Shootings: Medications and Video Games

[Ormond]

There is never going to be just one cause of school shootings, either at the level of explaining an individual shooting or in explaining the overall incidence of them. 

If one wants to explain the difference between the level of mass shootings in the USA (in schools or anywhere else) and most other countries, one has to look at that causal factors that are the most different between the USA and other countries. It seems to me that the gun culture and ready availability of guns is the biggest difference between the USA and other "developed" nations. So I think we'd get the most results from tackling that issue.  Unfortunately in terms of American politics it's one of the harder of the causal factors to really change in our culture. 

[TrueMetis]

6 hours ago, Martell Spy said:

 

Never said that anyone on this board has claimed this. I put it in the title as video games are a favorite scapegoat for shootings. And medications are being used a scapegoat for the same thing. And I'm an active player of violent video games, so it's a pet peeve of mine.

I do think all the various scapegoats are letting off the actual culprits. Gun manufacturers, the Supreme Court, gun activitists.

 

You're psychic.

ETA: Oh and apparently this is a fake account, why does the news suck so much at fact checking?

[karaddin]

15 hours ago, DMC said:

Whomever said this reminded them of the 90s was spot on - I feel like it's post-Columbine all over again.  Perhaps we should have complementary threads blaming Marilyn Manson, Natural Born Killers, trenchcoats, and Hitler's birthday.

Finding out what an abusive piece of shit Manson is, and that he used this public persona as a perfect cover (that's just his public image, not really who he is!) has really undermined my ability to look back at the bullshit that was trotted out.

I think my big pet peeve with the kind of blanket statements that initiated this thread spin off is it sucks all the oxygen out of the room to discuss legitimate issues with the pharmaceutical industry and it's business model, along with only counting adverse effects on those who take it and not the adverse effects on those whose lives would have been appreciably better had they had access to appropriate medications from an earlier age.

Yes antidepressants are a complicated tool. I have major concerns about them being utilised in some inappropriate cases due to a patient being in need of assistance, and they are the only potential assistance the doctor has a chance of providing, so they get tried. But the issue there isn't the drugs, it's the lack of other options for people in need. I also have concerns about insufficient warning being provided about many of them forming strong dependency with nasty withdrawal, so patients aren't aware they may face it in the future and may not know about the need to taper off slowly. Still doesn't mean the drugs don't have appropriate uses though, just that they need better processes around their use.

The elephant in the room if you're talking about the US specifically is the utterly horrifying lack of regulations around pharmaceuticals and marketing. They shouldn't be products pitched directly to consumers via TV advertising FFS.

But the pharmaceutical industry as a whole is a lot more complex than simplistic demonizing makes it out to be. There are an awful lot of excellent researchers working within the field with the intent of improving people's lives and they're entirely distinct from the layer of capitalism that sits on the top and is responsible for the vast majority of inappropriate behavior.

The slam on ADHD drugs in particular is a popular one that comes up again and again, but for those that they work on they can be transformative and denying those that need them out of an alarmist insistence that they're terrible just fucks over a different group of people. I know several people who take methylphenidate (the drug in Ritalin) in a couple of different forms and it's wonderfully effective for them. The same for others with dexamphetamine.

I can't claim to know where I'd be if I'd received the medications I needed before I flushed the "prime of my life" down the drain, but I'm pretty sure I'd have had a more successful career with a lot less pain in my teens and 20s. So please keep in mind the need for balance instead of just panic merchanting.

[Centrist Simon Steele]

16 hours ago, Ormond said:

There is never going to be just one cause of school shootings, either at the level of explaining an individual shooting or in explaining the overall incidence of them. 

If one wants to explain the difference between the level of mass shootings in the USA (in schools or anywhere else) and most other countries, one has to look at that causal factors that are the most different between the USA and other countries. It seems to me that the gun culture and ready availability of guns is the biggest difference between the USA and other "developed" nations. So I think we'd get the most results from tackling that issue.  Unfortunately in terms of American politics it's one of the harder of the causal factors to really change in our culture. 

I think these are great points, Ormond. Lots of cultures play violent video games, and lots of cultures use medication to treat issues surrounding mental health. Those cultures with the lowest incidences of gun violence, are the same cultures that regulate firearms.

2 hours ago, karaddin said:

Finding out what an abusive piece of shit Manson is, and that he used this public persona as a perfect cover (that's just his public image, not really who he is!) has really undermined my ability to look back at the bullshit that was trotted out.

I think my big pet peeve with the kind of blanket statements that initiated this thread spin off is it sucks all the oxygen out of the room to discuss legitimate issues with the pharmaceutical industry and it's business model, along with only counting adverse effects on those who take it and not the adverse effects on those whose lives would have been appreciably better had they had access to appropriate medications from an earlier age.

Yes antidepressants are a complicated tool. I have major concerns about them being utilised in some inappropriate cases due to a patient being in need of assistance, and they are the only potential assistance the doctor has a chance of providing, so they get tried. But the issue there isn't the drugs, it's the lack of other options for people in need. I also have concerns about insufficient warning being provided about many of them forming strong dependency with nasty withdrawal, so patients aren't aware they may face it in the future and may not know about the need to taper off slowly. Still doesn't mean the drugs don't have appropriate uses though, just that they need better processes around their use.

The elephant in the room if you're talking about the US specifically is the utterly horrifying lack of regulations around pharmaceuticals and marketing. They shouldn't be products pitched directly to consumers via TV advertising FFS.

But the pharmaceutical industry as a whole is a lot more complex than simplistic demonizing makes it out to be. There are an awful lot of excellent researchers working within the field with the intent of improving people's lives and they're entirely distinct from the layer of capitalism that sits on the top and is responsible for the vast majority of inappropriate behavior.

The slam on ADHD drugs in particular is a popular one that comes up again and again, but for those that they work on they can be transformative and denying those that need them out of an alarmist insistence that they're terrible just fucks over a different group of people. I know several people who take methylphenidate (the drug in Ritalin) in a couple of different forms and it's wonderfully effective for them. The same for others with dexamphetamine.

I can't claim to know where I'd be if I'd received the medications I needed before I flushed the "prime of my life" down the drain, but I'm pretty sure I'd have had a more successful career with a lot less pain in my teens and 20s. So please keep in mind the need for balance instead of just panic merchanting.

Couldn't have said it better myself (but, duh, you have a real skill in communicating issues surrounding complex ideas with empathy and kindness). When I was growing up, ADHD was considered laziness. All my life I was told I was lazy, super smart but unwilling to work hard--and it hurt a lot. I felt like I was working hard. I lived a childhood full of anxiety thinking something was wrong with me. I struggled through college, but kept it together enough to graduate. I struggled through my first years of teaching middle school--I did a great job with students, but I couldn't manage the grading, the planning, the organization. In my early 30s, I was finally diagnosed with (according to my psych, a severe case of) ADHD. She put me on Concerta. Within a month my entire life changed. My inability to organize and put into routine stacks of grading suddenly became clear. I got ahead in everything. I felt happy. Now I'm a year away from obtaining my PhD and getting a tenure track position.

It changed everything. 

I hate the demonization of medication. We need lots of better mental health support services in this country, and medication is a piece of the issue as you said.

[Martell Spy]

Not trying to shut down discussion of medications. That's partly what this thread is for. It would probably be a good idea to provide some evidence when linking them to gun violence, and school shootings in particular, however.

There are many financial barriers for low-income people in the U.S. I'm quite familiar as I have a disease that requires maintenance. It's quite costly and made more so by the AMA's status as gatekeeper. You can get cut off from something as simple as a cream to heal eczema, a situation I've been in.

There's also a lot of pain patients, legitimate ones, that get cut off from pain medications. This is especially difficult as obviously addiction is also a legitimate worry. But I've suffered many times because I'm aware I can't ask doctors for pain medications. I know I'll label myself as an addict if I do that. So I'm left to the whims of the doctors as they decide how much pain I get to endure during a bout of illness. (Outside the hospital that is, when hospitalized you can easily ask for pain meds)

 

 

 

[Martell Spy]

4 minutes ago, Martell Spy said:

Not trying to shut down discussion of medications. That's partly what this thread is for. It would probably be a good idea to provide some evidence when linking them to gun violence, and school shootings in particular, however.

There are many financial barriers for low-income people to access medications in the U.S. I'm quite familiar as I have a disease that requires maintenance. It's quite costly and made more so by the AMA's status as gatekeeper. You can get cut off from something as simple as a cream to heal eczema, a situation I've been in.

There's also a lot of pain patients, legitimate ones, that get cut off from pain medications. This is especially difficult as obviously addiction is also a legitimate worry. But I've suffered many times because I'm aware I can't ask doctors for pain medications. I know I'll label myself as an addict if I do that. So I'm left to the whims of the doctors as they decide how much pain I get to endure during a bout of illness. (Outside the hospital that is, when hospitalized you can easily ask for pain meds)

All this is to say I'm worried much more about lack of access to medications than I am them being too available. It's a somewhat myopic view, but it's also not fair to assume the starting position of there being immediate access to medications. The ACA changed a lot, but the landscape is still pretty damn bad out there.

 

 

 

[DMC]

5 hours ago, karaddin said:

I think my big pet peeve with the kind of blanket statements that initiated this thread spin off is it sucks all the oxygen out of the room to discuss legitimate issues with the pharmaceutical industry and it's business model, along with only counting adverse effects on those who take it and not the adverse effects on those whose lives would have been appreciably better had they had access to appropriate medications from an earlier age.

Yeah between that and providing a distraction from gun control as Ormond mentioned it's doubly unproductive.  Also, reflecting on memories circa Columbine, it undermines the overprescribing to children which actually is a problem, or at least was at the time in my experience.  To the point that the clear majority of my upper middle class high school* was either prescribed pharmies or taking them recreationally - and kids would attempt to get prescribed adderall etc. in order to sell them.  I always thought making kids see Christina Aguilera monsters and enjoy Phil Collins' music was enough of a cautionary tale without making the fallacious connection to school shootings (or violence in general).

*And even this appears to be isolated to a rich kid problem - studies show, in the aggregate, if anything children are under-prescribed potentially helpful medication.

[HoodedCrow]

I found overprescribing all sorts of psychiatric meds, in kids and adults. It is disturbing and concerning. The worst part was the sloppiness in the diagnoses and very little monitoring. 
I know a current adult friend who doesn’t seem to know that her bald spots, lethargy and weight gain (like now needs knee surgery) are probably due to a medications for bipolar disorder. She had mild OCD, and doesn’t fit the criteria for bipolar. She is a mess now in 2 years of every antidepressant there is, in multiples. She was much better before it started. Strangely, she didn’t have “ bipolar” until her medication were switched around. It’s more arbitrary than you think. 
I’m all for good diagnoses, thoughtful medications and real follow up with real monitoring. ( which would include bmi, muscle tone checks, blood pressure and heart rate checks, lab tests, sleep checks and mood questions, especially at first.)

I do prefer non drug solutions, if possible. Cognitive Behavior Therapy can help Positive psych is good if it is well timed and IFS can be used well. If medications work and helpful, great. Good is good. 

[Martell Spy]

Quote

 

I found overprescribing all sorts of psychiatric meds, in kids and adults. It is disturbing and concerning. The worst part was the sloppiness in the diagnoses and very little monitoring. 

 

 

 

I will say, I found it kind of disturbing that family medicine doctors prescribe anti-depressants. I didn't even know this was a thing until a while back I heard about a close relative that was prescribed it. I'm not a health professional, but the reason I found it disturbing is that means they are diagnosing, or treating with diagnosis. I know family medicine doctors are kind of jack of all trades, but this just seems to be taking it too far. 

 

[karaddin]

5 hours ago, Martell Spy said:

 There's also a lot of pain patients, legitimate ones, that get cut off from pain medications. This is especially difficult as obviously addiction is also a legitimate worry. But I've suffered many times because I'm aware I can't ask doctors for pain medications. I know I'll label myself as an addict if I do that. So I'm left to the whims of the doctors as they decide how much pain I get to endure during a bout of illness. (Outside the hospital that is, when hospitalized you can easily ask for pain meds)

Yeah I was biting my tongue to avoid mentioning this angle due to the focus being on a bogus connection to gun violence. This is absolutely a problem, and it's one that's mitigated by privilege so screws over those with less resources a lot more. I'd be dead without having had access to sufficient pain killers for months after issues healing from a surgical procedure, a lot of people in that situation will turn to the black market as it's easier and often cheaper to get what you need there. Of course it's also less safe, with the risk of fentanyl where it's not supposed to be, and if you do OD under those circumstances you get categorized as an addict and used as a statistic in justifying the policies that caused you to need to use the black market in the first place.

I'm in the privileged bucket on this one and do actually have access to what I need, but it feels like being on thin ice and makes my blood boil for those who don't have the money to see less overworked doctors, the education to be able to articulate their need, and the other privileges (race is obviously a big one here) to be able to get what they need.

3 hours ago, DMC said:

Also, reflecting on memories circa Columbine, it undermines the overprescribing to children which actually is a problem, or at least was at the time in my experience.

Yup, it's complicated (bet you didn't see that coming? Lol). I think the overprescribing has largely been focused on the visible and much more stereotypically "male" symptoms - the hyperactivity and associated disruptive behavior, because those are the ones easiest to see and most annoying to parents and teachers. It's also often less of an issue long term. The attentive and executive function issues on the other hand can be hard to spot in a kid, if they're even manifesting yet - if you find school sufficiently easy you can coast to university before it starts to cause serious problems, and they're much less of a problem for teachers and parents. So these have been under diagnosed and treated, and there's a heavy gender skew on this as well. The actual numbers of people with ADHD are pretty balanced when you look at adults, but there's a significant gap in the childhood diagnosis.

The executive function difficulties get increasingly disruptive as you try to be a functioning adult, and a lot who only get diagnosed as adults have similar revelatory experiences to what Simon described. So yeah. Complicated lol.

2 hours ago, Martell Spy said:

I will say, I found it kind of disturbing that family medicine doctors prescribe anti-depressants.

As I said in my earlier post, some of this just comes down to people needing help and family doctors having nothing else they can even try to do. It's not all the cases obviously, but it will help some of the people. I don't like them being pushed as the front line choice, but they do at least function as a poor crutch for some and a poor crutch can still be better than none at all. I do wish there was more acknowledgement of "I feel shit because my life is objectively in a shit place right now" actually being a reasonable assessment of circumstances rather than depression, when those circumstances are shit. There are other options which can still provide a little aid in those cases while carrying less side effects.

3 hours ago, HoodedCrow said:

I’m all for good diagnoses, thoughtful medications and real follow up with real monitoring. ( which would include bmi, muscle tone checks, blood pressure and heart rate checks, lab tests, sleep checks and mood questions, especially at first.)

This flies in the face of the medical concept of informed consent, although obviously the other half of that is that the patient needs to be aware that these side effects can happen and able to discontinue treatment if they experience any side effects unacceptable to them. The focus on weight gain here at the top really gets me into an antagonistic mindset though.

I'm on several medications to prevent migraines and most of them carry weight gain as a side effect, and it's a side effect I've very much experienced. They undid some very hard work I did before that, but I'd take that trade again in a heart beat. My life, which I'm largely happy with, wouldn't be possible without a number of the medications I take, so I view the whole thing as a series of trade offs and they're all excellent value.

In my quest for an effective combination I have tried other medications which were not worth the trade off and was able to discontinue their use. These side effects have ranged from near catatonic levels of fatigue, to vulnerability to seizures I don't normally have with bonus significant personality change for several months, to causing every major joint in my body to loosen to the point of popping in and out quite easily. In all these cases I was able to taper off the medication and go back to the drawing board.

But the weight gain? Not a major issue. You start talking about mandatory BMI tests and it sounds a hell of a lot like you're going to start taking people off medication without their consent. And given the experience in the last 10 years for people with chronic pain losing access to the pain killers they need, that sounds alarm bells. Some testing should absolutely be done and it should be guided by what you're taking, one of my medications can cause heart problems so I was monitoring my blood pressure and had an ECG upon reaching the therapeutic dose. I have semi regular blood work done to monitor a number of other factors. But at the end of the day I'm the patient and as long as I'm aware of the risks its my decision to make. Personality changes are more complex, as they're not easy to measure and the ability to monitor for them will also rely on having family or colleagues/peers who are trusted enough to recognize and report on them.

And none of this very long post really has anything to do with gun violence in the US because these subjects are far more wide reaching with the potential to impact a lot of people if you get it wrong.

[Raja]

5 hours ago, Martell Spy said:

but this just seems to be taking it too far. 

 

I disagree. Family Medicine, or GPs on this side of the pond are supposed* to be the first point of contact for the majority of the population, and they are an entirely appropriate doctor to diagnose and treat depression, some of this will involve prescribing anti-depressants whilst for others it will mean CBT or talk therapy. Family Medics or GPs treat newborns to people that are in their 90s, they are trained to have that breath of experience and know their patients better than anyone else in the health system. Anti psychotics on the other hand are generally prescribed by a psychiatrist. Family medicine doctors prescribe a whole host of medications among the various specialties of medicine ( Cardiology, Respiratory, Nephrology etc).

Antidepressants work wonders for some, they don't work at all for others. A lot of medicine is trying to find what works best for our patients, and ensuring that they are involved in the decision making so that we move away from the paternalistic approach that we've had historically.

This whole conversation regarding medications is a very strange one.

[Centrist Simon Steele]

3 hours ago, Martell Spy said:

I will say, I found it kind of disturbing that family medicine doctors prescribe anti-depressants. I didn't even know this was a thing until a while back I heard about a close relative that was prescribed it. I'm not a health professional, but the reason I found it disturbing is that means they are diagnosing, or treating with diagnosis. I know family medicine doctors are kind of jack of all trades, but this just seems to be taking it too far. 

 

We had to do this with my son--psychs in your insurance network aren't available, or those in your network won't see kids, or the specialist copay is really, really steep. It's an insurance issue, and family doctors are just filling that gap for us.

[HoodedCrow]

Badly filling the gap, but it’s much better if you do your own checking. No, the BMI check is to see if the person gains or loses too much weight from the meds. I gained 20 lbs I cxouple of months. This change represented a quarter of my body weight, and I was just started on the med for insomnia. I also had irritability, anorgasmia, costipation, fatigue, increased heart rate by a lot, increased blood pressure, my blood sugar was never checked, and orthostatic hypotension. The new GP insisted that I increase the dose as a solution, but I got better when she suddenly stopped it when I said “ enough”. Just weight alone( yes it’s not a good measure but doctors use it anyway) would show if the meds continue to cause weight gain.
Like I said one friend was given a meds and now requires knee replacement and a wheelchair. This person was friendly and active. She made her own deer repellant! Sent creative cards. Now, she is afraid to be on her own at all. She is on three meds, which keep getting charged. I do not believe that she suddenly became bipolar in her fifties, coinciding with being given a med or three. She still doesn’t know the basics of how to settle herself with many simple methods…which could have been learned ages ago. She still doesn’t read the side effects, or get what they would do. She is quite intelligent but she does trust her doctor too much. She is not unique.

if someone does respond well to meds, then they are fortunate. It is probably a good match with their personal enzyme pathways. It isn’t a moral issue. And, hurray! I dont think someone like Simon would sit around if he had poor results:)

[Week]

*Taps mic*

The question was: where are the casual links to violence and, specifically, school shootings?

[HoodedCrow]

I think the weight checks should totally be guided by informed consent. The troubling part is that I have never heard even of a doctor here that really does informed consent. ( usually they don’t even trouble themselves to tell you your own blood pressure! )You are right about the gender gap in ADHD, but there seems to be a real one in autism, for example. Simon has credible and fixed ADHD. I found a med for insomnia which helps, after trail and error. It is not a cure my family is hardwired for that. For routine insomnia there is sleep hygiene.

For garden variety anxiety and depression, there are many helpful strategies. Some are very easy to learn. If someone were suicidal, that is a good time for SSRI’s. Parenting classes for parents could help some of this.

For real, an old good book is Feeling Good by David Burns..( CBT) There are many excellent books that aren’t as clunky. I like Richard Swartz’ ideas and therapy. Martha Linehan has good stuff on Borderline personality, but it is broadly applicable. Meditation helps with many things. Breathing methods can help a lot. Having other people around that get you helps. Positive psychology is good if you are up enough for it. ( forcing someone depressed to feel grateful is a non starter.) Music and movies help. Some Buddhist thought experiments can work. Knowing how you think helps. Exercise in the right way helps.

[mormont]

1 hour ago, HoodedCrow said:

there seems to be a real one in autism, for example

No, there doesn't. Again, modern research suggests this is due to differential diagnosis.

ETA - also, 'borderline personality disorder' is misdiagnosed far more frequently than even ADHD, depression, and autism to the point where many doubt that it even exists as a separate diagnosis.

[HoodedCrow]

Yes, borderline is used as a catchall, and I wouldn’t trust it. The materials used for “ borderline” personality” are excellent and could be used more broadly. The diagnosis for autism has become so commonplace as to be meaningless. We miss real ADHA because it’s mildly tricky!

[Ormond]

23 hours ago, Martell Spy said:

I will say, I found it kind of disturbing that family medicine doctors prescribe anti-depressants. I didn't even know this was a thing until a while back I heard about a close relative that was prescribed it. I'm not a health professional, but the reason I found it disturbing is that means they are diagnosing, or treating with diagnosis. I know family medicine doctors are kind of jack of all trades, but this just seems to be taking it too far. 

 

As someone who taught Abnormal Psychology to college undergraduates for over 30 years, I have to point out that many experts believe the above is a major part of why there is a correlation between taking antidepressants and suicide risk. 

A fact about the relationship between suicide and major depression that doesn't seem to be generally known by regular physicians is that the highest risk for suicide for someone with severe depression is NOT when they are at the "bottom of the curve".  Severe depression usually leads to a lack of energy and motivation and ability to plan which means that people at the deepest level don't act on their self-hatred and suicidal thoughts. It is just when one is starting on the upswing from the deepest level again, when many have energy and motivation back before their suicidal thoughts have disappeared, when people are actually most likely to actually kill themselves.

Though of course there are charlatan and/or incompetent psychiatrists, psychiatrists are more likely to be seeing patients regularly and to be aware of the above information and so monitor them more closely for possible suicidal tendencies when they are on the "upswing" than general practitioners are. The marketing of drugs like fluoxetine (Prozac) to general practitioners may have resulted, ironically, in people whose depression was being a little bit lifted by the drugs being more able and willing to act on their suicidal thoughts. 

[mormont]

4 hours ago, HoodedCrow said:

Yes, borderline is used as a catchall, and I wouldn’t trust it. The materials used for “ borderline” personality” are excellent and could be used more broadly.

I'll bow to others on that but my understanding is that this is a significant oversimplification. The spectrum of issues you seem to be taking issue with runs from mental illness to personality disorders to neurodiversity, and the fact of the matter is that these are all very different things. It would be irresponsible to pretend that treatment options even within these categories, let alone across them, share so much that the above is a fair statement.

4 hours ago, HoodedCrow said:

The diagnosis for autism has become so commonplace as to be meaningless.

That is simply not true.

[karaddin]

Yeah there's still a strong weighting for traits more commonly associated with autism in boys in the diagnostic criteria that makes it a lot harder to get a girl diagnosed. As an example the stereotypical socialization difficulties of being awkward socially and having a hard time reading the emotions of other people is a substantial part of diagnosis, but socialization issues can also manifest as personality mirroring where you become whoever the people you're talking to expect you to be. It's hard to explain succinctly and I'm doing a poor job, but it's much more common in girls with autism.

Given the substantial overlap in things like executive function difficulties I'm not at all convinced ADHD and autism are even distinct things, ADHD could simply be one set of typical presentations of underlying neurological changes which can include additional things we group together and call the autism spectrum. The ones we can ADHD just happen to be the ones we also can often help with medications, and I'd also say are ones people are less likely to identify with and want to keep. 

None of which has anything to do with shootings because there's no casual link between ADHD, and it's medications, or autism and shooting up your classmates.