Giving the public an understanding of the characteristics of a spree killer may also facilitate law enforcement's efforts by encouraging people to convey relevant information: "In that sense, forensic psychiatry ... [has] a good understanding about people who become involved in spree killing and what kinds of common qualities they have."
Rather than damaging the profession, Welner insisted that the best commentary came from mental health care practitioners: "I think that psychiatrists had a far more mature contribution to make than nonpsychiatrists did, and I'm not simply being provincial about this."
As for the possibility of enhancing the stigma of mental illness by linking it to violence, Welner denied that his kind of commentary does anything to make things worse. "Violence is a behavioral problem issue. Violence is a behavioral problem. Violence is a behavioral science issue," Welner told PT. "It may be an expression of brute criminality, but it is pathology. Antisocial behavior is a psychiatric problem. The fact that we don't have a treatment to make antisocial people prosocial doesn't mean that it's any less psychiatric. It's just essentially the equivalent of the cancer that we have not yet cured."
Welner believes that what is important is to make certain that the behavioral component of violence is what is emphasized and to avoid linking it to mental illness unless there is reason to believe that a mental illness is involved. "Psychiatrists have to appreciate our discipline for the serious science that it is," Welner said. "We have that expertise, in certain respects and within certain limits, to contribute whether it is appreciating the qualities of the behavior that we are seeing or whether it is assisting the public to come to terms with the chaos that is visited. If we aren't qualified, then what did we go to train for all these years?"
Dorothy Otnow-Lewis, M.D., a psychiatrist with academic appointments at both New York University School of Medicine and the Child Study Center at Yale University School of Medicine, has studied serial killers for more than two decades. It was her comment in the New York Times that NAMI criticized in its news alert. In an Oct. 10, 2002, article, the paper reported that Otnow-Lewis said, "The sniper's claim to be God struck her as 'clearly psychotic, very out of touch with reality.'" In addition, she opined, "He may be highly manic and 'getting more delusional and more revved up' with each execution."
However, Otnow-Lewis, in an interview with PT, pointed to a Nov. 4, 2002, Newsweek article that referred to her as "one of the few talking heads to get it right during the long sniper siege." She insisted that her comments were appropriate and based upon her years of experience.
"It would be dangerous and improper to make a diagnosis without having evaluated the person," Otnow-Lewis explained. When asked about whether there is any evidence of severe mental illness, she referred to her experience and confirmed that--from her viewpoint--those who go on periodic rampages may suffer from episodic psychosis.
As for the sniper situation, Otnow-Lewis acknowledged having said, "if he really did write on that tarot card 'I am God,' ... this is consistent with a delusional man and delusions are psychotic symptoms. ... And so I did say that if indeed he had written that, and if indeed he believed it, that he was delusional."