Throwaway05
6d 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
6d 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
6d 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."
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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