1. The Question - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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1. The Question

Therapist Resources > Therapy Books > How Dangerous

 How Dangerous is this Person? Assessing Danger & Violence Potential Before Tragedy Strikes

**Author’s Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.  

The e-mail arrived from Sandra in my Inbox in late April 2007.  It could have been another message, at another time, and after another tragedy.  It could have come after Aurora, Colorado or Newtown, Connecticut, or a decade or more earlier or next year.  It could have come yesterday, today, or arrive tomorrow.  In one form or another, it will inevitably come again. One way or another, the same type of inquiry arose after the bombings at the Boston Marathon on Patriot Day in 2013 even during the final editing of this book.  By the time one may be reading this book, there will likely be other individuals and communities confused and devastated by personal, local, national, or international tragedies.  Some events will have the attention of the world or the entire country or a small community or a single victim.  Other occurrences may shatter the lives of a few select people- a part of the background of violence in society.  The e-mail said,

“I have a young Korean-American client who is a college graduate student in literature.  He’s a writer.  I'll call him Jim. His initial presenting issues were dealing with a sense of isolation and his long-term resentment and anger from being misunderstood and bullied throughout his school career. This young man felt very alone and angry when he was younger.  Jim wanted to work on this because he was concerned it might eventually affect his relationships and career.  He is clearly exceptionally intelligent, and perhaps even brilliant in his work.  He has been recognized for his writing and received awards since high school.  He has been involved in an internship with one of his instructors, an editor for a literary magazine.  He finds that very stimulating although he is doing somewhat menial work as a "gofer."   

He talked about working on a graphic novel where the protagonist is dealing with anger over rejection, 'and being invisible' with the themes of justice, compassion, violence, suffering, victimization and bullying, and redemption.  It is very clear, that the novel is semi-autobiographical and that he identifies with the main character.  The plot of the novel culminates with an intense massive act of vengeance upon the main character’s abusers.  I don't want to be simplistic, and really don't want to be stereotypical or even worse, racist, so I need to be more clear if there is potential for violence with him. The conversation was disturbing to me after the recent violence at Virginia Tech.  

To be more blunt, my question is, how dangerous is my client?  How dangerous is this person?”

Sandra could have asked about two Chechen-born young men, a college student, odd character in the neighborhood, or disaffected former employee.  I received this query because I am a psychotherapist- a Licensed Marriage & Family Therapist in the state of California.  I work with all kinds of people in my private practice.  I see individuals, children, teenagers, couples, and families.  Due to my reputation, I get a fair proportion of very difficult teenagers and couples with highly challenging issues and presentations.  I have led drug diversion groups in the past.  I also train therapists, social workers, teachers, Head Start staff, vocational development programs, human services professionals, parents, and various other groups about understanding and working with people, including adults of all kinds, young children, teenagers, couples, families, groups from various ethnicities, religions, and vocations, gangbangers, at-risk youth, difficult or aggressive individuals, moody or angry people, and many others.  A variety of circumstances may be targeted: couples, families, classrooms and playgrounds at schools, at home including grandma's, mom or dad's new boyfriend or girlfriend's place, or the neighborhood, the "hood", or the mall, and at the workplace, organization, or institution.  I have researched and written about domestic violence as a part of my doctoral work on couples and couples therapy, which I will be publishing soon.  I have books published by a teacher press on children's behavior, discipline, tantrums, and bullying, as well as twenty dvds of me training on similar topics geared towards teachers.  As a result of my various activities, I am often asked to consult about problematic behavior a professional or a parent may encounter.  This occurs in my consulting and training work and this e-mail message was from someone who had attended one of my presentations.

The e-mail came shortly after April 16, 2007.  It could have come shortly after April 15, 2013 with only minor differences in the details.  On that April day in 2007 on the campus of Virginia Tech in Blacksburg, Virginia, a student, Seung-Hui Cho killed 32 people and wounded many more, before committing suicide.  This was the deadliest school shooting in U.S. history.  Only eight years before on April 20, 1999 at Columbine High School, two students, Eric Harris and Dylan Klebold, killed 12 students and a teacher, as well as wounding 24 others.   They also committed suicide before they could be captured.  Fresher on the national consciousness is the tragedy in Newtown, Connecticut.  On December 14, 2012, 20-year old Adam Lanza fatally shot twenty children and six adult staff members at Sandy Hook Elementary School in the village of Sandy Hook after first killing his mother.  And, the echoes of the bombings at the Boston Marathon still resonate as authorities are just beginning to interrogate the nineteen-year-old suspect Dzhokhar Tsarnaev and his older brother Tamerlan has died in a police shootout as these words are typed.  People all over asked, "Why?"  Speculation after the bombing began immediately and theories were presented prior to any conclusive evidence and before the suspects were identified (Weber, 2013).

The therapist, other professional, and acquaintance, co-worker, classmate, family member, or neighbor that had contact with a potential killer prior to violence may be need too more than ponder the questions, but be able to take protective actions.  Various professionals are mandated and in the position to protect other community members if duly informed.  In fact, anyone could direct the attention of authorities to a potentially dangerous individual.  In hindsight, lay people and professionals alike identify or remain confused about cues and indications about the individual's lethality.  The layperson may honor a moral responsibility to take steps to protect fellow community members.  There are of course, limitations to what the layperson or a professional including law enforcement and the medical profession may, can, and must do.  However, arguments about the scope of professional or ethical responsibility beg the professional's implicit responsibility to assess, diagnose, treat, and protect.  With greater responsibility comes greater anxiety for the professional.  What should the professional or therapist have known?  What can the professional or therapist recognize?  No professional can completely predict the future or the actions of his or her client.  However, the therapist or professional is often if not always anticipating and guessing at what the client or individual of concern will do based on a multitude of clinical observations of the individual's personality, temperament, emotions, and thinking, as well as knowledge of history and patterns.   In addition, the therapist or professional draws upon his or her education, training, readings, and experiences of comparable individuals or circumstances for consideration.  Sorting the expanse of indications, cues, knowledge, and observations is a demanding challenge, but a necessary one given the consequences of missing or misdiagnosing violence potential.

A therapist who should be actively and continually assessing his or her client may be directed by the guidance in this book.  However, the therapist is only one of many professionals who are among many people who may unknowingly come into contact with the individual with violent potential.  As is appropriate given education, training, experience, and accumulated expertise, other professionals may find the information in this book useful to guide further assessment, possible investigation, and appropriate action.  In addition the information may be useful as well to others, since everybody is a member of communities where they may not hold professional roles or responsibilities but are invested in personal and group safety.  For anyone, especially a non-professional further consultation with appropriate duly and legally responsible professionals or authorities remains absolutely essential.   Personal safety and the protection of individual civil and legal rights need to be honored.  While the information and concepts presented may have relevance as representative of types of violent individuals, assessment of an actual specific individual must conducted with great care by persons and organizations legally mandated and professionally trained to do so.   The therapist Sandra (not real name) presented her question to me out of her professional conscientiousness not to stereotype her client Jim based on ethnicity.  She also did not want to unnecessarily activate actions by protective authorities from a false sense of alarm.  If she did determine that he was dangerous to others, she may have been compelled to breach the confidentiality of the therapeutic relationship.  Breaching confidentiality would be a violation of Jim's fundamental legal rights to have his communication with his therapist protected from others knowledge without having given his permission.  Such a breach is allowed only under specific legal conditions that primarily seek to protect the client and others from harm.  In addition reporting Jim for example, to the police as a danger to others would set off a chain of actions where his liberty to move about freely would likely be restricted.  He could be imprisoned or hospitalized involuntarily.  

Seung-Hui Cho was of Korean ancestry having moved here as a young child.  Cho left behind angry and vengeful writings and videotapes chronicling a long history of mistreatment by others.  His intense resentment seemed to motivate his homicidal actions.  After the fact, laypeople and professionals have struggled to figure out the cause and origins of his violence, as was done after the killings at Columbine High.  And continue to be done after the killings at Sandy Hook Elementary, and have begun after the Boston Marathon bombings.  For some, this is to understand the tragedy.  For others, it is also to understand, anticipate, and hopefully prevent similar explosions in the future.  Unfortunately, examining prior episodes of violence by others such as the Columbine killers did not prevent Cho's outburst. “With his sadistic creative writing, contempt for snotty rich kids, militaristic posing, and heavily plotted revenge fantasy, Virginia Tech killer Cho Seung-Hui has eerily reminded many Americans of Columbine murderers Eric Harris and Dylan Klebold. Cho apparently saw Klebold and Harris as kindred martyrs, giving the boys two separate shout-outs in his suicide manifesto” (Cullen, 2007).  Will examination of other killers help prevent future homicidal outbursts?  No professional or therapist wishes to be similarly reminded of Cho, Harris, or Klebold, or Lanza or the Tsarnaev brothers suspected of the bombings at the Boston Marathon the one who failed to recognize a client’s potential for violence.  

Sandra's e-mail received shortly after the shootings, posted a question that was not hypothetical or academic.  Television and other media analysts (the Today Show, NBC Nightly News with Larry King among others) have argued as to whether Cho was an angry depressive, a psychopath, a schizophrenic, or a psychotic among other diagnoses.  Several resources, including Time (Veale) quoted family members saying that he had been diagnosed with autism when very young. This brought a quick response from AutismLink and Autism Center of Pittsburgh Director- Cindy Waeltermann that it was "unfair to blame Cho’s actions on autism."  As mental health clinicians, it is hard for the therapist not to speculate on the evolution and causes of Cho's violence.  Other professional and media pundits as well as laypersons make their guesses- sometimes, without any foundation and sometimes to the detriment of innocent persons who fall under unjustified suspicion.  Speculation however can be beneficial if it serves the professional to assess another individual, such as a client or client's intimate relationships for the potential of violence.  This can be in therapy with an individual, a couple, or a family.  The potential for violence may be expressed in vandalism, physical assault, suicide, homicide, child abuse, or intimate partner abuse. The aggression may be the material of common clinical attention such as emotional or psychological hurting or abuse or cross into physical or sexual abuse with intensifying levels of danger requiring professional breaching of confidentiality to report to appropriate governmental authorities.  The therapist who wrote the e-mail was concerned because there were elements in her client that were similar to Cho and his history.  However, there were also distinct elements the consulting therapist identified that allowed her to have confidence that her client was unlikely to erupt into violence.  These elements also help direct the therapeutic process.

The therapist can have a client like Jim in individual, couples, or family therapy.  He can be the father of children that would be vulnerable to child abuse if Jim were violent.  Jim could be married or in an intimate partner relationship and the partner would be vulnerable to emotional abuse, sexual abuse, and physical abuse.  He could have an elderly parent or grandparent who is dependent on his good will… who become dependent on his good mood or not whether he or she is fed, clothed, exploited financially, or beaten.  And, a violent Jim could strike out and kill and injure unknown strangers that somehow become the target of resentment in some self-righteous vigilante “retaliation.”  James E. Holmes was accused of killing 12 people and wounding 58 others in a movie theater in Aurora, Colorado on June 20, 2012.  As yet, there is no definitive explanation for why he chose to do this.  According to reports, he had been the patient of a psychiatrist at the University of Colorado’s Anschutz Medical Campus (CNN, 2012).  At preliminary court hearings he appeared dazed and out of touch with the events around him.  What the psychiatrist knew is unknown and what if anything the psychiatrist could have recognized as to his potential for violence unknown. His parents saw Jared Lee Loughner behaving more bizarrely prior and took some but not all recommended steps to care for or find care for him before he shot Representative Gabby Giffords in the head and killed six others on January 8, 2011 at a shopping center in Tucson, Arizona where Giffords was speaking (Siemaszko, 2013).  His "parents felt powerless to stop their son's descent into madness." Anders Behring Breivik killed 77 people in a bomb attack and gun rampage in the attacks in Oslo and on Utoya Island on July 22, 2011.  He was judged to be sane by a Norwegian court (CNN, 2012).  Breivik bragged that he was an ultranationalist who killed his victims to fight multiculturalism in Norway.  He acted he claimed to prevent the “Islamization” of his country.  Scott Roeder killed Dr. George Tiller as he was in his church, asserting the killing was necessary to protect "preborn children and the necessity to defend them" (NBCNews.com, 2013).

How are Klebold, Harris, Cho, Lanza, Holmes, Breivik, and suspects Tamerlan and Dzhokhar Tsarnaev similar or dissimilar?  They are almost all are acknowledged killers of strangers (Lanza, Holmes, and Dzhokhar Tsarnaev as yet not convicted as of the time of this writing).  Is killing strangers identifiably different than assaulting or killing someone known to killers- that is, abusers or killers of friends, family, spouses or partners, children?  How might they be similar or different than Lyle and Erik Menendez who were convicted of killing their parents August 20, 1989 when Lyle was 21 and Erik was 18 years old (Los Angeles Times, 2012)? Was Brian Mitchell who kidnapped and raped Elizabeth Smart when she was fourteen years old after he “married” her anything like the others (ABC News, 2011)? Was Phillip Garrido who kidnapped and raped Jaycee Dugard essentially the same as Brian Mitchell (New York Times, 2011)? Are those two kidnappers and rapists essentially different than Jerry Sandusky-former Penn State football coach who was convicted of 45 counts of charges of sexually assaulting 10 boys over 15 years (ydr.com, 2012)?  How do those circumstance have any relevance on singer Chris Brown physically assaulting his pop star singer girlfriend Rihanna in 2009 (CNN, 2009)? Was Chris Brown’s behavior different from San Francisco Sheriff Ross Mirkarimi who pled guilty to a misdemeanor count of false imprisonment after video evidence of his wife’s bruised arm was presented as evidence of domestic violence (sfist.com, 2012)?  Aside from being known celebrities, what might Rihanna and Mirkarimi’s wife Eliana Lopez- a Venezuelan telenova star share with Greg Louganis- Olympic gold medal winner who suffered domestic violence and rape from his male live-in lover (samoanmusicandvideo.com, 2012)?  What commonalities may be relevant to the two nursing home workers in Georgia, Jermeller Steed and Cicely Reed who were “charged with false imprisonment and battering a patient for the 2008 incident? The 89-year-old victim was restrained while the two women used a shower hose to run water over the victim's face, simulating drowning similar to the controversial torture technique, waterboarding” (wlrlawfirm.com, 2012).

What about Judge William Adams whose daughter Hillary posted a video of him beating her with a belt when she was sixteen years old for “discipline?”  He did not think he had done anything wrong in beating Hillary who has cerebral palsy (ABC News, 2011).  Sandusky also still does not admit any impropriety with the boys- just wrestling or horseplay in the showers. Judge Adams did not have charges filed against him.  On the other hand, four months was the sentence for James Moss who “brutally beat his then-9 year old son, stripping him naked, burning his hands and then throwing him into a kitchen oven.”  Thinking his son had stolen money from him,  “James Moss took his son to the basement and ripped off his clothes. Then he took the boy to the kitchen and used a spatula to beat him. He heated up two burners on the stove and held the boy's hands over the flames for two minutes. Police said Moss punched his son in the face and then pushed him into the oven, threatening ‘I'm going to burn you alive!’ The boy begged to be let out of the oven, which wasn't turned on, and then the father forced him, still naked, out the front door.”  Moss, unlike Judge Adams expressed remorse for his behavior when he was being sentenced.  Garrido, Brown, and Mirkarimi also expressed remorse for their behavior.  Are these apologies genuine?  Dugard, Smart, and Hillary Adams condemn the abuse they suffered if not also their abusers.  Lopez remained committed to Mirkarimi and Rihanna has had repeated interactions with Brown.  And Moss’ son spoke in his father’s behalf at his sentencing.  The questions presented are not rhetorical questions that imply judgments or opinions but are actual important inquiries whose answers can serve therapy, treatment, and intervention of potential perpetrators and potentially protect others.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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