Tag Archives: Katherine Flannery Dering

On Understanding Dylann Roof

By Dr David Laing Dawson

Dylann Roof suffered from two delusions. The first was that the actions of others, that specific groups of others were responsible for his own distress and failures, his limitations, his hopeless future. From the little we know of him, I think we can assume his target might have been a different group of others, perhaps Jews, in another place and time and context.

The second delusion was that he, an undereducated, unemployed 21 year-old boy, could and should engage in a single act of violence that would, he believed, change the course of history.

How should we think of this, beyond such words as racism, terror, evil, horror, derangement, and tragedy?

If we want to prevent this happening again we do need to try to understand it. We do need to understand if this was a singular inexplicable event, ultimately unpredictable and not preventable, or the failure of the mental health system, the correctional system, the educational system, the policing system, or one vulnerable kid acting on both the subliminal and overt attitudes of many others.

The human brain, especially the 21 year-old human brain, craves explanation, organization, ways of understanding its perception and experience. It especially demands ways of understanding failure, distress, fear and limitations. And up to a point it is natural in the adolescent phase of development to blame others: teachers, parents, rules, cops, peers, the referee, bad luck. In different times and different contexts this young brain is easily directed by propaganda to blaming Jews, Infidels, Apostates, Indians, Chinese, The Government, Hispanics, Blacks.

One of the jobs of parents and teachers is to adjust these assumptions and conclusions, sometimes gently, sometimes decisively.

By 21 we hope our children have learned to assume some personal responsibility, that their brains are figuring out and accepting the nuances and subtleties of cause and effect, of external and internal control, of responsibility. We hope that they are developing some empathy for others, even others quite different from themselves.

We also hope that their assessments of themselves within this world are beginning to be grounded in reality.

That first delusion. We can arrive at that first delusion, the belief that a group of relatively disenfranchised others (not crooked politicians, recessions and depressions, wall-street barons, lack of educational opportunities) are ruining our lives, through two routes.

The first may be actual, definable, treatable, mental illness: The inability to engage with others, to share information, to process all the complex nuances of interpersonal life, an inability to understand messages of avoidance, of intimacy, of competition, of friend or foe, and because of this, an inability to gain a realistic appreciation of how I fit in, of who is responsible for what.

A delusion satisfies the craving for explanation. But when a delusion is the product of illness it is usually very autistic, a conclusion that one’s life is being controlled by a microchip or radio waves, for example. Though it is quite possible for an ill person to further conclude that certain person(s), or a non-human for that matter, are behind this nefarious plot. The delusion derived from illness, from schizophrenia or depression or mania, does not need corroboration. It does not need anyone agreeing with it. It does not need sanction. And thus it is usually seen by everyone else as crazy, improbable, if not impossible. It is usually suffered privately. It is usually only harmful to self and family. And, of course, it is treatable.

But it is not necessary to have a brain illness, a biological cognitive deficit to come to terrible conclusions. It can arise from reaching 21 still blaming others, still searching for external answers to explain one’s limitations, fears and failures. And from a failure of parents to nudge that teen to healthier schemata, and from access to information, propaganda, symbols and persuasive people who tell this boy, “It is not your fault that you are helpless, useless, hopeless, that you can’t get a girl or a job. It is their fault.”

And then this boy looks around his neighbourhood and sees that many others quietly believe the same. And now on the Internet he can find a revisionist history and many persuasive (persuasive if one’s knowledge and maturity are limited) voices exhorting the same viewpoint. “It is their fault. They are taking away my power, control, my future.”

So for Dylann Roof this was, in a non-clinical sense, a delusion. The externalization of control and blame. A belief shared by too many others. But it was not the autistic delusion that emanates from a treatable psychotic illness.

The second delusion is more problematic. Dylann came to believe that he could and should engage in a single violent act that would change the course of history. Without this second delusion he might have spent his life sober, drunk, employed or unemployed, living with someone, or living alone in a cabin in the woods, occasionally, especially when drunk, upsetting people with a racist rant.

But he came to the manic, grandiose conclusion that he, an uneducated unemployed boy with an average I.Q. and no notable skills or talents, no formal allegiances, should do this thing. But he didn’t behave in a manic fashion, simply grandiose and narcissistic, and without empathy. Perhaps he was simply sufficiently narcissistic, sufficiently naïve, sufficiently sociopathic, to believe he could do this thing, cause a revolt, change the course of history, and be hailed as a hero.

He could read the symbol on the flagpole of the South Carolina Statehouse. He could fill himself with hate propaganda on the Internet, all of which would overtly or covertly demand action. And he could absorb the subliminal messages all around him, even in the street names of Charlestown.

The tool to do this thing was easily available. He did not need a complex plan to acquire and conceal a gun. He bought it and carried it.

So, how do we prevent another of these events?

  • A better mental health system would be fine, but might not have helped Dylann. This was probably not, strictly speaking, the product of a treatable mental illness.
  • A more functional and stable family? Yes. But we have no way of making this happen.
  • A better educational system? Yes. Definitely. And one that offers alternative programs for those inclined to drop out.
  • Good, dignified employment. Yes. Let’s work on that through social policy at all levels of government.
  • Gun control? Yes. Definitely. It is social and legislative insanity to let a 21 year old buy any guns, let alone handguns. Pure and simple. It should not happen. And while murder can be committed by other means, those other means are not as deadly, not as easy, and not as amenable to a momentary impulse.
  • And then we have communal attitudes, overt attitudes, subliminal attitudes, and symbols of hatred, fear and racism. They have a lot of work to do down there. Leaders need to watch the language they use (e.g. “Take back our country”) lest it be mistaken for a call to arms by the less stable among us. And the symbols. The State could quickly remove those symbols of defiance and racism and confine them to the museum. And the State could take a leaf from Germany and ensure the present generation understands and appreciates the truth of their country’s past.

Well, so far, though it looks like Dylann Roof’s name will be long remembered, his actions may have brought about something quite opposite to what he imagined.

David Laing Dawson is the author of The Adolescent Owners’ Manual

To better understand what delusions from a serious mental illness look like, read Katherine Flannery Dering’s blog about her brother

Schizophrenia and the Family

newer meBy Marvin Ross

In one of my earlier blogs, I talked about the stress that families with children with serious mental illnesses experience. Of course, parents who have a child with any serious chronic illness all have stress. But, when that illness is a serious mental illness, then the stress is even more horrendous for two reasons.

The first is that an illness that involves the brain results in significant changes. A happy, bright, funny person may become angry, violent, and unable to think rationally when in the throes of a psychotic state. Reasoning becomes impossible with someone who is delusional and who may very often deny or fail to understand that something is wrong. How do you cope and get that person the treatment  they need? It is difficult and can tear families apart.

We can read the above words or my previous blog on the suffering of families and think that we understand but to truly understand, we need to see it. And my fellow blogger, David Laing Dawson, managed to do that in this scene from his film, Cutting For Stone about a young man developing schizophrenia. Dominic Zamprogna who is best known for his roles in Edgemont and General Hospital, plays the young man Philip and, in this scene, confronts his parents after an escape from the hospital. While fictitious, the scene that is portrayed reflects the reality of many families and, having been there when this scene was shot, the emotion effected all of the crew.

After Vince Li, a man with untreated schizophrenia, murdered a fellow passenger on a Greyhound Bus in Manitoba, David filmed this interview with Philip’s mother in a short called “10 Years Later”.  And this is the second problem faced by families, the stigma of the illness and the horrific things that those who are untreated do. And, before seeing this clip, I should point out that Vince Li was released from a Toronto hospital while still psychotic with no follow up. Since being in a forensic unit receiving treatment, he has improved considerably, His psychiatrist told the review board that he is at low risk to re-offend. Risk assessments done by several other doctors came to the same conclusion.

The above is fiction based upon David’s many years treating patients and so is as realistic as it can be. However, Katherine Flannery Dering who wrote about her brother with treatment resistant schizophrenia provides an actual description of how mental illness impacts the entire family. This is an interview that Katherine did with journalist, Ardina Seward, in a diner in Westchester, NY.

Should We Bring Back Mental Asylums?

newer meby Marvin Ross

Dr Dawson provided an excellent history of how much we have regressed in our treatment of those with mental illness in his five part series. Despite better (but not perfect) medications, and greater knowledge of the brain, we have, as he said, “For a significant number of mentally ill people (and their families) we have, over the past 30 years, reversed the reforms provoked by Dorothea Dix in 1843.”

Certainly, the statistics for Canada, the US and the UK, bear this out. The Canadian Journal of Psychiatry pointed out that there was a rapid closure of beds in the 1970s and 1980s but that was offset by an increase in days of care in the psychiatric units of general hospitals. They called this transinstitutionalization. But, by the 1990s the overall days of inpatient care began to decrease. Between 1985 to 1999 there was a decline of 41.6% in average days of care per 1000 pop in psychiatric hospitals and a decline of 33.7% in psych units in general hospitals. Days in hospital declined but there were more frequent stays for patients – the revolving door.

In a document by the Public Health Agency of Canada called the Human Face of Mental Illness, it was stated that “This discontinuity and inadequacy of care after hospitalization is common among seniors who have lived with schizophrenia for most of their lives. After being transferred from psychiatric institutions they may find themselves in long- term care facilities that generally have limited availability of mental health professionals.”

Meanwhile, there was a near-doubling in the total proportion of prison inmates in Canada with mental illnesses between 1997 and 2009. Prisoners often end up in segregation units and without adequate treatment because the prisons don’t have the staff or resources to properly care for them.

In the US according to the Treatment Advocacy Center, in 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. And we know that the largest psychiatric facilities in the US are the jails in New York City, Chicago and LA.

The Guardian newspaper in the UK recently reported that more than 2,100 mental health beds have closed since April 2011, amounting to a 12% decline in the total number available. It also found that seven people had killed themselves since 2012 after being told there were no hospital beds for them.

On one occasion last year, there were no beds available for adults in England.

In 2011, Dr Peter Tyrer, a professor of community psychiatry at the Centre for Mental Health at Imperial College, London, wrote in the British Medical Journal that “I am now rueing the success of the community psychiatric movement in the UK, where the inane chant of “community good, hospital bad” has taken over every part of national policy. At some point in the steady reduction of psychiatric beds, from a maximum of 155 000 in 1954 to 27 000 in 2008 the downward slope has to level off or rise.”

Meanwhile, earlier this year, three medical ethicists at the University of Pennsylvania, Dominic Sisti, Andrea Segal and Ezekiel Emanuel, argued for a return of the mental asylum in the Journal of the American Medical Association. They said that their use of the word asylum wasn’t meant to be “intentionally provocative.”

“We’re hoping to reappropriate the term to get back to its original meaning, which is a place of safety, sanctuary, and healing, or at least dignified healing for people who are very sick.”

The United States, they said, now has 14 public psychiatric beds per 100,000 people, the same as in 1850. On average, Sisti said, countries in the European Union have 50 beds per 100,000.

On a personal level, author Katherine Flannery Dering whose book Shot in the Head discusses how she and her 8 siblings cared for a brother with schizophrenia, described the impact of what she called The Great Emptying on one of the talks that she gave. As she says, the number of people needing hospitals did not shrink as much as hospitals did.

Asylums (or psychiatric hospitals) do not have to be evil places where patients are abused or ignored. There is no reason they cannot be caring compassionate places that give patients the necessary time to heal or to protect them from the outside world if that is what they need.