The fear is very real, because adults can’t watch kids and teens every moment of every day. The possibility of repercussions — such as even worse bullying — for reporting bullying behavior reinforce the fear and cycle of bullying.

That’s why it’s so refreshing and gives us hope to have come across this video the other day by 16-year-old Canadian Megan Landry. Join over 105,000 others (as of this writing) who’ve already watched and give a view below.

Luckily, Megan is reaching out to share the video with sites like ours:

Hi, I’m 16, I wrote this because I was bullied. I did the video myself too. I hope my song will give other kids the power “to look right over their heads.”

[...] I know it’s making a difference because of all the comments.

Just incredible. We think it’s making a difference too, and are honored to share it with our readers here.

Homegrown projects like this — that are so moving and sharp — gives us hope that we can turn the tables on bullying. We imagine it will give other teens hope as well.

We had a brief email exchange with Megan, a single child, to learn more about the video, and I asked her what inspired her and her friends to create this video.

I was bullied in grade 8 and grade 9 by a group of mean girls. It was a tough time because if anyone was nice to me, the bullies would be mean to them, so I was alone a lot.

I’m now in grade 11 and it’s over. You never though totally trust again. I wrote the song and asked a good friend Caroline to bring a couple of her friends so they could be in my video. If you Google “Megan Landry” Stronger you will see how much people have shared it.

This means the most to me because I hope other kids will be able to be strong and grow from it and not let it hurt them. I want to write music that will make a difference.

Sometimes those with innate musical talent, as I believe Megan has, underestimate their own abilities. When asked if she had an agent or any professional interest, she replied, “No, I don’t think I’m that good yet.”

“I’ve been playing piano since I was four, self-taught up to age nine then I got lessons. I wrote my first song when I was eleven. ”

I believe Megan has shown in this video alone that she has a lot of potential and is a rising teen star to watch.

Subscribe to Megan’s YouTube channel.

How do we deal with those who embrace an ideology of destruction?

How do we reckon with those who suckle their children on hatred?

What do we say to ourselves, to our kids, to our loved ones when a horrible thing happens?

We will all have different responses to these questions. Here are mine…

• We remember the words of those we hold in high esteem.

  “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of disaster, I remember my mother’s words and I am always comforted by realizing that there are still so many helpers – so many caring people in this world.” — Mr. Rogers

• We cherish what we hold dear.

  We hug our kids a little tighter. We appreciate our loved ones even more. We commit random acts of kindness to make life easier for those we know and, perhaps more important, for those we don’t know. We cherish the freedoms we have and are grateful to those who dedicate their lives to making that freedom possible.

• We reach out to those more vulnerable than we are.

  Of course, we do what we can do for those directly affected by the tragedy. But we do more than that. We extend a helping hand to those who are more vulnerable than we are. They may need to share their story, to dissolve into tears, to quiver with fear, to explode with rage. Whatever they require, we are there for them. It’s healing for them; it’s healing for us.

• We do not define the human race by its worst elements.

  People are fantastic! They are kind. They are compassionate. They are big-hearted. They are considerate and generous and loving and sympathetic. Need I say more? And yes, there are those who are cruel and cold and brutal and mean. But we do not let ourselves be corrupted by those elements. We deal with them when we must. But we do not allow them to corrupt our hearts.

• We resolve to become more resilient.

  We may consider ourselves to be anything but resilient. Indeed, we may view ourselves as nervous, unable to deal with storm clouds and ticking bombs. We want life to be safe. Why not? But we recognize that life is fragile. Hence, when tragedy strikes, we strive to become survivors, not victims. When we are ready and only when we are ready, we resolve to do what we can to make ourselves and our little corner of the world a better place. We rejoice in the wonder of life and feel blessed to be a part of it, no matter how awful it is when horrible things happen.

Stay safe and take care of yourself and your family.

And in a patriotic showing of support and love for our country, the national anthem was begun by Rene Rancourt … but then was handed off to the crowd, who sang it with the soul and heart of a nation standing together. Standing strong. Boston Strong.

Click through to watch the video, or to consider a donation to the fund setup by civic leaders and local businesses to help support the victims of the Boston Marathon bombings.

Boston continues to heal from the tragic events of Monday.¹ Last night’s Bruins NHL hockey game was the first major public event since the bombings, and it drew together tens of thousands of fans and citizens from throughout the city.

Want to help through a monetary donation? The One Fund Boston has been setup to help the victims of the bombing:

Massachusetts Governor Deval Patrick and Boston Mayor Menino today announced the formation of The One Fund Boston, the purpose of which is to raise money to help those families most affected by the tragic events that unfolded during Monday’s Boston Marathon.

“I am humbled by the outpouring of support by the business community and individuals who are united in their desire to help; The One Fund Boston will act as a central fund to receive much needed financial support,” Governor Patrick said. “At moments like this, we are one state, one city, and one people.” According to Mayor Menino, support from the business community was immediate. “Within an hour, I had calls from business leaders and local philanthropists who, like me, were heartbroken by the impact this hideous tragedy has had on individuals, their families, and friends. And they want to do everything they can to help these people physically and psychologically in the future.”

The cornerstone donation to The One Fund Boston is a $1 million commitment from John Hancock.

Donate today to help the victims of this tragic event.

1. Psych Central’s offices are north of Boston, in a seaside town called Newburyport, so we were not affected by the bombings.

Other countries have long had to deal with seemingly random bombings in urban areas; the U.S. is relatively late to this particular brand of horror. I’m not sure how one ever gets used to the idea that by just going shopping or watching a parade or sporting event, something really bad could happen.

But life carries on — we cannot stop living out of fear.

With the prevalence of always-on media, it’s tempting to keep updated when tragedies like this strike by monitoring the news 24/7. But that would be a mistake, as we become overwhelmed with the sheer magnitude of information (at first), and then the agonizingly slow trickle of new information (later on).

But there are some things you can do to help yourself — and others.

Elvira G. Aletta, Ph.D., for instance, had these helpful suggestions after the Newtown, CT shootings:

• Share in our humanity. Highly sensitive people (and who among us is not?) feel empathy profoundly. Just because it has not happened to us directly does not mean we do not grieve. Even from a great distance we are sensitive to the depth of loss. Cry, be sad. Allow grief to happen. Then wash your face, breathe deeply and allow life to happen, too.

• Turn off the radio, television, step away from the computer and put down the newspaper. Allow yourself the space to adjust to the news at your pace, not theirs.
• Do good. I do not mean make a donation or give blood. Although all that is good, there is more we can do. I mean what Chris said in a comment he left on my blog the day of the shooting, let us out-grace one another. Let us look for opportunities to act with kindness. Pay forward the kindness received from others. Let us breathe in the healing love and goodness in the universe and breathe out the poison.
• Stop the hate. Now that I’ve breathed out the hate I am hopeful I can let it go.

These are still helpful suggestions today. I would also add:

• Talk about it. Get together, face-to-face, with some friends or family members to share in your grief, or just the need to talk. Spending more time with others helps reinforce those emotional and social bonds that help us feel safe and secure.

• Engage in self-care. Now is not the time to challenge yourself to start a new diet, or challenge some habit or behavior you’ve been meaning to change. Instead, ensure you are getting your emotional needs met — ask for a hug, give a hug. Let others know what you need, and take the time you need to keep yourself together.
• Volunteer. While the Red Cross in Boston isn’t in need of blood donations right now, they will again in a few weeks. Commit to helping by giving blood, or donating in some other way that can help the victims of this tragedy (or even a recent tragedy closer to your own home or local community).

Our hearts and prayers go out to those who were injured or lost a loved one in the Boston Marathon bombings.

The bystander effect is a psychological phenomenon whereas the more people that are present when a person is in distress, the less likely anyone intervenes to help that person. Both cases involved a young girl being sexually assaulted and raped while at a house party with other teenagers.

Add alcohol to the mix — and the emotionally-based (often poor) judgment associated with the teenage years — and yes, it appears to be the perfect recipe for disaster.

The bystander effect first became popularized in the media in the case of Catherine “Kitty” Genovese. On March 13, 1964, New York City resident 28-year-old Genovese was returning to her home in Queens from work that day. As she approached her apartment entrance in the Kew Gardens neighborhood, she was attacked and stabbed by a man.

About a dozen people in the apartment building had heard the attack (as they later told police) and also heard Genovese’s calls for help. But rather than responding immediately — either by actively helping the victim directly, or by calling the police — nobody did so. It took about a half hour before someone finally picked up the phone and called the police. By the time the police arrived, Genovese was dead.

Dozens of more modern psychology experiments have been conducted to confirm the existence of the bystander effect since then. Modern research finds that, in general, the bystander effect disappears when the situation is perceived as being a dangerous emergency (because others are seen more as potential helpers, not as people who will socially judge or otherwise intervene instead).

But some things make the bystander effect even stronger — making people less likely to intervene when another is in distress — according to researchers Fischer et al. (2011):

• More people present (it’s a linear, direct relationship)

• If most of the people are strangers to one another (as opposed to friends)
• More females present (males appear to be less affected)

We don’t know the makeup of the parties that these two young girls participated in, but if it’s like most teenage parties, it’s safe to guess there was a mix of friends and strangers who didn’t know one another.

While we don’t know if the sexual assaults took place in a bedroom — largely shielded from most party-goers’ view — we do know that in Audrie Pott’s case, one of the photos taken of the assault apparently made the rounds at the party itself. And still nobody apparently did anything to stop it or to help Audrie.

We hope a clear response to these incidents is justice — significant jail time for everyone who participated in the sexual assault and rape. And despite these teens being “just children” (in Audrie Pott’s case, the perpetrators were 16 year olds), their names should also be released to the public.

There is no better justice than ensuring that the public never forgets the identify of these criminals, and what they did to helpless girls — both of whom ended up taking their own lives.

And listen up if you’re a teen — do not let this happen again. If you see something that you know is wrong — stop it. Get others to help you stop it. Call the police if you need to. Do not be a victim of the bystander effect — take charge, take action, and let’s prevent these horrible incidents from ever occurring again in the future.

Reference

Fischer, Peter Krueger, Joachim I. Greitemeyer, Tobias Vogrincic, Claudia Kastenmüller, Andreas Frey, Dieter Heene, Moritz Wicher, Magdalena Kainbacher, Martina. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and non-dangerous emergencies. Psychological Bulletin, 137, 517-537.

Read more: How Bad Is ‘Viral’ Rape Shame? It Pushes Teenage Girls into Killing Themselves

“A lot of doctors and other mental health professionals just throw up their arms, and say, ‘What’s the point of even identifying antisocial personality disorder? What are we going to do with these people?’” said Donald W. Black, M.D., a professor of psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine in Iowa City.

Dr. Black, also a consultant to the Iowa Department of Corrections, has been studying antisocial personality disorder (or ASP) for over 20 years. You might be more familiar with the term “sociopath,” which is used more often in the media. “Antisocial” isn’t the best word to describe the disorder, according to Black, because it’s often associated with being shy. “The term arose because the disorder is anti-society. It’s behavior that’s directed against society.”

Black believes it’s vital to study ASP. Not only is ASP costly to our society – economically, socially and emotionally – but you might be surprised to learn that it’s actually quite common. ASP is as common as attention deficit hyperactivity disorder, panic disorder and obsessive-compulsive disorder.

In fact, it might be even more common, because antisocials deny or lie about their symptoms. Black said ASP likely could be traced to “just about any bad thing” in our society, from domestic violence to murder.

Yet, ASP remains highly misunderstood. Below, you’ll learn more about antisocial personality disorder along with its myths and facts.

What Is Antisocial Personality Disorder?

In his new book Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy), Revised and Updated, Black describes ASP as “a recurrent and serial pattern of misbehavior that involves all significant facets of life and is marked by violation of social norms and regulations that occur over time, ranging from repeated lies and petty theft to violence – and even murder, in the most serious cases.”

The major symptoms seem to strike individuals in their early teens and 20s. This is especially problematic, because this time is critical for completing education, starting a career and establishing a family life, Black said. “Antisocials never catch up with their peers.” (This is where early identification and intervention can help.)

Like other disorders, ASP lies on a continuum of severity, Black said. At one end of the spectrum are serial killers. At the other end are mildly affected individuals who commit bad acts from time to time that influence their and others’ lives, he said.

Also, like other disorders, ASP is a complex combination of genetic, biological and environmental causes. It runs in families. Identical twins are more likely to have the disorder than fraternal twins, he said. “Antisocials often come from very dysfunctional families, suffer childhood abuse, have head injuries as children, and their moms are more likely to smoke during pregnancy.” They’re also more likely to have antisocial friends, which only encourages, validates and reinforces bad behavior, he said.

Interestingly, people with antisocial personality disorder tend to gradually improve over time. According to Black, “if you follow them long enough, a certain percentage won’t meet criteria for antisocial personality disorder.” No one knows why they improve, but many other disorders, such as schizophrenia, also may improve over time.

Myths About Antisocial Personality Disorder

There are many myths about ASP. These are some of the most common misconceptions.

1. Myth: Antisocial personality disorder is untreatable.

Fact: Only one randomized controlled trial has been conducted. It tested the efficacy of cognitive-behavioral therapy (CBT) for treating ASP. The treatment didn’t work. However, Black said to contrast that with schizophrenia or bipolar disorder, where researchers have conducted literally hundreds – or thousands – of studies looking at the effectiveness of certain medications and psychotherapies, he said. “It is wrong to conclude that antisocial personality disorder is not treatable. We just don’t know.”

In other words, more research is needed. For instance, some medications have been shown to reduce aggressive tendencies, Black said. “Those may be helpful for antisocial persons in whom aggression is an important symptom.” For instance, atypical antipsychotics, which target mood and irritability, could help these individuals.

Smaller studies have suggested that CBT might hold promise for individuals on the milder end of the spectrum, he said.

2. Myth: Studying antisocial personality disorder coddles criminals and gives them an excuse.

Fact: “[Many worry] ASP is just an excuse for bad behavior, and courts will use it to excuse criminals from criminal responsibility,” Black said. However, he noted that ASP has never been used successfully in court.

According to Black, “An ASP diagnosis is not a license for patients to behave as they like, but instead is a lens through which to view their misbehavior, which is unusual by any standard.”

In another section of his book, he explains, “Although some antisocials – and their attorneys – may attempt to use ASP as an excuse, psychiatrists see the disorder differently. Antisocial personality disorder describes a pattern of behaviors, choices and feelings, but it does not mean that people with the disorder are unable to chart their own paths through life. Unlike some other mental disorders, ASP does not entail a break with reality. Antisocials know full well what is going on around them. They know the difference between right and wrong but may simply be unconcerned with it. Their actions are deliberate and focused on their self-centered goals. They are responsible for their own behavior and should be held accountable.”

3. Myth: You can’t prevent antisocial personality disorder.

Fact: About 40 percent of boys and 25 percent of girls with conduct disorder – the childhood precursor to ASP – are at a high risk for developing ASP as adults, Black said. However some research has shown that if you identify these kids early and work with their families to help them recognize and correct their child’s misbehavior, and steer them away from bad peers, it’s possible to stave off this trajectory, he said.

“Other data suggest that early adjudication may help. Placing a child before a judge and court and providing some kind of sentence has a preventive effect.” In other words, these kids are less likely to become antisocial adults. Adjudication teaches them that bad behavior has negative consequences, and they’re responsible for their actions, even as kids. (Excusing their behavior deprives kids of this vital lesson.)

Again, Black stressed the importance of researching antisocial personality disorder. As he writes, “ASP may be at the root of a substantial amount of the troubles that plague society, and … learning more about the disorder might help us fight crime, violence, and other social ills.”

Relationship addiction might be called “the hidden epidemic.” You could be a love or relationship addict without even knowing it because your symptoms are only triggered by a certain type of person. You might be a sucker for the mysterious, silent, withholding type or the demanding, controlling type or the impulse-driven, pleasure seeker. If you have ever thought, ‘this relationship is not good for me but I can’t keep myself from going back,’ it might be time to recognize you’re addicted to love.

I was inspired to write this article after reading about the highly publicized romance between superstars Chris Brown and Rihanna.

As I read about their on-again-off-again relationship and their public feuds, including his beating and bruising her several years ago, I can’t help but think about so many other young romantics who, in seeking true love, find only a dramatization of their inner conflicts.

If I were to counsel these young lovers, I would start by asking them to look honestly at the value and purpose of relationships in their lives: What need or value does this relationship serve for you? Are you in it because of the amazing chemistry? Are you in this relationship to avoid being alone? Or would you like a relationship that inspires you to be the best person you can be … or one where you feel safe enough to be vulnerable so you can heal and grow?

Many of us, when seeking a meaningful relationship, forget to ask these basic questions. We think it should all come naturally if we’re really in love. Well, if this is your belief, I have bad news — not everyone who feels like your soulmate is right for you. Maybe they lack the basic communication skills needed to negotiate differing needs and expectations. If you are with someone who gets so threatened by the fact you sometimes want one thing while he wants a different thing — so threatened he will harass you or even threaten you until you agree, this relationship is not going to be good for you.

Take the following Love Addict Quiz. It will help you start paying more attention to any tendency you might have for getting into unhealthy relationships.

1. Are you in a break up and then make up cycle with a romantic partner?

2. Do you often think to yourself that this person is not good for you?
3. Do any of your close friends tell you that this person is not good for you?
4. After you two have been apart for a few days, do you get to a point where you feel empty or lost without this person?
5. During the days immediately following a breakup with this person, do you experience difficulty sleeping, eating, or carrying out other self-care activities?
6. Do you need emotional intensity in order to feel alive?
7. Do you feel “high” when the two of you re-connect after a fight or a falling out?

If you answered yes to more than two of these questions, I suggest you take a serious look at yourself and your current relationship. If you need emotional intensity, for example, I ask you to look at what you might be avoiding with this pattern: Are you avoiding feeling ordinary? Do you have a need to feel special as a compensation for deeper feelings of insecurity?

Can you locate the source of your insecurity? What do you fear, specifically? Do you fear being alone, being rejected, being insignificant? If you can feel even a bit of this fear here and now, do any memories come up — possibly of a time someone important to you rejected you? If you can actually feel a bit of this fear intentionally and with compassionate awareness, this is a first step to healing this fear. Learning to feel painful feelings with compassion toward yourself allows you to dip into these feelings while you are in control — as opposed to needing these feelings to get triggered unconsciously by a lover.

If you tend to feel empty or lost without your lover or if you are obsessed with worries about the relationship, you probably have a deep-seated fear of abandonment or of being alone. If this is your issue, I recommend allowing yourself to experience the “alone” feelings triggered by the relationship but in very small doses.

And do this with intention, with the conscious aim of touching into your pain from a wiser, more loving place in yourself — a place that knows it’s okay to experience emotional pain, a place that realizes a certain amount of “fear of loss” is normal when you love someone.

Most dysfunctional relationship patterns arise out of the need to stay unconscious about our normal fears and about the normal emotional discomfort we feel when differences arise. When we just can’t stand any emotional discomfort, like when we have to have our own way in a relationship, that’s when we get into inappropriate relationships that force us to feel our hidden fears and insecurities — even to the point of dramatizing these.

You can have it all in love: both hot sex and healthy love. You do not have to choose between being passionately in love and being a cooperative team. But to achieve this, you need to realize that if your current relationship is unhealthy, you need to take an honest look at how you tend to avoid what I call, “the normal discomforts of relationship.” Dealing with differences is uncomfortable, yes. But to avoid dealing with your differences in a relationship can only create needless suffering or what we might call, “the unnecessary dramas of relationship.”

More on abusive relationships from YourTango:

• 3 Signs You’re In An Abusive Relationship
• 6 Warning Signs You’re In An Abusive Relationship
• 5 Steps To Escaping An Emotionally Abusive Relationship

Heart and key photo available from Shutterstock

The study — published in the BMJ and conducted on data derived from the entire population of Sweden (can we say, “Big study!”) — found “After adjustment for sociodemographic confounders, any mental disorder was associated with a 4.9-fold risk of homicidal death, relative to people without mental disorders.”

In plain English — people with mental illness in Sweden were at nearly 5 times the risk of being murdered than citizens without a mental illness diagnosis.

Rather than wasting time passing laws to try and minimize outlier, tragic events (which, by their very definition, cannot be minimized by the passage of new laws), we instead should be putting more resources into protecting and helping treat people with mental illness.

The researchers examined the 615 homicidal deaths that occurred in Sweden from 2001 to 2008, in a population of over 7 million. Just to put that 615 into some perspective, that’s nearly the number of murders in just one year in New York City (ranging from 414 – 536/year in the past few years; NYC has a population of over 8 million).

The researchers looked at a wealth of demographic data and characteristics — such as gender, race and income — to ensure these variables might not be contributing to the relationship the researchers found.

They found that the risk of being murdered was highest, at nine-fold, for people with substance use disorders, a number that may of course be subject to confounding lifestyle variables. But it was also increased for people with other mental illnesses in a way that couldn’t be explained by substance use.

Those with diagnosed personality disorders, for example, had a 3.2 times increased risk of being a victim of murder. For depression, the risk was increased by a factor of 2.6, for anxiety disorders, 2.2, and for schizophrenia, 1.8.

Some were at even greater risk than others. “Unmarried males with low socioeconomic status were particularly likely to be victimized; they were also at a heightened risk for suicide or accidental death, as previous studies have already established.”

The researchers concluded,

In this large [...] study, people with mental disorders, including those with substance use disorders, personality disorders, depression, anxiety disorders, or schizophrenia, had greatly increased risks of homicidal death. Interventions to reduce violent death among people with mental disorders should tackle victimization and homicidal death in addition to suicide and accidents, which share common risk factors.

And yet has any lawmaker in the U.S. suggested a law to better help and protect the population most at risk for becoming a victim of violence?

Not a one.

Read the full article: Study: People With Mental Illness Are Five Times More Likely to Be Murdered

Reference

Crump et al. (2013). Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study. BMJ, 346. doi: http://dx.doi.org/10.1136/bmj.f557

According to a National Council on Disability report, people with psychiatric illnesses are routinely deprived of their civil rights in a way that no other people with disabilities are (2). This is particularly so in the case of people who are involuntarily committed to psychiatric wards.

Under present standards of most states, a person who is judged by a psychiatrist to be in imminent danger to self or others may be involuntarily committed to a locked psychiatric ward and detained there for a period of time (3). Some would argue that involuntary civil commitment is a necessary approach justified by safety and treatment concerns. Others would counter that it is an inhumane and unjustifiable curtailment of civil liberties.

Let’s look at the example of recent suicide survivors in order to examine this debate in more depth.

On one side of this argument are the vast majority of mental health specialists and an uncertain percentage of former patients. They argue that forced confinement is, at times, justified by safety concerns and to ensure that proper treatment is administered. Psychiatrist E. Fuller Torrey, eminent advocate of greater use of coercive psychiatry, criticizes the reforms gained by civil rights advocates (4). He says that these reforms have made involuntary civil commitment and treatment too difficult and thus have increased the numbers of mentally ill people who are homeless, warehoused in jails, and doomed by self-destructive behavior to a tortured life.

D. J. Jaffee claims that the high-functioning “consumertocracy” anti-psychiatry people do not speak for the severely ill and homeless (5). If you are suffering from serious mental illness, “freedom,” Torrey and Jaffee say, is a meaningless term. Many a family member has bemoaned the difficulty in getting a loved one committed and kept safe. Torrey pleads with passion that involuntary commitment should be facilitated and the time of commitment lengthened.

No one can contest the problems that Torrey describes, but a nation dedicated to civil liberties should question the solutions he advocates. Prominent critics of coercive psychiatry include early activist psychiatrist Loren Mosher and psychologist Leighten Whittaker, the consumer organization Mindfreedom.org, consumers (or service users) such as Judi Chamberlain, and civil rights attorneys.

In presenting counter-arguments against the use of involuntary commitment with suicide survivors, I consider here the interlinked issues of safety and science-based medicine, as well as civil liberties and justice. Here are my concerns:

• There is no reliable methodology behind the decision of whom to commit.

  Despite studies and innovative tests, doctors still cannot accurately predict who will make a suicide attempt even in the near future. As Dr. Igor Galynker, associate director of Beth Israel Department of Psychiatry said in 2011, it is amazing “how trivial the triggers may be and how helpless we are in predicting suicide.” (6) In fact, an average of one out of every two private psychiatrists loses a patient to suicide, blindsided by the action. (1)So how do hospital psychiatrists choose which people recovering from a suicide attempt they should commit? There are patient interviews and tests, but commitment is primarily based on the statistics that a serious recent suicide attempt, particularly a violent one, predicts a 20-40 percent risk of another attempt. (7) However, this statistics-based approach is akin to profiling. It means that those 60-80 percent who will not make another attempt will lose their liberty nonetheless. So should we accept locking up individuals when evaluation and prediction of “danger to self” is so uncertain?

• Confinement does not offer effective treatment.

  Erring on the side of caution and confining all people who have made a serious suicide attempt is particularly unjust and harmful because the vast majority of psychiatric wards do not offer effective stabilization and treatment. A report by the Suicide Prevention Resource Center (2011) found that there is no evidence whatsoever that psychiatric hospitalization prevents future suicides. (8) In fact, it is widely recognized that the
  highest risk of a repeat attempt is soon after release from a hospital. This is not surprising, given the limited therapeutic interventions usually available on wards beyond the blanket administration of anti-anxiety and psychotropic medications. What the hospital can do is reduce the risk of suicide for the period of strict confinement. Despite this data, in Kansas v. Henricksthe U.S. Supreme Court found that involuntary commitment is legal even if there is an absence of treatment.

• Involuntary psychiatric hospitalization is often a damaging experience.

  Psychiatrist Dr. Richard Warner writes: “…we take our most frightened, most alienated, and most confused patients and place them in environments that increase fear, alienation, and confusion.” (9) A psychiatrist who wishes to remain anonymous told me that voluntary psychiatric programs often see patients with post-traumatic stress from their stay on a locked inpatient ward. Imagine finding yourself surviving a suicide attempt, glad to be alive, but suddenly locked up like a convicted criminal with no privacy, control over your treatment, or freedom.

• Involuntary confinement undermines the patient-doctor relationship.

  The prison-like environment of a locked ward and the power dynamics it entails reinforces a person’s sense of helplessness, increases distrust of the treatment process, reduces medication compliance, and encourages a mutually adversarial patient-doctor relationship. Hospital psychiatrist Paul Linde, in his book, Danger to Self, critically labels one of his chapters, “Jailer.” (10) Yet, like some other hospital psychiatrists, he talks about the pleasure of winning cases ‘against’ his patients who go to mental health courts, seeking their release. The fact that judges almost always side with hospital psychiatrists undermines his victory and patient access to justice. (11)

• Finally, coercive treatment of people with mental illness is discriminatory.

  Doctors do not lock up those who neglect to take their heart medications, who keep smoking even with cancer, or are addicted to alcohol. We might bemoan these situations, but we are not ready to deprive such individuals of their liberty, privacy, and bodily integrity despite their “poor” judgement. People who suffer from mental illness also are due the respect and freedoms enjoyed by other human beings.

One might think from the widespread use of involuntary civil commitment that we have few alternatives. On the contrary, over the past decades, there have been several successful hospital diversion programs developed which use voluntary admission, peer counseling, homelike environment, and noncoercive consultative approaches, such as Soteria and Crossing Place. (12)

Community-based cognitive therapy has been fairly effective with suicide survivors at lower cost, yet we continue to spend 70 percent of government funds on inpatient settings. (13) Yes, many underfunded community clinics are in a disgraceful state, but the same may be said of some psychiatric hospitals.

For a nation that prides itself on its science, its innovation, and its civil rights, we have too often neglected all three in our treatment of those tormented by mental illness and despair who have tried to take their lives.

Endnotes

1. Civil commitment refers to involuntary commitment of individuals who have not been convicted of a crime.
2. “From privileges to rights: People with psychiatric disabilities speak for themselves.” National Council on Disability.(1/20/2000). http://www.ncd.gov/publications/2000/Jan202000
3. ”State-by-state standards for involuntary commitment.” (n.d.) Retrieved September 4, 2012 from http://mentalillnesspolicy.org/studies/state-standards-involuntary-treatment.html.
4. Fuller Torrey, E. (1998). Out of the Shadows: Confronting America’s Mental Illness Crisis. New York: Wiley.
5. Jaffee, D.J. “People with mental illness shunned by Alternatives 2010 conference Anaheim,”
   Huffington Post. 9/30/ 2010. Jaffee is found at Mentalillnesspolicy.org which argues his views.
6. Kaplan, A. (5/23/2011). “Can a suicide scale predict the unpredictable?” Retrieved 9/23/12 from
   http://www.psychiatrictimes.com/conference-reports/apa2011/content/article/10168/1865745. See also Melton, G. et. al. (2007). Psychological evaluations for the courts. Guilford Press, p. 20.
7. There are a wide variety of estimates of the heightened risk found in different studies.
8. Knesper, D. J., American Association of Suicidology, & Suicide Prevention Resource Center. (2010). Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc. p. 14.
9. Richard Warner ed. (1995). Alternatives to the hospital for acute psychiatric care. American Psychiatric Association Press. p. 62.
10. Linde, Paul (2011). Danger to self: On the front line with an ER psychiatrist. University of California Press.
11. Personal observation and comments made by hospital psychiatrists to the author.
12. Mosher, L. (1999). Soteria and other alternatives to acute hospitalization. J Nervous and Mental Disease. 187: 142-149.
13. Op.cit. Melton (2007).

Fortunately, each of us holds the power to defuse our own anger and even others,’ Dr. Shrand said. This is especially critical because often it’s not our own fuse that hinders our success; it’s someone else’s, he said.

The key in cooling anger lies in respect. As Dr. Shrand said, when was the last time you got angry with someone who showed you respect?

“Anger is designed to change the behavior of someone else. Being respected feels great, so why would we want to change that?”

Another key lies in using our prefrontal cortex, instead of letting our primitive limbic system run amok. Our limbic system is the ancient part of the brain known as the “lizard brain,” according to Shrand, also medical director of CASTLE (Clean and Sober Teens Living Empowered) at the High Point Treatment Center in New Bedford, Mass. It houses our emotions, impulses and memory. And it’s the source of our fight-or-flight response.

The prefrontal cortex is the more advanced, newer part of our brains known as the “executive center.” It helps us plan, solve problems, make decisions and control our impulses. It’s the prefrontal cortex that helps us in deactivating anger in ourselves and others.

Recognizing & Defusing Your Own Rage

Anger is a perfectly normal part of being human, Shrand said. It becomes dangerous when we’re unable to recognize it, or it transforms into aggression. So it’s important to first understand and defuse your own anger.

Angry runs on a spectrum, from irritation to rage. Shrand suggested creating your own anger scale from 1 to 10. For instance, his 10-point scale looks like this: “irritation, aggravation, annoyance, frustration, impatience, displeasure, anger, wrath, fury and rage.” Figure out your triggers for all 10 levels.

Pay attention when your anger surpasses level 5. That’s when our limbic system overwhelms the prefrontal cortex, Shrand writes in Outsmarting Anger. And that’s when we’re more likely to get into verbal or even physical fights.

According to Shrand, there are three major reasons, or domains, why we get angry: resources, such as food and money; residence, which includes not just your home, but your community, work, school and country; and relationships, which include your close family, coworkers, political party and religion.

Specifically, the suspicion that someone wants to take something away from us – resource, residence or relationship – can activate our anger. Another trigger is envy, when someone has something we want in any of the three domains.

To better understand your own anger, Strand suggested considering the various triggers in each of these domains.

Once you recognize the presence of your anger, it’s vital to channel it, he said. “Anger doesn’t have to be destructive but [can be] constructive.” Shrand advised against punching things because you can “go from a pillow to a face.” Instead, “defuse the energy of anger.”

Go for a run, focus on your artwork or finish a DIY project, he said. “Break something that needs to be broken.” As he said, the most amazing works, including music, poetry and art, have been created from anger.

Defusing Other People’s Anger

According to Shrand, you can deactivate another person’s anger by not getting angry yourself. In fact, doing so can connect you to others in profound ways. Take the following example. A stranger was putting up a yard sale sign on Shrand’s lawn. He was pretty annoyed, but, as he approached the man, decided to calmly ask him what he was doing. The man responded defensively.

But Shrand responded with a joke, which eased the tension. This led to a meaningful conversation. Shrand learned that this man – his neighbor – was having a yard sale to finally sell his wife’s belongings, three years after her passing. “His eyes welled with tears as he spoke, this man who just a few moments before had been a burly stranger engaged in a meaningless defensive posture,” he writes in his book.

Shrand’s calm and amicable demeanor sent the message to his neighbor’s brain that Shrand wasn’t a threat. He wasn’t going to steal the man’s resources, residence or relationship.

Another important component of deactivating another’s anger is empathy. For instance, in the above example, Shrand showed his neighbor that he was interested in him and wanted to better understand his thoughts and behavior, which sent another message: “You have value to me.”

And that’s a powerful thing. As Shrand said, “In our heart of hearts, a human being wants to feel valued by another human being.” “Feeling valued leads to trust. In turn, the feeling of trust reduces the other person’s anxiety and potential for anger,” he writes in Outsmarting Anger.

Shrand encouraged readers to “Keep it frontal, don’t go limbic.” In other words, focus on your prefrontal cortex, without getting suspicious of others or lashing out.

You might worry that this leaves you vulnerable to being exploited. But “you’re enhancing your survival potential. You become seen as a benefactor yourself… or a person of integrity and character that others want to be around [and trust].”

Cooperation trumps competition. Group dynamics research has found that while selfish members do better temporarily, altruists win, because they are working cooperatively, he said.

You also never know where people are coming from or the day they’ve had. While we don’t have control over anyone, we do influence everyone, he said. “We have to decide what kind of influence we want to be.”

But it sure makes a legislature feel good about themselves, doesn’t it? “Hey, look, we’re doing something. We’re going to keep guns out of the hands of those crazies.”

Such laws won’t even make a dent in the annual murder rate in the U.S. And at the same time legislators are “doing something,” they are reinforcing the discrimination against those with a mental illness label. Because most of the laws are focused on the labels of mental illness — not actual violent or criminal behavior.

The New York Times has the latest story, which again points out the rude reality — the numbers of people with mental illness committing murders are pretty inconsequential:

But critics say that this focus unfairly singles out people with serious mental illness, who studies indicate are involved in only about 4 percent of violent crimes and are 11 or more times as likely than the general population to be the victims of violent crime. [...]

But such killings account for only a tiny fraction of gun homicides in the United States, mental health experts point out.

Besides the research indicating that little violent crime can be linked to perpetrators who are mentally ill, studies show that those crimes are far more likely to involve battery — punching another person, for example — than weapons, which account for only 2 percent of violent crimes committed by the mentally ill.

The reality of murders in the U.S. are simple — they are committed with handguns, they are committed by people who usually know the victim, and the person who commits the murder is rarely someone with mental illness.

The focus of the new laws is basically to remove the constitutional right of Americans with a mental illness diagnose to own a gun. New York state’s new law is quite clear:

New York’s provision, Dr. Monahan said, differs from virtually every other state’s laws in allowing guns to be taken not only from those committed against their will but also from patients who enter treatment voluntarily.

Umm, so maybe people who value their constitutional rights may be less inclined to seek out mental health treatment in the future — especially under the fear that if they say the wrong thing to a health or mental health professional, they may find those rights trampled upon.

Because of this, some criminal justice experts say it makes more sense to pass laws addressing behavior, rather than a diagnosis of mental illness.

In Indiana, for example, firearms can be confiscated from people deemed a potential threat, whether or not they have a mental illness.

Problem is, professionals have a lousy track record of determining what is a legitimate “potential threat.” They almost always err on the side of caution, which results in taking action when no action is needed.

Involuntarily Commitment Threshold Lowered

States also want to make it easier to involuntarily commit people with mental illness. I guess the thinking is, “If we find the crazies with the guns before they use them, and get them treatment (whether they want it or not), they won’t use the guns to kill others.” It’s a pretty shaky line of reasoning there (especially in the service of reducing gun violence).

The threshold of being an imminent danger to oneself or others is now being lowered to simply a belief that there is a “substantial probability” of potential harm to oneself or others.

To me, these are all just legal semantics, because all professionals do is take a guess. Yes, it may be a somewhat educated guess, but it’s a guess nonetheless. And again, professionals will always err on the side of caution, since it’s their neck on the lines.

Mental illness is an easy scapegoat in the national discussion on gun violence. But it’s also a red herring — it has little bearing on stopping the violent acts perpetrated in this country everyday.

So while legislators across the country will pat each other on the back for “doing something” about gun violence, don’t be fooled by their smug assurances. These laws will do nothing to address the prevalence of murders — or murderous rampages — aided by weapons that can raze down dozens before any defensive action can be taken.

Read the full article: Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say

As a firm believer in gun control laws and restrictions on violent video games, I am in favor of an in-depth conversation on legislative reform. However, as I read multiple reports on the passing of this new law, I began to question whether this legislative act will actually remedy gun violence. I pondered whether the confiscation of weapons from an individual deemed mentally impaired could lead to more problems than expected.

Severe, untreated mental illness is a complex phenomenon, and dealing with it can be quite a challenge. I have identified three issues that should prompt further consideration before such gun laws are implemented in other states.

1. Negative response by individuals unaware of the extent of their illness. Most people are unfamiliar with the behavioral characteristics, including rule resistance, that individuals with severe, untreated mental illness exhibit. Their behavior can present as extremely rigid and being asked to follow the simplest rule can provoke outbursts.

Past incidents of law enforcement coming in contact with individuals with severe untreated mental illness have resulted in tragedy.

Many individuals with untreated mental illness do not see the necessity of seeking treatment, and many will not think they are ill enough to have their weapons taken away. Confiscating the weapons of people unaware of their own mental impairment could lead to a tug-of-war between the individual and law enforcement, resulting in bloodshed.

2. Negative response due to reduced autonomy. Confiscating weapons feels to many individuals like an attack on their autonomy. When a person feels as if their freedom is being curtailed, the resulting behavior is often negative. Some people will verbally or physically challenge authority; some may be willing to die for their “freedom.” Confiscating weapons from an individual who feels this way will not be a positive experience.

3. Lack of mental health education for law enforcement personnel. The work of men and women in law enforcement requires great courage and stamina. They live dangerous lives. Many, however, are unaware of mental health issues and how they may affect the compliance of individuals they encounter. If law enforcement personnel are to become more involved in the mental health field by having to confiscate weapons from severely impaired individuals, they should be required to engage in continuing education about mental health.

When therapists are trained to work with the severely mentally ill, they are taught to identify patterns of behavior that might signal agitation or violent outbursts from clients. For the most part, experience, education, and intuition come together in such cases. Mental health professionals are also trained to calm emotionally intense situations. Unfortunately this is not the type of training law enforcement personnel receive.

Neglecting the True Problem

Citizens are understandably horrified by the recent cascade of violence in our communities and society appears desperate to find a remedy. The problem with some of the proposed laws is that rather than address mental health issues, they neglect them. It is important to learn better ways to approach people with severe mental illness when weapons must be retrieved.

Because reporting the potential for violence among clients is more art than science and requires personal judgment, it is very risky for a therapist to step out on a limb and report a client. It not only reduces trust in the therapist-client relationship, but labels the client as well. Innocent clients who might never engage in violence may be labeled “potentially violent.”

We need a frank discussion that focuses on how to safely confiscate weapons from an individual with a severe, untreated mental illness. Society will not be made safer by simply sending in law enforcement professionals to retrieve guns. What is required is knowledge about how to calmly and wisely approach those who have the potential to kill.

Gun photo available from Shutterstock

But in focusing on these one-off tragedies that subjectively seem epic (but objectively, are a drop in our national murder-rate bucket), the over-reaction of the lawmakers was predictable.

So lawmakers have decided to turn every physician, nurse, social worker, therapist and mental health professional in New York into a new kind of mandated reporter — people who turn into police officers when it comes to certain behaviors. In doing so, lawmakers in New York have single-handedly shred the foundation of confidentiality and trust in the doctor/patient and therapist/client relationship.

Is this a sensible reaction?

The New York Times notes the big change:

The most significant new proposal would require mental health professionals to report to local mental health officials when they believe that patients are likely to harm themselves or others. Law enforcement would then be authorized to confiscate any firearm owned by a dangerous patient; therapists would not be sanctioned for a failure to report such patients if they acted “in good faith.”

Currently in most states, mental health professionals already have an ethical duty to report certain kinds of behavior to authorities — active and ongoing abuse (whether child, partner, spousal, or elder), and certain threats of homicide or suicide. But the key difference is that the state has generally left this up to a professional’s experience and judgment to decide when to report, and when not to.

There may be many methods to helping someone in these situations, but most importantly, most of them do not involve immediately betraying the trust of the patient and reporting them to the authorities. From an ABC News article on the new law:

This flexibility allows a therapist to deal with a risk of violence without breaching confidentiality in all cases, he said. And even if those steps are enough to blunt the danger, the proposed law would still require that the patient be reported to mental health authorities, he noted.

“It undercuts the clinical approach to treating these impulses, and instead turns it into a public safety issue,” [said Dr. Paul Appelbaum at Columbia University.]

The new law, if health professionals follow it, completely throws away the therapeutic relationship with the patient, and breaches the patient’s trust and confidentiality. People with mental illness are being scapegoated, despite the lack of research demonstrating a conclusive link between mental illness and violence.

Worse, it encourages smart people to simply not admit to any such impulses of violence — even if they have little or no intent to carry them out. Patients are now encouraged — through the haphazard, quick passage of this law — to self-censor while talking to their therapist. Certain thoughts will be reported to the government otherwise.

If this doesn’t sound like Big Brother, I don’t know what does.

So while well-meaning, New York lawmakers have just managed to completely undermine the good, hard work that therapists do with citizens of that state. And state residents will learn to keep their mouths shut if they want to keep their Constitutional rights intact.

Kudos.

Instead, they — like many well-meaning but apparently brain-dead newspapers — tie the need to fix our mental health care system — something others have been advocating for for decades — to recent headline-news grabbing acts of atrocious violence.

Only buried in this hypocritical, two-faced gutter-piece editorial do you find the truth — “Only the tiniest fraction of the mentally ill ever become violent, and then, usually when they fail to get treatment.” It’s even worse than that — statistically speaking, mental illness is a horrible predictor of violence, and nobody who’s read the research would ever suggest otherwise.

I have no problem with you advocating to help people with mental health concerns. I have a big problem if you’re doing so because of violence in America. The two have little to no connection with one another.

People let to get all riled up and angry when something tragic occurs. It’s one way many of us cope and try to figure out such events. But when we respond to tragic events with action, we’re likely to do so in a way that makes little sense in the overall, broader picture.

The fact is people with mental health conditions are no more likely to be violent than is the general population.
~ Wayne Lindstrom

For instance, every year in America, over 12,000 people a year are murdered — most by some sort of gun. Nobody gets upset at that huge number, or that 30,000+ people a year who take their own lives.

Instead, the thing that USA Today wants us to get motivated by are these horrific acts of violence that barely read in the overall number of deaths per year due to gun violence. USA Today doesn’t seem to care about the 30,000+ people each year who, because of untreated depression or other mental health concerns, choose to end their lives.¹

Wayne Lindstrom, the CEO of Mental Health America, on the other hand, gets it right in his response to the crummy piece of what passes for “insightful opinion” at USA Today:

The premise that we can predict or prevent violent acts is unsupported. Even in the case of severe mental illnesses, mental health professionals possess no special knowledge or ability to predict future behavior.

The fact is people with mental health conditions are no more likely to be violent than is the general population. Continuing to link violence and mental illness only stigmatizes people and deters them from seeking care.

We whole-heartedly share and endorse these words. We stand proudly with Mental Health America and other organizations who’ve read the research and know that linking mental illness to violence is like linking terrorism to a specific religion — it’s a feel good strategy imbeciles do to make themselves feel better.

USA Today rues the good ole days, when we could lock up anyone society disagreed with or didn’t like the looks of in a mental hospital (nowadays referred to an inpatient psychiatric hospital): “Many states have become so strict that it is almost impossible to get people committed until they are in deep crisis, or try to commit suicide or harm someone.” Awww, what a shame — we actually have a reasonable, humane standard before trying to take someone’s freedom away from them.

USA Today should be ashamed of itself for publishing an editorial that only reinforces the discrimination, stigma and prejudice against people with mental health concerns. They continue to spread misinformation about the link between mental illness and violence,² and suggest we have some sort of magical powers of foresight that would allow us to predict these kinds of incidents with such accuracy, it would be like the science-fiction story, “Minority Report” (we don’t have such magical powers, sorry).

USA Today crap editorial: Editorial: Fix broken mental health system

Wayne Lindstrom’s response: Opposing view: Don’t link violence with mental illness

1. Worse, they cite the example of Seung-Hui Cho — who actually had contact with mental health professionals!
2. There really isn’t much of one, according to you know, the actual research.

But the recent suspension — and possible expulsion — of San Francisco high school student, Courtni Webb, is a fine example of how not to deal with suspected school violence.

Ms. Webb was suspended, according to news reports, for writing a poem about the Newtown killings, which apparently violated the school’s policy against threats of violence.

Poets, of course, have been deemed a threat to society ever since Plato banned them from his ideal “Republic.” Poetry, Plato argued, spoke to the heart, not the mind — and thus encouraged rebellion against the natural order of things.

But having heard Ms. Webb read her poem in its entirety, I found little in the way of violent rebellion, and certainly no overt threats to her classmates. Yes, the poem might be called self-absorbed — but isn’t that part of normal adolescence?

When Ms. Webb writes, “When you don’t feel loved/ you hate the world,” she could easily be expressing the feelings of thousands of alienated young people from time immemorial. Most of the poem seems to be an attempt to express her personal frustrations, and to understand the motivation of the Newtown shooter — not to threaten new violence.

We would be fortunate, as a society, if more lonely and alienated young people expressed their feelings in poetry, and fewer, through acts of violence.

We have yet to create a well-validated “profile” of those who carry out acts of so-called targeted violence, such as school shootings. The evidence to date suggests that perpetrators of such attacks tend to have very low self-esteem, a “persecutory/paranoid” outlook, depressive symptoms, narcissistic traits, and feelings of rejection. Perhaps one can find intimations of a few of these characteristics in Ms. Webb’s poem.

But as my colleague, Dr. James Knoll, has pointed out, focusing too heavily on these factors by “profiling” students would deluge school officials with “false positives.” Profiling alone — in the absence of careful, on-site assessment — casts far too broad a net to be useful.

Furthermore, as Prof. Eric Madfis of the University of Washington at Tacoma has pointed out, “zero tolerance” policies with mandatory arrests, suspensions and expulsions appear to do little to thwart targeted violence in schools.

Rather, schools do best by heeding the early warning signs of planned, targeted violence, such as when a would-be perpetrator “leaks” elements of the plan to another classmate, or posts threats on a website. Indeed, research from Finland found that adolescents aged 3-18 who expressed “massacre threats” online were a riskier group than adolescents who expressed the threats offline — for example, those who made online threats had often begun making actual preparations for the attack.

Of course, utilizing these early warning signs presupposes that knowledgeable peers or family members are willing to come forward to school authorities or police — and this happens all too rarely. As Prof. Madfis has noted, there is often a “code of silence” among adolescents that discourages coming forward with such information — which is widely regarded as “snitching.”

Nevertheless, the recent case of Blaec Lammers, in Bolivar, Missouri, shows that timely, personal intervention can make a huge difference. The young man’s plans for an Aurora-style movie theater massacre were thwarted when his mother reported him to local police.

Perhaps the most sensible recommendations for preventing targeted violence in schools come from the Interdisciplinary Group on Preventing School and Community Violence, writing in the aftermath of the Newtown, CT shootings. Among their conclusions was that the most effective way of preventing violence targeted at schools is by

“…maintaining close communication and trust with students and others in the community, so that threats will be reported and can be investigated by responsible authorities.”

The group did not endorse the use of “profiling” or checklists of personality traits. Rather, they urged the use of trained staff members who would investigate specific instances of apparent threats. Of course, schools strapped for funding will find it hard to implement such staff training — yet arguably, this may be more effective in preventing violence than posting armed guards at all our schools.

I also believe that greater cooperation between school health personnel and outside mental health specialists is sorely needed. For example, the school nurse or school psychologist could meet periodically with family physicians and psychiatrists in the community, to discuss students believed to be at high risk for targeted violence. This could be done via anonymous case presentations that would protect the privacy of potentially innocent students — and without simplistic “profiling.”

Some of these adolescents might be tugged off the path of violence through appropriate, voluntary counseling or mental health intervention. In cases of extreme or imminent threats of violence, involuntary treatment might be required, via appropriate judicial processes.

What will not help, in my judgment, is targeting students like Courtni Webb, who engage in acts of poetic expression, rather than savage violence.

References and Further reading    

Sankin A:  Courtni Webb, San Francisco High School Senior, Suspended For Writing Poem About Sandy Hook Shooting. Accessed at: http://www.huffingtonpost.com/2012/12/28/courtni-webb_n_2376833.html

Dibble L: 3Qs: Analyzing and preventing school shootings. Accessed at: http://www.northeastern.edu/news/2012/03/madfis/

Zarembo A: Plotters of school killings tend to tip off someone in advance. Los Angeles Times, Dec. 23, 2012. Accessed at: http://articles.latimes.com/2012/dec/23/nation/la-na-massacre-prevention-2012122

Interdisciplinary Group on Preventing School and Community Violence.  Accessed 12/20/12: http://curry.virginia.edu/articles/sandyhookshooting

Knoll JL: Mass Shootings: Research & Lessons. Psychiatric Times (in press).

Knoll J: Mass Shootings and the Ethic of the Open Heart. Medscape Psychiatry Dec 20, 2012. Accessed at: http://www.medscape.com/viewarticle/776427

Nina L, Atte O, Eila S, Riittakerttu KH: Adolescents expressing school massacre threats online: something to be extremely worried about? Child Adolesc Psychiatry Ment Health., 2012; 6(1):39.