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Huskerzoo

Ask a PhD in clinical psychology anything (No personal help)

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One of the things I'm most passionate about is mental health especially as it relates to treatment. I usually start talking when there's a school shooting to dispell some stigma surrounding mental health. I find that folks have a lot of questions or misunderstandings, I figure it wouldn't hurt to give everyone a chance to ask questions to their heart's content. No judgment, no bs, just my opinion and any science I can find to back it up. 

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Thanks for starting this thread, zoo. 

 

One of the things that always comes up in response to another slaughter-by-firearm is the idea that the fault lies in inadequate mental health treatment. Do we have more of a "mental health" problem in the US than in other countries? Are people with various "mental health" issues more dangerous and likely to become violent criminals? How often does a severe "mental health issue" go undiagnosed until after the fact? 

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Anything?  Well, okay.  The entirety of my knowledge in psychology comes from the psych 181 class I took my freshman year at UNL.  But I remember one chapter in particular that described a rat maze study.  I have a two part question about that study:   

 

1) The study concerned a rat maze experiment with two groups of rats and a control group.  Group 1 was trained to run a maze to reach a food reward.  After a number of cycles their maze times improved significantly.  Then Group II and Group III (control group) were put through the same learning process.  Group II learned the maze faster than control Group III by a statistically significant amount.  The difference was that before maze training of Groups II and III, the Group II mice were fed the brains of the Group I mice who had previously learned the maze.  Eating the brains of the Group I mice who had already learned the maze made the Group II mice learn it faster.  

 

2)  Where can I purchase human brains?  Preferably from smart people?

Edited by NUance

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22 minutes ago, zoogs said:

Thanks for starting this thread, zoo. 

 

One of the things that always comes up in response to another slaughter-by-firearm is the idea that the fault lies in inadequate mental health treatment. Do we have more of a "mental health" problem in the US than in other countries? Are people with various "mental health" issues more dangerous and likely to become violent criminals? How often does a severe "mental health issue" go undiagnosed until after the fact? 

 

Happy to offer something of interest. 

Question 1: Does the USA have more of a mental health problem than other countries:

 

To answer your question, I think it's extremely important to understand mental health and mental illness. The too long didn’t read is, it’s really hard to tell, but it’s possible (though there may be a better explanation, see below). In a 2004  study published in the Journal of the American Association, The World Mental Health Survey Consortium found “The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.

A 2014 meta-analysis published in the international journal of epidemiology published by Steel et al., supported this conclusion. “There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates.

So why am I skeptical?

The DSM-5 (Diagnostics and Statistics Manual; and the previous iterations) is a document that was designed as a descriptive rather than explanatory text. To make a diagnosis, you observe a set of behaviors and you say "oh we call these things occurring together major depressive disorder". This is in the direct contrast to the medical model which is explanatory where you observe a set of behaviors and say "You're doing this because you're depressed". Within psychology, there is more or less a consensus to reject the medical model. There is ongoing research to justify the medical model that is primarily conducted by psychiatrists but so far the results do not support an underlying disorder (equivalent to having a virus or bacterial infection) that would explain alterations in human behavior. 

The rest of the world (for the most part) uses a different standard of diagnosis which is the ICD (International Classification of Diseases) manual. There have been continued efforts to synchronize these texts, but I do not believe they're at 100% (not my specialty area). What this means is that even from our starting point what we in the USA recognize as a disorder or mental illness is not always (though it is most of the time) what other parts of the world view as mental illness. That is to say, we're comparing apples to something that's very similar to an apple, but not quite an apple. 

The next thing we have to understand why people are diagnosed. If we look at diagnostic criteria for a disorder, you regularly encounter something like this: there are 12 possible symptoms, if you endorse 8 of them you “have” the disorder, if you diagnose 7, you don’t. This doesn’t mean that people who are sub-clinical aren’t distressed. It just means that they don’t meet that criteria. To go back to our medical model example, imagine going to the doctor with a bunch of symptoms that are similar to the flu, but you’re told you come back negative for the flu. Would you expect insurance to pay for your flu treatment (that they don’t think you need…because you don’t have the flu)? So psychologists and others will routinely have some flexibility in diagnosis in order to give distress individuals access to treatment. This artificially inflates numbers. It’s also important to note that lots of people just plain suck at diagnosing. You’ll get a lot of things like PTSD diagnosis for individuals who experienced a “social trauma” which is not a diagnostic criteria. The bad diagnosis problem is further complicated by the people who give the most diagnoses and treatment; primary care providers. Even psychiatrists don’t’ receive any training in mental health until after they’re done with med school. Most PCPs have a very limited understanding of mental health despite the fact they are almost always the first point of contact. They want to prescribe meds to help (that’s the tool they have), so they need to provide a diagnosis that justifies the use of meds. All in all, the impact of our insurance system has a HUGE impact on diagnostic over expansion.

 

 

Question 2: Are people with various “mental health” issues more dangerous?

The long and short is no. You’ll see certain symptom presentations that do predict an uptake in this such as paranoid features and command hallucinations (a voice telling you to do something).

However, research suggests that overwhelmingly individuals diagnosed with a mental health disorder and likely to be the victims of a violent crime rather than the person who commits the crime. The biggest predictors of violent behavior is a past history of violent behaviors and substance use. Violent acts are overwhelmingly committed against people you know as well instead of strangers. I need to step out of my office so I don’t have the time to find the citation right now, but I’ll search for that in a bit.

 

Question 3: “ How often does a severe "mental health issue" go undiagnosed until after the fact? 

Diagnosing “after the fact” cannot be done. The people who do this are acting unethically. To make a diagnosis you need to sit down and talk to the person. It’s the same reason people making diagnoses re: Trump or Charlie Sheen are full of BS. You cannot diagnose unless you sit down and talk to a person.

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24 minutes ago, NUance said:

Anything?  Well, okay.  The entirety of my knowledge in psychology comes from the psych 181 class I took my freshman year at UNL.  But I remember one chapter in particular that described a rat maze study.  I have a two part question about that study:   

 

1) The study concerned a rat maze experiment with two groups of rats and a control group.  Group 1 was trained to run a maze to reach a food reward.  After a number of cycles their maze times improved significantly.  Then Group II and Group III (control group) were put through the same learning process.  Group II learned the maze faster than control Group III by a statistically significant amount.  The difference was that before maze training of Groups II and III, the Group II mice were fed the brains of the Group I mice who had previously learned the maze.  Eating the brains of the Group I mice who had already learned the maze made the Group II mice learn it faster.  

 

2)  Where can I purchase human brains?  Preferably from smart people?

 

https://motherboard.vice.com/en_us/article/ypwjev/the-brain-market-how-to-acquire-brains-both-legally-and-illegally

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What roll do you think deinstitutionalizing people with mental health problems has lead to problems such as homeless and crime?

 

Are there other countries that treat mental health in a much better way that you can point to as what we need to move towards?

Edited by BigRedBuster
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is it a smart idea to sell assault type weapons to teenage boys?   what % of these teenage boys are not mature enough to handle the responsibilty of said weapon?  would raising the legal age to own these weapons to 21 possibly help alleviate at least some of these school massacres?

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34 minutes ago, BigRedBuster said:

What roll do you think deinstitutionalizing people with mental health problems has lead to problems such as homeless and crime?

 

Are there other countries that treat mental health in a much better way that you can point to as what we need to move towards?

 

Institutionalization is an issue with a lot of information around it that you need to take into account. First, we don't really have institutions anymore, we have in-patient treatment facilities. The majority of people that are put into an in-patient setting are there voluntarily. This is important because to put someone in this type of treatment facility without their consent is taking away their constitutional rights (freedom) that are usually only taken away in the event that you violate the law. 

 

According to the 2010 annual homeless assessment report suggests that 46% of individuals in shelters (where we can collect data) can be diagnosed with severe mental illness or a substance/alcohol use disorder. We also know that crime/violence is strongly correlated with substance/alcohol use.  While correlation doesn't imply causation, it seems like a reasonable step to work towards a system where we maximize access to treatment and assess the impact on homelessness and crime. 

 

With regards to macro-level treatment, I'm pretty naive about other countries ways of approaching treatment. I specialize in understanding what it is about treatment that makes a difference. So I can't say there's a way another country does things that we should emulate. What I can say is that there's a general thing that I think we should teach everyone (school age kids being the first group). Namely, we should work on validating feelings even if we don't understand or agree with why they are happening. Additionally, we should work on accepting feelings instead of working to teach people how to get rid of feelings or ignore them. There's a strong evidence base to point to that would suggest that many problems in mental health are an artifact of ourselves or others not accepting our feelings. 

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38 minutes ago, commando said:

is it a smart idea to sell assault type weapons to teenage boys?   what % of these teenage boys are not mature enough to handle the responsibilty of said weapon?  would raising the legal age to own these weapons to 21 possibly help alleviate at least some of these school massacres?

 

This crosses over into a domain that I can't really answer (surrounding the intersection of developmental psychology and policy). 

 

I'm a pacifist. I don't like violence and while I can understand hunting guns actively scare me and I'd prefer that we limit access to them. That is to say that I'm biased here. However, I think "assault-style" needs to be operationally defined. The variables that seem important to me are things such as rate of fire and the damage produced by each round. I think it would behoove us as a country to use language that defines what we're scared of and why rather than a blanket term (such as assault style or mental illness...which realistically as I understand them can mean just about anything). 

 

To bounce back to your question. Age is a poor metric for any restrictions one way or another in my opinion. We set those guidelines to say "on average people at this age posses the skills we want for this behavior/action". If I was ever going to set an age limit on anything I would set that number at 25 in every case. At age 25, the prefrontal cortex has completed its development. The prefrontal cortex is the part of the brain that is most responsible for attention, complex planning, impulse control, and control of emotional reactions. Barring an age limit of 25, I would want to develop some sort of task that assesses emotional impulsivity.  

 

I do not think legal gun ownership by the individual fully addresses our concerns. It can certainly make things harder, but the same way kids still find ways to get alcohol or illegal drugs, if it's out there people will get it. To address happenings of school shootings I do believe that we need to make drastic changes to access to weapons such as what has been done in England and Australia. This will slowly change things, but it will take a lot of time and it will be a bumpy ride. I don't think this will happen as we have significant cultural variables that factor into a fear of a tyrannical government or invading foreign power that evoke a lot of fear from people. When you let fear instead of values guide action, you tend to get messy outcomes. 

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If a train leaves Boston going 65 MPH and another train leaves San Diego going 49 MPH, what are the chances they are even on the same railroad track? :P

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7 minutes ago, Comfortably Numb said:

If a train leaves Boston going 65 MPH and another train leaves San Diego going 49 MPH, what are the chances they are even on the same railroad track? :P

 

6.24? (I'm not always the best at math). 

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1 hour ago, Huskerzoo said:

Institutionalization is an issue with a lot of information around it that you need to take into account. First, we don't really have institutions anymore, we have in-patient treatment facilities. The majority of people that are put into an in-patient setting are there voluntarily. This is important because to put someone in this type of treatment facility without their consent is taking away their constitutional rights (freedom) that are usually only taken away in the event that you violate the law. 

 

According to the 2010 annual homeless assessment report suggests that 46% of individuals in shelters (where we can collect data) can be diagnosed with severe mental illness or a substance/alcohol use disorder. We also know that crime/violence is strongly correlated with substance/alcohol use.  While correlation doesn't imply causation, it seems like a reasonable step to work towards a system where we maximize access to treatment and assess the impact on homelessness and crime. 

I fully understand the individual rights issues that were prevalent when we had large institutions that we put people in against their will.  So, we got rid of them.  But, I think it's also important to realize that this also causes other major issues in society.

 

Many people with mental issues are not going to voluntarily go into a treatment center.  But, they still need treated.

 

Society has got to figure out how to handle this.

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3 minutes ago, BigRedBuster said:

I fully understand the individual rights issues that were prevalent when we had large institutions that we put people in against their will.  So, we got rid of them.  But, I think it's also important to realize that this also causes other major issues in society.

 

Many people with mental issues are not going to voluntarily go into a treatment center.  But, they still need treated.

 

Society has got to figure out how to handle this.

 

I agree and disagree. I think people would benefit from treatment, but you cannot mandate treatment. Society would also benefit from people receiving treatment. Additionally, you can make the argument that most mental illness are just extreme manifestations of normal behavior. We need to teach foundational skills to keep, we need to de-stigmatize mental health services, and we need to work as a society to promote access to services. 

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29 minutes ago, Huskerzoo said:

 

I agree and disagree. I think people would benefit from treatment, but you cannot mandate treatment. Society would also benefit from people receiving treatment. Additionally, you can make the argument that most mental illness are just extreme manifestations of normal behavior. We need to teach foundational skills to keep, we need to de-stigmatize mental health services, and we need to work as a society to promote access to services. 

I understand...at least up until they commit a crime.  For instance, you can't mandate alcohol treatment.....until someone gets arrested for DUI.

 

To me, how to deal with people who need treatment but refuse treatment, is quite possibly the biggest problem in all of this.


I would be very interested in knowing how other developed countries handle this.

Edited by BigRedBuster

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2 minutes ago, BigRedBuster said:

I understand...at least up until they commit a crime.  For instance, you can't mandate alcohol treatment.....until someone gets arrested for DUI.

 

To me, how to deal with people who need treatment but refuse treatment, is quite possibly the biggest problem in all of this.


I would be very interested in knowing how other developed countries handle this.

 

There's a whole theory set up around identification and intervention that's really fascinating. See below, we try to do the same thing. However, group level intervention results in reduced precision in changing behavior. A good example was DARE. It was an attempt to change behavior, but it didn't work well. Everyone got it though which was good. If we developed better group level interventions that we include in school programming it could go a long way. You're starting to see some of this pop up in the form of mindfulness programs in school. Unfortunately, folks do not fully understand why we use mindfulness skills, so some of the benefits may be lost. This is a very important step for research, it's just difficult (and expensive) to track long-term outcomes of an infrequent behavior (e.g. homicidal acts of violence). 

 

https://www.google.com/imgres?imgurl=https://www.med.uottawa.ca/sim/data/Images/Prevention_stages_e.gif&imgrefurl=https://www.med.uottawa.ca/sim/data/Prevention_e.htm&h=529&w=945&tbnid=Kq35e7cUiNHtEM:&tbnh=118&tbnw=211&usg=__dpAaO5GGbKnCkWqvuUqLrNE9Eyo%3D&vet=10ahUKEwiTps7nn6vZAhVFR6wKHbI5ApgQ9QEIMDAA..i&docid=4rkY1iSWJDD7yM&sa=X&ved=0ahUKEwiTps7nn6vZAhVFR6wKHbI5ApgQ9QEIMDAA 

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I would assume that mental illness effects both men and women.  When you take into consideration those who report and those who don't report or get treatment lets say it is probably 50/50 split between the sexes.  

 

Working with that assumption, and the argument of the right that it isn't guns but mental illness that kills people in these shootings, why are the gunmen 98% of the time men?

 

(I guess not so much a question as it is something to ponder for all of us)

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22 hours ago, Huskerzoo said:

 

6.24? (I'm not always the best at math). 

 

 

 

There's a 100% chance that the chances of them being on the same train track is between 1 in 1 and 1 in infinity, so 6.24 in 1 is unpossible.

Edited by Moiraine

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19 minutes ago, Moiraine said:

 

 

 

There's a 100% chance that the chances of them being on the same train track is between 1 in 1 and 1 in infinity, so 6.24 in 1 is unpossible.

 

Infinity? There is definitely a relatively small finite number of railroad tracks, routes and even trains.

 

6.24 may be a hair off but how dare you doubt the train related probability calculations of a PhD in clinical psychology. Shame, shame on you.

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1 minute ago, Comfortably Numb said:

 

Infinity? There is definitely a relatively small finite number of railroad tracks, routes and even trains.

 

 

 

I said it's between 1 in 1 and 1 in infinity, which is 100% correct. It's just not precise.

Edited by Moiraine
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Just now, Moiraine said:

 

 

I said it's between 1 in 1 and 1 in infinity, which is 100% correct.

 

Yeah but that’s cheating :P

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Just now, Comfortably Numb said:

 

Yeah but that’s cheating :P

 

 

Well the point was to say he's wrong wrong wrong wrong wrong. Not to actually give my own guess.

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4 minutes ago, Moiraine said:

 

 

Well the point was to say he's wrong wrong wrong wrong wrong. Not to actually give my own guess.

 

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Piggybacking on what NM had already asked, I've heard the argument on this very board that a possible underlying cause of gun violence in our country is the phenomenon of our society having "broken boys." I take that to mean ones who do not have adequate social support at home or lack strong maternal/paternal guidance which pushes them toward social isolation and thus makes them more susceptible to perpetrating gun violence. Do you buy that? Is there any evidence supporting that as a possible cause or is it just an unfortunate coincidence?

 

If being a male is a factor, is it at all related to that stat you hear tossed around a lot about suicide about how men are more likely to opt for a gun as a mean and that they're more likely to follow through than women?

Lastly, given your knowledge, do you personally believe restricting gun access for those with a diagnosed mental illness is a fruitful avenue for curbing gun violence? No judgement.

 

Thanks zoo, this is an awesome idea for a thread. Thanks for sharing your expertise.

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