Question for DUers with experience working in mental health

[NNguyenMD]

Can an individual in at some stage of Schizophrenia or Schizoaffective disorder, who has obviously been inadequetely treated, still function at a relatively high level that he his able to conspire and organize a heinous, yet carefully crafted crime?

My experience in the mental health field is limited to the standard 6 week Psychiatry rotation, but from that experience it was my impression that someone severely afflicted with Schizophrenia, without treatment, is poorly functional and not likely able to sustain the attention and thought processes needed to plan something like this out.

[ends_dont_justify]

1. Yes

As a matter of fact, if someone (not just of this, but any disorder) spends all their free time devising such things because they no longer feel desires or interests in normal, every day events, it can be enhanced. Hitler actually used a lot of people with disorders and used them as tacticians. The reality, I think, lies in the interest of the individual less than the disorder; if they decide to be violent and conspiring, they certainly can like any person can. If they decide to seek treatment or live their lives without taking stock in the negative parts of the world as they see it, they don't need to be viewed as a threat to themselves or others (however, treatment would still be beneficial as the condition is often stressful and very uncomfortable to the person with it).

Being schizophrenia is a disorder which impairs the individual's ability to see every day reality the same way those around them may, it is not so much an impairment on one's ability to function in the world around them; but the way they perceive the world around them which may allow them to believe certain things, dangerous or not, that may not especially be true.

[Warpy]

2. Simple answer? Yes

especially if he's been cut loose by the system as he continues to deteriorate and spin away into delusion, fear and rage.

Some can be reasonably high functioning for a very long time if they're capable of hiding their interior life.

Remember, on your rotation you only saw the ones who were sick enough to come in for treatment and had the money to afford it.

[mdmc]

YES!

In NYS we have some very high officials in the Office of Mental Health that are mentally ill. They manage hundreds of employees and are responsible for million dollar budgets.

All you need to do is manage your symptoms and develop your skills.

While mental illness never "goes away", it can be controlled to an amazing degree.

[The empressof all]

3. Yes but not typical

In his suicide he shot out his right temporal lobe making an autopsy for a purely organic component like a tumor unverifiable. However from what we have available of his history of behavior and isolation he was experienced in isolation and social withdrawal as a mechanism for covering his psychosis.

[Name removed]

4. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Wickerman]

5. Schizophrenia has many types

I'm guessing if the gunman is determined to have suffered from Schizophrenia, it will be Paranoid. Some accomplish much with Schizophrenia, some accomplish much prior to the events that precipitate the diagnosis. If he is issued this diagnosis postmortem I'd guess it would be pretty early as the disease is fairly debilitating when not treated.

Found this website:
http://www.schizophrenia.com/famous.htm

Interesting for some perspective.

[mdmc]

13. thanks for a link

:kick:

[aikoaiko]

6. Yes, the disorder varies, but be cautious about abling label to news cases.

[NNguyenMD]

9. oh I'm didn't mean to put a label on this, just wanted to ask if someone with schizophrenia

has the capacity to be this calculating, and invest in the attention needed to plan all of this.

[hyphenate]

7. Since schizophrenia

is a disease that actually alters chemicals in the brain, there is no time that they can act "normal" without their medication which helps to rebalance the brain and its functions.

However, schizophrenia is not normally a disease which makes a person "insane"--most schizophrenics that I know who are on medication are viewed as mostly normal as long as they don't go off their medication.

Many schizophrenics are not diagnosed as children, but later in their development, often at puberty. Schizophrenia in and of itself, like all illnesses, can be extreme or mild, and depending on what treatment they are part of, they can often escape the attention of most people who might meet them.

There are mitigating factors, however, and with a diagnosis of schizophrenia, paranoia might follow, or any one of a dozen or more other illnesses tied to chemical imbalance. If you are thinking about Cho, I would imagine that there was far more than just a paranoid schizophrenic personality--somewhere along the line he developed a sociopathic streak which was enhanced by a technological environment--one of those with a very small percent of violence in games or other outside influences. Most kids/young people can watch violence in games without any damage to their psyche, but for that portion of the populace that is more susceptible to influence, their minds are fragile and can lead to a complete psychic break.

[uppityperson]

8. Yes, some stages yes.

Some stages of schizophrenia possible and yes definitely possible schizoid personality disorder.

[reign99]

10. Maybe

he just really didn't like these people? I'm somewhat in line with the OP's thinking on this subject, I don't see someone with schizophrenia being this coherent. From the little I've read of things he wrote, to the sheer amount of planning involved, his line of thinking just seems way to rational. Keep in mind too that he was more than likely unmedicated, and while a medicated schizophrenic may seem quite "normal", those I have seen off medication were anything but. Granted, I do not have extensive experience in this regard, only limited personal experience.

Still, I think it is quite possible for a human being to commit these types of act without having something "severely" wrong with them mentally, like schizophrenia. He isolated himself from all of his peers, teachers, even his roommates. Without interaction with other human beings in this way, I think any human being would be free to create some world of their own making. There is nothing really there to challenge his beliefs, he boxed himself in and came to his own hateful conclusions about the people around him. Since he did not interact with them, and saw only what he wanted too, those beliefs could grow and become more and more solid. Without good human interaction I think we all have the potential to go awry, he just happened down a really dark path, one that unfortunately no one was able to help him off of.

[uppityperson]

12. I was speaking in general terms, not just about Cho. And another comment..

You wrote "Without interaction with other human beings in this way, I think any human being would be free to create some world of their own making. There is nothing really there to challenge his beliefs, he boxed himself in and came to his own hateful conclusions about the people around him. Since he did not interact with them, and saw only what he wanted too, those beliefs could grow and become more and more solid." You also wrote " Maybe he just really didn't like these people" so killed a whole shitload of them. Yet you think he did not have anything "severely wrong with them mentally"?

Seems you gave a description of mental health issues there.

[reign99]

16. Point taken

He certainly had something wrong with his mental process, but I just don't necessarily believe it was a physical problem, like schizophrenia is. I think had environmental factors been different, he could have been a relatively well adjusted individual. All I am saying is that it is quite possible that a human being with a brain functioning "normally" could become a monster like this through an unbroken chain of events. If say, his freshman year he had met a girl similar to him, and had a good experience with her, things may have been different. If he had found a friend who he could identify with, and enjoy some things in life outside of school with, things may have been different. If someone around him had recognized the signs of his behaviors for what they were, and taken the initiative...well you get the picture.

Unfortunately he is dead now, and it seems there was little diagnosis performed with him in regards to his mental health. Because of this getting a clear picture of his state of mind will never really be able to be accomplished. Sure we can speculate based on things he wrote, or the little bit of other evidence he has left behind, but it will only be that, speculation. Diagnosing a dead man with schizophrenia to make ourselves feel better by putting a name to the horrible face of his crime doesn't solve anything. Not only that, it could very well hurt those who do have schizophrenia, many of which are non-violent, and all of which would be looked at very differently following this case.

[uppityperson]

19. Indeed and welcome to DU

Putting fear onto people with schizophrenia or asians is wrong. He could have had/been:
1. a genuine asshole
2. mentally ill (beyond being a mass murderer I mean)
3. physically compromised, even a brain tumor
4. other

How much is environmental, how much is physical, how much is mental that is not physically related is always an issue.

[Lex]

11. Read this--

"Paranoid schizophrenia usually does not involve the disorganized speech and behavior that is seen in other types of schizophrenia. Patients with paranoid schizophrenia typically are tense, suspicious, guarded, and reserved."

http://www.nlm.nih.gov/medlineplus/ency/article/000936.htm

[bling bling]

14. It doesn't seem likely to me.

The fact that he had a history of anti-social behavior and especially the fact that he changed his routine and started going to the gym to "bulk up" at night in preparation for the massacre really seems more like someone with a personality disorder than someone with a psychotic disorder or someone who had a brief psychotic break with reality.

But that's just my opinion based on limited information.

[JustFiveMoreMinutes]

15. Also, what are the diff between para-schiz & Delusional Hubris?

[kerry-is-my-prez]

17. Some of them can - if they're not too sick.

n/t

[H2O Man]

18. Yes.

Good question. Some people with schizophrenic disorders are far more capable of being organized than others.

What I think is interesting is the timing. This fellow was apparently going to graduate in a few weeks. I wonder what, if any, pressure he felt from that.

[Fiendish Thingy]

20. Has Cho's diagnosis been disclosed?

Was he, in fact, suffering from schizophrenia or other thought disorder/psychosis?

I know there's been lots of discussion of his symptoms, and his history of contact with the mental health system, but I don't recall seeing a quote referring to a specific diagnosis, only speculation. Can anyone provide more info?

[RobinA]

21. Maybe

I've worked with schizophrenics in a hospital and in a community mental health setting, and as you say, in those settings, most schizophrenics are not capable of this sort of planning, even medicated. But then, maybe that's why they were in those settings to begin with. Because this kid was young and his problem may have just been emerging, he could have retained more function than he would have in, say, 10 years when he would have been hospitalized had he not blown up at the moment he did and you or I would have run into him. In a setting where a kid starts out with decent resources, like this kid obviously did, schizophrenia can fester for years under the radar, because the person has enough cognitive ability in reserve to keep functioning. And as far as schizoaffective....paranoia plus mania? Look out.

[etherealtruth]

22. Emphatically yes!