John W. Thompson Jr, MD

A study released by the FBI in September 2014 reported that the number of active shooter incidents had tripled in recent years. The average of 6.7 per year from 2000 to 2007 had increased to 16.4 per year from 2007 to 2013. This trend of increasing violence by mass shooting juxtaposes a homicide rate that has been declining since the mid 1980s and has remained relatively stable in recent years. By my calculation, mass shootings may now represent 3.4% of the US homicide rate.

[[{"type":"media","view_mode":"media_crop","fid":"33294","attributes":{"alt":"Treat Aggressive Behavior","class":"media-image media-image-right","id":"media_crop_1918556007751","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3514","media_crop_rotate":"0","media_crop_scale_h":"149","media_crop_scale_w":"150","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Â© Chris Parypa Photography / Shutterstock.com","typeof":"foaf:Image"}}]]Along with these tragedies comes the usual retrospective analysis of the shooter, and the inevitable turn to mental health professionals for answers that delve into the psyche of the shooter. The age-old arguments rise to the surface. Was the behavior driven by “madness or badness”? Was the mass shooter misunderstood and bullied as a child, harboring anger and rage that drove the behavior, or was the person a “psychopath” whose only care was his or her own needs at the expense of others’ lives”?

I use this example of extreme violence to wake us up and to help us think as psychiatrists about the real levels of violence we deal with in our practices and in our lives. In actuality, these “mass shooting” events are rare and difficult to predict but profoundly change the way we think and act. Our patients for the most part are not criminals or dangerous people but are suffering and in need of help. The population with mental disorders as a whole is no more dangerous than the general population.

Like it or not, the public demands our help in sorting out issues of violence and aggression, both in our patients with serious mental disorder and in the individuals we treat and interact with in correctional systems (now the largest mental hospitals in the country).

How then should we assist our colleagues in filtering out what is relevant and what is not? How should we change our practices to look more closely at risk assessment and its inevitable implications? Are there actual neurobiological models of aggression? Can these models lead to active treatments and prevention models that make practical sense?

My hope is that this Special Report will provoke thoughtful contemplation on various topics related to aggressive behavior and continue to foster the process of research and understanding into the drivers of aggressive behavior. Understanding the substrates that lead to aggression will, we hope, lead to the treatments and prevention strategies we so desperately need to curb both the everyday aggression we encounter and the mass aggression that is increasing at an alarming rate.

Dr Thompson is Professor, Chair, and Director of the division of forensic neuropsychiatry and Founding Director of the fellowship in forensic psychiatry the Tulane University School of Medicine in New Orleans.

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Dr Thompson introduces a Special Report meant to provoke thoughtful contemplation on various topics related to aggressive behavior.

Author | John W. Thompson Jr, MD

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