Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior (22 page)

For some people, the loss of a job may be a blow that reverberates with some hidden vulnerability rooted in their past. It may trigger an overwhelming rage that seems out of proportion to the immediate loss they have experienced. Such persons look into the abyss and consider violence. “I’ll show you that you can’t do this to me and get away with it,” they think; they conceive violence as a way of restoring their selfesteem. As their vengeful, bitter, envious thoughts continue spiraling downward, they may think, “I can make the life of others a failure, and at the same time nullify my pain and failure, by snuffing out their lives. Why should other people go on having what they want and enjoying themselves, when I can’t?” They then decide that if they are going to die—and most decide that they will not survive their rampages—they will not die alone. Some killers may kill familiar coworkers for “companionship.”

These individuals may also contemplate the notion that after they are done, the media will report what has happened to millions upon millions of people throughout the world. Their name will become a household word for a few minutes. Even a few moments of notoriety are acceptable, so long as their personal psychodrama hits the world stage. They may decide to leave a suicide note so that the world will understand their “just cause.” Whereas most people die quietly and unnoticed, perpetrators of workplace violence will leave this world in a blaze of horror, even though killing innocent people is the last, and the most pathetic, refuge of the defeated. And so, psychologically armored, they gather their weapons and go to wreak vengeance on the world and on themselves. In most incidents, these individuals appear to be calmly going about their gruesome task. And although these perpetrators may be in a seeming dissociated mental state, their methodical, calculated, cold-blooded killing spree is usually the result of deliberate, covert planning.

If workplace violence often is a staged suicide using the murders as a prop, there are plenty of disgruntled and disordered employees who commit suicide without killing anyone else. Some work-related suicides do take place on the job, but most—as in police suicides—take place outside the workplace and principally at home, even though the acts are clearly interwoven with the suicide victim’s work. Policemen see the unabated dark side of life, often developing psychological disorders such as major depression and posttraumatic stress disorder, which can sometimes prove fatal.

When a troubled worker displaces his or her violence to a nonwork setting, that is known as “silent workplace violence.” More often than not, this silent violence does not emerge as suicide, but is directed into physical and psychological abuse of the worker’s family.

Preventing the Unpredictable: Listening for the Snake’s Rattle

In the wake of one of these terrible incidents of workplace violence, people often say that the supervisors should have known it was going to occur because warning signs were clearly present. It is true that there usually are warning signs displayed. As with rattlesnakes, most people who commit workplace violence emit sounds of warning and distress before they strike. But the predictive “signal” for violence is often of low fidelity, and it is further degraded by the background noise of undecipherable motivational and situational factors that lead to garbled messages and error. For example, John Taylor, the mailman who thought he was being “set up,” told managers about his fear, but he was not reassured by their denials. Taylor’s paranoia was a clear signal that he was in mental trouble, but by itself it was not enough to warn that he was at high risk for violence. He displayed other signals to friends: some knew or suspected that he was drinking more alcohol in the weeks before the event than he had done before. Alcohol abuse is also a warning sign, for excess drinking can spark a mental disorder or be a symptom of a developing mental crisis. There was also a third signal that few knew about: Taylor was having trouble at home with an unemployed 22-year-old stepson. These signals of potential violence were all important; yet none of them, alone or together, including Taylor’s growing paranoia, could be said to have predicted the killings, even in hindsight. It is likely, though, that psychiatric examination of Taylor before the incident might have provided an opportunity for intervention and treatment, thereby possibly preventing the outbreak of violence.

The following are some guidelines for the prevention of workplace violence by employees or former employees:

• Conduct an initial screening of job applicants to exclude violent or seriously dysfunctional people. Those who are potentially violent usually have prior histories of making threats or acting in a violent manner.
• Foster a supportive work environment.
• Make conflict resolution possible by promoting team-building and negotiation skills.
• Post a clear, written policy against sexual or any other form of harassment.
• Provide fair and reasonable grievance and review procedures.
• Both management and other employees should identify, as early as possible, those persons who may be at risk for violence. Most potential perpetrators make threats before they explode. Every such threat must be taken seriously and must be seen as a reason for intervention. Part of the process must be to allow the person making the threats to fully ventilate his or her feelings to a mental health professional. That professional must be willing to listen in a nonjudgmental way to the person’s
full
story in order to effectively diffuse potential violence.
• Provide effective and appropriate intervention-prevention programs, consisting of many factors including evaluation and treatment support.
• Establish a workplace violence aftermath debriefing program for all employees and their families within 12 hours of an incident. Provide aftercare for employees who have been psychologically traumatized by workplace violence.
• Identify and assess workplace stressors with measures to reduce employee job stress.
• Identify abusive managers with written policies for counseling, discipline, transfer, or termination.
• Educate employees to recognize violent tendencies in themselves and other employees, to seek help, or to report threatening comments and behaviors.
• Create a central office for reporting threatening behaviors.
• Provide appropriate and supportive out-placement programs for former employees.

The clustering of workplace violence in other places throughout the country may follow a mass murder in the workplace. Knowledge that there is a clustering phenomenon can be used as an early prevention alert to heighten security and to institute other preventative measures.

The notion that mental health professionals can predict violence is a myth. Psychiatrists have long known that they cannot predict violence with any great degree of accuracy. The clinical prediction of violence is accurate less than 50% of the time. Simply flipping a coin would increase accuracy to 50-50. One of the reasons that psychiatrists and other mental health professionals have such a low predictive rate is that they overpredict violence out of concern for their patients as well as endangered third parties. They are able to achieve better predictive rates when the base rate of violence in the underlying group is well known; for example, we can make accurate predictions in 25% to 30% of cases in disturbed psychiatric inpatients. Actuarial assessment attempts to predict reasonably accurate risk probabilities of violence for specific populations, for example, the likelihood of new violence by a previously violent offender when considering him or her for parole.

The forensic psychiatrist has an even harder job in conducting assessments of potential violence for the courts, especially because the evaluation must address a person’s
dangerousness
—a legal term of art that is very vaguely defined by the courts and has little clinical meaning. The courts want to know if the person in question is going to act violently at some point in the future. Psychiatrists, however, cannot predict dangerousness, although the courts insist that we do so. The United States Supreme Court has held that if jurors must make decisions about dangerousness, certainly psychiatrists are in an even better position to do so. Psychiatrists can assess the risk of violence, as well as manage violence. They can assess the risk of violence based on the evaluation of certain risk factors—for example, those listed in Table 6–2. The assessment of violence risk factors is a here-and-now evaluation. Violence risk assessment is a process, not an event, meaning that a potentially violent person should usually be assessed more than once. That is why the use of the term
imminent
violence is a fiction; it presumes a predictive capacity that does not exist. Mental health professionals cannot reliably predict when or even whether violence will occur. The purpose of clinical violence assessment is to inform treatment and management of the
potentially
violent individual; it is a lot like weather forecasting: pretty good for the moment but not so good for the longer term. And, as with weather forecasts, the assessments of potential violence must be frequently updated to be of value.

In assessing violence risk factors, psychiatrists especially look for the presence of mental disorders. However, the connection between mental disorders and violence is murky. More violent crimes are committed by people who are not identified as mentally ill than by those who have been so diagnosed. So many factors enter into the making of a violent episode that credible analysis of predisposing factors is a daunting, if not inherently impossible, task. The most reliable risk factor for future violence is past violence. Threats made against specific individuals are another serious risk factor. The combination of a history of past violence and present threats is an ominous sign that heightens the risk of violence dramatically. Coworkers who after a violent event say that people should have seen it coming because of previously uttered threats could actually help prevent some of this violence. Management and workers need to learn how to identify such expressed warnings and take action to diffuse the potential for violence.

Threats must be taken seriously. However, forcefully confronting the disgruntled employee may increase his or her humiliation and rage. Counterthreats can also cause an escalation in the risk of violence. Engaging the employee in a fair and reasonable grievance procedure is often the best way to productively harness and diffuse work

TABLE 6–2.
Factors to consider in psychiatric assessment of violence risk

• Specific person threatened
^a
• Past violent acts
^a
• Individual-specific violence risk factors (triggers)
•Motive
• Therapeutic alliance (ongoing patient)
• Other relationships

• Psychiatric diagnosis (major psychiatric disorders and personality disorders)

• Control of anger
• Situational status
•Employment status

• Epidemiological data (age, sex, race, socioeconomic group, marital status, violence base-rates)

• Availability of lethal means
• Available victim
• Violent feelings or impulses, acceptable or unacceptable
• Specific plan
• Childhood abuse (or witnessing spouse abuse)
• Alcohol abuse
•Drug abuse
• Mental competency
• History of impulsive behavior
• Central nervous system disorder
• Low intelligence

^a
When a specific person is threatened and past violence has occurred, a high risk rating for violence is achieved.
Source.
Adapted from Simon and Tardiff 2008.

place anger. A referral for evaluation and possible treatment should always be considered because disgruntled employees may have depression or some other psychiatric disorder. Some potentially violent employees may refuse referral to a mental health professional, considering it another insult.

Except when violence is random, it is usually the interactive result of a specific individual and a specific situation. If that trigger situation never occurs, some potentially violent people are able to keep their violence from exploding. Almost everyone can become violent, given the right circumstances. Moreover, the violence may be appropriate if, for example, one’s life or the life of another person is threatened. It is clear in retrospect that the repossession of James Pough’s red Pontiac Grand Am became a specific trigger for his violence against General Motors Acceptance Corporation, although the deeper psychological meaning that the car had for him will never be known.

Is Your Job A Dead End?

Have you or your coworkers ever given any thought to what you can do to assess the risk of a potentially dead-end job? If the evidence mounts that you are heading for emotional trouble, will you seek help? Do you know where to go to get it? Have you ever considered violence as a possible (though illusory) solution to problems, as some of the workers who “went postal” said they had? Equally important, are you able to identify and to help coworkers who seem dangerously distressed and headed for violence? Or will you do as most people have done, deny and ignore plain signals of trouble that are invariably present before violence breaks out? Violence in the workplace is everyone’s concern. The prevention of violence begins with the worker’s recognition that his or her place of employment can be a dangerous place and that he or she, in concert with enlightened management, must take prudent precautions.

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7
Multiple Personality and Crime

A Real Whodunit

Though a good deal is too strange to be believed, nothing is too strange to have happened.
—
Thomas Hardy

A
n unusual witness took the stand at a rape trial in Oshkosh, Wisconsin. A 27-year-old woman testified that Sarah was “the name of the body” she inhabited. It was also the given name of the rape victim. Sarah had no memory of having met the man on trial for raping her, 29-year-old grocery bagger Mark Peterson, but testified that she had been told about the rape by her other 6 personalities and 15 personality fragments who also inhabited her body. They said it was the naïve and fun-loving Jennifer who had had sex with Peterson. He had violated “the body.”