May 29

96 Hour Involuntary Holds Save Lives

By Dr. Micaela Wexler

In the aftermath the murderous rampage at UC Santa Barbara May 2014, I found myself feeling profoundly grateful to be practicing psychiatry in Missouri, a state that allows law enforcement officers to issue a warrant on people suspected of having a mental health crisis so they can be taken to an emergency room to be evaluated by a mental health provider for an involuntary hold for 96 hours. The public has been eager to blame this rampage on an easily identifiable cause. It has been blamed on misogyny, easy access to guns, video games. Our collective ignorance of mental health issues allows us to blame these factors, while allowing mental illness to claim more lives. At the same time, we ignore, or take for granted factors which allow the mental health system to work.

In this part of Missouri, guns are ubiquitous. So are video games. It is popular for young men to express misogynistic views. Given what I have seen in the media, we should be having these sorts of events all the time here in Missouri. The fact we are not may be due to the role of the 96 hour involuntary hold. If a family member or therapist suspects a person may be in crisis, law enforcement officers do a “wellness check.” Very often, the person is taken to the nearest emergency room to be evaluated by a mental health professional who can then determine if the person requires an involuntary 96 hour hold.

In looking at the videos and reading the killer’s manifesto, it is clear to me, as a psychiatrist, that it is very possible he was experiencing a bipolar manic episode. In his manifesto, he claims to have been planning his revenge for years. This may be true, or it may be the grandiose expression borne of mania. A person in mania could easily write a document of that length in a short amount of time. If is true that he was planning this rampage for years, then it was, fortunately for us, poorly executed. He stated that he was going to go to a sorority house and kill all the women inside, yet he had no real plan for accomplishing this. He didn’t even know how to get into the sorority house once he arrived. Instead of killing everyone inside, he killed two innocent bystanders who were not even members of that sorority. As the rampage proceeded, it became more disorganized, ending with his suicide.

He uploaded a large number of repetitive videos in a short amount of time, another sign of mania. We have no evidence other than what he states in his videos and manifesto that he was a virgin, that he was suffering for years in a deep rage, nor has anyone come forward with any proof of his hatred that he talks about. We have no way of knowing for sure how long he had truly harbored these thoughts. One of his childhood friends mentioned in the manifesto expressed genuine surprise that the killer had these feelings.

When a person experiences mania or mixed mania, thought processes become derailed. They become irritable and paranoid. Time perception is disturbed. The level of activity is increased, however this activity is not well organized. His manifesto has been quoted widely, with the implication that what he said should be accepted as fact. He says he planned it for years, then it must mean he was planning this for years. However, it is just as likely he was planning it for a much shorter time, and his report of years was the result of the same psychotic thinking that motivated his rampage. He talks about previous attacks on women and couples, and blames a high school crush for his “retribution.” Again, we have no real proof that he really carried out these attacks. Nor is there any proof he really did harbor hatred against his childhood crush for so many years.

I am not his psychiatrist, and I am not claiming that my assessment is accurate. However, if it is true that his rampage was the result of a psychotic break or manic episode, then shame on all of us. These episodes are easily treated in the inpatient units. In the amount of time since the killer first posted his videos on YouTube, in April, here at our lowly rural behavioral health unit (BHU) we have successfully treated over a dozen young men experiencing either a manic or psychotic episode. Many of these young men were brought in by law enforcement officers. Every one of us should be grateful to these officers for doing their job to keep us all safe.
Click on this link for a great reference guide if a family is looking at the process of involuntary procedures in Missouri.

Dr. Micaela Wexler provides child, adolescent and adult pscyhiatric services in Kansas City.

Please visit Wexler Family Psychiatry to schedule an appointment.

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Appointment information for Dr. Micaela Wexler: wexlerpsych.com