FRIDAY, July 29 (HealthDay News) -- Any time there's a violent
tragedy -- the killing of at least 86 people at a youth camp in
Norway, the shootings of a congresswoman and others in Tucson, the
Virginia Tech massacre -- one question seems to ring clearer than
others: Why didn't someone notice beforehand that the suspect might
be disturbed and capable of committing deadly violence?
Psychiatrists and mental health experts say there are some clear
warning signs that a person could be suffering a mental breakdown
and needs help.
"The road to the crisis is often long, and there are a lot of signposts," said Bryan Gibb, director of public education for the National Council for Community Behavioral Healthcare. "It's our job to educate people about those warning signs so people can get the treatment they need early."
But the experts also warn that a breakdown rarely leads to
violence. "It's the rare person who has an extreme form of behavior
that becomes either violent or self-injurious," said Dr. Thomas
Wise, a professor in the psychiatry and behavioral sciences
department of Johns Hopkins Medicine in Baltimore and chairman of
behavioral health services for Inova Health Systems in Fairfax,
People prone to mass violence often have fallen victim to an
"overvalued idea," a psychiatric term for an unreasonable belief
over which the person has become obsessed, Wise said.
Overvalued ideas are not delusions, in that people with
overvalued ideas are not completely and irrationally fixed in their
beliefs despite any evidence provided them, he explained. The irony
is that people suffering from delusions and clearly mentally ill,
he said, are less likely to commit violence than people teetering
on the brink of obsession who are not technically suffering from a
"People who have overvalued ideas often act on them," Wise said. "People with delusions do not. They often are surprisingly passive, given all the conspiracies they believe surround them."
Public interest in better identifying people in crisis has
increased in recent months, said Gibb, whose group helps sponsor
Mental Health First Aid classes across the country aimed at
preparing people to spot signs of trouble and intercede.
"Calls to us increased quite dramatically after Tucson," Gibb said.
Any talk of violence, either to oneself or to others, should be
considered a clear warning sign, both men said.
"When you talk about things that are uncomfortable and potentially violent, in our culture that is highly unusual, threatening and should give someone pause," Wise said.
It's even more worrisome if the person has no idea that the way
he or she is talking or acting is disturbing those around them. "If
he has no sense of how he affects others, that's a sign of
trouble," Wise said.
People should especially be on alert if a person who has been
agitated and talking of violence for some time suddenly becomes
calm and placid. That could mean that the person's internal
conflicts are over, and he or she is intent on action.
"When they set up a plan, they no longer feel conflicted," Gibb said. "They can almost feel euphoric because they've made that decision."
A past history of violence is another predictor of whether
someone with a mental problem might act out. Drug and alcohol use
also can be a warning sign, particularly with someone who has
already been acting strangely, Gibb and Wise said.
People exhibiting these warning signs should be confronted, but
gingerly, they say.
Wise recommends having a heart-to-heart talk with the person in
a public place. "Let them know, 'Hey, you're scaring me a little
bit,'" he said.
Reaching out to the person's friends and family is important,
too, he said. The more people who know about the problem, the more
likely the person will be willing to accept help from someone.
Gibb agreed, adding that it's important to try to de-escalate
the person's mood. Listen to them, calm them down and offer help --
even if the help is as simple as fetching a glass of water.
"It sounds hokey, but we teach about the 'ministry of presence,'" Gibb said. "Tell them you're here and you want to help. 'Hey, I noticed you seem kind of upset. Is there something I can do for you?'"
The American Psychiatric Association has more about the
warning signs of mental illness.