Trying To Predict Violent Acts

By Dr. John Donkervoet
Interviewed by Rasa Fournier
Wednesday - June 01, 2011
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Dr. John Donkervoet
Director Of Psychology And Therapeutic Services At Kahi Mohala Behavioral Health

Where did you receive your schooling and training?

I have a B.A. in psychology from Trinity College in Hartford, Conn. My Ph.D. is from the University of Rhode Island and I was an intern and post-doctoral at the Medical University of South Carolina.

How long have you been practicing?

I have been a practicing psychologist for 16 years, 15 of those in Hawaii.My area of expertise is along the lines of risk for violence and aggression in individuals who have some form of mental illness.

When someone commits a violent act, are there usually warning signs?

When you ask about aggression in the general public, it’s important to recognize that the vast majority of people are never physically aggressive or violent. Aggression and violence is a phenomena with a surprisingly low base rate, so most of us can get through most of our days without ever experiencing significant aggression. Over a lifespan, however, most people will have at least one event in which they experience significant aggression. As for whether or not it’s predictable, there are a number of factors that can increase the likelihood of violence. They include substance abuse, significant stressors in the home or community, and situations in which individuals feel that they have been provoked by some outside circumstance and don’t have another avenue by which to vent their anger. But I would not consider it a common occurrence, and the prediction of it is extremely difficult.

When can odd behavior be considered just eccentric versus an actual danger?

That’s a really difficult question, and that’s one of the reasons why people like the Arizona shooter (who last week was found mentally incompetent to stand trial) or the individual at Virginia Tech can be allowed to continue in a community despite presenting with marked oddities. Although neighbors and family members may say after the fact, “I saw things that were suggestive that this was a strange person or a person who gave me an eerie feeling,” the vast majority of people who give us those strange feelings and eerie sensations don’t commit acts of aggression. As a result, it’s really difficult for a service system to intervene because the number of times we would say, “You’re giving your neighbor a difficult time; you might be violent - we need to force you into mental health services,” or “We need to jail you for a period of time,” would be patently unfair. People who might never become violent would wind up in some form of treatment unfairly.

Registered art therapist kelsey Fagan, teacher in the residential program Frank dumlao, dr. John donkervoet and roPeS (reality oriented physical experiential services) instructor Jacque Cadiz share a laugh during a meeting for developing a treatment plan. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Can mental health treatment be sought against someone’s will, particularly by parents of adult children?

Unless a person has run afoul of the law or in some way is a danger to themselves or to other people, it’s very difficult for the system to step in. For instance, if someone walks into an office and says, “I’m thinking violent thoughts,” the practitioner can’t necessarily call the police unless that person says, “I’m thinking violent thoughts but specifically I’m thinking I’m going to go home to get a gun and shoot my neighbor.” When they get specific to that extent, then of course it is possible for the mental health system to intervene.

Is there a correlation between mental health disorders and acts of violence?

The vast majority of people with mental health issues never become violent or aggressive. When it happens, part of the problem is the media immediately embraces it. When those kinds of things happen they appear so alarming that it comes to the public’s attention in a way that makes it appear more frequent than it actually is.

As for people with mental health disorders, there’s no reason for major concern over their presence in our neighborhoods, in communities. Here at Kahi Mohala, we are an 88-bed, private, not-for-profit psychiatric facility. Even though we are treating people with fairly serious disorders, the actual incidence of aggression is extremely rare.

Why do some people show signs of problems all along and others seem to just snap?

Mental illness can manifest in a variety of ways. I’m acting under the assumption that the Tucson shooter has a mental illness, but I haven’t spent any time with him; I haven’t even seen him speak. I’m basically going on what other people have said; I think we all have been. Sometimes mental illness develops over a significant period of time. There may be people who have a little bit of difficulty in their younger years, and over the course of adolescence and adulthood begin to display more symptoms and have more challenges in being able to function in the community. Other forms of mental illness are brought on more rapidly by significant and acute stress. Something goes dramatically wrong in an individual’s life and their capacity to cope is overwhelmed, and it can occasionally lead to them to acting out in a very dramatic fashion. Recent stressors our society has faced are the loss of jobs and uncertainty about the future. Other stressors which are much more common and pervasive are significant breakups, divorces or damaging custody difficulties.

Are there preventative measures that can be taken?

One of the ways we can assist one another in the community is by being more vigilant about those around us and more attentive when anyone is experiencing significant distress. Again, violent acts are really difficult to predict and there are some people who keep a lot of things well-hidden inside. But I think if you ever perceive that someone is making meaningful, credible threats about violence or aggressive behavior or about harming themselves, then certainly at that point notifying some form of authority about the possibility of risk is warranted.

Can the majority of people with mental disorders live a relatively normal life if they get the proper therapy and medication?

Absolutely. We have this sort of myth in our society that people who have mental illness need to be sequestered away. Really the opposite is true. There are a variety of medications that have a great positive impact on multiple disorders, and there are a variety of therapies that allow for treatment to occur in multiple settings. By and large, with people with mental illness, there is a great likelihood of recovery if effort is made and if services are appropriate and supportive.


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