Examining the Causation : New Details Emerge In Probe Of Oregon College Shooting

In 2015, the CBS News reported on the investigation into Chris Harper-Mercer and the massacre he has been deemed responsible for, at the Umpqua Community College, in Oregon. Although the article reports briefly about the crime, the victims, and the investigators, the focus of the report is on information pertaining to the shooter (CBS, 2015). Apparently, Mercer left behind a multi-page typed note that media has since been depicted his “manifesto” (CBS, 2015). The media describes the contents of the note as the “philosophical ranting of someone who was mad at the world” (CBS, 2015). It also stated that the contents of his note reveal Mercer had a low opinion of himself and his place in the world (CBS, 2015). Moreover, the shooter's social media pages suggest he was interested in the “IRA, frustrated by traditional organized religion and tracked other mass shootings” (CBS, 2015). Reportedly one social media post even suggests he was impressed with the “limelight” that other mass murderers had received for massacre shootings (CBS, 2015).

In the main picture in the article is of the police standing solemn-faced as they stand guard outside the apartment of the shooter. In conjunction with the image, the text in the article presents the criminal justice system as competent, well informed, and vigilant in their search for answers and possible motivation. Though they indicate as of yet there is no connection to any outside involvement or specific reasoning found, the information found and presented seems to suggest that the shooter had premeditated the crime for a long time (CBS, 2015). There is also the implication from the bulletproof vest that the shooter expected to be met with equal force and in a shoot-off with police (CBS, 2015).

Overall the article makes you feel as though the shooter was mentally unwell previous to the shooting. An example: In the first paragraph they cite, depressed and angry (CBS, 2015). Then later reporting they report he had feelings of low self-worth and/or feelings of hopelessness in regard to his place in the world (CBS, 2015).

From a psychological perspective, crime is explained on the individual level, as the result of dysfunctional thought processes and/or behavioral patterns, and/or personality characteristics (Conklin, 2008). The psychological theories that can explain the Umpqua Community College Shootings could be the “psychotic offender”, or a personality “trait theory” which resulted in a “rampage killing”. A personality trait theory perspective would indicate that certain features of personality may contribute to a persistent pattern of behavior that leads one to trouble with the law (Conklin, 2008). Whereas the psychotic patient may be driven impulsively to criminality by the onset of delusions or grandiose ideas (Schmalleger, 2014).

In this example, the investigators reported that the shooter had previously joined the US military in 2008 but was discharged after he failed to meet the military’s standards in boot camp (CBS, 2015). Perhaps this personal failure, in conjunction with “the personal inability, to tolerate frustration without resorting to aggression and violence” could have contributed to his violent behavior (Conklin, 2008). This would be concurrent with both “life course perspective” suggests that turning events in people’s lives can contribute to criminality and psychological theories that indicate a dysfunctional personality features are at the root of criminality.

Being that the crime has multiple victims, is not related to domestic or gang homicide, follows (although not immediately) the discharge from military, and involves a mentally unwell shooter who later dies on the scene, the reported crime fits the description of a rampage killing (Conklin, 2008). Unfortunately, many of these rampage killings involve victims who are unrelated to the cause of the rampage, such as students and teachers (Conklin, 2008). But, the most distinctive features of rampage killings is that the shooters are previously viewed as mentally unstable or mentally unwell and die either by suicide or engaging in activity that will likely kill them (i.e. shooting at an officer) (Conklin, 2008). Thus, it possible, given the information, that the killer was mentally ill, perhaps psychotic, but obviously depressed, filled with self-hatred, and based on his actions-ready to die.

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The Brain: Effective Depression Treatment

If I told you within this paper you would find the cure to a common and troubling illness, would you continue to read the whole paper through? According to the National Institute of Mental Health, of the estimated 18.8 million Americans who are affected by some form of depression, 9.5 million have major or clinical depression. Sadly, only 20 percent of these people are currently receiving treatment. Last year, two surveys indicated that 75 percent of depressed patients that seek treatment will receive an anti-depressant. About half of those taking an antidepressant will feel a positive effect from those medications. Less than half of the patients who receive antidepressants will receive psychotherapy treatment for their depression. Possibly, the most effective treatment for depression is treating the source of depression in conjunction with a lifestyle change. Medication should only be used to treat symptoms while receiving psychotherapy with the ultimate goal of being medication free. For more than half my life I suffered from a crippling depression that ruled my every action.  While receiving psychotherapy weekly and medication daily; I also researched mental illness and treatments thoroughly. I now feel cured and no longer receive medications or psychotherapy for depression and anxiety. Only after successfully treating my depression was I able to see clearly the only effective treatment for depression is a targeted and individualized therapy plan.

Most recent studies indicate a strong link between childhood trauma and adult symptoms of mental illness, including depression. The effect of childhood trauma on the developing brain can include increased levels of stress hormones, altered gene regulation, physical changes in hippocampus volume, and cortisol regulation malfunction. Trauma does not need to be life-threating, like physical or sexual abuse for it to be life-altering. Some of the other childhood traumas that result in adult depression can be unobvious ones. For example, emotional abuse, instilling fear in a child, repetitive and unwanted criticism are all examples of unobvious trauma. A child can also be traumatized by the unintentional neglect of two working parents, or rather the events that take place while the two parents are working. Another example of childhood trauma is a prolonged parental separation of any kind. Adoption as a result of abandonment or separation; even if the child grows up in a happier home, they often still feel very abandoned or alone. Violence in the family, neighborhood or TV can cause equal psychological damage, as exposure to constant fighting or yelling within the home. Possibly the most common childhood traumas today that cause adult depression are divorce, family addiction, racism, and poverty, yet this is often not taken into account. Many are aware of the underlying emotional issues that result from these experiences, but how many know these experiences actually shape our brains to be predisposed to depression and mental illness? Experiencing trauma in early life, changes our brain first physically, and then chemically; equally and as a result of our perception of reality and our perspective on life also changes.  With all these chemical changes within the brain, I can understand why so many seek to remedy the problem chemically with medication.

However, I am not convinced that a chemical or drug is an effective long term treatment solution for depression. I have actually tried Paxil, Zoloft, Prozac, Abilify, Celexa, Lexapro, Effexor, Cymbalta, Welbutrin, Lithium, Depakote, Seroquel, and Lamitical, with no success at treating my depression. In fact, living with side effects was often worse than the depression.  While attempting to treat my depression with medication, I gained 80 lbs and was diagnosed with Fibromyalgia. At age 26, I felt as though I was left with a depressed mind and a broken body. After many doctors and therapists, after countless failed attempts to get the “right” combination of medication, after a million tears, I stopped leaving it up to the doctors and started researching on my own. When I started reading the facts about depression medications, I was startled to find out the long list of lasting side effects these medications can leave you with. For example, Tardive Dyskinesia is a facial tic that can be a devastating side effect of some of these medications. Besides the fact, these medications have serious side effects there is also little evidence to support their effectiveness. It made me crazy to read, the pharmaceutical companies sponsored researchers are finding there is little difference between the placebo and the pill. Some studies also indicate no significant advantage to taking higher doses of these medications, as it is suggested by many doctors. Modern research suggests these drugs even target the wrong neurochemicals and the real problem is structural. So many fail to recognize, even effective medications are only treating the symptoms of depression, they do not actually treat the cause of the depression. Ultimately medication is a Band-Aid and underneath the problem is still unchecked. With an average of only 30% of these patients feeling relief from their depression when treated chemically, isn’t it time we tried another method?

The road to recovery from depression is a long, rocky and uncertain climb. Many will never see actual recovery from depression, some will see a remission of their depression symptoms, and most will see a re-occurrence of their symptoms within their lifetime. However, there is hope for those willing to explore the path less traveled, often called psychotherapy. Psychotherapy is less frequently received than medication, yet it yields higher recovery rates and lower relapse rates. Recovery from depression requires treating the underlying relationship causes to depression with psychotherapy, creating a safe environment for the patient to grow in, meeting relationship needs that were not met in childhood, and giving the patient the tools to identify and combat any negative emotional, relationship, cognitive or neuromuscular patterns. Utilizing such tools as, Cognitive Behavioral Therapy (CBT), Repatterning Movements (RPMs), and even hypnosis you can safely address the faulty thought processes that keep the mind depressed. Evidence suggests that psychotherapy can induce positive neuro-biological and structural changes within the brain. Meditation, yoga, art and movement therapies can be quite soothing and help significantly with the many symptoms of depression. In addition to psychotherapy, maintaining a healthy lifestyle is critical to the success of any depressed patient. One important step to depression recovery that is often left out is exercise. Exercise not only helps with the physical body, but it also releases endorphins and affects self-image too. In addition, a patient must change their physical environment and surroundings to reflect their change of mindset. There will be little success for any patient who remains in an unhealthy or re-traumatizing environment. Since the source of one’s depression is individual and unique to them, I do not believe in a universal answer to depression. I see a combination and individualized approach as the solution and possible cure for depression.

During the last few paragraphs we have discussed depression facts; we have mapped the possible sources, exposed startling facts about depression medication and even directed the way to recovery.  With almost 19 million Americans suffering chances are that you know and love someone with depression. I want you to know there is hope for your loved one. Hope for the depressed lies within successfully treating the source of their depression with psychotherapy, not in successfully managing their symptoms with medication. Although treatment of depression symptoms is a critical first step to successfully treating the depression it is not the last, but rather the first of many steps. I can’t stress enough how important psychotherapy is to healing and how fundamentally important processing childhood trauma is to develop a healthy adult mind. I know there is truth in what I say because I did not just write this paper, I have lived it.  Although this paper was supported with detailed research, it was written and inspired by the real experiences of depressed patients and her struggle to find a cure. The answer wasn't always as clear as I wrote it for you today. It took countless hours of reading, over a thousand heartbreaking therapy sessions, ten years of independent research, hard work, and even some trial and error to come to this one conclusion. Only after successfully treating my own depression was I able to see clearly the only effective treatment for depression is a targeted and individualized therapy plan.

Dissociative Identity Disorder: Research Concerning Etiology, Treatment, and Diagnosis

Dissociative Identity Disorder, formerly called Multiple Personality Disorder is a disorder in which the persons suffers from a disturbance in normal integrative functions of memory, identity, and consciousness. The DSM-IV-TR (2012) has classified Dissociative Identity Disorder under the following criteria: “The presence of two or more distinct identities or personality states that recurrently take control of the person’s behavior, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self with an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness” (American Psychological Association, 2012, Butcher, 2009, p.292). This disturbance is “not caused by physiological effects of a substance like blackouts or chaotic behavior during Alcohol Intoxication or a general medical condition like complex partial seizures” (American Psychological Association, 2012; Butcher, 2009, p. 2009). Lastly, in children, these “symptoms are not attributable to imaginary playmates or other fantasy play” (American Psychological Association, 2012).

Current research of Dissociative Identity Disorder has focused on understanding the memory disturbances, clinical features, best treatment and as always proving the etiological validity of the diagnosis. The etiological validity of the diagnosis has been of particular interest to researchers because this diagnosis has historically been discounted as not-real because of a controversy surrounding its pathology. Spano’s (1994) suggested the sociocognitive model of Dissociative Identity Disorder, that suggested this disorder is constructed iatrogenically through therapists and maintained by clients who enact social roles. However, most, if not all, of the current research, discredits the sociocognitive model of Dissociative Identity Disorder and supports the trauma models which suggests that development of did nearly always occurs in the face of early trauma and childhood abuse (International Society for the Study of Trauma and Dissociation, 2011).  In fact, the data supports the validity of three different trauma models.

The Four Factor Model

The Four Factor Model suggests that the following for factors precede the development of Dissociative Identity Disorder: the child has the capacity for dissociation, the experiences that overwhelm the child’s non-dissociative coping capacity, there is secondary structuring of Dissociative Identity Disorder  in which alternate identities with individualized characteristics such as names, ages, genders; and there is a lack of soothing and restorative experiences rendering the child isolated or abandoned and need to create ways of managing distress on their own (International Society for the Study of Trauma and Dissociation, 2011).

Structural Dissociation Model

The Structural Dissociation Model of development in Dissociative Identity Disorder supports that this disorder develops as a result of the failure to integrate aspects of personality, including ideas and functions, following traumatizing events. In this model, the whole personality system is first divided into two parts including the “apparently normal part of the personality” dedicated to daily functioning and an “emotional part of the personality” dedicated to defense i.e psychobiological functions of survival in response to life threat, such as fight/flight (International Society for the Study of Trauma and Dissociation, 2011). This theory suggests that chronic traumatization, neglect, and/or child abuse can lead to “secondary structural dissociation and the emergence of additional emotional parts of the personality” (International Society for the Study of Trauma and Dissociation, 2011).

Developmental Model

In the Developmental Model of Dissociative Identity Disorder, this disorder is thought to begin in childhood when early attachment needs are not met, childhood integration does not occur and personalities states do not integrate into one continuously unified personality state (International Society for the Study of Trauma and Dissociation, 2011). Attachment to primary caregivers is a biologically programmed need and attachment style is an important factor in childhood development and the development of relationships later in life (Howell, 2011, p.89-104). Healthy attachment occurs when the primary caregiver and the child form a secure bond. A secure bond is formed when the caregiver responds to the babies needs in a way that soothes him or her and keeps the baby happy and safe, thus the baby develops a feeling that their caregiver is a secure base which they can leave to explore and then return to when distressed (Howell, 2011, p.89-104). However, when the child forms a bond because this caregiver is the only source of the attachment and the relationship must be preserved, even in the face of abuse, a disorganized attachment is often the result (Howell, 2011, p.89-104).

No one is born with a unified sense of self or personality this is created through linking behavioral and personality states (Simeon, 2008). A sense of a unified identity develops from experience in childhood when behavior states become linked over time and grouped together in sequences that flow effortlessly (Howell, 2011). For proper integration and identity development, this linking of behavioral and personality states must occur (Howell, 2011). For this linking to occur, the child must have a secure attachment that responds to the child in such a way that the child begins to create an internal singular representation of themselves (Howell, 2011). In the face of severe ongoing trauma and neglect which is repeated consistently throughout early childhood and other important developmental stages integration or the development of a unified sense of identity is delayed (Howell, 2011).

A child has the natural ability to separate many of their feelings and memories from consciousness (Howell, 2011). This innate ability allows children in the face of abuse to escape to a the fantasy world and create alternate states (Howell, 2011). In the face of ongoing neglect and trauma, these alternate states can endure the abuse or neglect while the child maintains attachment. Sadly, if this pattern of abuse and attachment continues through development these dissociated parts (most commonly referred to as alters) can develop a sense of self, accompanied by their own memories, state of consciousness, biophysical characteristics, and manifest their own speech mannerisms, physical behavior, handwriting, somatic manifestations of the disease, sense of body, sense of history (Howell, 2013). Commonly terminology to describe alters includes describing them by their function or characteristic, i.e. hosts, children alter, abuser alters, differently gendered alters, animal alters, manager alters, inner-self helpers, protector alter, caretakers alters and abuser alters (Howell, 2011).

Dissociative states are a normal response to trauma and stress found in all humans across all cultures and studies indicate that the etiology models of DID that explain the symptom patterns found in Dissociative Identity Disorder patient that include chronic childhood trauma have validity for the entire human race (Ross & Ness, 2010). Dissociative Identity Disorder differs from simple dissociative states because the dissociated states develop a sense of self and identity and there are dissociative barriers or an amnesic boundary between the fragmented states of self-called alters (Dissociative Identity Disorder, 2013). Interestingly, research demonstrates these different alters show variable “visual acuity, medication responses, allergies, plasma glucose levels in diabetic patients, heart rate, blood pressure readings, galvanic skin response, muscle tension, laterality, immune function, electroencephalography and evoked potential patterns, functional magnetic resonance imaging activation, and brain activation and regional blood flow using single-photon emission computed tomography and positron emission tomography with switches” (International Society for the Study of Trauma and Dissociation, 2011, p. 121).

While this sounds as though it may appear dramatic in easy to spot this actually contrary to the truth, in fact, less than 6%  of the population with Dissociative Identity Disorder will present so obviously (International Society for the Study of Trauma and Dissociation, 2011).  More likely they will not appear in and the overdramatized histrionic presentation that is often presented in the media, instead, the person will likely be “intellectualized, obsessive, introversive, with an avoidant and/or self-defeating personality profile with co-morbid disorders both dissociative and post-traumatic symptoms, as well as many apparently non-trauma-related issues such as depression, substance abuse, eating disorders and anxiety” (Jewels, 2013). The symptoms displayed can be categorized more accurately in three major groups’ straight forward dissociative symptoms, Schneiderian first-rank symptoms, and psychotic-like dissociative symptoms (Dell, 2006). Straight forward dissociative symptoms include “amnesia, voices, conversion, self alteration, derealization, depersonalization, flashbacks, trances, identity confusion and awareness of alters” (Dell, 2006). Schneiderian first-rank symptoms include “voices arguing, voices commenting, thought withdrawal, thought insertion, made impulses, made feelings and made actions” (Dell, 2006). Lastly, Psychotic-like dissociative symptoms including both “auditory hallucinations and visual hallucinations” are also commonly reported by these patients (Dell, 2006).

Tragically, the classification of the DSM-IV-TR barely touches many of the important factors associated with making a diagnosis of Dissociative Identity Disorder such as causation and etiology, terminology, functional dynamics, symptomatology and most importantly non-observable symptoms such as state-dependent amnesia, conversion symptoms, self-alteration, derealization, depersonalization, flashbacks, trances, identity confusion, awareness of alters, voices, thought withdrawal and insertion, made impulses, feelings and actions and nonpsychotic auditory and visual hallucinations (Dell, 2006). Accurate diagnosis of this disorder can be done with diagnostic tools such as the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ-20), and the Structured Clinical Interview for Dissociative Disorders (SCID-D), as well as, through patient self-reports and clinician observation (International Society for the Study of Trauma and Dissociation, 2011). Sadly, despite diagnostic availability often these patients spend 11.9 years seeking treatment before they receive an accurate diagnosis (International Society for the Study of Trauma and Dissociation, 2011). Misdiagnosis for a Dissociative Identity Patient really is tragic because treatment can significantly reduce symptoms and with integration therapy helps the patient form a more unified and functioning sense of self.

Treatment that is given with a focus on relieving dissociative symptoms is effective in reducing a range of symptoms associated with dissociative disorders including dissociation, depression, posttraumatic stress disorder, distress, and suicidality (Brand, Classen, McNary & Zaveri, 2009). Effective therapy for these patients often includes phase-oriented treatment plans starting with phase one establishing safety, stabilization, and symptom reduction (International Society for the Study of Trauma and Dissociation, 2011, p.135). The focus of early treatment is helping the patient understand, accept, and access the alternate identities that play an active role in their current lives will help the patient develop internal cooperation and increase co-consciousness (International Society for the Study of Trauma and Dissociation, 2011, p.139). In phase two, the therapeutic focus is on confronting, working through, and integrating traumatic memories (International Society for the Study of Trauma and Dissociation, 2011, p.135) The later stages of therapy are focused on identity integration and rehabilitation (International Society for the Study of Trauma and Dissociation, 2011, p.135).

Dissociative identity disorder has been closely linked to early childhood abuse, trauma memories and disorganized attachment patterns that delay the normal process of normal personality development and memory integration in early childhood. Dissociative Identity Disorder is a challenging mental health disorder to recognize and treat because of multiple causative factors and confusing symptomatology. It is important for those who are working in the field to be aware of the etiology of Dissociative Identity Disorder, the symptoms and presenting a presentation, current diagnostic tools, terminology, and treatment for this disorder because this disorder is often misdiagnosed or left undiagnosed and untreated. Treatment of this disorder mainly consists of psychotherapy geared at relieving dissociative symptoms and the integration of dissociated memories and personality states. This treatment is unique to this group of patients and medication alone will not relieve the dissociative symptoms, which is why an accurate diagnosis is vital to symptom reduction and treatment.   

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References

American Psychiatric Association (2000-06). Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc. pp. 526–529. ISBN 978-0-89042-024-9. Retrieved from DOI:10.1176/appi.books.9780890423349.

Brand, Classen, McNary, Zaveri. (2009) A Review of Dissociative Disorders Treatment Studies Journal of Nervous & Mental Disease Volume 197 - Issue 9 - pp 646-654. Retrieved from doi: 10.1097/NMD.0b013e3181b3afaa.

Butcher. (2009). DSM-IV-TR Dissociative Identity Disorder  Abnormal Psychology, 14^th Edition. Pearson Learning Solutions. VitalBook file

Dell P. (2006). "A new model of dissociative identity disorder". Psychiatric Clinic North America. Retrieved from http://www.copingwithdissociation.com/Dell_2006_ANewModelofDID1.pdf#

Dissociative Identity Disorder. (2013). Dissociative Identity Disorder: Etiology. Dissociative Identity Disorder.org. Retrieved from http://www.dissociative-identity-disorder.org/

Gillig, P, M. (2009). Dissociative Identity Disorder A Controversial Diagnosis. Psychiatry Edgmont 6(3): 24–29. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2719457/

Gleaves, D, H. (1996). The Sociocognitive Model of Dissociative Identity Disorder: A Reexamination of the Evidence. Texas A&M University. American Psychological Association, Inc. Retrieved from https://www.ptsdforum.org/c/gallery/-pdf/1-41.pdf

Howell E. (2011). Understanding and Treating Dissociative Identity Disorder. New York: Routledge. ISBN 0415994969.

International Society for the Study of Trauma and Dissociation (2011) Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12:2, 115-187 retrieved from http://dx.doi.org/10.1080/15299732.2011.537247

Jewels, K. (2012). An Examination of the Evidence: Misdiagnosis and Dissociative Identity Disorder. A Literature Review on Dissociative Identity Disorder. Retrieved from http://www.kaytjewels.com/2013/05/dissociative-identity-disorder.html

 Ross C, & Ness L. (2010). Symptom Patterns in Dissociative Identity Disorder Patients and the General Population. Journal of Trauma & Dissociation.11(4): 458-468. Abstract. Retrieved from  DOI:10.1080/15299732.2010.495939

Simeon D. (2008). Dissociative Identity Disorder: Patient's Reference. Merck.com. Merck Manual for Health Care Professionals. Retrieved from http://www.merckmanuals.com/professional/psychiatric_disorders/dissociative_disorders/dissociative_identity_disorder.html