Aaron Alexis and the Threat of the Loner

Here’s an Op-Ed I wrote with my husband in Friday’s Washington Post:

SHOOTER0061379350985In seeking to find out what led to the shootings at the Washington Navy Yard, we must ask the right questions. What features of American society make us more prone to mass homicides? Many will focus on the availability of guns. Others will note that mass homicides are overwhelmingly committed by men, or comment on the role that untreated mental illness can play. We must also examine the role of social isolation: It can be a tripwire for violence and mask our ability as a society to see violence coming.Americans have always had dueling commitments, both in our national mythology and in our everyday lives, to rugged individualism and to civic engagement. We want people to stand alone, but we also want to band together.

Unfortunately, our zest for independence can become something far different: toxic social isolation. And our society doesn’t do well at bringing vulnerable people at our margins back into the fold. It’s not just for their sake that we should do so, however, but for our own.
In a national sample of Americans that we surveyed annually in collaboration with the Gallup organization, respondents were asked, “Who do you spend free time with?’’ and “Who do you discuss important issues with?” The study, published last year, found that U.S. residents identify an average of 4.4 close social contacts. On average, people identified the following contacts: 2.2 friends, 0.76 spouses, 0.28 siblings, 0.44 co-workers and 0.3 neighbors. At one extreme, 5 percent of Americans had eight such people with whom they were socially intimate. But at the other end of the spectrum, 8 percent of Americans reported having no one with whom they could talk about personal matters or spend free time. (This percentage has stayed relatively constant over time, despite the advent of the Internet and the increase in online and mobile interactions, according to the Pew Internet & American Life Project.) This isolated minority often suffers in silence.The same Gallup survey followed up on socially isolated and more integrated people. It found that socially isolated individuals were less likely to donate blood, money or clothing; support political candidates; or volunteer to help prepare for a major public emergency. In other words, they lacked the social-emotional connectedness that many Americans take for granted. Such individuals might also be more prone to violence.

University of Chicago psychologist John Cacioppo and his colleagues, using the nationalHealth and Retirement Study and other data, have documented the heavy burden that social isolation and, in particular, loneliness place on individuals. Loneliness increases one’s risk of depression, and Cacioppo and his colleagues have noted that it affects physical outcomes such as blood pressure, cholesterol level and the risk of early death. When people feel socially isolated, they increase their vigilance for threats and feel more vulnerable. Sometimes they even become paranoid. There is some evidence, from a 2005 paper in the British Journal of Psychiatry, that social isolation is a risk factor for the development of schizophrenia.

Unfortunately, as seems to be the case with Aaron Alexis, a mentally ill person’s social isolation makes it hard to recognize, or act on, the danger signs of impending violence.

We can’t know what went on in Alexis’s mind. Not all people who are alone feel lonely, of course, and extremely few go on killing rampages. But it is worth paying attention because social isolation harms not just those directly affected but also the majority who are not isolated.

Research we have conducted with political scientist and geneticist James Fowlerfound that a person’s sense of loneliness depends on how those in his social network are feeling. You are about 52 percent more likely to be lonely if a person to whom you are directly connected is lonely. But there is an even more extraordinary pattern at the edge of social networks. On the periphery, people have fewer friends; this makes them lonely, and it paradoxically drives them to cut their few remaining ties. But before they do, they may “infect” their friends with the same feeling of loneliness, starting the cycle anew. These reinforcing effects mean that our social fabric can fray at the edges, where it is weakest, like a yarn that comes loose at the end of a sweater.

To combat loneliness in our society, we should aggressively target the people on the periphery with interventions to repair their social networks. Even better would be to prevent some of these individuals from ever becoming socially isolated. Society’s many options to reduce risks of social isolation include targeting not just veterans suffering from stress disorders but also broader groups, such as young people who feel alienated, or bullied or the unemployed who feel unwanted. By helping those at risk of social isolation, we can protect our social fabric from unraveling.

About ErikaChristakis

Yale Lecturer in early childhood education/Licensed teacher/Former preschool director and Harvard College house master/some-time journalist. In possession of: unmarketable bachelor’s degree (Harvard, anthropology), semi-marketable graduate degrees (public health, education…). Rewarding career at the intersection of family, society, and schools (including long stint in parenting vortex). Forging a new path to connect all of the above.
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3 Responses to Aaron Alexis and the Threat of the Loner

  1. Jay Maybruck says:

    Best Solution:

    1) Mandate free National pre-school through grade 12 MANDATORY Public Education and fund schools equally and adequately..Mentally assess and test all students at key ages of development competently. Pay field experts and cognitive learning professionals to design a detailed core National Curriculum pre-school-grade 12. Include daily course work in learning skills, mental and emotional health, diet, and exercise for all students at all grades.

    2) Mandate actual training in early childhood development, (dumbed down) for all first time mothers.

    3. Repair Foster care and properly fund and administer Childhood Protection Services.

    4. Pass meaningful gun laws nationally.

    5. Grasp what cannot be controlled through social institutions.After the above politically difficult actions (a vast understatement) are accomplished and are put in place for 20 years, mass shootings will probably decrease.

    6. Execute all broadcast news/opinion anchors who ask WHY in cases like the Navy Yard shootings. The answer is self-evident.

  2. Ava Healy says:

    I am writing this in response to the recent op-ed by you and Nicholas in the Washington Post, “The Threat of the Loner,” published 9-20-2013. That this piece blames the Navy Yard massacre (or most of the most recent similar tragedies from Newtown CT, Aurora CO, the Gabby Giffords shooting in AZ, etc.), on those who are “loners” or lonely is so contrary to established scientific knowledge about schizophrenia that it harkens back to Freud and his fantastical theories, which set mental disease back to the dark ages just as advances in curing or treating diseases below the neck were advancing rapidly in the late 19th and 20th century.
    One of my parent’s siblings suffered from this disease and unfortunately killed someone in the throes of a psychotic episode, and I have an educational background in science, so I was just appalled by this op-ed. I urge you and Nicholas to read Charles Krauthammer’s op-ed, this same day for a very clear analysis of the problem. Mr. – or Dr. Krauthammer – was a practicing psychiatrist before becoming a pundit and although I rarely agree with anything he writes politically, he was spot on with this issue. [Nonetheless, I do think that restricting the sales of guns in our society would help, as it has in other countries such as Australia].
    Most, if not all of these recent massacres were caused by individuals suffering in the throes of a psychotic state cause by a disease that arose probably in the womb, that has both genetic and physical causes, none of which have anything to do with being lonely or isolated. Indeed, the withdrawal and/or isolation seen in schizophrenia are symptoms of, NOT causes of the disease. Fever, for example, is not a “disease,” it is a symptom of a disease usually caused by an infectious agent, like a bacteria. This is a disease in which the actual brain wiring, myelination, and chemical balance in the brain is completely awry.
    Yes, there are lonely people in our society, and yes they can suffer mental health issues like depression as a result, and yes, we should try to help them, but that is like comparing a common cold to stage 4 cancer. And it is rare that these cases result in these mass shootings, or mail bombings like the Ted Kaczynski case. And, there are actually those who are introverts and/or may be functioning autistics and prefer their solitude, and your “loner” moniker is a slur against those who are healthy, functioning and non-violent members of society.
    There is a real difference between being a “loner” as the press so mistakenly identifies these perpetrators and, excuse the expression, “bat-shit” crazy. It is similarly futile, and I say this as an attorney, to try to find a “motive” for these individuals’ actions. Motive is entirely irrelevant when a voice inside your head, caused by auditory short circuits in the wiring of the brain, is telling you that others are trying to harm you via microwaves. It is also backwards to try to punish these mentally ill, no matter how heinous their crimes, when they are in such a psychotic state. To do so assumes a capacity and mentally healthy way of thinking that these poor souls completely lack. Yes, they need to be held against their will so that they do not cause harm to themselves or others, and yes, they need to be treated (and yes again, against their will as they have no capacity to make rational decisions about their own care), but what purpose does punishment serve in these cases? It is as nonsensical as their actions.
    No amount of touchy-feely interaction with a paranoid schizophrenic is going to help (and might even be perceived as threatening), unless that interaction results in getting necessary medical treatment for that individual, especially given the difficulty in treating mentally ill people who don’t want to be treated, or will not continue with meds.
    Please don’t trivialize these tragedies with screeds about loners or loneliness. It minimalizes a serious public safety issue.

    • Thank you for your comment. You raise many important issues and are correct to point to a shameful history of victim blaming. However, I think you have missed some key points we tried to make or perhaps we have failed to explain our point of view adequately (not helped by the title, which is always selected by an editor, not the op-ed writer, and designed to simplify and/or distort meaning for maximum impact, I’m afraid.)

      That being said, for context, we do have a lot of experience with people suffering psychosis, in my case both as a counselor on an inpatient ward for individuals with schizophrenia and other thoughts disorders and also in my own personal social circle. My husband/co-author is a physician (former hospice doctor and hospice director) who has also had a lot of clinical experience with serious mental illness. Some of your comments resonate, but quite a few do not align with my direct experience or my review of the current scientific literature.

      But rather than engage in a clinical dispute (about which, frankly, none of us is expert!), let me just say that our intent was in no way to stigmatize or harm people with serious mental illness. On the contrary, we want to help vulnerable people who are living on the periphery of society and who deserve compassion and care. I certainly don’t want to return to the damaging era of labels like “schizophrenogenic mother” and all of the terrible baggage that came from those blaming and inaccurate labels.

      Nonetheless… 21st century science is shedding light on the complexities of many primarily biological processes and it’s increasingly clear that the old nature/nurture arguments are largely moot for a great many conditions. The field of epigenetics is changing the way we understand gene expression – not as something fixed at birth but malleable subject to different conditions. Obesity would be a good example of how this switching on/off process works but there are countless more. It’s long been known that schizophrenia varies considerably under different environmental conditions and now there is some evidence of the directionality of that causal relationship (i.e. it’s not ONLY that psychotic people might flock to cities for whatever reason, thus increasing the prevalence of psychotic people in urban areas, but also that there might be something about urban life that could help, in part, to trigger psychosis in genetically susceptible people). In many ways, this shouldn’t be surprising to us. We know for example that formerly healthy prisoners can become psychotic under the influence of extreme sleep deprivation, noise pollution, or, yes, social isolation; indeed, solitary confinement is a well-recognized form of torture – used extensively by psychiatrists in the Soviet era to induce psychosis and, unfortunately, psychosis is a too common byproduct of our own American prison system where thousands live in total isolation.

      And there is increasing evidence, too, that early identification of some of the prodromal symptoms of schizophrenia noticed as early as childhood or the teenage years can improve the functional prognosis of a person who eventually suffers from the illness via earlier medical management – including not only pharmacology but behavioral and environmental strategies, too. In my own personal experience, I saw individuals suffering from major thought disorders like schizophrenia who responded (to varying degrees) to cognitive behavioral strategies such as teaching the ill person how to manage the voices in his/her head, what to ‘say’ to them and how to manage them in public situations etc. I’m not talking about people in the absolute worst throes of florid psychosis but I AM talking about people who are by no definition ‘normal,’ i.e. they are actively hearing voices and making disturbing/strange comments that suggest ‘craziness’. A recent New Yorker article from the last couple weeks discusses a case, with a relatively positive outcome, in some detail.

      I mention all of this because I think it’s incredibly important that we learn as much as we can about mental illness not only to help the mentally ill but also because, as we argued in our article, the problem of social isolation also harms society in another way: people who are mentally ill can become socially isolated, thus making it harder and harder to recognize and intervene to prevent the rare but devastating cases when such a person commits violence. Many perpetrators of psychotic violence had multiple warning signs and even tried – sometimes in the throes of their psychosis – to get help. Their social isolation makes it hard to see this coming or to offer help.

      It seems to me an injustice to ignore the complexity of factors that can both contribute to the expression of mental illness and make it hard for mentally ill people to be helped. There is much we still don’t know. But we can’t allow our fear of discredited (and damaging) theories to blind us to new and important ways of looking at mental illness. In the meantime, it’s hard to argue that increasing efforts to help socially marginalized people is a bad thing. I can’t possibly back away from that argument.

      Thank you, again, for taking the time to write.

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