prevention

David Earl Johnson, LICSW

17 minute read

I really enjoy reading the blog Kellevision.com. She says it like it is and seldom misses the point of what she’s writing about. She identifies a problem in programming for homelessness and proposes a set of concepts to help clarify the situation. Image via Wikipedia “Many of the “barriers” faced by the chronically homeless are not external. They are self-inflicted. Repeatedly failing to pay one’s utility bills is not a barrier.

David Earl Johnson, LICSW

5 minute read

Many of the boomer adults were raised with a lot of TV. It would appear things have gotten worse. We know a lot more about what TV does to children, but it doesn’t appear to have had much effect. Simple logic will tell us that the experience of TV will decrease a child’s ability to tolerate a delay in gratification of desires. Certainly, the TV ads are designed to create the desire for things we didn’t know we needed, a certain frustration that we can’t have it all, now.

David Earl Johnson, LICSW

5 minute read

We’ve all heard about viruses and websites that steal our sensitive private information. Cyberstalking has also become a problem on social media sites. Blogs, Twitter, MySpace and Facebook, in particular, are prone to this sort of abuse. Image by luc legay via Flickr But even cellphone texting can be a problem since you can forward others details where ever you want. Although there are mixed reviews of just how much of a risk there is, there is agreement there is a risk.

David Earl Johnson, LICSW

2 minute read

While I’m not surprised by this news, I’m deeply saddened reading this. It more or less confirms that had Zamora been treated, there is a good chance, this wouldn’t have happened. Now we have another victim, the perpetrator appears to be psychotic. Now, if treated, and he comes back to the real world, he will be haunted forever about what he did. This could have been avoided. There needs to be a more progressive court intervention for potentially dangerous persons with mental illness.

David Earl Johnson, LICSW

11 minute read

Image via Wikipedia Another shooting, another story of a mentally ill man in need of court ordered treatment who didn’t get it. My thoughts follow the story. TwinCities.com “A shooting rampage in which six people died along a trail of blood stretching from a tiny town to the state’s busiest highway ended with the surrender of a man who was recently released from jail, authorities said. The dead included a sheriff’s deputy who had tried to help the mentally ill man’s family in the past, the man’s mother said.

David Earl Johnson, LICSW

6 minute read

Recently, the []1NYTimes.com had an article about a malicious sort of on-line anti-social behavior called Trolling. One of the people the author interviewed was Jason Fortuny, a thirty-two year old web programmer, who’s passion is trolling. “Today the Internet is much more than esoteric discussion forums. It is a mass medium for defining who we are to ourselves and to others. Teenagers groom their MySpace profiles as intensely as their hair; escapists clock 50-hour weeks in virtual worlds, accumulating gold for their online avatars.

David Earl Johnson, LICSW

1 minute read

Apparently, one of his previous counselors has spoken up anonymously. I believe that confidentiality is still required despite the client now being deceased. Duley spoke of her court case for a restraining order. We also get more details of Ivin’s drug and alcohol abuse. Mental illness and drug abuse makes both problems much worse. []1WaPO “Ivins was abusing vodka, sleeping pills and anti-anxiety medication, according to a fellow scientist who is in recovery from addiction.

David Earl Johnson, LICSW

15 minute read

More information in the anthrax case have emerged, questions about security of US weapons development, the story of his last couple years under the FBI investigation, and details about Dr. Ivins psychiatric condition in the past year and his treatment. Associated Press

“Privacy concerns, bureaucratic loopholes, the demands of a criminal investigation — all combined to let Ivins keep his job and stay out of jail for years. And in the high-security lab until last November. Or was it just that the government’s evidence was too weak to act? That’s what Ivins’ attorney says. “If it’s such earth-shattering stuff, what’s been going on since 2005?” Paul F. Kemp asked Wednesday after the government made its case with a news conference and a pile of documents. “Why is he on the street if they think it’s that important?” That question goes beyond the criminal investigation. It goes to the heart of how secure the nation’s nearly 1,400 biological defense labs are and whether the estimated 14,000 scientists working with deadly toxins are being screened for the kind of mental illness Ivins exhibited. The Army Medical Research Institute of Infectious Diseases, known as USAMRIID, follows strict security measures meant to weed out troubled scientists. It has offered no explanation for why Ivins was allowed to work with some of the world’s most dangerous toxins while taking antidepressants and receiving counseling to control his inner demons. [..] It wasn’t until November 2007, after the FBI raided his home, that Fort Detrick revoked his laboratory access, effectively putting him on desk duty for the past year. “If he really was the guy and he acted alone, then that’s pretty scary because that’s a lot of damage that can be done by one person,” said Gigi Kwik Gronvall of the Center for Biosecurity at the University of Pittsburgh Medical Center. “USAMRIID is not like being in a shack in the wilderness. It’s interacting with people in a pretty secure place.” Anything Ivins discussed with his therapists, doctors or at Alcoholics Anonymous meetings would have been protected by privacy policies. But David Fidler, an Indiana University law professor and expert on biosecurity, said he didn’t understand how a scientist spending late nights in a secure lab could go unnoticed. Ivins’ explanation — that he wanted to escape a troubled home life — should have also raised questions. “Didn’t his superiors notice this odd behavior?” Fidler said. “That ought to have set alarm bells ringing.” It’s unclear from the documents whether those bells went off, and the military has not said how long it knew of Ivins’ problems. Mental health reviews are a key part of the military’s security program, but at least one former colleague at Fort Detrick has said it’s usually up to scientists themselves to report their problems. Ivins had no trouble purchasing weapons. Jack Moberley, manager of The Gun Center in Frederick, Md., said he sold two Glock pistols to Ivins in 2005. The following year, Ivins traded in one of those guns and bought a different Glock, Moberly said. Moberley said Ivins had passed the background check conducted by the Maryland State Police. “If I even suspected that he was anywhere close to being mental, I would not have done the paperwork at all. The state of Maryland approved him,” Moberley said. “No gun gets out of here unless there’s a background check.” Lawmakers have pledged to investigate the anthrax case and lab security generally. Bills in the House and Senate would order a review of how scientists work with deadly toxins. “If we don’t have a good handle on this at USAMRIID, it’s probably true we don’t have a good handle on it across the board,” Fidler said.” Clearly this has stirred a hornets nest within the security community and probably among all employers concerned about having a dangerous person in their midst. The chance of this situation doing damage to an already delicate perception of mental illness by the general public is very high. And we have more information about his therapist and his treatment in the last year. Associated Press

“Bruce E. Ivins, the late microbiologist suspected in the 2001 anthrax attacks, told his psychotherapist after learning he was about to be indicted that “he was going to go out in a blaze of glory, that he was going to take everybody out with him,” she said. Social worker Jean C. Duley also said Ivins left her a telephone message in mid-July, after she had alerted police to his threats, telling her that that her actions had made it possible for the FBI “to now be able to prosecute him for the murders.” Duley testified at a Frederick County District Court hearing July 24 in a successful bid for a protective order from Ivins. The New York Times obtained a recording of the hearing and posted on its Web site Saturday. Duley testified that Ivins had tried to poison people even before the 2001 attacks. “As far back as the year 2000, the respondent has actually attempted to murder several other people, either through poisoning … He is a revenge killer. When he feels that he’s been slighted or has had — especially toward women — he plots and actually tries to carry out revenge killings,” Duley said. She added that Ivins “has been forensically diagnosed by several top psychiatrists as a sociopathic, homicidal killer. I have that in evidence. And through my working with him, I also believe that to be very true.” Duley told the judge she was “scared to death” of Ivins. Duley told the court that she had known Ivins for six months and had been meeting with him for group sessions weekly and for individual counseling every other week. She said that on July 9, Ivins showed up for a group session “extremely agitated, out of control.” She said that when she asked him what was wrong, he said he had obtained a gun and described to the group “a very long and detailed homicidal plan” to kill his co-workers. Duley said she called Ivins’ two lawyers and the city police, who went to Ivins’ workplace and had him committed to Frederick Memorial Hospital for a psychiatric evaluation. She said Ivins was transferred the next day to a high-security, psychiatric treatment center and placed on “homicidal and suicide watch.” Duley said Ivins’ scheduled release from the hospital on the day of the hearing prompted her to seek the protective order. Duley said that on July 11, Ivins left her two ranting voice messages, blaming her for his commitment. On July 12, he left another “rather scary” voice message from a hospital in which “he very calmly thanked me for ruining his life and opening — allowing the FBI to now be able to prosecute him for the murders, and that it was all my fault and it’s going to be my fault that they can now get him.”” It appears that Ivins was a dangerous man, someone who should have been better contained. What’s missing is what happened in his treatment before February of 2008. He had lost his job in November of 2007 after the FBI raided his home. He had been in many treatments since 2001. Perhaps more details will emerge. Here is a very interesting discussion of the obligation of therapists to protect the public from their dangerous clients. Salon

“The 1996 Supreme Court case Jaffee v. Redmond officially recognized psychotherapist-patient privilege in federal courts. That decision, concerning a police officer accused of excessive force who sought to keep his social worker’s notes out of a trial, states that “effective psychotherapy … depends upon an atmosphere of confidence and trust in which the patient is willing to make a frank and complete disclosure of facts.” Patients, in other words, should feel secure that what they reveal in a clinical setting is between them and their psychologists. Although all states recognize some form of this privilege, 27 of them, including Maryland, require therapists to breach confidentiality if the patient poses a serious danger of violence to others. (In some other states, psychologists have explicit permission to warn the cops but aren’t obligated to do so.) The exact nature of this requirement varies slightly from state to state, but the general formulation is that a mental-health professional must warn either the police or the potential victim if a patient makes a specific threat against an identifiable third party. That is, the patient has to be doing more than just blowing off steam (“God, I’m gonna kill my boss!”). He has to have an actual plan (“I’m going to buy a gun”) and an actual victim (“and shoot my neighbor”) in mind. But it’s up to the therapist to decide if the patient truly intends violence and is capable of carrying out the threat. Arguably, Duley could have kept quiet if she thought Ivins’ apparent plan to kill his co-workers was really just a fantasy. The “duty to warn” concept dates back to the 1974 case []4Tarasoff v. The Regents of the University of California – Supreme Court of California, 1976. In Tarasoff, a patient told his therapist that he intended to kill a young woman who had spurned him. A couple of months later he did so, and her parents sued the therapist for failing to warn their daughter. The case ended up in the Supreme Court of California, which ruled that therapists have a “duty to warn” not just the police (which the therapist had done) but the potential victim as well. In a 1976 rehearing, the court replaced the phrase “duty to warn” with “duty to protect.”” So there is much information missing to know if there was a breach of the law in the treatment of Ivins. There is no reason to expect that more information about his treatment will emerge unless there has been other court involvement in this treatment. That part is public record. But his death removes any compelling reason for his treating professionals to come forward legally to release information. Just as I say this, more information emerges. Associated Press

“A microbiologist claims she was stalked for decades by Bruce Ivins, the suspect in the deadly anthrax mailings of 2001 who, according to court documents, was obsessed with the sorority she joined in college. Nancy L. Haigwood and her former husband, Carl J. Scandella, also think Ivins may have wanted to get close to her when he moved in down the street from the couple in the suburbs of Washington in the early 1980s. [..] Haigwood, now the director of the Oregon National Primate Research Center, said she suspected Ivins in the anthrax mailings as early as November 2001, when he e-mailed her, his immediate family and other scientists a photo of himself working with what he called “the now infamous ‘Ames’ strain” of anthrax, which was used in the attacks. She reported her suspicions to the FBI in 2002 and, at the behest of investigators, kept in touch with Ivins by e-mail and shared their correspondence with investigators. Haigwood, 56, met Ivins in the late 1970s when he was doing a postdoctoral fellowship at the University of North Carolina, where she earned her doctorate. She was cordial to him, but she noticed that he took an unusual interest in her Kappa membership. In the summer of 1982, Haigwood moved in with Scandella, then her fiancee, in a townhouse in the Washington, D.C., suburb of Montgomery Village. On Nov. 30 that year, Scandella awoke to find the Greek letters “KKG” spray-painted on the rear window of his car and on the sidewalk and fence in front of the home. Although a police report filed by Scandella does not mention any possible suspects, Haigwood quickly concluded that Ivins was responsible. “My address wasn’t published, and I only lived there a short while before Carl and I got married and moved out of state,” Haigwood said Friday. “No one knew my address or my phone number. You had to stalk me to figure this stuff out.” Records show that Ivins was living on the same street, about a block away, shortly after the incident. It was not clear when he moved in. Scandella did not know that Ivins had been their neighbor until he was told Friday by a reporter. “I was blown away by that,” Scandella said. “I had no idea he lived anywhere in the vicinity … I wonder if it’s possible that Ivins moved to that location to be close to Nancy.” Soon after the vandalism, Haigwood bumped into Ivins — she doesn’t remember where — and accused him. “I said, ‘This happened and I’m sure you’re the one who did it,’ and he denied it,” Haigwood said. “And I said, ‘Well, I’m still sure you did.’ What can you do at that point?” Ivins kept in touch with Haigwood via phone calls, letters and e-mails, and while some of the correspondence made her uncomfortable, she never cut off contact with him, a decision she later regretted. She said she sent him polite but curt replies. “He seemed to know a lot about myself, my children, things I never remembered telling him, which always disturbed me,” she said. “I kept him at arm’s length as best I could.” She also suspected Ivins of writing a letter in her name to The Frederick News-Post that defended hazing by Kappa members. [..] Haigwood said she was not aware of Ivins stalking any other Kappa sisters. In an interview Friday, Kappa Kappa Gamma executive director Lauren Sullivan Paitson said the FBI asked in August 2007 for help documenting decades’ worth of Ivins’ contacts with the sorority, including breaking into the now-closed chapter house at the University of Maryland. The sorority disbanded at Maryland in 1992. But before being contacted by the FBI, Paitson had been engaged in an editing war on Wikipedia.com with a writer by the name of “jimmyflathead” who threatened to post secret rituals and bad publicity about the sorority on the Web site. Court affidavits listed “jimmyflathead-at-yahoo.com” among Ivins personal e-mail addresses. Only after the government asked for the sorority’s help did Paitson realize that the online Kappa nemesis was the top suspect in the anthrax investigation.” He was apparently potentially dangerous for many years. It appeared to be just a matter of time before his actions would manifest. And they did, tragically so.

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David Earl Johnson, LICSW

12 minute read

The Anthrax mailing attack on several government institutions was a chilling aftermath to the 9/11/2001 attacks. The letters, poisoned with a rare and hard to produce highly refined weapons grade anthrax, were postmarked 9/18/2001. The letters containing the spores contained references implying that the sender was Muslim. However, the nature of the refinement of the spores made it highly likely they came from a government sponsored bio-weapons program because of the scientific sophistication needed. The USDOJ makes a fairly convincing circumstantial case detailed here. My intent here is not to pass judgment on the accused man, but to comment on the information building a case that Ivins suffered an active mental illness and the implications for prevention and emotion education, as well as the issue of confidentiality and a therapist’s duty to report a dangerous client. First the story from the []2LA Times.

“Bruce E. Ivins, the bioweapons scientist who apparently killed himself as the goverrnment was preparing to indict him in the 2001 anthrax attacks, had a long history of mental illness that flared just before mail contaminated with the fatal spores was received in New York, Florida, Connecticut and Washington, D.C. Newly released government documents show that in the months before the mailings that led to the deaths of five people and made 17 ill, Ivins — who had worked at the Army’s top biodefense laboratory for 28 years — told a friend that he had “incredible paranoid, delusional thoughts at times” and feared that he might not be able to control his behavior. The revelations have sparked questions at the Pentagon and on Capitol Hill about how someone known to have such disturbed thoughts was still allowed access to the government’s infectious-disease laboratories at Ft. Detrick, Md., where anthrax and other deadly plagues were studied in classified projects. Ivins’ apparent suicide from an overdose of acetaminophen occurred just as prosecutors were readying murder charges against him. In the last several days, the public learned of Ivins’ recent threats toward a therapist and others he thought had wronged him. But those outbursts occurred after he was informed that he was a suspect in the case and had been barred from the top-secret labs. The information released Wednesday showed a much longer history of emotional turbulence within a man whose outward veneer of respectability was enhanced by the government awards he had received for his research. The documents provided detailed evidence showing that Ivins’ mental illness flared about the time of the 2001 anthrax mailings. According to U.S. Atty. Jeffrey A. Taylor, “Dr. Ivins had a history of mental health problems and was facing a difficult time professionally in the summer and fall of 2001” — in part because an anthrax vaccine he was working on was failing. Ivins’ problems before and around the time of the mailings — including strange physical symptoms and treatment with Celexa, an antidepressant — were detailed in e-mails and other documents released to reporters after they were unsealed by a federal judge. On June 27, 2000, Ivins wrote in an e-mail to a friend: “Even with the Celexa and the counseling, the depression episodes still come and go. That’s unpleasant enough. What is REALLY scary is the paranoia.” A week later, on July 4, he wrote to his friend that his psychiatrist and his counselor now thought that his symptoms “may not be those of depression or bipolar disorder, they may be that of a ‘paranoid personality disorder.’ ” That Aug. 12, he wrote about what he called one of his “worst days in months.” “I wish I could control the thoughts in my mind. It’s hard enough sometimes controlling my behavior. When I’m being eaten alive inside, I always try to put on a good front here at work and at home, so I don’t spread the pestilence… .” he wrote. “I get incredible paranoid, delusional thoughts at times, and there’s nothing I can do until they go away, either by themselves or with drugs.” In one e-mail he acknowledged, “Sometimes I think that it’s all just too much.” The first deadly mailings — anthrax-laced letters sent to news media in New York and Florida — were postmarked Sept. 18, 2001, a week after Islamic terrorists hijacked four passenger jets and crashed them into the World Trade Center, the Pentagon and a Pennsylvania field. A second batch of letters was sent that Oct. 9. After sophisticated tests were developed to identify the genetic material of anthrax spores, investigators used it in 2005 to trace the particular blend of spores recovered from the letters back to Ivins, then set about building a case against him. The letters — which mentioned Allah and called for the destruction of Israel and the United States — forced the closing of a Senate office building, a newspaper headquarters and a large postal facility, and they made the entire nation, already on edge from the Sept. 11 attacks, fearful that foreign terrorists were now targeting the U.S. with a deadly microbe. On Oct. 16, 2001, one of Ivins’ co-workers communicated to a former colleague that “Bruce has been an absolute manic basket case the last few days.” From 2000 through 2006, Ivins was prescribed “various psychotropic medications including antidepressants, antipsychotics and anti-anxiety for his mental issues,” the documents showed. Long before, however, Ivins had acted oddly; for example, the documents released Wednesday said that he had used two post office boxes over 24 years to “pursue obsessions” — including an intense interest in the Kappa Kappa Gamma sorority. One confidential witness said Ivins had admitted breaking into a Kappa Kappa Gamma sorority house to steal a secret handbook, apparently while he was pursuing a postdoctoral fellowship at the University of North Carolina. The documents also included a message board post by Ivins on a conspiracy theory website, www.abovetopsecret.com. Asking for replies at the e-mail address goldenphoenix111-at-hotmail.com , he wrote that the sorority had labeled him as an enemy decades ago. “I can only abide their ‘Fatwah’ on me,” he said. The posting was significant, according to a government document, because “in his own words Dr. Ivins defines the depth of his obsession” and knowledge of the sorority. The document noted that letters containing anthrax were deposited in a mailbox in Princeton, N.J., just 60 feet from a building the sorority used. The documents also revealed the results of searches of Ivins’ property, including the contents of a black briefcase — Glock 34, Glock 27 and Beretta pistols, makeup and “false hair,” and a copy of Albert Camus’ book “The Plague.” Federal law restricts scientists’ access to potentially deadly materials if they have been judged mentally disturbed. Last week, after Ivins was identified as the target of the anthrax investigation, Sen. Susan Collins (R-Maine), a member of the Senate Armed Services Committee, told the Associated Press that it was time to reexamine the rules. Collins said that federal standards should not discourage scientists from working in government labs, but that someone as disturbed as Ivins should not “have access to some of the most lethal substances imaginable.”” Dr. Ivins, as evidenced by his own emails, was a deeply disturbed man, someone clearly who presented a security risk to his employer and everyone else, given the volatile nature of his job. A man capable of paranoid delusions is placed under overwhelming stress during and after events like 911. Paranoid thoughts quickly develop into conspiracy theories and occasionally into rash impulsive or even calculated acts. A person with these traits might find mixed feelings and conscious pangs about the work he was doing evolving into obsessions, delusions. One can only guess about the motivations of Ivins at this stage. His emails however, suggest he was a man raked by paranoia fear and guilt about the knowledge he could be dangerous. So my guess is that Ivins was not without conscience. It’s conceivable that Ivins was wracked by guilt about helping produce anthrax and so was obsessed with developing an antidote. His motivation was certainly helped by the financial and professional rewards of such an endeavor, but it’s likely these incentives were secondary because the nature of his symptoms would make the motive of fear primary. One possible explanation for his alleged acts may be as his emotional state deteriorated in the months before 911, he became increasing driven by his delusional thinking. Then 911 pushed him over the top. A bright man, Ivins recognized the implications of 911 and the fact that bio-terrorism was a likely method to be pursued by those so inclined. He also recognized the agent with which he was an expert was perhaps the ideal weapon for a terrorist. So driven by a combination of fear, guilt, and a grandiose belief in his foresight and ability, he decided to use his access and knowledge to force the US government to develop a bio-terrorism program that included his anthrax vaccine. He then sent the letters, knowing he would put only a few people at risk, believing that the ends justified the means. Clearly this man should never have been doing this kind of work. Working with any kind of weapons technology that could easily be smuggled to terrorists might be best served by employees with a certain set of personality traits and mental stability. These traits would include a rule-based value system, a compulsive nature that ensures a high level of competence in detailed work. These traits were likely present in Ivins, but he lacked stability. Predicting future stability is a very difficult task. Personality assessment is often used in high security settings to screen out instability and very likely here as well with demonstrated effectiveness. It’s probably possible to do a better job screening applicants to highly sensitive positions, but it’s probably not possible to be 100% accurate in those assessments. The job brings with it a high level of stress given the danger and responsibility involved. The chances of disturbances emerging later is probably pretty high. Should such employees be routinely reassessed on a regular basis? Any hope for such prescience would require complete information about all aspects of the employee’s life. Getting complete information about an employee in a high security setting would require access and control of all aspects of his life. For example, all health services available would have to report all usually confidential and private information. Such employees would have to forfeit most civil liberties. It’s not likely there would be many willing and qualified candidates. One can only guess about what the mental health professionals treating Ivins knew about the nature of his work and the risk he presented. It’s likely he was more honest in his emails than he was in his sessions. It’s well known that one common reason mental health treatment fails is that the client withholds crucial information. It’s common that the critical nature of the information was most evident to the treating professionals was not only not known to be so important by the client, but also this information was likely to be largely inaccessible to his conscious awareness. If indeed, Ivins was torn by the responsibility of bringing such a dangerous substance to the world, he couldn’t possibly live with that thought daily. He simply had to suppress it, consciously or unconsciously. Its also likely that Ivins was forbidden by his employment agreement to discuss with anyone the nature of his work. So my guess is, the professionals involved had no clue that he was engaged in such sensitive work. The confidential nature of mental health services would likely have prevented a report to his employer unless they had sufficient details of his delusions as well as details about the nature of his work. Could laws be changed to better protect the public? Sure, we could strip everyone with a potentially dangerous mental illness of privacy, ensure their permanent unemployment and poverty and probably their inability to financially support their psychiatric treatment. We could certainly offer them permanent Social Security disability status. I would hate to see it come to this. The fact is that most people with serious mental illness have a good chance at recovery to an acceptable level of autonomy including employment. The major problem with mental illness is due to the high level of stigma associated with it. If Ivins had informed his employer of his struggles, he likely would have been transferred to a less risky setting. Certainly, he should have done so, but the very nature of his illness prevents him from trusting anyone. With the possible exception of the person he was emailing, it was likely that no one else had the whole story, the employer, his treating professionals, or this friend. So no one had enough to act on. Educating the public about emotion, mental illness, decreasing stigma, and ensuring access to treatment are the only means to protect the public. But will the public agree to pay the financial cost? I would argue, they will pay now or pay later by an ever increasing frequency of deadly incidents.

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David Earl Johnson, LICSW

5 minute read

Knoxville Police Chief sheds a little more light on the motivation of Adkisson’s murderous tirade. He blamed liberals from keeping him from a job. []1CBS News “He felt he was being kept out of the loop because of his age and because he was not liberal.”” It seems unlikely that this belief has any basis in rationality. The thought would probably qualify as a paranoid delusion. I have found it quite common for themes of religion and sex in delusional thinking.