The criminal's keeper

Like many, I spent Friday night riveted to the television, waiting for the authorities to locate and capture Suspect No. 2 in the Boston Marathon bombings. Terrorist events are not about psychiatry, but like everyone else, I felt overwhelmingly sad.

I was sad for the victims of the explosions, for the young MIT police officer who was killed in the gunfight, for the teenage terrorist and his brother who surrendered their promising futures for the senseless sake of taking innocent lives, and for the entire town of West, Tex., where a fertilizer plant had exploded on Wednesday.

I simultaneously felt sad for the Maryland teenager who was killed by a hit-and-run driver while walking with friends, for the three people murdered in Baltimore last week, and for the local teenager whose tragic suicide has been kept so quiet. None of those losses received attention from Anderson Cooper or Wolf Blitzer, but their lives are gone, nonetheless. And all of these tragedies come as we continue to mourn the horror of Sandy Hook, and just months after so many people died at a movie theater in Aurora.

As much as I feel profound sadness for the victims, I also ache for the mothers of both the victims and the criminals, and in the situations where the perpetrators have been suffered from mental illness, I also feel sympathy for their psychiatrists. The roles of mother and psychiatrist are ones I know well.

When a child behaves in an unseemly way, regardless of whether the transgression is minor or catastrophic, the first people who come into question are the parents, the mother in particular. When a child grows up well, parents are quick to take credit; their love, attention, and ability to raise children with the precise formula of discipline and acceptance are what produced such a fine product of a human being. When children waiver from the path, their parents may blame biology, a difficult temperament, or outside influences. In some circumstances, the child is deemed a “bad seed.” The outside world, however, is quick to blame the parents.

When my children were young, I knew a great deal about how to be a good parent. When they became teenagers, I was quickly humbled and often wished they had arrived in this world with instruction manuals. I have been blessed with wonderful children, but I am never so sure that I want the world to judge my parenting by the things they post on Facebook or the clothing they choose to wear in public. Ah, tell them not to do that, a bystander might say – one with particularly compliant teenagers –  but I’ve learned that controlling another human being’s action is easier said than done, and sometimes it is close to impossible. Obviously, a teenager’s inopportune grunt or jeans that rest a bit too low are not events one should compare to mass murderers, but my helplessness in effecting precise cause and effect with my parental skills has left me feeling that it’s not as simple as following a formula.

In much the same way, if the perpetrator of an atrocious act has a mental illness, the psychiatrist is scrutinized. Did the doctor ask the right questions? Did she take any threatening comments seriously enough? Did she warn those who might be warned? Were the medicines pushed to high enough doses? Was the patient hospitalized? For long enough? Even if it was all done precisely right by psychiatric standards, the public has their own measures and often believe that more should have been done. We all live with just a little fear that a patient might suicide, or end up on a national news story. Even when it’s predictable, there is only so much we can do in an attempt to alter the outcome.

Certainly, there are terrible, negligent, and abusive parents, just as there are psychiatrists who rush through their day with little regard for whether they are considering standards of care and giving enough consideration to a patient’s potential to harm themselves or others. In those cases, my sympathy wanes. Since I spend a lot of time thinking about how I could be both an excellent parent and an excellent psychiatrist, I’m well aware that there is an element of luck to both endeavors. Often, kind and attentive parents have good kids, and conscientious psychiatrists have good outcomes. Sometimes, however, major mistakes are made, and things turn our well anyway; people can be very resilient. Horrible parents sometimes produce wonderful children, while shoddy psychiatrists get lucky. Other times, a single mistake can lead to a disastrous result.

Do we think the mother of the Newtown shooter would have gone to bed that night leaving guns accessible if she’d had even the slightest inkling that her son would kill her, much less innocent young children? We are all subject to moments of poor judgment, or of hoping the suicidal patient we opted not to hospitalize will make it through the night. Parents and psychiatrists both want luck to be on their side.

I like to believe that most parents try to do their best by their children, and most psychiatrists try to do their best by their patients. And when awful things happen, I feel badly for the mothers of both the victims and the perpetrators, and for the psychiatrists. It’s a myth – and a burden – we hold that any of us can completely control the behavior of another human being.

<[QM—Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011).

Like many, I spent Friday night riveted to the television, waiting for the authorities to locate and capture Suspect No. 2 in the Boston Marathon bombings. Terrorist events are not about psychiatry, but like everyone else, I felt overwhelmingly sad.

I was sad for the victims of the explosions, for the young MIT police officer who was killed in the gunfight, for the teenage terrorist and his brother who surrendered their promising futures for the senseless sake of taking innocent lives, and for the entire town of West, Tex., where a fertilizer plant had exploded on Wednesday.

I simultaneously felt sad for the Maryland teenager who was killed by a hit-and-run driver while walking with friends, for the three people murdered in Baltimore last week, and for the local teenager whose tragic suicide has been kept so quiet. None of those losses received attention from Anderson Cooper or Wolf Blitzer, but their lives are gone, nonetheless. And all of these tragedies come as we continue to mourn the horror of Sandy Hook, and just months after so many people died at a movie theater in Aurora.

As much as I feel profound sadness for the victims, I also ache for the mothers of both the victims and the criminals, and in the situations where the perpetrators have been suffered from mental illness, I also feel sympathy for their psychiatrists. The roles of mother and psychiatrist are ones I know well.

When a child behaves in an unseemly way, regardless of whether the transgression is minor or catastrophic, the first people who come into question are the parents, the mother in particular. When a child grows up well, parents are quick to take credit; their love, attention, and ability to raise children with the precise formula of discipline and acceptance are what produced such a fine product of a human being. When children waiver from the path, their parents may blame biology, a difficult temperament, or outside influences. In some circumstances, the child is deemed a “bad seed.” The outside world, however, is quick to blame the parents.

When my children were young, I knew a great deal about how to be a good parent. When they became teenagers, I was quickly humbled and often wished they had arrived in this world with instruction manuals. I have been blessed with wonderful children, but I am never so sure that I want the world to judge my parenting by the things they post on Facebook or the clothing they choose to wear in public. Ah, tell them not to do that, a bystander might say – one with particularly compliant teenagers –  but I’ve learned that controlling another human being’s action is easier said than done, and sometimes it is close to impossible. Obviously, a teenager’s inopportune grunt or jeans that rest a bit too low are not events one should compare to mass murderers, but my helplessness in effecting precise cause and effect with my parental skills has left me feeling that it’s not as simple as following a formula.

In much the same way, if the perpetrator of an atrocious act has a mental illness, the psychiatrist is scrutinized. Did the doctor ask the right questions? Did she take any threatening comments seriously enough? Did she warn those who might be warned? Were the medicines pushed to high enough doses? Was the patient hospitalized? For long enough? Even if it was all done precisely right by psychiatric standards, the public has their own measures and often believe that more should have been done. We all live with just a little fear that a patient might suicide, or end up on a national news story. Even when it’s predictable, there is only so much we can do in an attempt to alter the outcome.

Certainly, there are terrible, negligent, and abusive parents, just as there are psychiatrists who rush through their day with little regard for whether they are considering standards of care and giving enough consideration to a patient’s potential to harm themselves or others. In those cases, my sympathy wanes. Since I spend a lot of time thinking about how I could be both an excellent parent and an excellent psychiatrist, I’m well aware that there is an element of luck to both endeavors. Often, kind and attentive parents have good kids, and conscientious psychiatrists have good outcomes. Sometimes, however, major mistakes are made, and things turn our well anyway; people can be very resilient. Horrible parents sometimes produce wonderful children, while shoddy psychiatrists get lucky. Other times, a single mistake can lead to a disastrous result.

Do we think the mother of the Newtown shooter would have gone to bed that night leaving guns accessible if she’d had even the slightest inkling that her son would kill her, much less innocent young children? We are all subject to moments of poor judgment, or of hoping the suicidal patient we opted not to hospitalize will make it through the night. Parents and psychiatrists both want luck to be on their side.

I like to believe that most parents try to do their best by their children, and most psychiatrists try to do their best by their patients. And when awful things happen, I feel badly for the mothers of both the victims and the perpetrators, and for the psychiatrists. It’s a myth – and a burden – we hold that any of us can completely control the behavior of another human being.

<[QM—Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011).

Like many, I spent Friday night riveted to the television, waiting for the authorities to locate and capture Suspect No. 2 in the Boston Marathon bombings. Terrorist events are not about psychiatry, but like everyone else, I felt overwhelmingly sad.

I was sad for the victims of the explosions, for the young MIT police officer who was killed in the gunfight, for the teenage terrorist and his brother who surrendered their promising futures for the senseless sake of taking innocent lives, and for the entire town of West, Tex., where a fertilizer plant had exploded on Wednesday.

I simultaneously felt sad for the Maryland teenager who was killed by a hit-and-run driver while walking with friends, for the three people murdered in Baltimore last week, and for the local teenager whose tragic suicide has been kept so quiet. None of those losses received attention from Anderson Cooper or Wolf Blitzer, but their lives are gone, nonetheless. And all of these tragedies come as we continue to mourn the horror of Sandy Hook, and just months after so many people died at a movie theater in Aurora.

As much as I feel profound sadness for the victims, I also ache for the mothers of both the victims and the criminals, and in the situations where the perpetrators have been suffered from mental illness, I also feel sympathy for their psychiatrists. The roles of mother and psychiatrist are ones I know well.

When a child behaves in an unseemly way, regardless of whether the transgression is minor or catastrophic, the first people who come into question are the parents, the mother in particular. When a child grows up well, parents are quick to take credit; their love, attention, and ability to raise children with the precise formula of discipline and acceptance are what produced such a fine product of a human being. When children waiver from the path, their parents may blame biology, a difficult temperament, or outside influences. In some circumstances, the child is deemed a “bad seed.” The outside world, however, is quick to blame the parents.

When my children were young, I knew a great deal about how to be a good parent. When they became teenagers, I was quickly humbled and often wished they had arrived in this world with instruction manuals. I have been blessed with wonderful children, but I am never so sure that I want the world to judge my parenting by the things they post on Facebook or the clothing they choose to wear in public. Ah, tell them not to do that, a bystander might say – one with particularly compliant teenagers –  but I’ve learned that controlling another human being’s action is easier said than done, and sometimes it is close to impossible. Obviously, a teenager’s inopportune grunt or jeans that rest a bit too low are not events one should compare to mass murderers, but my helplessness in effecting precise cause and effect with my parental skills has left me feeling that it’s not as simple as following a formula.

In much the same way, if the perpetrator of an atrocious act has a mental illness, the psychiatrist is scrutinized. Did the doctor ask the right questions? Did she take any threatening comments seriously enough? Did she warn those who might be warned? Were the medicines pushed to high enough doses? Was the patient hospitalized? For long enough? Even if it was all done precisely right by psychiatric standards, the public has their own measures and often believe that more should have been done. We all live with just a little fear that a patient might suicide, or end up on a national news story. Even when it’s predictable, there is only so much we can do in an attempt to alter the outcome.

Certainly, there are terrible, negligent, and abusive parents, just as there are psychiatrists who rush through their day with little regard for whether they are considering standards of care and giving enough consideration to a patient’s potential to harm themselves or others. In those cases, my sympathy wanes. Since I spend a lot of time thinking about how I could be both an excellent parent and an excellent psychiatrist, I’m well aware that there is an element of luck to both endeavors. Often, kind and attentive parents have good kids, and conscientious psychiatrists have good outcomes. Sometimes, however, major mistakes are made, and things turn our well anyway; people can be very resilient. Horrible parents sometimes produce wonderful children, while shoddy psychiatrists get lucky. Other times, a single mistake can lead to a disastrous result.

Do we think the mother of the Newtown shooter would have gone to bed that night leaving guns accessible if she’d had even the slightest inkling that her son would kill her, much less innocent young children? We are all subject to moments of poor judgment, or of hoping the suicidal patient we opted not to hospitalize will make it through the night. Parents and psychiatrists both want luck to be on their side.

I like to believe that most parents try to do their best by their children, and most psychiatrists try to do their best by their patients. And when awful things happen, I feel badly for the mothers of both the victims and the perpetrators, and for the psychiatrists. It’s a myth – and a burden – we hold that any of us can completely control the behavior of another human being.

<[QM—Dinah Miller, M.D.

Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011).