1) "I read the comment when it came out, and dismissed it outright. Consider the source, Ian. He can be a professor of psychiatry, medicine, law, pottery, and basket weaving for all I care. But he doesn't do predictive modeling for a living, does he? That's a very special expertise. He isn't qualified to speak to the matter. (His statement of absolutes pretty much is a giveaway.)"
2) "No, you can't create a model that will predict the time, place, and act for each and every individual in a population. But you absolutely can predict the likelihood that any one of a number of events might happen. Over time, you can refine what it is you are predicting (making the findings "actionable") and refine what it is you'll do about the information that any model or set of models will tell you (making the entire process more practical). It's an iterative, never-ending process."
Ah. You've dismissed the guy and you agree with him. What did he say? He said that you can't predict all future incidents of violence. To say anything else would imply omniscience and would be delusional. That's why you admit that in throwing out his idea (and saying anyone who states absolutes is DQ'd from argument) you accept this point. The fact is there are absolutes. Here's one: "we will not prevent gun violence in the USA." Here's another: "We will not prevent all cancer deaths." What does he say next? That while we can predict some events we can't predict all and we might not get most. You haven't presented any data to the contrary. All you've said is that predictive modeling will contribute, which is true, but I would contend that your lack of experience with psychiatry handicaps you as much as his lack of predictive modeling experience. No one has all the answers.
"Your first mistake - a mistake you continue to make over a period of years - is to get defensive. We are not in a court of law. I am asking for solutions, and you keep giving me excuses. And I will not accept that kind of response."
I actually haven't heard specific entreaties for solutions. In the last discussion on Cho, I heard comments that people dropped the ball, based on tidbits from the news and no experience with how life works in, say, their psychiatry clinic. Yes, I am still responding to that. As far as giving you excuses, it's really not a fair characterization. I don't consider it "an excuse" to explain the context of how psych holds work, how people go off their meds or can't be forced to take them, or how prediction of these events will always be imperfect; that's just an explanation. It is a counterbalance to posts you make where you suggest that anyone who says violence can't be 100% prevented isn't qualified to participate in the discussion!
"The most recent systematic review on this subject, published in the journal PLoS Medicine in 2009 and involving over 18,000 subjects in 11 countries, found that individuals with schizophrenia were more likely, as compared to the general public, to commit acts of violence, regardless of how violence was measured (etc)"
No argument from me. It is of course no secret whatsoever that schizophrenics are more prone to violence than regular people, nor is it a secret that prior events, going off meds, drug abuse, and having disturbing command hallucinations are risk factors for violence.
"One study in American urban centers found that nearly a third of patients who were discharged from the hospital and also diagnosed with substance abuse were violent within one year.
Again, there's no argument from me. I add only the caveat that "violence" in this context has to be rigorously defined. It turns out that many of the "attacks" medical workers suffer are from confused elderly who hit us. Similarly, when we talk about schizophrenics being violent, much of this means being restrained by police or psychiatry workers, or some fisticuffs. I'm not at all minimizing the gravity of these events, just distinguishing them from organized, highly lethal mass murder which is vanishingly rare. We also must consider that substance use may reflect severity of schizophrenia as well as worsen it primarily. But it's a valid risk factor to consider.
"The United States Secret Service has studied eighty-three (83) such individuals. And by the account of the reporters on 60 Minutes, the similarities with Laughner are "alarming." Expert after expert is saying how these violent acts "are not impulsive, random events.""
Again, no argument from me. Of course there is value to USSS or FBI profiling. These people may have similarities. My caveats are that we MUST consider the denominator. Let's say that almost all people who murder have antisocial traits. Great! How many million people in the USA have antisocial traits? How many are holdable? Force medication-able (incidentally no meds work for antisocial PD)? How many can be barred from owning a gun (before their first big act of violence)? How many people are available to police this population? Who pays them?
"None of these strategies would necessarily have prevented the Arizona shooting, and they certainly will not eliminate the possibility of similar occurrences in the future. But they would reduce their likelihood and, at the same time, substantially improve the lives of one of the most disadvantaged and misunderstood patient groups."
"I'm not saying we don't try. I'm not saying we don't have high expectations. I'm not saying it won't be better if we do."
"Yes, there are great models for active mental health teams that go into the community, monitor intensively, provide lots of therapy and followup, and do better than others."
I have also repeatedly championed the provision of carefully rationed services to those in need; your statements on this matter have at times said little more than if people can't pay they might not get treatment, and this refusal to encourage dependency might enhance their dignity.
From Ian's highlighted quotes:
"It would mean you would actually have the resources to do something we haven't done yet, which is get people treatment. We have been very good at emptying the hospitals. What we haven't done is to offer treatment once people are out of the hospitals. In Arizona, for instance, they closed down most of the hospital beds. They are next to last in the United States in the availability of hospital beds for the population, and they have closed down some of the outpatient clinics. If you want to get serious about mental illness, then you need to provide the resources so people can be treated."
"He isn't qualified to speak to the matter. (His statement of absolutes pretty much is a giveaway.)"
"None of these strategies would necessarily have prevented the Arizona shooting, and they certainly will not eliminate the possibility of similar occurrences in the future."
Ok, now you've utterly lost me. I have never, ever, once come to these discussions and said that we can't help schizophrenics or prevent some episodes of violence. Of course we can and I'm the one who's voiced support for expanded (but rationed) coverage on these very forums. I'm the one that's bemoaned the defunding of AZ health services; I'm the one who bemoaned the defunding of San Diego mental health services; I'm the one who works with dozens of psychiatrists who deal with the half absent "safety net" for these people who are severely disturbed through no fault of their own.
I specifically say that we should try, set high expectations, and acknowledged the success of many active, outgoing mental health community teams. How, on earth, is your WSJ quote a "checkmate?" Your WSJ quote is my manifesto: support these teams, fund the healthcare, but admit that it's not going to be perfect or easy. It is 100% consistent with my prior statements.
Your WSJ quote is a checkmate to your comment about their previous expert; you go disqualify an expert from the discussion because he is absolutist and says prevention won't be perfect, and then you go and quote, as your coup de grace an authority who clearly states that these events are absolutely impossible to completely eliminate.