Sunday, August 26, 2007
Coverage of Cho may renew stigma of mental illness, experts say
Seung-Hui Cho's mix of mental disorders and violence was grossly atypical of most mental health patients, several professionals said.
Seung-Hui Cho
News coverage of Seung-Hui Cho's killing spree at Virginia Tech tied together mental illness and violence in a bloody knot.
Such cause-and-effect entanglement distorts reality and could discourage people with common psychological ailments from seeking help, said Amy Forsyth-Stephens, executive director of the Mental Health Association of the New River Valley.
"The progress we've made in fighting the stigma of mental health treatment will probably backslide for 25 years," she said.
Speculative diagnoses for Cho after the shootings have ranged from Asperger syndrome to the influence of demonic spirits.
Forsyth-Stephens sees it this way: Cho was an aberration, a profoundly troubled young man whose motives for violence might always defy comprehension.
The Wall Street Journal reported Aug. 20 that Cho, while attending public schools in Fairfax County, was diagnosed with "selective mutism."
Characteristics of the anxiety disorder certainly seem to fit Cho. In addition to an obvious reticence to speak, symptoms can include a lack of eye contact, no facial expression and immobility when confronted by specific social situations.
"I can tell you that Cho definitely had selective mutism," said Elisa Shipon-Blum, president and director of the Selective Mutism Anxiety Research and Treatment Center in Philadelphia.
But Shipon-Blum said The Wall Street Journal mischaracterized the disorder by describing it as an anxiety-related "refusal to speak."
Those who suffer from selective mutism do not "refuse" to speak, she said. Instead, profound social anxiety renders them unable or nearly unable to talk in certain settings.
From elementary school to Virginia Tech, Cho's silence was the characteristic people recall most vividly about him. Selective mutism is a complex and rare childhood anxiety disorder, and those affected by it can suffer teasing and bullying. Cho experienced both.
Studies do not show, however, that children diagnosed with selective mutism tend to strike out in violent acts, either as children or adults.
"The likelihood of violence from people with selective mutism is no greater than it would be with an individual who has any other depressive or anxiety disorder," said Shipon-Blum.
In recent decades, many disorders, ranging from depression to schizophrenia, have been linked to biological and genetic causes. Selective mutism might be another.
Forsyth-Stephens' worry about unfortunate ripple effects from Cho-related public perceptions driven by recent publicity is shared by many in her field, including Shipon-Blum and other experts working to reduce the lingering stigma of mental health treatment.
"Typically, the publicity about mental illness is when something really horrible happens and not about the millions of people who have mental illness and fight to be heard," said Dr. Susan Blank, a psychiatrist with Caron Treatment Centers in Pennsylvania.
Richard Shadick is director of Pace University's Counseling Center, a college just blocks away from Ground Zero in New York City. He has counseled Ground Zero workers and survivors.
"People who feel suicidal are much more likely to kill themselves than someone else," he said. "There has been intense coverage of the incident [at Virginia Tech], and an unfortunate result is that people tend to associate mental illness with violence."
In addition to affecting campaigns to lessen stigma, fallout from reactions to Cho's killings could also create concerns about whether individual treatment records will remain confidential. An internal review at Virginia Tech about the university's handling of Cho and April 16 recommended clarifying policies guiding communication among agencies about troubled students.
Forsyth-Stephens is convinced confidentiality will still apply "99.9 percent of the time."
"Confidentiality is certainly a cornerstone of the mental health profession," she said. "People need to know that what they say in a counseling session is kept confidential."
Other post-April 16 effects can include fears about public judgment, said Forsyth-Stephens.
People in the region who were once willing to speak openly about experiences with mental illness have clammed up, she said.
"They don't want to be stigmatized as someone who might be dangerous to other people," she said.
National figures such as journalist Mike Wallace and writer William Styron have openly detailed their struggles with depression.
"But we also need average, everyday citizens to speak up, too. We need to know that our neighbors, our fellow students, our professors are suffering," Shadick said.
Cho exhibited several classic depressive symptoms, including withdrawal and contemplation of suicide. The world knows now, with the advantage of hindsight, that his problems ran much deeper. A state panel report, expected to be released this week, might delve into new issues involving Cho and his mental state.
Forsyth-Stephens hopes people will recognize that Cho's behaviors were off the charts.
There is some chance, she said, that publicity about the crisis counseling that occurred after April 16 might help people understand the need to talk about and understand their troubles.
"We can hope for that outcome."
