Saturday, December 22, 2012

The Alternative Hypotheses

Zendo Deb over at 357 Magnum puts together an interesting posting on the role of psychiatric drugs in episodes of violence: suicide, homicide, murder/suicides and mass killings.  She offers it without much comment, but it's about 15 minutes worth of video to watch, and it is thought provoking. This (elsewhere) has been offered as a possible explanation for the Newtown shootings.

The other thing specified by name has been violent video games, and Erin over at Lurking Rhythmically talks about that.  Erin is more direct, and as far as I know, the studies that have been done categorically reject the idea that violent games lead to violence.

First, let me categorically reject the idiotic "if saves one life..." argument out of hand.  What follows will be a little pondering, an open-page rambling.  I hope it's a little interesting to you. 

In the "after action" analyses of these events, it gets hard to say anything analytically because as horrific as these things are, they're also horrifically rare.  I've heard, but can't confirm, that every school shooter we know of was on a psychotropic drug.  If someone is on such a drug, it gets hard to statistically “tease out” cause and effect. You need big samples and rigorous controls. You can’t data mine old studies. You can't say that any particular person killed themselves because they were on the drug without knowing more than you have available.  Put another way, maybe if they weren’t on Zoloft or whatever, maybe they would have killed themselves sooner. People on antidepressants kill themselves, but depressed people kill themselves: which is the cause? Did they kill themselves because they were taking the drug, or because the dosage was wrong, or because it didn't work in their body?  What if the drugs just mask another, bigger, underlying problem?

The problem with my argument is that you’d need many thousands of school shooters to conclude that the drugs cause their behavior to the kind of certainty that would be demanded, which (of course) is unacceptable.

One obvious problem is that when drugs are tested for efficacy, they're tested in isolation: that's the essence of a controlled trial.  No attempt is made to see if interactions between the drugs with other drugs or other factors change results, because the tests become so complex and expensive that they simply can't be done. (This problem - of interactions between combinations of drugs - is pervasive in medicine).
 
The problem that is never discussed, and here I put on my “olde farte” hat, is that these drugs – even if they were perfect – may be keeping kids from developing what we old timers call “character”. While I fully understand there are real brain chemistry issues that may require medication, these drugs seem to be massively over used. I read once they’re prescribed up to 20 times more in the US than in other countries. Trouble paying attention? Take this! Depressed because that boy or girl rejected you? Take this! Not “suck it up, it builds character”. Afraid of embarrassing yourself in band? Take this pill! Not practice harder, or work harder, or just plain “everybody gets that”. It’s one reason I oppose marijuana for kids. I’ve seen too many 40-something stoners living in mom’s spare room.  Adults who never developed “character” as a child.  Some times it takes hard determination to get through the day.  That's reality.

Both of these have been offered up as alternative hypotheses to explain spree shooters.  It's an attempt to keep shooters from being created.  There is no doubt that no matter what the cause, the way to stop a bad guy with a gun is for a good guy with a gun to be there. 

The truth here is that we may never be able to know with certainty, on a scientific basis, if either of these is a cause.  I can imagine there might be a sub-population of people, maybe just one in over a hundred thousand, who could be influenced by a bad rap video, a movie, or, yes, a game combined with the influence of a psychotropic drug.  I couldn't prove that wild-assed guess with a billion dollars worth of studies. 
One in a million kids will face a shooter.  All of them will face this.

10 comments:

HalfElf said...

I also have heard that all of the shooters shared 5 factors in common
1. Male
2. Disaffected from peer group, either by the group, or themselves
3. Single or absentee parent units
4. Violent video games
5. Psychotropic drugs, either for the schools, or the parents convience

RegT said...

I think that, to a certain extent, we get into a "nice to know" vs "need to know" situation. Could knowing the cause help prevent these rare occurrences? Perhaps, but as you say, it is almost impossible to actually determine causation. Besides, knowing the cause will not necessarily enable you to keep all such mental cases - or everyone will evil intent - from getting into a school, mall, office building, or what have you.

What we _need_ to know is how to prevent such massacres, and it has been amply demonstrated - in the real world - that the only way is through an immediate armed response. You probably will not be able to preclude the death of one or more victims (unless you get really lucky), but you can certainly prevent a massacre.

The Israelis have proven this, and real world examples of teachers and staff and others with their personal firearms have proven it can be done here as well.

We really need to hammer home the fact that guns in the hands of good people, trained people, are the only answer to this kind of violence.

Graybeard said...

Excellent points by both of you, HalfElf and RegT.

The practical answer for "what do we do?" is well known. The evidence is overwhelming that mass shooters, and include the Aurora movie theater loser, don't go where they expect resistance. The only "mass shooting" in US history that wasn't in a gun free zone was the Gabby Giffords shooting, and it's arguable that was an assassination attempt, not an attempt to kill a lot of innocents - although he certainly did.

Thinking ahead one move, though, the Palestinians have responded to being unable to commit mass shootings by suicide bombings and missile attacks. I wonder if it's reasonable to think of these mass shootings as suicide attacks, especially when the loser shoots himself as soon as the cops get close.

Will it get worse?



Borepatch said...

I'd like to (gently) point out that "suck it up" has limited utility when brain chemistry is out of whack. Are some drugs over prescribed? Sure. Are others under prescribed? You bet. That just says that our medical community is (like everything) imperfect.

But drug really can bring that brain chemistry back into balance. Not always, but sometimes. We shouldn't throw the baby out with the bath water.

Graybeard said...

My disclaimer wasn't enough for you? :-D

There are certainly people who need these drugs, but if it's true they're prescribed 20 times less often in most of the EU, either they're under-using or we're over-using (or both). You can't really tell me you haven't heard stories of teachers getting active children (the technical term is "boys") put onto a drug to keep them more manageable in crowded classes? You haven't heard of "the war against boys"?

Like all epidemics, it's useful to ask how it started. Why did it suddenly become necessary to put so many children on ADD drugs - drugs that didn't exist when you and I were growing up? When I was a kid, you could order serious WWII surplus and have it mailed to your door. There were no school shootings. A bad kid carried a switchblade.

What's do they say in "root cause analysis" classes? Ask "why?" five times and you'll get there.

Dan said...

It's unlikely that a person who is relatively normal
and well adjusted (a term that is subjective at best)
will go off on a mass murder spree as a result of extended
time playing violent video games. 99+ % of the population
have developed as a part of growing up the necessary coping
skills required to prevent them from acting out blood rage
fantasy's. Because the vast majority of video game players
possess adequate self regulation mechanisms any study of
the link between violent games and mass violence is going to
be skewed by those numbers.

The tiny subset of people who are truly defective mentally
are more than likely susceptible to some degree or another
to the impetus towards violence that these games may produce.
Mass murder perpetrators tend to be fundamentally lacking in
many areas of social development.....why they are lacking may
vary but they invariably do lack in their ability to interact
with the world and other people.

The combination of mental illness with the priming effect of
gratuitously violent video games is very probably a major factor
in why these tragic events occur.

Due to the microscopic number of actual mass murderers that exist
connecting the two phenomenon statistically is difficult but logically the connection is almost a certainty.

Graybeard said...

Very well said, Dan.

Steve D said...

One reason for their overuse is that the sheer pressure from educators put upon parents to ask for, and doctors to prescribe these medications is incredible.
I researched these drugs a while back when my son was having attention problems in school (grades 2 and 3). He would not pay attention in class. He would sit backwards in circle, stare out the window, wander around and engage in all manner of non-attentive behavior. In fact, his conduct was exactly like mine and my sister’s was at his age but his school teachers and school head insisted that he had ADD and that he needed to be evaluated and medicated.
So, my wife and I filled out the forms and took him to the doctor, who appeared shall we say very surprised since she said she could usually pick out children who would be a problem in school and she never had expected this of my son. She thought it very unlikely that he had any sort of medical problem but gave us the name of a clinical social worker, anyway. He tested my son and exactly as I had insisted to the teachers, his attention turned out to be ABOVE normal. They still insisted that he had ADD, so we took him to a psychologist who gave him additional tests with the same results. So here we have one doctor, one trained social worker, one psychologist and two parents all convinced that there was no medical issue AT ALL – only one of immaturity and boredom and the teachers STILL wanted to me medicate him. I told them they were not qualified to diagnose my son and anyway it was against the law for me to do this without a prescription from a doctor. That barely fazed them. I finally had to get the psychologist on the phone to talk to them and then later they decided to question his qualifications.
By the way, my son goes to a very expensive private school. I pay a whole lot of tuition and give the school a very big donation every year. I’m a biochemist; I understand drugs better than the educators and the average person. I knew some of the literature. We had everything in our favor but the pressure they put upon us was still tremendous – you would not believe it. I can’t imagine what a non-scientist parent sending their children to a government school would feel in similar circumstances.
(Educators know how to manipulate people; they learn that in teacher’s college.)
The psychologist told me his attention problems would disappear in the 4th grade as soon as my son started to receive a numerical grade. His competitive nature would ensure that he would work hard so the other kids would not get a better number. About a third of the way through grade 4, we had a parent/teacher interview with one of his main teachers and I tentatively brought up the issue of my son’s attention problem. The teacher looked at me, raised his eyebrows and then told me he had not observed any attention span issue. (I guess he didn’t get the memo from the other teachers). He did need to work on his organizational skills, though.
Also, having a male teacher in 4th and 5th grade helped him tremendously as it did me when I was in grade 5.

Graybeard said...

Steve - I wish I could say this was the only time I've heard of teachers doing this sort of thing. You have the resources and knowledge to dispute them, but as you say, many (if not most) parents can't put up resistance to the teachers demanding drugs for the children. I grew up in the days when schools still paddled students, and remember being threatened with it for being disruptive.

BTW, I studied biochemistry for my first iteration of college, before going back to school as an adult and becoming an electron wrangler and EM field wrestler.

I don't care much for organized conspiracy theories, and it's easy to put the "war against boys" into that category. I've seen with my own eyes, though, how schools bending over backwards to get girls into STEM has marginalized boys. Boys are more likely to get construction and trade jobs than go to college, because they're enforcing school systems that favor the way girls interact.

But males and females are different, despite what the feminists say, and they tend to think differently. Boys do tend to favor math and harder analytical sciences. Don't get me wrong, I work with lots of women as software engineers and I don't have any problem with that. On the other hand, I've known only a tiny handful of women who go into hardware engineering and only two in 40 years in my specialty. Of the women who have gone into hardware engineering, most want to use it as a springboard to management or sales.

Steve D said...

'and they tend to think differently'
I’ve always believed that differences in behavior between members of the same sex are much greater than dissimilarities between the two sexes and that as humans we should focus on what we have in common (which is A LOT) rather than our more trivial differences. Mountains vs. molehills.
I also think that subconscious attitudes projected on children probably have some effect. Studies have shown that people treat and talk to babies completely differently depending on the color of their clothes.
But for whatever reason boys and girls so learn differently, and it’s the educator’s job to work with what they have. It's hard enough for a female teacher to understand how a young girl thinks (they’ve forgotten a great deal by that age) let alone a young boy. Also, on average, a boy’s metabolic rate is higher – this may to lead a great deal of the other differences between boys and girls. If you are constantly bursting with energy it will affect how you think and learn.
I agree that there is no conspiracy, just a whole bunch of people with similar ideas. Interestingly, my son’s problems started in second grade. In the first grade, the teacher (a woman) gave the children a chance to play hard in the playground for 30 minutes before starting the instruction. She told me if she did that, he was much easier to handle, as were most of the boys and even some of the girls – in the second grade which was not adjacent to the playground, the children were expected to read for thirty minutes. Now which scenario favors boys given their higher metabolic rates? The second grade teacher was stuck on reading, she wouldn’t consider anything else.
BTW: I personally believe the huge focus on making children read as much as possible these days is somewhat overrated.