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Secret Closed System Families and the Duggers

~ Frank ~ Leave a comment

I have held off posting on the sad evolving tragedy of the Duggars who until both intra-families INCESTUOUS molestation of youngers sisters and molestations reported by national media encompassing such predatory repetitious behaviors with girls outside the family for over a month now. I had wished to gather my thoughts and center my psychiatrist thoughts around a unifying them that added something more of value to the media circus that has gone, not helped to die down by the Duggars themselves.

The newest  current article, entitled, “Duggarville’ Exposed: Jim Bob ‘Is Like a Dictator’; How He Controls His Clan ,with a Secret Codeword,” has furnished the theme to me. The link to the article in the current just out edition of People magazine is People magazine article on the Duggar Family, is a fairly well done piece but sort of misses an important point.

In the clinical arena of “family therapy” which is one of the more inclusive of different brands of mental health professionals, we call these families, “secretive families,” or my more favored descriptive phrase” closed family systems.” Those of us who trained in intensive family therapy, have long seen these families.Their family wife pathology is more often than not centered around, naturally enough a family secret, no surprise there I suppose but an issue that is still perhaps not as familiar to the public as it should.

Often it’s based on keeping something the family is deeply ashamed of, hiding and sheltering a chronically mentally ill relative. Some the classic great writers of Southern literature would have a literary character who was kept hidden away in the big multi-story home. Horror films has bastardized this notion with the over the top Hollywood theme of the crazy [forgive the crude term and vernacular that comes from these movies] who murders people anonymously and the family has varying notions some is badly wrong and resorts to keeping them locked up in the cupola tower of the home and all the other themes along these lines we have seen since the 1950’s or so.

More often the family secret is INCEST. Some adult who is supposed to be what I call the “true steward of the [parent-child usually] relationship, guard the child and one’s one boundaries with the child, violates this and it becomes the big secret.Time and again we have heard these humiliating secrets from persons who publicly come forth with their tales of incest publicly. For instance it is estimated that incest is far more common than realized. Some years ago the startling statistic emerged from confidential surveys incoming collegiate freshman women that one in four to at most, one of eight (!) had experienced at least one or more episodes of sexual assault by college, though of course not at all it within their families of origin.

Closed family systems have other characteristics too. They are secretive by nature. They are usually controlled by a dominant parent and threatened all their suffering lives at home to “keep the secret.” The above article emphasizes that the Duggar father, in essence, exerted dictatorial control over his children with a “code word” used I expect to shut them up when discussion with any outsider came too close to the secret. They are usually experts at presenting pervasive facades as I judge the Duggars to have done in their overdone Christian religiosity. They are unique as closed family systems take great pains constantly to be very isolative, closed off from the community but there are many such families that are exceptions to this trait of such families.

I have no doubt that the Duggars will continue to present themselves as the all-American wholesome family in some way or other. I fear that they may not deal the apparent and reported cancer of incest residing in their family by the evasive, delaying manner they handled son Josh’s unconscionable incest. In my clinical opinion, had this family come the attention and help of any responsive mental health provider of ANY discipline, DSS Child Protective Services would have been notified as well as the authorities and Josh Duggar would be a lifelong registered sex offender as he should be in my humble from the sidelines vantage point. The tragedies will not stop with the “corrective publicity,” and in years to come I would predict that other offspring in the Duggar clan will come forward with their own sad stories.

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Mass Shootings, The Emerging Unfortunate Truths and Dilemmas

~ Frank ~ Leave a comment

I felt it was time to share my thoughts on the mass shootings phenomenon that has been occurring to the dismay and horror of all of us over the last several years. My memory on this is somewhat longer than most people’s because of my profession as a psychiatrist and because I have been following this issue for now over twenty years when the first “modern” shootings started and the first was of school shootings by minors starting nearly two decades. This does not mean mass shooting have not occurred before in history as any internet search engine entry of “history of mass shootings” will give new reports and articles on shootings going back many many decades, eclipsing by far all our current lifespans.

I have seen as a psychiatrists people who have done isolated shootings very early in my training and early in my career after residency training. All of them were shootings in the singular or in pairs or more family members or persons known and close to the shooter/murderer. The first was an estranged young high school student who shot a supposed girlfriend he had an imaginary of delusional fixation on, and who finally jilted him at school, which was the trigger for his shooting her outside of school fortunately. He fit the now current profile we hear about in many of these cases, a younger, white loner male who is known by almost no one, a marginal student, on the fringes of almost all social circles in school and who suffers a traumatic loss and which constitutes the apparent motivating “last straw” or trigger for the murderous act which seems to come out of nowhere. As with at least some of the recent young white male shooters, he had had no contact with any sphere of mental health services and his family was certainly not aware of what was going on with him. Which leads to one of the central issues with many of these shooters, they convey their intentions usually to no one clearly though some of them display very disturbed, aberrant, angry, paranoid views toward one or more social groups they rant about and blame for various and sundry personal or national ills. Since the youths who become these murderous shooters, they have lived less long and have consequently displayed or entertained these issues for shorter periods of time, though in some of them by the time they reach their later teen or young adult years, it may have really been going on in their thoughts for several years. In the cases of the adult shooters, it seems to fall into two time frames, some for many years, in some for most of their adulthood with only hints conveyed to others rarely in the form of racial or ethnic group hatreds or “odd” ideas, that they do not expand upon long or often enough to raise alarm in their work colleagues or families if they are not total loners. The other class is the impulse shooter who usually is confined to giving way and losing control of murderous anger suddenly in reaction to a sudden loss, such as a job, rejection by a spouse with separation (usually a wife who leaves). These men then stalk their estranged wives, develop or increase their previous paranoid ideas that they wives are and have been cheating on them, though many or most of them have surveilled their wives so closely for so long with such sophistication, nowadays even planting secretly GDS directional instruments in the wives’ cars to track their driving patterns and destination, being convinced they will surely catch them in an affair. Also they typically, record  their wives’ cars’ mileage constantly, often follow them in their own cars, or do not permit them to drive as part of the over the top irrational jealousy and controlling behaviors toward their wives, in effect, keeping them captive, perhaps a milder subset that is related to though milder than the serial killers who capture women, torture them, but keep them in captivity as the case in Cleveland with the fellow who kept three women hostage for 10 years or so. Those men usually kill their spouses, and sometime qualify as mass shooters, which now is defined variously as killing two or three persons at once, though most authorities and experts still hold to the older threshold of at least three persons. An example would be the man in Minnesota who accosted his estranged wife in the beauty shop across from the large mall, shot and killed her, and killed one or more other women before turning his gun on himself. His shooting shows how indiscriminant the murderous rage can be as after he shot his wife which one would assume was his primary motive, intention and target, he shot, wounded and killed other women who just happened to be in shop at the time. Others of these men will not only shoot their estranged wives, but also their children, their own parents,-aut and/or their wives’ parents and thus qualify as “mass shooters.”

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Bring Back The Asylum? Really?

~ Frank ~ Leave a comment

This article will discuss the surprising but necessary and growing realization in this country that in order to adequate repair our broken national mental health care delivery system, we have to “bring back the asylums.” Instead of continuing to downsize and abolish inpatient beds, and close more and more state hospitals, we need more beds, more specialized units and more new, modern replacement state hospitals to replace our ageing physical plants of state hospitals that are on average, almost all over 100 years old!

I must also apprise/warn the reader that I have violated the big rule of blogging that I have read in every tutorial on blogging in the last three years, to keep your piece to say, 300-500 words maximum. I have ten-tupled that out of necessity to cover this complex and controversial subject fairly and adequately. I do not believe the batted about insulting Internet based concept that suddenly all American Internet readers have suddenly developed incredibly short attention spans. The blogging books and authorities all would hold me up, I am sure, as the Greatest Violator of Blogging Rules Ever. I would answer that if you are not interested in the crisis of mental health care, and/or mental health reform in this country, quit now, stop reading this piece, save yourself time and do something that fits and pleases you better. I will not mind. But if you are, I would hope you will find this piece informative, motivating and encouraging. I do not write from a pessimist’s heart, and am not the old character from the cartoon strip of Al Capp’s, Little Abner, now long out of print and unknown to anyone under 40 years old or so; this character was called “Joe #@?!” or something like that. He was a total gloom and doom guy, worse than Eyore of Winnie the Pooh. He was illustrated so well pictorially by Al Capp to give any reader of the comic strip an immediate recognition of this character’s constant and unfailing pessimism and even constant expectation that misfortune was waiting for him at any second, by drawing with a little black cloud just above his head that was already raining on him and no one else wherever he went. I am hoping to write and promote change in the opposite, optimistic, we can gradually make things better mode. And fortunately in my state of practice in North Carolina, no matter our present hurdles, we are working diligently on them, I think in the last few years we have turned a number of big policy and implementation corners, and I am proud of this state’s efforts under very very adverse circumstances. I also hope that by writing from that perspective, and by picking up and publicizing in my own small way, successes, victories and advances I find through my professional collegial grapevine of four decades of colleagues from my training years, different places I have practiced, and the wonders of my cool little Google Internet keyword army of helpful search bots, I can spread some good news of mental health reform efforts in other locales that are also fostering improvement and progress against the daunting odds and difficulties we face commonly all over this country. So get your favorite beverage, get you thinking and pondering cap on, and undertake to read [in as many sittings as it takes] this massive blog “missal” on “bringing back the state hospitals,” not exactly a popular or politically correct concept perhaps these days.

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But He Came From Such A “Nice” Family

~ Frank ~ Leave a comment

The above title to this post is actually a favored euphemistic comment offered by Southerners, and perhaps in other regions of the the USA, when perplexed observers, especially small townsfolk, offer to explain the seemingly inexplicable, ‘when someone goes bad.’ I think in the history of the Old South, it was used to describe people’s reactions to news that a well regarded person in the community had surprised if not stupefied everyone who knew that person, by doing some totally out of character bad deed. The local long time lawyer embezzling an elderly lady’s fortune, the head of the local town and sometimes only bank in the 1930’s making off with the bank’s funds and bankrupting the entire town etc. But much more often the scenario would involve that old bugaboo of sex. A scandalous affair, murder of a previous secreted paramour, backsliding into “sin,” and committing some crime “under the influence.” The reason/excuse/rationalization or just plain befuddled explanation offered to one’s friends or even if only to oneself, was the shibboleth, that ‘he [still] came from a nice family.” This harkened back to the days of the Antebellum South where good taste, being racially true and pure, whatever that was, always opening doors for ladies, always being polite and courteous to your worst enemy of romantic rival, having :good rearing,” by a “respected family” that was very successful, as somehow in most societies, perhaps perverted to an extreme in our modern business emphasis of greed and wealth as the only true standards of measure of a person, success equaled inviolate certainly of a steady moral compass in that person.

This past week we have had two nearly simultaneous scandals involving on the one hand, one of our lauded and over-idealized families of the national psyche, and a former highly regarded, middle America, salt of the earth, pillar of the community politician and warmly regarded former leader of Congress, emerge under new undeniable clouds of nefarious and to use a dated perhaps non “PC” [politically correct] phrase, “perverted’ circumstances. Of course I am referring to the public plights and perhaps overly well deserved media lashings now being suffered by Joshua Duggar of the “19 Kids and Counting,” TLC family reality television show about the now famous Duggar family, and, the former and longest serving in USA political history’s Speaker of the House, the former Honorable Dennis Hastert of the Midwest, the moral center point of our nation’s moral center if there is one.

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Mass Shooters Are Less “Psychotic” Than Commonly Believed

~ Frank ~ Leave a comment

One of the very understandable, beliefs, and possibly myths, about the past few decades of mass shooting incidents this country and others have suffered in a seemingly increase in occurrence of these horrific events, that most if not all of the shooters are “crazy,” or psychotic, actively mentally ill, deranged or just plain “off the chain.”

One of the earliest riveting examples of this was the ?Long Island Railway shooter of a number of years ago, who went on a shooting rampage killing a number of passengers randomly. It did turn out that he was indeed very psychotic and had been suffering from a major unchecked psychotic disorder, and that his shooting rampage was delusionally driven. This came out at his trial very clearly through testimony. His case was one of the national consciousness level cases that locked this sometimes erroneous impression into the national psyche and elevated  such a rare fluke like event to a nearly universally accepted knee jerk easy explanation whenever another of these incidents occurred. This was driven by the reassuring power to all of us at some level that we were ‘by odds’ safe from ever coming into the sights of such a rare individual.

However this method of distancing ourselves from the arena of the fantasied “remote” possibility of such a tragedy touching our lives was strained as it seemed that seemingly an everyday Joe husband, with over controlling jealous though often unsupported rages killing their  wives were found not to be mentally ill and acting out of a different social phenomenon. The beginning of the school shootings, perhaps the one of Arkansas a number of years before Columbia in which literally a young middle school student commandeered his family’s rife and started sniper shooting at his school mates began to jolt the national explanation out of credibility and point toward a more unsettling state of affairs, that one did not have to be stereo-typically “nuts,” crazy,” or psychotic, that ordinary persons including kids could suddenly be moved to commit such horrendous acts.

It started to be harder and harder to maintain as the automatic self reassuring explanation that made one feel safe if one was able to attribute the cause of the next incident to a mental vision of the very rare deranged killer who popped up out the lottery bowl ping pong ball numbers making their appearance “against all odds.”

Now comes a study that proves that psychotic symptoms, the behavioral and mental markers, identifiers, characteristics and legally accepted criteria for psychotic mental illness mostly are NOT present in the make up or motivating factors of mass shooters and are NOT the driving cause for their shooting episodes.

This article entitled “Hallucinations Rarely Precede Mass Shootings, Originally Posted by Yasmin Anwar-UC Berkeley on May 13, 2015,” makes for enlightened reading and offers welcome, though unsettling, additional information and increased basis for understanding somewhat more fully the motivations of the modern mass shooters from teens to adults. The research  proven fact derived from interviews post shooting acts conclusively shows that the vast majority of mass shooters did not have psychotic symptoms such as delusions or hallunications driving their acts of mass shootings as is more and more commonly thought by the public and it seems by our all too superficial national media in their hyperdrive for easy explanations for the news events that cover endlessly to fill the bottomless pits of 24 hour a day news cycles.

Some of the more relevant and somewhat startling points of counterintuitive knowledge include:

that a literature review of over 300 violent incidents in the United States found only 12 percent occurred in the setting of active psychosis and were derived by the false beliefs an perceptions that are part and parcel of actively psychotic mental states.

Other foundations and reasons for such violence involved brutality, anger toward separated spouses, rampant substance abuse and access to firearms at the times of heightened stimulant states to violence. These were far, far more common precipitants to mass violence than elements of psychosis.

“High-profile mass shootings capture public attention and increase vigilance of people with mental illness,” says lead author Jennifer Skeem, a clinical psychologist and associate dean of research at the School of Social Welfare at the University of California, Berkeley, stated in the study: :our findings clearly show that psychosis rarely leads directly to violence.”

Researchers focused on the most violent patients tracked in the MacArthur Violence Risk Assessment study, a major 1998 analysis of more than 1,100 offenders who had been discharged from psychiatric facilities.

Specifically, they looked at a subgroup of 100 high-risk patients, who had been involved in two or more violent incidents in the year after they were discharged from a psychiatric facility, to establish their mental states at the time they committed acts of violence.

“We wanted to examine the small group of people with repeated violence and see how consistently these violent incidents were caused by hallucinations and delusions,” Skeem says.

In a preceding study headed by Dr. Skeem, records of prior mentally ill offenders who has committed severe acts of violence were interviewed about what they were thinking and feeling immediately before they engaged in the acts of violence; as an additional source of corroborating data, the retrospective information their friends and family members had to contribute about the times of the offenses were collected.

The very telling finding was proven that psychosis occurred prior to the offenses and multiple violent acts in only 12 percent of the violent acts these patients who had been incarcerated for their offenses following their release for these acts!  Far more telling was the finding was the common circumstance that in subsequent violent acts in these offenders whose prior acts HAD been committed in states free of mental illness.

For the last few months in the Boston Marathon Tsaronov trial and the Batman Theater Killer shooting in Aurora movie theater trials, we have been and will be further subjected to the confusing airing of definitions of psychosis in legal terms, whether the shooters were suffering from mental illness or not. There may even be yet another “battle of the experts,” of forensic examiners who draw diametrically opposed conclusions about the mental mind set of James Wilson, Colorado shooter. These cases usually further confuse the public who cannot be expected to be intimately familiar with the complicated and subtle fine points of legal definitions of insanity as it relates to legal culpability. Yet these differences between the long evolved legal historical bases of legal insanity and psychiatric clinical definitions of insanity/psychosis have been essential for rational use by the criminal justice system to make functional decisions of such portent.

These trials and the inevitable future similar trials as further perpetrators of mass shootings and murderous violence, will hopefully gradually elevate the public’s grasp of the bases for our country’s determinations concerning these baffling and crimes with causative factors that almost always involve factors and long evolved highly personality motives outside the experiences of nearly all of the rest of us.