“Hurt people, hurt people” – The Sanctuary Model
Everyone was horrified to hear that an adolescent, Adam Lanza, walked into an elementary school and killed 20 children and 6 adults as well as killing himself. Many people have offered their view as to what was wrong with Adam and about what we could have done and should do to prevent these incidents. In this episode I’ll share my concerns over what I think is going wrong with community mental health centers and why they probably would NOT have been able to help Adam, which is the extraordinary focus on productivity – the application of the factory model – to current mental health settings. I also introduce one approach that might help if more mental health centers adopted it, which is the “Sanctury Model”.
Resources for this Episode
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- The Andrus Center for Children is where the Sanctuary Model was developed
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- Green Chimneys is a residential facility that utilizes the Sanctuary model, as well as incorporating “animal assisted therapy”. A fascinating place.
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- Top 10 Myths About Mass Shootings is an article that provides sobering facts about incidences of this type
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- Anatomy of a Murder-Suicide. A fascinating article by Andrew Solomon, author of “Far From the Tree: Parents, Children and the Search for Identity.â€
Michael
January 6, 2013Chris,
The difficulty with studying the effects of video game violence is that we can’t do an experimental study to firmly establish whether causation exists between playing/watching and real life violence. To my knowledge, the amount of violence among young people is actually on the decline for the past 20 years – while sales of violent video games is on the increase. The other issue is that while there is a lot of attention given to youngsters who commit violent crimes and the fact that they played violent video games, we have to remember that many, many youngsters play these games and do not commit crimes. There are so many other factors that determine whether or not a young person will become violent – poverty, presence of father and mother, parenting style, availability of guns, etc. I don’t care for violent games and I steer my own children away from them, but I’m hesitant to draw a strong connection between the playing of these games and actual, real-life violence.
chris
January 6, 2013Mr. Brit,
I enjoyed listening to your podcast on mental health, and about whether or not mental health services could have helped/prevented Adam Lanza from carrying out his mass murder. However, I was surprised to hear you nonchalantly dismiss violence in the media, specifically violent video games, and their scientifically proven direct link to future mass murders. Not saying that everyone who plays violent video games will turn out to be a mass murder, but that most of all the recent mass murders in the last decade have been avid violent video game players; mainly first person shooter video games. I’m curious to hear your opinion on Dave Grossman’s book Stop teaching our kids to kill: A call to action against TV, movie, & video game violence (Grossman & DeGaetano, 2014), in which Grossman describes how children are learning how to kill and killing with more ease and recklessness than ever before. He cites numerous epidemiological research studies that show the correlations to violence and desensitization, and how we as a society are teaching our children how to kill without remorse. I look forward to hearing your thoughts on this matter.
References
Grossman, D., & DeGaetano, G. (2014). Stop teaching our kids to kill: A call to action against TV, movie, & video game violence. (2nd ed.). NY. Print.
-Chris
psychologist in Pasadena CA
January 6, 2013Dear Michael–
Thanks so much for the link. Really interesting article. While “scam” certainly is strong language, I think he’s making the same point that the Shedler study is making: Insurance companies are businesses, and they care most about the bottom line– this means that they are not as motivated to see psychologists get to the “root” with their patients, because it is a costly.endeavor. Is it possible that, unconsciously (or consciously), the insurance industry cherry picks their “studies” and “findings” to support their financial agenda? How else do you explain their disregard for the literature that supports a longer-term type of treatment over CBT?
The psychologist in your article is referencing the same body of literature that Shedler references– studies show that psychodynamic/psychoanalytic treatment continues to have a positive impact on patients, even after the therapy is over. And, CBT patients do not enjoy the same results, unless their therapists are unwittingly employing psychodynamic techniques in their treatment..
If we were talking about cancer treatments, it would be an entirely different discussion. Unfortunately, our society does not take mental illness and the pain that it causes seriously.
Will look forward to your future discussion regarding how one can obtain “evidence” of a treatment’s success!
Leanne
Michael
January 6, 2013Leanne: thanks so much for your reply and for the link to the article. I downloaded it and definitely will read it. I don’t know if I agree with this psychologist that CBT is a “scam”, but I do think we need to look very closely at why certain therapeutic techniques are “preferred” over others:
http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html
I am very wary about the use of the term “evidence based” because it is very difficult to get good, solid evidence of effectiveness when it comes to psychotherapy. Maybe a topic for a future episode…
Again thanks – enjoyed reading your comment.
psychologist in Pasadena CA
January 6, 2013Hi, Michael–
Was recently thinking about the fact that we’re closing in on the 2 year anniversary for the Newtown shootings and decided to do a little search. I stumbled upon your podcast in the process– really appreciate that you dared to discuss the danger of short-term psychotherapy as the mainstay for patients with serious psychological abuse/neglect histories. No doubt, Adam Lanza needed an intensive course of psychotherapy– unfortunately, an individual as disturbed as Adam may not have been “healed”, even with longer term and more intensive psychotherapy treatment. But I do believe that longer-term, insight-oriented treatment may have, at least, given him a place to unload some of his rage and may have shored him up enough to prevent him from committing mass murder.
It appears to me that Adam was enraged with his mother. She was his first victim– and I doubt that her murder is without meaning. While it is politically incorrect to focus on his mother’s own psychopathology, I do believe that she was also a disturbed individual. (Less is known about his father– other than the fact that he had given up on his son. At the least, he was neglectful, in my opinion. My sense is that Adam felt unseen by both of his parents.) When his mom’s good friend released their email exchange history to the public, I found the content of her emails to be very telling. Her interactions were marked anti-social and narcissistic personality features in her writing. There was an immaturity and shallowness reflected in her writing, as she described “making trouble” for others at a wedding by telling lies designed to stir up drama, just for the sake of entertaining herself. My sense is that she was also struggling with paranoid personality features– she was a doomsday prepper and had a gun arsenal in her home; she taught her son how to use guns and contributing greatly to his isolated way of living. By day, she “faked it” well– socializing regularly in a local bar, but never bringing any friends into her home, pretending that all was well. Meanwhile, her son was hiding out, untreated.
Like you said in your podcast, insurance companies are all about the bottom line, so they naturally promote cognitive behavioral psychotherapy. A really good meta-analysis was conducted by psychologist Jonathan Shedler at the University of Colorado Denver School of Medicine demonstrating the efficacy of psychodynamic psychotherapy. He writes: “Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as
large as those reported for other therapies that have been actively promoted as “empirically supported†and “evidence based.†In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the
more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings…”
http://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf
Have a lot more to say on the gun control issue (vs. mental health reform). Will save for another day and perhaps, for my own blog. :~)
Leanne Watt, Ph.D.
TS
January 6, 2013Ashley,
There have been studies showing that if the child has 1 adult who is there for them,not necessarily a parent it tends to help them a lot.
From the podcast All In the Mind that has an episode on this , about epigenetics
“So it varies, it depends on what kind of other support is there along with the stress. They are seeing in a lot of studies that a family or a child can be in actually fairly extreme circumstances sometimes and have one of these variants but if they have one or two really important sources of consistency and support in their life from adults it can almost erase all the other vulnerability. One really neat study that was from 2004 by a Yale psychiatrist named Joan Kaufman looked at badly abused kids in New York State, these were kids that were so badly abused by their parents that the state took them away from the parent for at least a time. They ran two filters on this population of kids – one was the serotonin transporter gene and when they did that they found just what you would expect from previous studies. If the kid had a short version of this serotonin transporter gene they were much more likely to have mental health problems as a result of the abuse they’d suffered.
But then they ran one other filter on these kids. Someone had asked them a number of questions and one of the questions was do you have social support in your life? And in this case it was to find as an adult outside the family in the immediate home who they trusted, felt they could turn to for support and saw at least a couple of times a month. This could be an aunt, someone at school, someone down the hall, just another adult they trusted and could go to and felt they were there. And if the answer to that question was yes from these grade school children it erased about 80% of the combined risk of the abuse, these kids are usually beaten, of the abuse and the short serotonin transporter gene.”
http://www.abc.net.au/radionational/programs/allinthemind/orchids-dandelions-genes/4420952
If anybody is interested
Drs. Oldham, Breiling, Pandya andthers from the Menninger Faculty talk about this tradgedy
http://www.borderlinepersonalitydisorder.com/blog/news/special-call-in-discussion-tragedy-in-newtown-ct-dec-18th-8pm-to-9pm-est/
They discuss :
the media
advice for families
violence and mental illness,psychosis
video games
community
prevention
Sarah R.
January 6, 2013Sir,
Thank you for another thought-provoking podcast. I definitely think that the focus of society (and our government) is not where it should be after the shootings at Newtown. Here we are, over a month after the shootings, and gun control is on every news website, radio and television broadcast that you can find. No mention of mental health. It truly amazes me and makes me wonder if we are doomed to repeat this cycle. I wonder how many people it will take to redirect this issue…maybe it is much less expensive to address gun control instead of mental health care?
v/r,
Sarah R.
ashley
January 6, 2013I am a student at a college and at the moment I am taking psychology. What hit home is when you said ” you may know a child like this” and how most of us tend to stay out of others personal affairs. I know of a little girl that has been through some type of trauma and may still be going through the same type of trauma and she is only 5. The city has been involved in her case at one point but now the mother has full custody of her now but there are still symptoms showing that this little girl is being traumatized by another person. I have went around and around in my head trying to figure out a way to help this child. I know reporting it would be step 1 in to getting her out of the environment and into a safer one, maybe, the reason I say maybe is because “foster homes” or the “state” may not be as safe as some of us think. There are more cases of abuse in foster homes than we think. So what is the best way to go about this to help this child? I know getting her out of the home is a step but what happens after that? Will she get the proper treatment she needs to heal her wounds? Will she ever be able to have a “normal” relationship with anyone? She is just so young and has already had to endure so much pain.