSA) and their state and local chapters, patients and their illnesses don’t get many headlines, or much front-page space, unless they’re involved in something sensational.
That kind of publicity is full of inaccurate stereotypes and public misconceptions. Those who use it to increase support and understanding of mental illness are drowned out by the noise of media frenzy and sometimes by the anger generated by events such as those at the Century 16 theater on July 20, 2012.
Colorado did a lot to address its citizens’ acute mental health needs during the five years after the Aurora tragedy. It opened additional crisis centers and walk-in clinics and created many more hotlines. The new state funding, some $20 million, was a good thing and has helped many people. I haven’t seen evidence, however, in Colorado or elsewhere, of increasing dollars or other support for non-crisis services. Crises get much more attention than day-to-day, week-to-week, month-to-month inpatient and outpatient needs. But the latter is where the most important work gets done, where people get treatment that lasts and can put them on a path to real change.
Real treatment. It’s not just for crises and headlines; it’s for people, for the long haul.
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1 “Killing” doesn’t necessarily imply “murder.”
About the Author
William H. Reid, MD, MPH, is among the most experienced forensic mental health professionals in North America. He has been retained by attorneys, courts, and government agencies in virtually every kind of case that involves mental health and the law, in more than thirty-five states and federal jurisdictions. He recently received both the Manfred Guttmacher Award for forensic writing and the Seymour Pollack Award for Distinguished Contribution to Education in Forensic Psychiatry and is a past president of the American Academy of Psychiatry and the Law.
Dr. Reid was one of two psychiatric experts retained by the presiding judge in People of the State of Colorado v. James Holmes, the case this book is about. He spent more than a year reviewing some seventy-five thousand pages of written case materials and hundreds of CDs and DVDs containing photographs, audio, video, psychological and psychiatric assessments, other evidence, and defendant surveillance, as well as interviewing Holmes and other relevant people, culminating in almost seven days on the witness stand during the trial.
Reid had unfettered access to the perpetrator, James Holmes, and to virtually everyone known to be associated with the case or with Holmes: law enforcement, the defense team, the prosecution team, defense and prosecution consultants and expert witnesses, treating clinicians, other witnesses, and Holmes’s family, friends, and teachers. In addition to examining Holmes himself, he interviewed dozens of people for the case, in person and by telephone. He visited Holmes’s apartment building, the theater where the shootings took place, law enforcement interrogation sites, and the Arapahoe County cells where Holmes was held before his trial.
Reid interviewed James Holmes nine times, at both the Colorado Mental Health Institute, Pueblo, and the Arapahoe County Detention Facility. All of his interviews were video recorded, and word-for-word transcripts were created.
No other expert recorded his or her sessions with Holmes. Hundreds of thousands, perhaps millions, of television and Internet viewers saw redacted versions of the interviews during the trial, but no one except Reid, a handful of attorneys, and the judge had access to the unredacted videos and transcripts.
Dr. Reid has written, coauthored, or edited sixteen psychiatric books and over two hundred professional articles and book chapters, many on antisocial behavior, terrorism, and forensic practice. He lives, works, enjoys his family, and plays a little blues in Horseshoe Bay, Texas.
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