With recent mass shootings that have grabbed headlines, evaluating one's mental health is a topic that has frequently been discussed in the news. As a psychologist, I've been asked frequently about red flags or warning signs that may contribute to violent or aggressive behavior. For the most part, dozens of interpersonal red flags can be summarized by two alarms: change and disclosure of information.
While change isn't always a bad thing, it is almost always a little frightening. Change in sleeping habits -- sleep is the canary in the mine, so to speak -- weight, energy, mood, or attention require careful consideration, and often times, a bit of sleuthing to determine the cause. Those changes might signal affective distress or impending physical illness and nearly always respond to treatment. For persons with emerging thought disorders or very serious mental illnesses, the capacity to recognize change is impaired, making them more vulnerable to disease progression and making the input and intervention of others that much more important.
Most mental illnesses are defined by significant and enduring (e.g. two weeks or more) change. As before, here we mean change in affect, interest, mood or cognition (e.g. memory, attention, etc.). The more obvious (and alarming) changes are in self-care or hygiene. A person who loses the ability or motivation to maintain their basic hygiene needs emergent professional attention/evaluation.
The other red flag, then, is self-report/disclosure of information. We are an expressive, communicative species and are usually quite vocal in our self-assessment and intentions for the future. Always attend to reports of intended or implied self-harm and consider each one of those circumstances legitimate -- the more obvious statements are almost always a cry for help. The same is equally true for threats of harm to others.
Your gut is a finely-tuned psychological assessment tool. People are inherently excellent armchair psychologists, and we tend also to afford people tremendous latitude in our appraisal of their behavior (read: you are least likely to overreact). If your reaction strikes you as noteworthy, there is no downside to passing that appraisal along.
That brings us to the most important point. Without exception, there is an epiphany in the criminological reconstruction of events leading up to catastrophe (spree shooting, suicide, etc.). The reports of friends, relatives, neighbors, coworkers, and bystanders collectively paint a very clear picture of imminent danger -- a picture we're often rueful we "missed" in the moments before a tragedy occurs. The sad reality is that each single piece of "data" is less alarming than the accumulation of those warnings (hindsight being 20/20). For that reason, it is imperative that everyone make their perceptions of dangerousness available to a person tasked with managing that information (e.g., work supervisor, parent, family member, teacher, administrator, medical professional, security or law enforcement personnel). In almost every case, you can be assured of confidentiality. The kicker is that when you're right, you are never going to know.
Kim Gorgens is a clinical associate professor in the Graduate School of Professional Psychology at the University of Denver.
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