Sep 20, 2013

Aaron Alexis and the demon delusion

There is an out-of-character vibe to the Navy Yard shootings. A good guy, but big trouble. Intentional, planned violence. It's the kind of situation that generates talk about demons. Would an exorcism have derailed this particular murderous plan?

Maybe it would -- if a concerned knowledgeable spiritual advisor knew enough about the risk factors for mass violence, and took other steps to protect the shooter and the public too.

Mental health and addiction problems are said to be "biopsychosocial" meaning they have biological, psychological and social components. If we add a spiritual component, then we have four ways to approach the problem.

Interventions gain strength when they are stacked up. Medication for the biological, therapy for the psychological, the comfort of family and friends for the social, plus prayer and spirituality. All four, not just one. Demon-blaming can't stop bullets.

What Aaron Alexis needed was a realistic face-to-face discussion about what he was experiencing, and about what he might do to alleviate his suffering and stay safe, and about what was too risky for him and for others. A positive course of action, including accompanying him to a doctor and ensuring that his true concerns were revealed to someone who can take the next steps. Suicidal people often visit doctors with minor complaints, failing to reveal suicidal thoughts to the medical team. Friends and family can help make sure the doctor gets the full story. Alexis was also taking an antidepressant, which sometimes can spark thoughts of suicide or activate a person with thoughts of causing harm.

A spiritual discussion or a prayer or an expression of sympathy is not a strong enough dose of intervention for a person in crisis who is experiencing paranoid thoughts and who has a history of violent impulsive behavior. This is a high risk issue that must be confronted powerfully.

People who work with high-risk populations in jails or community settings know that people can't be trusted to reveal their suicidal or homicidal plans. People in charge construct protocols that ensure safety even when a person hides or disguises his true intentions. This is easier in an institution than it is in community settings. It is a stigma-connected blind spot for security agencies and law enforcement. People who think mental illness is too scary, too hard, too inexplicable or too mysterious find it easy to ignore signs of trouble.

But mental illness is not that complicated. It's thinking or feelings that are out of bounds or off the scale, plus issues relating to safety and risk. Nonclinicians don't have to diagnose anyone, just do their part to provide support, connect with other resources, and help a person stay safe. Sympathy should not displace realistic approaches to safety and risk.

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