My brother (3 years younger) suffers from pretty much the same global disorder as described in the blog; the main difference is that we're in France (well, my family still is; I moved a few years ago).

Throughout childhood, he presented a mix of pretty much every single psychological disorder possible- bipolar, paranoia, kleptomania, depression, etc. He was extremely manipulative, and knew how to be perfectly sweet like the author describes. I always saw it as a very contrived act on his part, one in perhaps in lost himself at times- but I believe that when he presents this adorable facade, he is mostly in control of it. He has definitely threatened my parents or myself with a knife, and I'm glad we have decent gun control in France. I believe that if he hadn't grown up in a wealthy privileged environment, he'd be dead or roaming the streets today.

IQ tests put him in the ~120-130 range, and psychologists recommended a wide array of solutions, ranging from the behavioral (for example one determined that it was because he didn't feel secure and had enough privacy, and suggested that he should get locks for his room etc.- that led to an entire different set of complications, and that psychologist was abandoned promptly.) to the medical (although he was never subjected to the wide variety of antidepressants cited in the article- France in the 90s-early 00s seemed to avoid those sort of things).

Ultimately, nothing worked. Things got much, much worse with adolescence; he went to 4 schools, all very different (one public school, one catholic private school, one boarding school in the countryside, etc.), and got kicked out of all of them but one. My parents did find a few things that mitigated his conditions: for example, he was in the boy scouts for a few years, which helped.

Today he's 20, barely graduated high school; he now lives somewhere in the French mountains with his girlfriend, chopping wood and harvesting grapes. We haven't talked (other than "hey what's up" at family meals once a year) in 7 years or so.

I could probably write an entire book on the topic, but would rather avoid to do so for the moment; but if anyone has questions, I'll gladly answer them.

The Hitchhiker's Guide to the Galaxy - Humans vs Dolphins “For instance, on the planet Earth, man had always assumed that he was more intelligent than dolphins because he had achieved so much—the wheel, New York, wars and so on—whilst all the dolphins had ever done was muck about in the water having a good time. But conversely, the dolphins had always believed that they were far more intelligent than man—for precisely the same reasons.”

― Douglas Adams

My question is, do you think your brother is better off now than he would have been had he been institutionalized?

A question could be - what would have been the goals of institutionalizing him? To make him more fit for life in our society with our standards; or to prevent him from harming others and himself?

Since you're asking specifically if he would have been better off, I'm assuming the former of the two- in which case no, I don't think he'd have been better off. I do think he's physiologically incapable of sitting at a desk, taking orders, living in an extremely codified manner where one has to respect certain hierarchies, hide certain feelings, etc. - and that perhaps he has now found a way to detach himself from it. I don't think that any institution could have addressed that.

But I'm sure that there are some people (former teachers, classmates, etc.) who think it'd have been better if he had been institutionalized.

With more modern drug regimes, extreme behaviour by these poor souls is more 'manageable'. And in many cases I think, that's the best you can hope for.

The effects of this policy are varied. On one hand, it can make the polices' job more complex. There was a period some time back where the police were being confronted regularly by dangerous behaviour, which lead to deaths by police shootings. It spawned a rash of confrontations and corresponding shooting deaths, which appeared to be escalating. It soon became obvious that these mentally unstable people were getting a fast ticket to pain relief, assisted by police action.

This lead to improved education for the police, in respect of resolution and firearms training. The situation deescalated after that, and the cycle of depression, anger and suicide by proxy was broken.

Australia is a large country, only a little smaller than the United States, with a population of only 20 or so million. So there are regional areas separated by reasonable distances from the major capitals. Two regional cities near to Melbourne that I am aware of have become the nexus for individuals that are part of this community care attitude.

Like attracts like in this instance, and a natural clustering has occurred so that the proportion of the population with mental health issues is greater than the average.

To get an inkling of the degree of organisation involved as a result of these policies, just google 'bendigo mental health'.

Does this sentiment not exist where you are from?

In my experience, people in the US in their 20s (both during and post university) tend to be more in the mindset "I want a relationship" (and they're actively looking for one, using dating sites, personal networks, etc.) or "I don't want a relationship" (in which case they actively avoid it); whereas in France and European countries, people tend to be more neutral by default and then hop into a relationship when the right person comes along.

Those are just my observations though- they could well be skewed.

There are likely multiple factors at play- it's quite conceivable that puberty hormones make the matters worse, and that he's slowly exiting this phase, it's something less in the way.

But I also think that as he grows up, there are less "triggers" for his episodes. Episodes are almost always triggered when something or someone contradicts him (for example in the original linked article, when the mom tells the kid he can't wear the pants he wants to wear). Now that he lives by himself in a small village with no parents, no teachers, etc., (when you think about it, schools are terribly oppressive environments) the triggers are much less numerous.

This leads me to further believe that his case his mostly genetic/physiological in nature.

We'll soon enough try gun control. That won't stop mass killings. Then we'll try increased mental healthcare access. That won't do much because we'll struggle with the Constitutionality of locking people up in mental hospitals when they aren't yet a threat to anyone.

By this point in the future, genetic screening will be ubiquitous and affordable, possibly mandatory. Cultural attitudes will shift with this, and it will be expected for people to study their genome and compare openly when dating. People will pass on mates due to a high risk of major issues occurring should they have children together (this already happens in the Jewish community with Tay Sachs). Eventually people will be a lot more picky and aware of heredity and we could see a lot of hereditary mental illnesses removed from the population.

(I want to make clear I'm not expressing an opinion on or endorsing this, merely trying to make a prediction)

One's logic could go like this, "Man, everything sucks, and those kids down at the preschool are always so damn happy. Fuck Them. If I'm not happy no ones gets to be happy. Lock and load assholes." Suddenly you've got another tragedy. I would imagine people that are suicidal sometimes feel like this. Maybe it depends on how introverted or extroverted they are. The introverts disappear quietly in the dead of night, and the extroverts start mowing down pedestrians in the town square and then blow their brains out standing on the Mayor's statue.

If a gene could be isolated for "suicidal tendencies" and also for intro/extro we might be able to reduce future events like this. But just because someone is a suicidal extrovert that hates everyone it doesn't necessarily mean they're going to start killing people. Maybe the ones that don't are just pussies and the gene for "guts" or "courage" would also have to be isolated?

I don't know I'm just rambling. I ask myself why I don't kill my neighbors. Is it because I'm "sane"? Well I guess so, if "liking others" and not wanting them to be sad is a characteristic of sane people. But I firmly believe that there's a tiny slice of murderer in all sane people, and I like to think of people like Adam Lanza as having just a bigger slice, because putting them in a different category of "mentally ill" sort of feels like I'm denying a part of my own nature.

An analogy: Any computer will crash when running buggy software - but a computer with a bad stick of RAM will crash much more often. The symptoms of both those problems will be fairly similar.

Likewise, most humans think about killing from time to time - but some mentally ill people think about it much more often. Unfortunately with humans one can't run memtest86+ or swap the ram out and see if the problem goes away.

Wasn't there a time not too long ago when tribes of people would go around raping, pillaging, and slaughtering others just for the hell of it? Because it was fun for them? If our world had respawn, I think life would turn into a sort of valhalla-ish existence for a not small percentage of people, and I bet many would learn about a part of themselves they did not know existed, or had supressed.

Maybe rampage shooters are just people born in to the wrong time period, where in another they would fit in perfectly. The line isn't fine, but they aren't as different as we make them out to be.

The interplay between genes, RNA, proteins and other macromolecules is so complex that I doubt we can pin down a mental illness to a single gene or safely remove a mutation that causes mental illness from the gene pool without reducing other collateral beneficial traits.

I simply don't share joonix' optimism that genetic screening can eradicate "unbeneficial" traits within next centuries without wrongly removing "beneficial" ones, before we have a better and complete understanding of our biological makeup.

More dangerous than ignorance is half-knowledge.

It's like a rocket. You need all the parts of a rocket to work or you won't get off the ground. If you are really unlucky, it may even explode

With psychiatric disorders, it's similar. Break a few choice genes and the whole system goes to shit. But unlike a rocket, it keeps working, just not in the fashion that other brains works. So you get some kind of disorder like schizophrenia or bipolar.

I was involved in a few projects where they were mapping schizophrenia with SNPs. Looking at the data, it's clear that some individuals cluster around certain SNPs...but most of them are scattered everywhere. Lots of things can cause schizophrenia, because it really isn't a single disease but a set of common symptoms.

I would be hesitant to assume that they're not genetic, though - I've personally decided not to have children entirely due to the fact that mental illness is so prevalent in my partner's family (about 50% of the current < 30 year olds in the family have either been hospitalized or tried to kill themselves, and I'm not willing to subject a child of mine to those odds). I frankly don't believe that this family has just been randomly unlucky, it seems far more likely that there's something genetic behind it, especially since even the "sane" people in the family tend to be so unhappy that they probably should have been treated for the same things that the "crazy" people have been hospitalized for.

DNA may only be one piece of the puzzle, but I think it's a big enough piece of that puzzle that we need to look into it a bit more. I can't recall the last truly "crazy" person I've interacted with that didn't have something messed up in their family history...

That said, epigenetics definitely could be the issue here, my partner is of Irish stock and that's one of the classic cases of epigenetic poisoning (the famines caused all sorts of epigenetic nastiness, a lot of which has been shown to persist for generations). I totally believe that some lineages have seriously detrimental baggage associated with them, and I believe that hers could be one of them.

In the end though, I don't know that there's much difference - a person's heritage, one way or another, ends up determining their children's susceptibility to mental illness, and if that susceptibility is high, a responsible "parent" should perhaps choose not to have the child.

Just my opinion. And to be fair, if everyone followed it and was a "responsible parent" (i.e. not having kids if your family history is fucking nutters), the woman I love would not have been born, so I don't hold it that dear...

Yet:

1) Hereditary factors can only explain a small part of the picture. Eliminating hereditary factors that predispose people to developing mental illnesses would only eliminate a fraction of the problem. Environmental factors play a huge role.

2) The point at which what you describe happens is a long way off (if it ever happens), at least a couple of decades away. In that time, we need a viable solution.

Part of that solution should be better access to mental health care. I don't think there will be any constitutional issues with institutionalized treatment of a child who has threatened to kill someone. AFAIK, a child's parent has considerable legal control over that child and the decision to institutionalize/otherwise treat.

EDIT (reply to below):

> wasn't known to have any violent tendencies >What were the environmental factors behind Lanza and Holmes (Aurora)? Both came from upper-middle class backgrounds. Both grew up in idyllic environments with "normal" parents with careers and health insurance.

I'm afraid it's simply to early to say these kinds of things. We still do not have a complete picture of Adam Lanza's life. I don't think any of us can say anything about his personality until more facts emerge. A middle class existence is not the end-all be-all of mental stability. There are tons of other factors - family situations, bullying, school environment, the list goes on. And obviously, hereditary factors may very well have played a role in his case.

>Meanwhile, someone without a mental illness has a moment of rage and threatens to kill a guy at a bar. Do we lock him up and drug him too?

This is a straw man. Firstly, I was only talking about the case of children/adolescents whose parents have legal powers over them. In the case of an adult (whose parents obviously have no legal control), the problem is that those adults (incl. the guy who threatens another in your case) will get sent to jail and there won't even be an attempt to diagnose/treat a mental illness even once they are in jail. The guy in your example would not get diagnosed with something he doesn't have. He'll just be in jail. Expansion of access to mental health care should include expanded access to inmates.

A schizophrenic may not ever have violent tendencies. Then, one day a voice tells them to kill everyone.

Meanwhile, someone without a mental illness has a moment of rage and threatens to kill a guy at a bar. Do we lock him up and drug him too?

What were the environmental factors behind Lanza and Holmes (Aurora)? Both came from upper-middle class backgrounds. Both grew up in idyllic environments with "normal" parents with careers and health insurance.

This is, of course, the crux of the matter. Clearly there is something in America's environment that makes us far more prone to this sort of thing than other places, with or without gun control. Identifying what that is will be critical to preventing this from happening again. Gun control can reduce the body count, but even a body count of one (suicide) is not acceptable. The silver lining to this is that these events raise a dramatic warning to us that there is something deeply, seriously wrong with our culture.

Remember when there were huge epidemics of suicide and Satanic ritual abuse in the 80s? Or rather, people said there were. In reality, suicide rates remained mostly flat, even declining slightly overall, and the evil Satanic cults were a myth. So, be careful about postulating something deeply wrong with our culture, when there may well be another explanation.

That's a bit of a disparity.

Source: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/14/n...

I pulled the above statistic because of the specific context of mass shootings. But hey, at least you got a pithy retort out of it.

Firearm related death rate, per 100K of population.

http://en.wikipedia.org/wiki/List_of_countries_by_firearm-re...

US: 9.0 Switzerland: 6.4 Finland: 3.64 Germany: 1.1 UK: 0.25

...

While guns may have increased the severity of the damage, the lack of a gun did little to stop a similar event from taking place. People that want to do harm to others will find a way, and while there's something to be said for trying to lessen how much damage they can do, that seems to be a poor attempt at treating the symptom rather than the disease.

Put another way: let's look at the overall violent crime rates by country instead. Here we go: https://en.wikipedia.org/wiki/List_of_countries_by_intention... US ranks at 4.2/100k

I'd also like to point out your selective data pull is very misleading (whether it was intentional or not I don't know; I'll give you the benefit of the doubt). Of those 9 deaths per 100k, 5.75 are suicides and 0.27 are unintentional; only 2.98 were murders (so we have nearly 75% of our murders by gun, but overall a quite low murder rate compared to over a dozen countries at 30+/100k and four over 50). Also from missing from your quote - the US is #12 in terms of firearm deaths per capita, not #1 as your data implies.

The only data that is really relevant to gun control arguments are murders that would not have been possible without a gun and (probably more relevant) accidental gun deaths. Anyone sufficiently determined to kill themselves will find any number of ways, so that's almost completely irrelevant to the discussion.

"...poor attempt at treating the symptom rather than the disease". Sorry, the symptoms (i.e. lots of people dead) are the problem here.

My data pull was primarily for the countries mentioned earlier, I added some others I find relevant because I have experience living there (never been to Finland). I did not imply the US was #1, the extract was obviously a very short one.

The Wikipedia page you cite tells essentially the same story as the Washington Post article: of the OECD countries, the US is by far the most violent, more than 4x more than Germany, for example. Take a look at the countries surrounding the US in the statistic! If you're not embarrassed, you're not paying attention.

The "would not have been possible without a gun" argument is specious, as is "anyone sufficiently determined" argument for suicides: you are assuming that anyone with a suicide attempt is sufficiently determined, as is someone wanting to kill someone. This is a fallacy, both logically and from what the data show.

Not being able to stop everyone is no excuse for not even trying to stop those that can be stopped (or reducing the damage...heck if no-one gut hurt, would the "rampage" even be a problem??)

If Wikipedia is correct, this was a whole series of attacks, sometimes with multiple assailants, with each attack having far fewer fatalities, so the point about reducing the damage stands.

Still awful.

Luxembourg (total population 1/2 million) has the higher variance you mention, the rest of are pretty stable.

It certainly looks like Scandinavia and the UK might have a problem. Europe as a whole still has fewer than the US for a similar population but it is high. None for China, India or Brazil. So it is not just about normalisation...

The most recent UK shooting of note, Derrick Bird, used a double-barrelled sawn-off shotgun and a .22 (bolt-action) rifle. Would it have been worse if he'd had handguns and semi-automatic rifles? We'll never know, but he did try to acquire another firearm mid-rampage so he clearly felt like he needed more firepower.

I'd agree that Scandinavia has a bigger problem (EU would be at 2 without Finland). (Norway is not part of the EU, and I also didn't count the US soldier going on a rampage in Afghanistan).

Of those mentioned in the list; 6 in the past 25 years are in Europe. 3 shootings, on this list alone, happened in the US in the past 6 months! Most European countries probably haven't had any of this type of thing happen in the past 25+ years.

Elsewhere in this thread I wondered if American dynamism and individualism produces individuals both great and vile - and that America tempered the 'vile' segment with moral education and community ties that's since gone on the decline. That's my culturally-based theory, but I'm sure we can find other plausible ones as well.

But mental illness is something incredibly shameful around the world and maybe even moreso in the US. Almost no parent will ever be able to admit that there might be something wrong with their children. And for the people around them, the most convenient path is to ignore the problem and say it's "a phase" they are going through.

Should we lock up those people to prevent the small number who might go on to commit violent crime?

The military will have need of sociopaths and killers.

I'm making predictions about the future here and you are looking through modern day eyes. Twenty years ago people would be appalled to see the kind of things we openly share on Facebook with our friends today. In the future people may have no qualms about sharing their genetic profiles. There very well may be an eHarmony type service that matches based on potential offspring rather than answers to a questionnaire.

I think this is more of a boyish fantasy or the landscape of a sci-fi novel, which by the end people will inevitably reject. It's not like this is some thing that will be instituted in a vacuum.

I think the general agreement in the field is that genetic abnormalities are necessary but not sufficient to cause Schizophrenia. If you are going to crack, it's usually because you are genetically predisposed to it and in the right environment to trigger the disorder.

Using Schizophrenia as an example, there are plenty of mid-20's males that are in stressful environments...but don't become schizophrenic. A minority of those males will have a genetic abnormality that predisposes them, and they start hearing voices.

The U.S. (and Australia, which was a penal colony) likely has a higher than average (at least for Europe) incidence of what I will call "maverick" traits -- gene based traits that make people less able to go along to get along, for some reason. They aren't necessarily bad traits, they just aren't very conducive to "domestication". The tend to be some of the same traits necessary for activities like exploration and other risky behaviors -- including founding a start up. One of the things YC asks about on its application is rule breaking behaviors. Folks who are too compliant are not well suited for doing groundbreaking work. So I don't personally think that breeding these traits out is necesarily a good thing.

The reason America has higher rates is because a lot of our ancestors left Europe (or other countries) when they just could not fit in. Many left to seek the right to worship as they saw fit -- in other words to think and believe as they wished. So it looks to me like Europe already tried to get rid of these genes and, instead of extinguishing them, mostly exported them, thereby concentrating them in a couple of countries. People with these genes tend to not "go quietly into the night". They tend to go kicking and screaming. So I do not think criminalizing people for having such traits is a good policy. It is better to find ways to help them live constructively with certain traits and to carefully distinguish between traits, which are value neutral, and outcomes or behaviors, which are not value neutral.

I usually do not say this publically, but if Joan of Arc were alive today, she would likely be in a psych ward having her meds adjusted, trying to make the voices stop, instead of playing midwife to the bloody birth of modern Fance. I have also read that Alexander the Great was likely bipolar. Again: I am not so sure that our desire to rid ourselves of people who aren't "normal"/adequately compliant or "cure" them of their differences is such a good thing. I think there are better ways to deal with peope like that than simply trying to break them. I think the goal of breaking them is likely a loss for both the individual being broken and for society. Take that too far and we lose important human traits, like adaptability.

I have a genetic disorder. It is more common in populations which historically were subjected to high death rates from a particular infectious disease (though I don't recall which disease). In other words, carrying at least one gene was likely protective against dying from this infection. Thus this deadly genetic disorder became more common in cases where it helped you survive in the face of worse things. The same is true of Sickle Cell disease, which is protective against malaria. Viewing genetic variations of that sort solely as defects and not as adaptations misses the big picture. If they weren't adaptive in some situations, they wouldn't be selected for by evolutionary pressure.

So, yes, I believe that. Europe may not have been explicitly trying to get rid of genes per se, but they did essentially ship literally boatloads of undesirables to both America and Australia, countries which have some things in common in terms of having maverick social norms, more so than a lot of older cultures.

I can't prove it in a few comments in a public forum, but it isn't just some idea I dreamed up earlier this afternoon. It is rooted in many years of reading and discussing the connection between inborn traits and characteristics like tolerance for risk. I am not someone who likes risk. But my genetic disorder has made me unable to go along to get along, even though my default personality makes me wish I could. So, yes, I see clear connections between socially difficult behaviors and genes.

Starting in the 1970s the West deinstitutionalized[1]. But at least in the US we never sufficiently funded community care, which was supposed to replace mental institutions. So the severely mentally ill end up living on the street (where they're often the victims of violence[2]) or in jails and prisons (which if you squint sort of resemble mental institutions, though without the emphasis on medical care).

Whatever we as a society try next, we need to recognize that with our current medical knowledge there are no cures for mental illnesses, only management. So our approaches need to be both humane and long-term. Returning full-circle to institutionalization in jails and prisons utterly fails those tests, offering brutal conditions, short-term containment, and usually insufficient medical care. We can do better.

[1]: http://en.wikipedia.org/wiki/Deinstitutionalisation

[2]: http://en.wikipedia.org/wiki/Prognosis_of_schizophrenia#Viol...

I mean, if at some point we identify a set of mental diseases that (a) can be accurately diagnosed; (b) can't be cured; (c) make the patient a violent threat to society - then wouldn't forced medical institutionalization be a better option then both current options of street-life or jails?

My first guess (being diagnosed, not self, with some weird neurotransmitter problem and very lucky to have found a cure which makes my life normal again) is that the medical/pharma world is not giving a shit at the moment. It's like financing research for rare diseases : no money to be made here.

Second guess is that (oh yeah, you'll like that) most psychologists are charlatans (the biggest of all being Freud, then Lacan imo) and they got traction after WWII, for obvious reasons : western societies at large were scared shitless of the Reich's positions as to all problems having only to do with genetics (jews, mentally ill people,...). So we got 60 years of this "be nice, try to understand" bullshit.

Third, what we learned with Aspergers is that something as radical as autism can be a continuum. This is quite a revolutionary discovery, and does not seem to have sunk in yet. We all know as programmers the difference between discrete and continuous, we live in a world built upon bits after all. There might be thousands, hell maybe quintillions of such continuums which chained together lead to a unique pathology each and every time : it's also called personality.

Roughly speaking, we are still apes (alas not) trying (hard enough) to further our scientific knowledge of psychic disorders.

My feeling is that until the human being, the individual, is placed at the center of all the fabric of our societies, the fact that each case in unique and requires a specific attention, we will get nowhere. Money has no personality, money is the key to almost anything as comes to survival in this world. This is the thing that has to change... Someday. Because money likes not diversity.