Throwaway05
2d ago
As before I will emphasize that I am a physician so my speaking is more to the medical model than the psychological one.
Physicians are often asked to "predict the future" we usually can't do this. People will ask "what will happen with my cancer" or other physicians will ask "is this patient medically cleared for surgery."
Usually we are only able to risk stratify. In the case of homicidal/violent ideation and suicidal ideation this is usually further bucketed into acute or chronic risk. Owning a gun ticks the needle substantially towards murder and completed suicide.
These are actuarial judgements more than practical ones. Is this person safe for discharge? At this time they have a low acute risk of harming themselves or others. Maybe 1/100 of people discharged in this way shoves someone onto the subway tracks. Maybe it is 1/1000. We cannot say definitively what an individual person would be, just as I can't tell someone asking about their malignancy what it is going to do. I can also speak of ratios and other such things.
As a matter of public policy you have to choose which things are sufficiently discriminatory to violate individual rights for the safety of the community. Having committed a felony? Yeah pretty convincing you shouldn't own guns anymore. I think most if not all states add an involuntary commitment to the list. If something increases your risk of doing bad shit 1,000 fold, maybe 10,000 fold? Pretty good argument that it's bad.
To the person here, when I speak about what this person reminds me of it's because I have not spoken to this patient or read his records. I can tell you that he pattern matches to other similar people who do meet criteria for something bad or I've treated in a forensic setting for having done bad shit who just need routine care because people get sick in jail. If interviewed as an adult a reasonable physician would likely be comfortable with a diagnosis like ASPD or NPD if the pattern of behavior holds.
Someone with those diagnosis are the central example of someone who should proactively have their rights taken away due to a tendency to violate the rights of others being a core part of the pathology.
I see some additional things in here like "Politicians justify releasing violent criminals from prison on the grounds that their problems are psychological, and thus implicitly treatable." I don't think that's what they are arguing, personality disorders are in general hard to treat and there is a reasonable stance that ASPD cannot be treated at all.
The actual discussion on this is complex although I imagine politicians are for the most part doing it wrong.
This was batched out at work quickly, apologies for typos etc.
Throwaway05
2d ago
You can't pick out individual things, you need to consider the whole context - this guy fought his dad, his mom was worried that he was going to be a "psychopath."
Some of the individual bits aren't too bad (who still posting here hasn't been called racist at some point) but the whole thing is highly alarming and as someone who has treated a lot of criminals this guy likely only evaded being outright criminal scum status by luck (born with enough social class/status and money to stay out of the underclass).
Some people will grow out of this but this person will lifelong struggle with impulsivity.
This is the kind of person who has a rocky childhood, figures it out, and then kills his wife and kids at age 57.
Throwaway05
2d ago
I don't understand how the NRA can't get anywhere with "this person can't complete the form because they were six years old and their parents are dead."
Throwaway05
2d ago
First, I do acknowledge that this stuff has been used to abuse gun owners, although less than they fear.
I've also filled out a million background checks and other similar documents, we have techniques, the classic of which was "no, I do not remember going to a psychiatrist three times at age 6." Patients forget things all the time. Patients forget heart attacks, and as long as you aren't in a centralized database (like for involuntary admissions) you won't be found out. Psychiatrists do cash pay for healthcare people to help facilitate this type of thing (so they don't have to report to boards).
And again, while it's onerous, practically speaking this shouldn't be a problem - people are required to store records and to use a document service if they sunset their practice. This is a common thing.
With respect to your linked case, are you familiar with it?
Through a cursory review the person described therein is a central example of someone who shouldn't own a gun and who should be prevented by any means necessary.
The guy has a history of violent and suicidal ideation, has acted out with aggression and violence, exhibits a pattern of poor impulse control, judgement, and insight and engaged in terroristic threats and other threatening behavior. To the extent that the person doesn't have any criminal convictions which precludes gun use is solely due to undercharging. The person likely meets criteria for a cluster-b personality disorder, probably on the border of Narcissism and Anti-Social. This person has a the profile of a mass shooter. I've seen people with multiple bodies who have less red flags. Put another way - I'd rather give a gun to a banger, at least he's only likely to shoot a civilian by accident.
Yes people age out of these personality attributes but it's pretty alarming, I imagine if you ran this case by non 2A people nearly 100% would say god no no guns, and even a super majority of 2A supporters would be like yeah fine.
Not a good test case.
Throwaway05
3d ago
Great, easy lawsuit then! "I went a few times as a kid to rule out ADHD and my parents and I don't have any records." Should be slam dunk 2A case.
I'm noting that your highlighted text does not note that seeing a psychiatrist outpatient is exclusionary.
Throwaway05
3d ago
have never seen any sort of mental health doctor,
Hold on isn't this just "involuntary or voluntary admission?" Per google found a law firm saying that's the case. Including voluntary is a bit sketchy in my mind but the steel man is pretty reasonable - "did someone in the community and a panel of experts on safety agree that you were an acute danger to yourself or others" is not that unreasonable. The reality of the situation means that sometimes admissions are soft but on paper "a bunch of people though you were going to kill yourself or someone else" is not that unreasonable of a disqualified for owning a firearm.
If for some reason this involves mundane outpatient interaction with a psychiatrist then people in the state have the easiest lawsuit in the world - just find someone who saw a psychiatrist one time as a kid because they were annoying, was going through grief or adjustment disorder or something like that and take it to the Supreme Court.
Throwaway05
3d ago
See response to FC, trying to call out one narrow bit.
Throwaway05
3d ago
At this point we aren't going to get anywhere with the whole "how real" COVID was discussion, but I am here to point out that we really authentically were worried. Healthcare was about to collapse (not because this was The One pandemic but because the system has little slack). The dominos are still falling directly from COVID.
Additionally, people zigzagged between it was a far right conspiracy theory to no this is real to scary Italian estimates to bad flu and all over the place but throughout we knew that some bad shit was going down.
What we did with that information is a much more debatable thing, but I'm here to remind the conspiracy types that if nothing else the healthcare and public health people believed it was a big deal.
Throwaway05
3d ago
I know many of the skeptics here remain insistent that COVID wasn't a big deal but that belief is nearly absent within healthcare itself, even the people who have concerns about the vaccine, social distancing plans, and other factors...they all think it was a big deal and if they worked inpatient they watched a lot of people die.
Even if he and they (us, really) were wrong...that's what we thought.
Also...the flu is bad and has been catastrophic before?
So in the acute phase this is the Y2K problem - people assume it wasn't an issues because everyone was proactive and the mitigation measures were opaque. We did stuff like put dermatologists in the ICU. That's not good! It worked well enough to get people through the immediate situation.
Now we have the chronic problems. Healthcare was already having a lot of problems but COVID kickstarted or hastened a lot. An example is the death of rural hospitals. Another is the way physicians have transitioned from being practice owners to hospital employees with a decrease in level of ownership (as in responsibility). Docs jump ship out of clinical practice way faster, won't put themselves at risk anymore. You also the travel nursing thing...
It caused a lot of problems that are still unfolding.
On the patient side we are still seeing things like decreased cancer screening and increase in treatment hesitance play out.
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