Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Suicide rate masked by coroners’ verdicts

By Martin Beckford, Health Correspondent
07 Oct 2011, Daily Telegraph (http://www.telegraph.co.uk/news/uknews/law-and-order/8811351/Suicide-rate-masked-by-coroners-verdicts.html)

Many more inquests are ending in “narrative verdicts” rather than a ruling that someone killed themselves, often because of caution over their intention.

But it is feared that this may mean up to 6 per cent of suicides being wrongly classified as accidents, which could be “masking the effects of the economic crisis on suicide”.

In an editorial published in the British Medical Journal, Prof David Gunnell at the University of Bristol and colleagues said: “This increased use of narrative verdicts has important effects on the estimation of national suicide rates because these verdicts present coding difficulties for the Office for National Statistics – when suicide intent is unclear such deaths are coded as accidents.”

Official figures show there were 4,648 suicides in England and Wales in 2009, based on the verdicts given by coroners after inquests into unexpected deaths.

But many hangings, overdoses and poisonings are being treated as possible accidents, with coroners ending inquests in narrative verdicts that give an account of how the death occurred in a few sentences.

The number of narrative verdicts has risen from just 111 in 2001 to 3,012 – more than one in 10 inquests – in 2009.

This is despite the fact that suicide is sometimes strongly implied in the verdict, with phrases used such as “deceased took his own life with an accidental overdose”, according to the BMJ study.

If all deaths from hanging and poisoning were classed as suicides rather than given narrative verdicts, the suicide rate would be 6 per cent higher.

This would account for almost a third of the National Suicide Prevention Strategy’s target of reducing suicides by 20 per cent.

But even this figure could be an underestimate because the ONS did not include all common methods of killing oneself.

The academics warn: “As the use of narrative verdicts rises, so too may the underestimation of suicide.

“The consequences of this could be incorrect rate estimates, misleading evaluations of national and local prevention activity, and masking of the effects of the current economic crisis on suicide.

“Furthermore, because coroners vary greatly in their use of narrative verdicts, suicide rates may (falsely) seem to decline in areas served by coroners who make most use of such verdicts.”

But Prof Louis Appleby, chairman of the Government’s National Suicide Prevention Strategy Advisory Group, insisted: “There is nothing new in finding that some probable suicides are omitted from official statistics because of doubts about the person’s intent.

“Coroners used to record verdicts of accident or misadventure in many such cases, now they may record a narrative verdict.

“There is no reason to doubt the fall in suicide in England in the last decade, though of course we should continue to examine how narrative verdicts are used.”

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Supervision lacking on emotional issues

Supervision lacking on emotional issues, survey finds
Kirsty McGregor, Community Care
Tuesday 12 April 2011 12:12

Nearly three-quarters of social workers (71%) do not feel supervision covers the emotional issues that arise in practice, a survey has shown.

BASW – The College of Social Work released the survey results to launch a consultation on its draft supervision policy, published today. This stipulates that supervision should enable social workers to manage the emotional impact of their work.

It comes a week after children’s minister Tim Loughton told Community Care that employers should “debrief” social workers after particularly traumatic child protection cases to avoid burnout.

“Supervision is an absolutely vital element to successful practice, to social workers’ confidence, morale and, in some cases, mental health,” said BASW policy officer Fran McDonnell.

Two in five survey respondents said they received formal supervision every two months or less, and 11% rarely or never received it.

“This survey shows that many social workers are not getting even the most basic of requirements from employers, which jeopardises the quality of support they can provide to families most in need,” McDonnell added.

BASW’s supervision policy recommends that every social worker, no matter how experienced, should receive formal supervision at least once a month. Supervision should be weekly and then fortnightly for newly qualified staff.

The Social Work Reform Board recommended the same frequency in its draft supervision framework for social workers in England, published in December 2010.

More than half of the online survey of 177 BASW members do not feel their supervision covers accountability issues or personal development and training.

Community Care’s social work contract states that social workers should receive a minimum monthly professional supervision of at least 90 minutes.

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Validating female psychopathy subtypes: Differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health

Finally, I present this bit of research. Interesting because it unusually looks at female rather than male psychopathy.

However, you cannot understand it if you don’t not know what is understood by the terms primary and secondary psychopathy. I can only offer an abstract of the article (above) – academics can follow this up, for most practitioners it may just be food for thought.

[Journal Article]
Validating female psychopathy subtypes: Differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health.
Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.
Personality Disorders: Theory, Research, and Treatment, Vol 1(1), Jan 2010, 38-57. doi: 10.1037/a0018135
Abstract

1. Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems, including symptoms of posttraumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to nonviolent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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THE PSYCHOPATH

Here we go, the scary word. Lets see what the angelfire website has to say:

Psychopaths cannot be understood in terms of antisocial rearing or development. They are simply morally depraved individuals who represent the “monsters” in our society. They are unstoppable and untreatable predators whose violence is planned, purposeful and emotionless. The violence continues until it reaches a plateau at age 50 or so, then tapers off. Their emotionlessness reflects a detached, fearless, and possibly dissociated state, revealing a lower autonomic nervous system and lack of anxiety. It’s difficult to say what motivates them – control and dominance possibly – since their life history will usually show no bonds with others nor much rhyme to their reason (other than the planning of violence). They tend to operate with a grandiose demeanor, an attitude of entitlement, an insatiable appetite, and a tendency toward sadism. Fearlessness is probably the prototypical (core) characteristic (the low-fear hypothesis). It’s helpful to think of them as high-speed vehicles with ineffective brakes. Certain organic (brain) disorders and hormonal imbalances mimic the state of mind of a psychopath.

There are four (4) different subtypes of psychopaths. The oldest distinction was made by Cleckley back in 1941 between primary and secondary. However, we’ll explore the other two subtypes first:

DISTEMPERED PSYCHOPATHS are the kind that seem to fly into a rage or frenzy more easily and more often than other subtypes. Their frenzy will resemble an epileptic fit. They are also usually men with incredibly strong sex drives, capable of astonishing feats of sexual energy, and seemingly obsessed by sexual urges during a large part of their waking lives. Powerful cravings also seem to characterize them, as in drug addiction, kleptomania, pedophilia, any illicit or illegal indulgence. They like the endorphin “high” or “rush” off of excitement and risk-taking. The serial-rapist-murderer known as the Boston Strangler was such a psychopath.

CHARISMATIC PSYCHOPATHS are charming, attractive liars. They are usually gifted at some talent or another, and they use it to their advantage in manipulating others. They are usually fast-talkers, and possess an almost demonic ability to persuade others out of everything they own, even their lives. Leaders of religious sects or cults, for example, might be psychopaths if they lead their followers to their deaths. This subtype often comes to believe in their own fictions. They are irresistible.

PRIMARY PSYCHOPATHS do not respond to punishment, apprehension, stress, or disapproval. They seem to be able to inhibit their antisocial impulses most of the time, not because of conscience, but because it suits their purpose at the time. Words do not seem to have the same meaning for them as they do for us. In fact, it’s unclear if they even grasp the meaning of their own words, a condition that Cleckley called “semantic aphasia.” They don’t follow any life plan, and it seems as if they are incapable of experiencing any genuine emotion.

SECONDARY PSYCHOPATHS are risk-takers, but are also more likely to be stress-reactive, worriers, and guilt-prone. They expose themselves to more stress than the average person, but they are as vulnerable to stress as the average person. They are daring, adventurous, unconventional people who began playing by their own rules early in life. They are strongly driven by a desire to escape or avoid pain, but are unable to resist temptation. As their anxiety increases toward some forbidden object, so does their attraction to it. They live their lives by the lure of temptation.

Blimey! This reads a bit like description of people I have come across in the past and really didn’t like. The trouble with these labels, like slogans, is that they highlight one aspect of a person and encourage you to see everything else as irrelevant.

I have met many people who are undoubtedlly struggling with schizophrenia, depression, anxiety and somatic disorders. Yet while I might want to label people I don’t like, or who do terrible things as “psychopaths” – actually I have only encountered one person who accurately fits the description. Let him be called BOB!

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The Sociopath

Is this not the same as someone with APD? The general understanding is that a person wth little or no regard to social or legal rules. But that can’t be right otherwise we might have to describe Nelson Mandela as a sociopath. Obviously I have never met the man, but while I could describe many politicians as having sociopathic tendencies – Nelson has always come across as a thoroughly decent human being – – may be I’m wrong. Let’s see the official version:

So what is a sociopath? You won’t find criteria in the DSM IV or official psychiatric nomenclature, but the construct refers to the largest subgroup of APDs. Most are males, but an increasing number are female. They have otherwise normal temperaments (as opposed to psychopaths who have abnormal temperaments). Some are aggressive, fearless sensation seekers, and others are Machiavellian manipulators. A Machiavellian is a personality type who is a cross between an antisocial personality and a narcissist, and someone who also has an extremely high sense of entitlement. The one thing that all sociopaths have in common is that they are “too much” to handle for their parents or anyone else. It’s common to refer to them as unsocialized, but the dyssocial sociopath does socialize to the mores and values of a dyssocial outgroup, like a gang. Let’s explore the four (4) subtypes of sociopaths:

COMMON SOCIOPATHS are the largest subtype and have a weak or unelaborated conscience. They are not ashamed by the same things as you or I would be ashamed of. They are like feral children grown up, taking pleasures and gratifying impulses at every opportunity or temptation. They especially enjoy and take pride in bending or breaking the rules. As teenagers, they are often runaways. As adults, they are often geographically mobile, living in shelters, or taking advantage of welfare systems. They are experienced shoplifters. They have quite active sex lives. They are usually of average intelligence, but don’t do well in school and never seem to break out of low-paying dead-end jobs. Nevertheless, they seem genuinely happy with their lives, unburdened by any sense of negative self-worth or the fact that they have not been a functional, contributing member of society.

> ALIENATED SOCIOPATHS have never developed the ability to love, empathize, or affiliate in real life with another person. They will show more emotion toward their pet or a personal artifact than toward a person. Or, they may hate animals and live out their emotional life by watching TV (identification with soap opera characters is a common pattern). Dating and marriage relationships will be very barren and empty. They won’t get along with the neighbors. They live in a shell. They have a cold, callous attitude toward human suffering or any social problem in the society they live in. They just don’t care because it’s outside their range of empathy. Most will believe they are justified in this because they feel they were cheated in some way themselves by society, and a few will be more than happy to rant and rave about it to anyone who listens. They are chronic complainers, and underneath it all, they would like to see nothing better than all of society destroyed.

AGGRESSIVE SOCIOPATHS derive strong, yet nonperverse gratification from harming others. They like to hurt, frighten, tyrannize, bully, and manipulate. They do it for a sense of power and control, and will often only drop subtle hints about what they are up to. They polish their aggressive, domineering manner in such a way to disguise any intimidation others might feel. They seek out positions of power, such as parent, teacher, bureaucrat, supervisor, or police officer. Their style is one of passive aggression as they systematically go about sabotaging the ideas of others to get their ideas in place. In their spare time, they like to hunt or occasionally do sadistic things like find stray dogs and cut them up. They are usually effective at getting their way, and are especially vindictive if resisted or crossed. They don’t follow the social norm of reciprocity like others do.

DYSSOCIAL SOCIOPATHS identify and hold an allegiance with a dyssocial, outcast, or predatory subculture. Any subculture will do, as long as it runs counter to established authority. They are capable of intense loyalty, and even a feeling of guilt and shame, within such limited circles. They seem to continually fall upon bad luck and bad companions, however. While they will constantly complain that none of this is their fault, behind it all is a kind of self-defeating mechanism in the poor choices they made themselves.

Well … now I can pathologise all the people I really don’t like – with ever greater exactitude! In fact my next door neighbours now merit a label a label of alienated/aggressive sociopaths! The trouble is, while I might feel really smug now, I am no further down the line in knowing how to deal with them.

But let’s go on … the next posting

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Antisocial Personality Disorder

Personally I find this term unhelpful as it suggests that it refers to something rather more grandiose than it really is. Again I quote angelfire website:

“Antisocial Personality Disorder (APD) is practically synonymous with criminal behavior. It’s so synonymous, in fact, that practically all convicted criminals (65-75%) have it, with criminologists often referring to it as a “wastebasket” category. Psychologists consider it an adult version of juvenile conduct disorder. The main characteristic of it is a complete and utter disregard for the rights of others and the rules of society. They seldom show anxiety and don’t feel guilt. There’s really no effective treatment for them other than locking them up in a secure facility with such rigid rules that they cannot talk their way out.”

Sounds like a crook and a wide boy to me rather than a “disorder”. Isn’t it just like some people are like that – just blike some people are really caring, are really funny/humourless, gloomy/optimistic etc. If we are to pathologist criminals, we should also pathologise really, really honest folk, not normal).

But we need a language to summarise our thoughts – so let’s continue with our explorations Next posting

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Antisocial Personality, Sociopathy, and Psychopathy

I’m aware that although I use these terms on various courses (“Difficult, Disturbing and Dangerous Behaviour” and “Working with Violent Perpetrators” there is considerable confusion and media hype about the use of the above terms. So I thought I woulkd put together a series of postings (for the most part lifted from the literature) to sort out what we are talking about. This has been prompted by a very interesting study that I recently came across “Validating female psychopathy subtypes: Differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health” – unfortunately to interpret the study would, for many of us, be like a new language.

A very helpful article in this respect can be found at http://www.angelfire.com/zine2/narcissism/antisocial_sociopath_psychopath.html. I will take some quotes directly from that site:

People who cannot contain their urges to harm (or kill) people repeatedly for no apparent reason are assumed to suffer from some mental illness. However, they may be more cruel than crazy, they may be choosing not to control their urges, they know right from wrong, they know exactly what they’re doing, and they are definitely NOT insane, at least according to the consensus of most scholars (Samenow 2004). In such cases, they usually fall into one of three types that are typically considered aggravating circumstances in addition to their legal guilt — antisocial personality disorder (APD), sociopath, or psychopath — none of which are the same as insanity or psychosis. APD is the most common type, afflicting about 4% of the general population. Sociopaths are the second most common type, with the American Psychiatric Association estimating that 3% of all males in our society are sociopaths. Psychopaths are rare, found in perhaps 1% of the population.

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Iain’s Blog has Moved!

Unfortunately I couldn’t edit my blog using my 3G card and laptop which made it pretty much useless. So now I’ve restarted the blog at a newsite:

www.dangeroustrainer.worrdpress.com

Hope  you will visit!

Iain

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What makes an arsonist?

Fires don’t come any more dramatic than those that have blazed across the Australian bush this week. The bushfires, helped by record summer temperatures and nourished to deadly effect by gales, have left a trail of deaths, injuries and homelessness in their fast-moving wake. Their ferocity has horrified all who have come into contact with them.Well, nearly all. Perhaps one or more individuals will have been watching the flames excitedly and gazing upon their own handiwork. Two people have already been charged with arson, and more arrests are expected.

Why would anybody start a fire intentionally, let alone one that results in so many deaths? In the case of the Australian bushfires we don’t yet know, but when those responsible put a flame to the tinder, they, like all arsonists, had their motivations. It may have been mindless vandalism or an act of bravado to impress delinquent friends; a quest to stir up a little excitement, or a plot to gain an insurance payout. The motive may even have been sexual – for some pyromaniacs (compulsive fire-starters who have a psychiatric condition that leaves them with an uncontrollable urge to start fires), nothing holds more erotic charge than a lit match. And there are remarkably few treatments or interventions for serial offenders, although Rampton Hospital in Nottinghamshire runs a treatment programme for the most dangerous arsonists.

An obsession with fire can start very young, according to Dr Louise Almond, a psychologist at Liverpool University who has studied the motivations of arsonists in Britain. “Many children between the ages of 5 and 10 are fascinated with fire and want to play with matches,” she says. “This is a normal fascination but it can grow into a curiosity-driven behaviour with their own property, so they may set fire to their toys.” In some cases the consequences are tragic – a handful of children are killed each year in this way. (Some scientists have speculated that a fondness for “fire-play” is a natural consequence of our evolutionary history, and that pyromania happens when the brain circuits that allow us to deal with fire go wrong.)

Of the children – mostly boys – who indulge their curiosity about fire, some 40 per cent persist with the behaviour into their teens; they tend to be children with higher levels of behavioural and psychological problems. But not all arsonists start their behaviour in childhood. Some come to it later in life.

People who start fires deliberately fall into distinct categories. Some are simply hooligans, and their crimes come under the heading of “vandalism”. They are not necessarily mentally disturbed but are prone to antisocial behaviour, such as truanting. For them, starting a fire may achieve the same pointless end as smashing a window.Their targets – often schools – are opportunistic, and the fire might be started by a youth keen to show off to his friends. According to The Burning Issue, a 2002 report on arson written by academics for the Government, to which Dr Almond contributed, this sort of incident accounts for about a third of deliberate fires and is more common in socially deprived areas.

Another category is the “malicious firesetter”, who uses fire as a weapon to get back at someone or something. It is not unheard-of for disgruntled former employees to wreak revenge on their bosses in this way, or for a divorced man to set fire to his ex-wife’s house. It has been mooted that someone with a grievance against the Australian Government might be motivated to start a bushfire, because it devastates Government-owned land.

Then there is the “criminal firesetter”, who lights the petrol-doused rag for criminal reasons – perhaps to cover up another crime, such as murder or robbery. Joyriders often burn out the cars they steal, to cover their tracks. Criminal firesetters may simply want an insurance payout for an old car or a business that is about to go into liquidation. Dr Almond says: “We know there are professional fire-setters out there, who will use very sophisticated techniques to burn down, say, a failing business. They use lots of accelerants and start fires in multiple places. But they are not easy to track down – it’s like trying to find a hitman.” She notes that there has been a rise in vehicle arson as the value of scrap metal has plummeted – now more people are setting fire to their cars to claim on the insurance.

But perhaps the most perplexing category is the person who starts a fire for reasons of “emotional expression” (also known as psychological fire-setting). This category, which accounts for just over a quarter of fires started deliberately, encompasses pyromaniacs, who find a kind of release, sometimes sexual, in starting fires (and sometimes achieve gratification through watching the fire brigade dealing with their activities). Pyromania is a psychiatric condition that can be treated with drugs but, as with other mental health problems, the results of drug treatment vary from patient to patient.

Pyromaniacs represent only a small proportion of emotionally motivated fire-starters. “Some people use fire as a way of communicating their pain, or as a cry for attention,” Dr Almond says.

Among those in the “emotional” classification is the would-be hero who starts the fire, then rushes to report it and/or deal with it. Firefighters and security guards have been known to do this. Fleur Lombard, the first female firefighter to die during peacetime, was a victim of this type of arson in 1996. Martin Cody, a security guard, spent a troubled childhood dreaming of becoming a hero, and started a fire in a Bristol supermarket on his first day at work. He even helped the deputy manager to escape it, by smashing a window. Cody phoned a friend to boast about what he had done. Unfortunately, Lombard did not survive the fire and Cody was jailed for manslaughter and arson.

Meanwhile, the tragedy in Australia continues to unfold. In 2004, the Australian Institute of Criminology recognised that bushfires started deliberately were a specific form of arson that needed closer investigation. It reported that “in most cases it is likely that adults who set bushfires do so for excitement or thrills, or the need for attention”.

The report also raised the disturbing prospect that some fire-setters, seeing bushfires splashed all over the media, could be tempted to add their own efforts, whether they were thrill-seekers or motivated by the prospect of being hailed a hero: “The response of fire services may be rapid and on a large scale, and is likely to be heightened by a sense of urgency which adds to the overall experience.

“The existence of other fires and community concern will increase the likelihood of extensive media coverage. This, in turn, will increase the potential for community recognition and the according of ‘hero’ status to those for whom this is a motivating factor.”

But perhaps we can only truly understand by listening to the words of an emotional fire-starter. Sarah Wheaton – a pseudonym – once wrote of her life as a pyromaniac for the American Psychiatric Association.

She wrote that she “revel(s) in the notoriety of the unknown fire-setter”, even if it was someone else who dropped the match: “I watch the local news broadcasts for fires that have been set each day and read the local newspapers in search of articles dealing with suspicious fires. I read literature about fires, fire-setters, pyromania, pyromaniacs, arson and arsonists. I contact government agencies about fire information and keep up-to-date on the arson detection methods that investigators use. I watch movies and listen to music about fires. My dreams are about fires that I have set, want to set or wish I had set…

“A fire not my own offers excitement and some tension relief. However, any fire set by someone else is one I wish I had set. The knowledge that there is another fire-setter in the area may spark feelings of competition or envy in me and increase my desire to set bigger and better fires.”

That must be the last thing that those in the Australian bush around Melbourne want to hear.

Terrible legacy of the fire-starters

A fire at an East London warehouse (above) in May 2004 destroyed more than £50million of modern British art, including 16 Damien Hirst paintings and Tracy Emin’s £40,000 tent. Another part of the warehouse had been burgled and the thieves were thought to have started the fire to cover their tracks.

A 15-year-old boy caused £1.5 million in damage to Manor Comprehensive School in Mansfield, Nottinghamshire, when he set fire to it. The teenager told police that he hated school and wanted to burn it down so he wouldn’t have to go. He was given three years’ detention.

An arson attack on an Iranian cinema in 1978 claimed more than 400 lives. The country’s Intelligence Service was implicated in causing the fire at the Cinema Rex, but the Shah of Iran at the time, Mohammad Reza, said that Islamic militants were responsible.

In June 2000 a homeless fruit-picker set fire to the Palace Backpackers Hostel in Childers, Queensland, Australia, while dozens of teenagers slept inside. Fifteen backpackers were killed, seven of them British. Robert Long, who had a history of mental illness, was sentenced to a minimum of 20 years for the attack.

Rogue property developers were accused of starting forest fires that swept across Greece in summer 2007. More than 60 people died in the blazes, which were fanned by strong winds. It was claimed that arsonists had been paid by developers who wanted to get round planning laws.

Chloe Lambert

Filed under: Other Mental Health, Uncategorized, Violence

Changing Suicide Rates

Figures released by the ONS showed that the number of people in the UK committing suicide is continuing to fall and is now at its lowest level in 17 years.

The ONS said that, in 2007, there were 5,377 suicides in adults aged 15 and over, 177 fewer than in 2006 and 940 fewer than in 1991. Three-quarters of the suicides in 2007 were by men – a proportion that has remained fairly constant since 1991.

The suicide rate for men in 2007 was 16.8 per 100,000 people, while the rate for women was five per 100,000. Suicides among men reached a peak in 1998 – 21.1 per 100,000 – but the rate has since fallen. Suicide rates among women have been consistently much lower and have decreased more steadily.

In the early 1990s, the highest suicide rates for men and women were in those aged 75 and over. Rates in this group have since decreased and were among the lowest in 2007.

In recent years, the highest suicide rates in men have been in those aged 15-44, while the highest rates among women have been in the 45-74 age bracket. Suicide rates in women aged 15-44 have consistently been the lowest and fell to 4.2 per 100,000 in 2007.

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