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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING NURS 509 Killers School of Nursing Jeff Tebbs UNIVERSITY OF WASHINGTON SCHOOL OF NURSING NURS 509 Killers School of Nursing Jeff Tebbs Eric Pauli Page Collins

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=n. J 4 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=n. J 4 hd. Ck. Q 7 EI

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING KILLERS ‘‘With Canis Minor and a beautiful blue UNIVERSITY OF WASHINGTON SCHOOL OF NURSING KILLERS ‘‘With Canis Minor and a beautiful blue moon. With a smile—stars surround me and peace and love are mine. They can’t be taken or touched. I WIN. ” -Gary Evans 1998 (Wolf & Lavezzi, 2007, p. 200)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Killers • Outline – Introduction/Definitions – Types & UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Killers • Outline – Introduction/Definitions – Types & Theory • Components • Theory • Female Killers & HCP – Biological Theories – Infanticide – Conclusion

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Introduction • “Serial Murder”: popularized ’ 80 s UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Introduction • “Serial Murder”: popularized ’ 80 s (FBI). 1 st: 1400 s. Gille de Rais, friend of Joan of Arc torture/murder≈140 children (Castle & Hensley, 2002; Brinanica, 2007) Definition: >2 -3 victims, common characteristics Different times, “cooling off” (1997) • No apparent connection to initial killing (Wold & Lavezzi, 2007) – Sexual attacks & resulting deaths … by male kilers – Follow physical or psychological patterns (Egger, 1998; Castle & Hensley, 2002) • Expanded to include women, different motives (Hickey, 1997; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Killers (fun facts) • Men ≈ 6 -7 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Killers (fun facts) • Men ≈ 6 -7 X more likely to kill (others) (Frei, Vollm, Graf, & Dittmann, 2006) • Serial Murder – Relatively rare – Rate ↑ in US (last 20 years) • enhanced technology/information linkage • media ↑ public awareness (≠ entire increase) • Of 337 serial murder cases in US: – 35 – 302 1800 -1979 1980 -1995 (Castle & Hensley, 2002) 0. 2 20. 1 case/yr

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Murder • 5 elements, in most cases… UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Murder • 5 elements, in most cases… #1 repetitive, continued for months or years #2 typically 1: 1, some “team killers” #3 rarely b/t intimates » Typically, no prior relationship. #4 compulsion to kill » ≠ passion crime » ≠ victim precipitation #5 ≠ economic motives (Holmes & De. Burger, 1988; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Murder • 7 major components: #1 #2 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Murder • 7 major components: #1 #2 #3 #4 #5 subsequent murder no prior relationship (generally) murders at different times & no apparent connection different geographical locations (usually) motive not material gain BUT power or dominance (men) #6 symbolic value; killers perceive victims as powerless For this reason… #7 victims vulnerable, least valued, marginalized: – homeless, prostitutes, homosexuals, vagrants, missing children, women alone in isolated areas, college students, older women, & migrant workers. (Egger, 1990; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING The Serial Killer “Profile” According to popular media: UNIVERSITY OF WASHINGTON SCHOOL OF NURSING The Serial Killer “Profile” According to popular media: white, late 20 s-30 s middle-class male who suffered child abuse, kills strangers, is a ‘‘sexual sadist” (Wolf & Lavezzi, 2007)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killers • Most serial killers are not UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killers • Most serial killers are not insane – Legally, vast majority know right and wrong at the time of crime • <4% of serial killers use insanity defense • 1% found not guilty by reason of insanity • <1% of all killers used insanity as a defense • Only 25% of these cases were successful • Some pathological process associated (Carlisle, 1993; Castle & Hensley, 2002) • Some serial killers may have a neurological disorder – Childhood head trauma – Can cause episodic aggressive behavior (Norris, 1988; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Schizophrenia? • Often associated with unprovoked bouts of UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Schizophrenia? • Often associated with unprovoked bouts of violence – d/t hallucinations or delusions • Command to kill: – David Berkowitz, “Son of Sam, ” tried schizophrenia defense – Claimed neighbor’s dog commanded him to kill (but recanted) (Newton, 2000). • Some single homicides CAN be accounted for by schizophrenia, but never an authenticated case schizophrenic serial murder – Paranoia Sx: also senility, seizures, & brain damage (Brizer & Crowner, 1989; Newton, 2000, Hickey, 1997; Lewis 1998; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING DID? Did not? • DID, AKA multiple personality UNIVERSITY OF WASHINGTON SCHOOL OF NURSING DID? Did not? • DID, AKA multiple personality disorder. – ≥ 2 different personalities or personality states – response to childhood trauma – dissociate from pain • Kenneth Bianchi, Hillside Stranglers (Bianchi/Bruno) – attempted an alternate personality “Steve Walker” – Bianchi was faking DID & was found competent for trial – Seizures started in childhood • X 1 successful defense for single homicide – never authenticated any serial killer (Hickey, 1997; Castle & Hensley, 2002).

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Episodic Aggression Patterns 1: ritualistic behavior 2: masks UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Episodic Aggression Patterns 1: ritualistic behavior 2: masks of sanity 3: compulsivity 4: search for help 5: severe memory disorders 6: chronic inability to tell the truth 7: suicidal tendencies 8: sexual assault hx 9: sexual deviance/hypersexuality 10: head injuries or birth injuries 11: chronic drug or alcohol abuse 12: substance-abusing parents 13: victim of abuse 14: cruel parenting 15: result of unwanted pregnancy 16: product of difficult gestation 17: interrupted bliss or no bliss in childhood 18: cruelty to animals 19: arson tendencies 20: neurological impairment sx -evidence of genetic disorders 21: powerlessness/inadequacy. (Norris, 1998; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Personality Disorder • “…enduring patterns of inner experience UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Personality Disorder • “…enduring patterns of inner experience and behavior that deviate markedly from the individual’s culture” (APA, 1994, p. 629) • PD is most common psychological SK factor • Most common SK-linked is antisocial PD • Historically, the term was psychopath (Johnson & Becker, 1997; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Psychopathy 1991 Psychopath Checklist: • superficial charm • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Psychopathy 1991 Psychopath Checklist: • superficial charm • narcissism • pathological lying • manipulation • lack of remorse and guilt • shallow affect • lack of empathy • failure to accept responsibility for actions The psychopath’s lifestyle: • parasitic • prone to boredom • poor behavioral controls • lack of long-term goals • impulsivity • irresponsibility • juvenile delinquency • promiscuous sexual behavior • short-term marriages • criminal versatility (Hare, 1991; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Antisocial • SK’s may exhibit some but not UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Antisocial • SK’s may exhibit some but not all traits • Psychopathy is a broad category – Should not describe SK – Term psychopathy replaced with antisocial PD • SK pathology commonly includes an ↑ of: – – – anger hostility frustration low self-esteem feelings of inadequacy (Hickey, 1997; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Compartmentalization • Neutralize guilt and remorse • Separate UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Compartmentalization • Neutralize guilt and remorse • Separate self from crime • 2 categories of human beings – those whom they care about – victims • Learned/used in everyday roles (variation of norm) – eg. cutthroat businessman vs loving husband father – Nazi doctors “doubling” (Fox and Levin, 1994; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Dehumanization • Neutralization method learned by SK to UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Dehumanization • Neutralization method learned by SK to kill w/o guilt – Nazi’s: victims subhumans of whom the world needed to be rid – Expendable, sacrificed for scientific inquiry • In the US dehumanization has justified: – Enslavement, segregation & violence against minorities • “Subhuman” elements of society selected as victims – Prostitutes, homosexuals & homeless viewed by SK as subhuman • Dehumanization may also occur after victim’s capture – objects that SK can rape, torture, mutilate, & eventually murder • “SK’s behavior can also be learned in different environments” (Fox & Levin, 1994; Castle & Hensley, 2002) Dr Albert Heim / Dr Death

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Humiliation • Learning theorists: deviant behavior learned – UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Humiliation • Learning theorists: deviant behavior learned – can also be unlearned • Internal drives of a SK often overlooked – Victims often resemble who caused humiliation • SK humiliation can → criminal behavior • Only if recognized & internalized as a motive (Hale, 1993; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Frustration Theory Amsel (1958): • SK internalizes perceived UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Frustration Theory Amsel (1958): • SK internalizes perceived wrong – justification for murder • Initial cues associated with later humiliation • Later humiliation is a nonreward situation • Nonreward where reward previously occurred – unconditioned frustration response • Humiliation cues (internal stimuli): – anticipatitory frustration response – Motivates avoidance of humiliating situations

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Discrimination Learning Hull (1943) and Spence (1936): • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Discrimination Learning Hull (1943) and Spence (1936): • Reward situations (reinforcement): – discrimination b/t stimuli – Able to chose behavior to produce reward • SKs: few/no situations produce reward • When cues indicate humiliation – SK associates nonreinforcement situation (frustration) • Abundance of nonreinforcement situations – SK can’t discriminate 1 instance of humiliation from another

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Ascociation-Reinforcement Burgess & Akers (1966) • Operant principles UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Ascociation-Reinforcement Burgess & Akers (1966) • Operant principles – Acknowledgment of contributory cognitive processes – Boot camp: Social context • Violence & aggression → learning to kill • War & combat strengthen/reinforce learning • Killing also learned in nonsocial situations: – When reinforcing/discriminating • Likelihood repeat behavior ← reinforcement

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Association-Reinforcement Burgess & Akers (1966), continued • Learning UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Association-Reinforcement Burgess & Akers (1966), continued • Learning in groups that control reinforcements – The military = major source of reinforcements – The military becomes the individuals’ primary social group • Servicemen learn to accept death/killing • Learned techniques & attitudes reinforce behavior – Dehumanization/objectification allows killing behavior – Compartmentalization allows life outside of killing • May be learned by SK in the military → civilian life

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Association-Reinforcement • ↑ Potential for deviant behavior when: UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Association-Reinforcement • ↑ Potential for deviant behavior when: – Conforming behavior → normative definitions – And verbalizations have discriminatory value • Strength of deviant behavior a function of: – amount, frequency, & probability of reinforcement • Value of killing positively reinforced • Specific reward may Δ – but SKs murder because it provides reinforcement (Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Learning Theory Dollard & Miller (1950): • Instigated UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Learning Theory Dollard & Miller (1950): • Instigated behavior → predicted response • (observed/inferred) consequence – Behavior instigated to seek goal (approval) – Barrier to reaching goal = frustration & aggressive impulse • Frustration/aggression directed at humiliation source – BUT control & humiliation may prevent this – Therefore, the humiliation becomes internalized if not corrected – Aggression displaced to ↓ threat object (transference) • Via generalization – SKs transfer internalized humiliation to victims • attempt to rectify past humiliation

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Theory Applied Hale (1993) • Transference occurs only UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Theory Applied Hale (1993) • Transference occurs only if SKs – recognize – AND internalize humiliation as motive for murder • SK confuses cues from the past with present – d/t abundant nonreinforcement situations Note: victims have some symbolic value for the killers, but not all of the victims resemble someone from their past

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Servicemen were not very inclined UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Servicemen were not very inclined to kill – – Civil. War: vast majority fired over the enemy’s head World. War II: 15% to 20% able to fire at an exposed enemy Korean. War: shoot-to-kill rate ↑ to 55% Vietnam. War: shoot-to-kill rate > 90% • Today methods include: – – brutalization classical conditioning operant conditioning role modeling (Grossman, 1996)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Classical Conditioning – Violence=pleasurable consequences UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Classical Conditioning – Violence=pleasurable consequences – Japanese Military • • • Chinese prisoners in a ditch A few servicemen bayonetted the prisoners Young servicemen on banks watched and cheered Afterward, treated to nice meals and prostitutes Very effective – associated pleasure with death & suffering. (Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Operant Conditioning – Servicemen & UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Military Training • Operant Conditioning – Servicemen & police officers: • Shoot at man-shaped targets (stimulus) • Shoot the target (conditioned response) • Trainees repeat this many times • Role models – Drill sergeants personify violence and aggression • Dehumanization – Enemies subhuman/objects – Learned, conditioned responses take over. • Note: of 354 SK cases, 7% had military background **only 1 empirical studyexamined possible link between serial murder & military experience (Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Cyclic Nature • Ritual – Often leaves SKs UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Cyclic Nature • Ritual – Often leaves SKs depressed & unsatisfied – SKs begin cycle again, to “cure” the depression… – Rarely do murders leave SKs satisfied rewarded • Yet, SINCE behavior frequently reinforced – More likely to be repeated • Military just 1 social group – May provide SKs associations & reinforcements (Holms & Holms, 1994; Castle & Hensley, 2002)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female Serial Killers • Domestic environment: 23% spouse-killing UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female Serial Killers • Domestic environment: 23% spouse-killing – Suffered long periods of abuse by their partner Can be reconciled with perception of women as nurturing and vulnerable, and only capable of extreme violence if provoked • Female SK’s do not fit this stereotype • Aileen Wuornos & PK both fit ‘hedonistic’ or ‘power Saltzmann, 1989; Trube-Becker, 1982; Frei et al, 2006) seeker’ (Mercy &

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female SK Cases • In 34 cases of UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female SK Cases • In 34 cases of US female serial killers 1795 -1988 – – ½ had a male accomplice Mean age 33 6 were female nurses (17. 6%) ¾ of cases motivated by material gain • Poisoning was the most common method • Most killed people they knew (Hickey (1997; Frei et al, 2006) • In 105 female SK • Poisoning most common • Time between the 1 st kill & apprehension was longer (Wilson & Hilton, 1998, Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female SK Casese • • In 86 American UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Female SK Casese • • In 86 American cases victims most commonly children, elderly or spouses. ‘black widows’ Women had longest average active period – over 10 years (Kelleher and Kelleher, 1998; Frei et al, 2006) Holmes & Holmes (1998): Motives & Patterns • ‘geographically stable’ • lived in area where they killed – ‘comfort killer’ most prevalent (series of husbands). – ‘hedonistic’ type was rarely observed – ‘power seeker’ in caring professions (‘death angels’)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Categoiries (Frei et al, 2006) UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Categoiries (Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Categories & Commonalities Kelleher & Kelleher (1998): • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Categories & Commonalities Kelleher & Kelleher (1998): • ‘black widow’ (26%)* • ‘angel of death’ • ‘sexual predator’ • ‘revenge’ • ‘profit or crime’ • ‘team killer’ (28%)* • ‘question of sanity’ • Female serial killers have in common with male counterparts: – – – no one theory can explain the phenomenon. Positive reinforcement might drive future offences Psychopathic traits & grossly abusive childhood Role of a ‘private internal world’ of violent fantasies Displaced aggression (Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Narcissism • Psychodynamic perspective – primitive defence mechanism UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Narcissism • Psychodynamic perspective – primitive defence mechanism of malignant narcissism • Narcissistic personality structure – – – Grandiosity need for power unrestrained aggression antisocial behavior ego-syntonic sadism has been associated (Haller, 1999; Turco, 2001; Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Neuropsych Development • Aautistic spectrum disorder (ASD) – UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Neuropsych Development • Aautistic spectrum disorder (ASD) – • More common in males than females • Characterized by a triad of symptoms: 1) impairment of social interactions 2) communication difficulties 3) restricted repetitive patterns of behavior (e. g. Silva et al. , 2002; Silva et al. , 2004; Berney, 2004; Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING ASD Link? • Onset: early childhood – More UNIVERSITY OF WASHINGTON SCHOOL OF NURSING ASD Link? • Onset: early childhood – More apparent/disabling as social skills more important (Berney, 2004) • Case studies most commonly describe sexual and physical violence • Theory of Mind and Empathy: (Siponemaa et al. , 2001) – Lack of understanding another person’s thoughts/feelings underlies ASD aggression (Murrie et al. , 2002) • Antisocial & schizoid PDs: differential diagnoses of Asperger’s • Schizoid PD and Asperger’s closely related • The distinction b/t PDs and ASD is challenging when sx are mild (Berney, 2004) (Wolff, 2000) – More blurred as etiological models for both disorders have moved closer together (Frei et al, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK • Cagregiver Associated Serial Killings • ‘‘the UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK • Cagregiver Associated Serial Killings • ‘‘the most prolific serial killer in the history of the UK and probably the world. ’’ • Harold Shipman, British physician • 218 patient deaths attributed to lethal administration of Diamorphine (diacetylmorphine) (Yorker, Forrest, Lannan, & Russell, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK • Charles Cullen RN Killed 40 patients UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK • Charles Cullen RN Killed 40 patients – 9 hospitals & one nursing home – 16 -year period in 2 States • Common Themes: – Cluster of cardiopulmonary arrests – Suspicions aroused b/c patients suffer multiple MI – The resuscitation rate is unusually high • Typical scenario: – – A common injectable substance in postmortem OR post-event toxicology screens Deaths that cluster on the evening or night shift presence of a specific care provider increased (Yorker, Forrest, Lannan, & Russell, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK Review • • Significant concern beyond a UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK Review • • Significant concern beyond a few shocking, isolated incidents Of 90 worldwide prosecutions (1970 -2006) • 3 suits resulted in payments of $8 million, $450, 000 and $27 million • In 36 years 2113 (≈ 59/yr) patients died suspiciously while in the care of a convicted healthcare provider – – – – 54 convictions 45 HCP convicted of serial murder 4 convicted for attempted murder/assault 5 pled guilty to lesser charges More CASKs indicted & awaiting trial or outcome not yet published 8 more charged with serial murder, but with insufficient evidence to convict 4 more nurses successfully appealed their convictions for serial murder – There an additional 80 murder charges & 26 assault charges – There an additional 242 suspected victims (Yorker et all, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASKs by Profession (Yorker et all, 2006) UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASKs by Profession (Yorker et all, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK Cases by Method (Yorker et all, 2006) UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASK Cases by Method (Yorker et all, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASKs by Injection (Yorker et all, 2006) UNIVERSITY OF WASHINGTON SCHOOL OF NURSING CASKs by Injection (Yorker et all, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Risk/benefit • • Very few of the killers UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Risk/benefit • • Very few of the killers had a criminal record many had histories of falsifying their credentials or background • • • HCP misrepresentation a serious risk factor Influenced by shortage of nurses Risk management favors policies geared toward preventing lawsuits: • Cost of defending an employment rights lawsuit: – often not picked up during hiring process – in cases when they were known about, did not seem to present a significant barrier to hiring. – Fraud or fabrication consistent with sociopathic traits and with Munchausen Syndrome – wrongful termination, denial of employment, or defamation. – Often several hundred thousand dollars. – Cost appears to have influenced current risk management policies. (Yorker et all, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killers: Born Bad University of Washington NURS UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killers: Born Bad University of Washington NURS 509

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Serial killer Carl Panzram himself wrote: UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Serial killer Carl Panzram himself wrote: "All of my family are as the average human beings are. They are honest and hard working people. All except myself. I have been a human-animile ever since I was born. When I was very young at 5 or 6 years of age I was a thief and a lier and a mean despisable one at that. The older I got the meaner I got. " • German child killer Peter Kurten had drowned two playmates by the tender age of nine. Are the psychopathic criminals really different from birth?

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=k. Xk ZMA UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=k. Xk ZMA 73 -2 U

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Perhaps morality is a complex system of UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Perhaps morality is a complex system of inhibition and activation using portions of the brain designated to both. • Neurobiology has its work cut out for it. There may be many physical reasons for an individual to be immoral.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • "After I'm dead, they're going to open up my head and find that just like we've been saying a part of my brain is black and dry and dead, " said Bobby Joe Long, who suffered a severe head injury after a motorcycle accident.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Brain defects and injuries have been an UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Brain defects and injuries have been an important link to violent behavior. When the hypothalamus, the temporal lobe, and/or the limbic brain show damage, it may account for uncontrollable aggression.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Brain Damage • In many case studies, offenders UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Brain Damage • In many case studies, offenders have been found to have had a history of head trauma and abnormality on Computerised Tomography (CT) scans, Electoencephalography (EEG) scans and neuropsychological testing. • Among the many serial killers who had suffered head injuries are Leonard Lake, David Berkowitz, Kenneth Bianchi, John Gacy, and Carl Panzram. • John Gacy had a form of psychomotor epilepsy as a child. Arthur Shawcross had psychomotor seizures related to temporal lobe damage. The EEG abnormality focused on the temporal lobe - an area associated with personality, emotion and behavior.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • One theory is that the psychopathic brain UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • One theory is that the psychopathic brain is organized differently as the result of imperfect socialization in the very early years -- arising either from inherited deficits or from a pathological family environment (or both). This could cause attributional differences to occur in the mind of an individual who has been subjected to kindling or other phenomenons. • The anatomical basis for a classical conditioning mechanism in the brain of these altered individuals could be the proximity and interconnection of limbic structures linked with feeding and aggression (the amygdala), with structures controlling sexual functions (the hippocampus and septum).

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • The diencephalic structures of the thalamus and UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • The diencephalic structures of the thalamus and hypothalamus have been suggested as having a direct role in aggressive behavior, as well as a role in associating positive or negative emotions with incoming stimuli. Abnormalities in the thalamus might explain a serial killer's inability to maintain personal relationships or display empathy for his victims (Sears, 1991). Also, the thalamus has been associated with pathological activation of fearful and combative behavior (aversive experiences) along with oral and sexual functions (pleasant experiences). When one area is stimulated, arousal may extend to other areas, producing pleasurable feelings associated with violent acts. Perhaps the behaviors that the brain rewards itself for have been altered somehow in the mind of the serial killer. If this is so, then the brain itself attributes positive responses to negative actions.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Cold Blooded • Another interesting finding shows that UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Cold Blooded • Another interesting finding shows that psychopaths have a greater fear threshold, and are less likely to respond to fear-inducing stimuli. This is not only true for complex situations, but sudden loud noises that would be expected to frighten any individual. • Psychopath's heart rate and skin temperatures are low, and their "startle reactions" are substantially less than the average person in these situations.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Hypothalamus • Similarly, the hypothalamus plays a role UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Hypothalamus • Similarly, the hypothalamus plays a role in the reticular activating system, which may block otherwise stimulating activity from reaching the judgement-related cerebral cortex. It has been suggested that such a mechanism may be what is responsible for chronic underarousal in the psychopath, leading to antisocial behavior in an attempt to increase cortical levels of arousal (Bartol, 1980). This seems to be able to explain the thrilloriented serial killer who increases the frequency of his murders.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING UNIVERSITY OF WASHINGTON SCHOOL OF NURSING "It was an urge. . A strong urge, and the longer I let it go the stronger it got, to where I was taking risks to go out and kill people … risks that normally, according to my little rules of operation, I wouldn't take because they could lead to arrest. ” Edmund Kemper

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • 5 -hydroxyindoleacetic acid (5 -HIAA), a metabolic UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • 5 -hydroxyindoleacetic acid (5 -HIAA), a metabolic bi-product of the neurotransmitter serotonin, may have an abnormally low concentration in the cerebrospinal fluid of persistently aggressive and anti-social males.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING The Triad • Animal Cruelty: Torturing animals is UNIVERSITY OF WASHINGTON SCHOOL OF NURSING The Triad • Animal Cruelty: Torturing animals is a disturbing red flag. Animals are often seen as "practice" for killing humans. Ed Kemper buried the family cat alive, dug it up, and cut off its head. Dahmer was notorious for his animal cruelty, cutting off dogs heads and placing them on a stick behind his house. • Pyromania: “What power I feel at the thought of fire!. . . Oh, what pleasure, what heavenly pleasure!” -Joseph Kallinger • Bed Wetting: By some estimates, 60% of multiple murderers wet their beds past adolescence. Kenneth Bianchi apparently spent many a night marinating in urine-soaked sheets.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Extra Chromosome? • Multiple murderer Bobby Joe Long UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Extra Chromosome? • Multiple murderer Bobby Joe Long had an extra X (female) chromosome, otherwise known as Klinefelter's syndrome, which meant he had the female hormone estrogen circulating in higher amounts in his system. His breasts grew during puberty, which caused him great embarrassment.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Mass murderer Richard Speck's legal defense said UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Mass murderer Richard Speck's legal defense said he had an XYY genetic makeup, but further tests proved this wrong. While an extra male chromosome seems like a logical explanation for mutantaggressive behavior, there is not much evidence that links the X or Y chromosome to serial killers.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Right Brain vs. Left Brain • Noting that UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Right Brain vs. Left Brain • Noting that the right hemisphere of the brain is specialized for processing the emotional significance of words, researchers theorized that psychopaths may rely more on the left hemisphere, which "uses a more verbal-analytic strategy. " This was found to be the case and indicates fundamental organizational differences in the brain processes of psychopaths and serial killers.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Using PET and MRI scans, the function UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Using PET and MRI scans, the function and structure of the brains of 41 murderers and 41 control subjects found that there was lower activity in the pre-frontal cortex of the brains of murderers when compared to that of normal control subjects. • When the murderers where further divided into affective and predatory groups, both showed higher than normal activity in the sub-cortex. • The affective group showed lower activity in the pre-frontal cortex while the predatory group showed an intact pre-frontal cortex.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killer Traits • Dr. Helen Morrison wrote UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Serial Killer Traits • Dr. Helen Morrison wrote “My Life Among the Serial Killers. ” She completed hundreds of hours of face-to-face interviews. She describes them as having the emotional age of an infant. They are generally charismatic and able to fit in by learning to behave as normal people do, while lacking the empathy most normal people possess. Most serial killers are fluent liars, often protest against the injustice of their incarceration and are unable to understand that they did anything wrong. • Serial killing has occurred throughout history and in all societies.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Morrison's list of serial killer traits include: ・No UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Morrison's list of serial killer traits include: ・No understandable motive for killing ・No personality structure, no personality development over time ・They are not psychopaths; in some ways they lack self-control, and the ability to think and feel ・Most are above average intelligence ・They are psychologically incomplete human beings, but learn to act as though they are ・Not all have been sexually or physically abused ・They are uncontrollably addicted to killing ·Frequent instances of hypochondria. ·Remarkable lack of tobacco use or alcoholism

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Morrison’s Theory • She disagrees with or downplays UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Morrison’s Theory • She disagrees with or downplays theories that attribute serial killing to complex psychological motives such as suffering child abuse, which is not a consistent factor. She contends that serial killers are so lacking in emotional development that they have no capacity for complex emotional motives. An illustrative example notes that serial killers experience profound physiological events during their crimes that are related to the hypothalamus and that the serial killer's lack of emotion has a similar connection to the hypothalamus. Morrison also describes how serial killers' crimes are similar to drug addiction.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Art? UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Art?

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING For the kids UNIVERSITY OF WASHINGTON SCHOOL OF NURSING For the kids

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Reform • One of the most outspoken critics UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Reform • One of the most outspoken critics of "reform" is a serial killer himself, the unrepentant Carl Panzram: "I have no desire to reform myself. My only desire is to reform people who try to reform me. And I believe that the only way to reform people is to kill em. My Motto is, Rob em all, Rape em all and Kill em all. "

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=djeo abid 7 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • http: //www. youtube. com/watch? v=djeo abid 7 s 4

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING http: //www. youtube. com/wat ch? v=kme. ULp 1 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING http: //www. youtube. com/wat ch? v=kme. ULp 1 M 85 c

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References Bateman, A. L. , & Salfati, C. UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References Bateman, A. L. , & Salfati, C. G. (2007). An examination of behavioral consistency using individual behaviors or groups of behaviors in serial homicide. Behav Sci Law. Beasley, J. O. , 2 nd. (2004). Serial murder in America: case studies of seven offenders. Behav Sci Law, 22(3), 395 -414. Geberth, V. J. , & Turco, R. N. (1997). Antisocial personality disorder, sexual sadism, malignant narcissism, and serial murder. J Forensic Sci, 42(1), 49 -60. Martens, W. H. , & Palermo, G. B. (2005). Loneliness and associated violent antisocial behavior: analysis of the case reports of Jeffrey Dahmer and Dennis Nilsen. Int J Offender Ther Comp Criminol, 49(3), 298 -307. Morana, H. C. , Stone, M. H. , & Abdalla-Filho, E. (2006). [Personality disorders, psychopathy and serial killers]. Rev Bras Psiquiatr, 28 Suppl 2, S 74 -79. Myers, W. C. , Husted, D. S. , Safarik, M. E. , & O'Toole, M. E. (2006). The motivation behind serial sexual homicide: is it sex, power, and control, or anger? J Forensic Sci, 51(4), 900 -907. Silva, J. A. , Ferrari, M. M. , & Leong, G. B. (2002). The case of Jeffrey Dahmer: sexual serial homicide from a neuropsychiatric developmental perspective. J Forensic Sci, 47(6), 1347 -1359. Silva, J. A. , Leong, G. B. , & Ferrari, M. M. (2004). A neuropsychiatric developmental model of serial homicidal behavior. Behav Sci Law, 22(6), 787 -799. Wolf, B. C. , & Lavezzi, W. A. (2007). Paths to destruction: the lives and crimes of two serial killers. J Forensic Sci, 52(1), 199 -203. Wright, J. , & Hensley, C. (2003). From animal cruelty to serial murder: applying the graduation hypothesis. Int J Offender Ther Comp Criminol, 47(1), 71 -88.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Overlap PTSD is not necessarily the most UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Overlap PTSD is not necessarily the most common disorder, but its onset is most easily defined (Foa, Stein, & Mc. Farlane, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Duration “Acute stress reactions are normal & UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Duration “Acute stress reactions are normal & expected responses, seen in the majority of cases. ” (Foa, Stein, & Mc. Farlane, 2006, p. 15)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Resolution • PTSD is not immediate • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Symptom Resolution • PTSD is not immediate • May represent a lack of resolution of the acute stress response • PTSD resolves in 60% of cases • (Foa, Stein, & Mc. Farlane, 2006)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Public mass-shooting • Victim’s Sx generalize to perpetrators UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Public mass-shooting • Victim’s Sx generalize to perpetrators • Some develop PTSD – Their violence becomes their trauma • gruesome consequences (bloody body) • unintended severity (accidental death) • social pressure (gang-related) (Evans, Ehlers, Mezey, & Clark, 2007 b)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • 5. 7% PTSD – PTSD rate UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • 5. 7% PTSD – PTSD rate much lower than victim’s • 45. 7% current intrusive memories of violent offense • 48% h/o psych disorder hx (vs 23%) • 58% h/o violent offenses (vs 33%) • More shame = more severe sx • Antisocial traits protective against intrusive memories • Supports “discrepancy theories” (Evans, Ehlers, Mezey, & Clark, 2007 b)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • In contrast to victims: – 6% UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • In contrast to victims: – 6% of the intrusions were about events immediately preceding the assault – Initiated by perpetrator, not initially distressing – Trauma usually did not coincide with onset of assault, but when meaning changed for the worse – Usually an unintended outcome of the assault (Evans, Ehlers, Mezey, & Clark, 2007 a)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • Implications for Ψ assessment of offenders UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Perpetrators • Implications for Ψ assessment of offenders • Relatively precise information about attitudes towards acceptability of violence – generally difficult to elicit • CONTENT & MEANINGS of intrusive memories may be useful in RISK assessment (Evans, Ehlers, Mezey, & Clark, 2007 a)

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References • • Bikel, O. (2007). When Kids UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References • • Bikel, O. (2007). When Kids Get Life. On Frontline [Television Program]. Boston: WGBH Educational Foundation. Carlos Otero, J. , & Njenga, F. G. (2006). Lessons in posttraumatic stress disorder from the past: Venezuela floods and Nairobi bombing. J Clin Psychiatry, 67 Suppl 2, 56 -63. Evans, C. , Ehlers, A. , Mezey, G. , & Clark, D. M. (2007 a). Intrusive memories and ruminations related to violent crime among young offenders: Phenomenological characteristics. J Trauma Stress, 20(2), 183 -196. Evans, C. , Ehlers, A. , Mezey, G. , & Clark, D. M. (2007 b). Intrusive memories in perpetrators of violent crime: emotions and cognitions. J Consult Clin Psychol, 75(1), 134 -144. Foa, E. B. , Stein, D. J. , & Mc. Farlane, A. C. (2006). Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry, 67 Suppl 2, 15 -25. Herman, J. (1992). Trauma and Recovery. London: Pandora. Kurtis, B. (2007). A KILLER ON CAMPUS: A BILL KURTIS SPECIAL REPORT [Television Program]. Manhattan: A&E Television Networks. Shiloh, R. , Stryjer, R. , Weizman, A. , & Nutt, D. (2006). Atlas of Psychiatric Pharmacotherapy (2 nd ed. ). Boca Raton: Taylor & Francis.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shootings: Survivalism By: Eric Pauli NURS 583 UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shootings: Survivalism By: Eric Pauli NURS 583 University of Washington

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Bowling for Columbine http: //www. youtube. com/watch? v=H UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Bowling for Columbine http: //www. youtube. com/watch? v=H 6 Welsq 8 v. ZM

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting School shootings have received a disproportionate UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting School shootings have received a disproportionate amount of media attention due to the nature of the settings and the assailants. Less than 1% of all homicides among school-aged children 5 -19 occur in or around school grounds or on the way to and from school. The epidemic of youth violence actually peaked in 1993. Homicide rates for 15 -19 y. o. have dropped approx. 174% since 1981.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting Differ from “typical violence” in that UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting Differ from “typical violence” in that they have taken place in smaller cities and towns, not involved rival gangs, or narcotics trade with the assailants primarily from middle class or affluent families and no previous criminal record. The residents of these communities considered themselves insulated from lethal youth violence. Events are infrequent and idiosyncratic making it difficult to profile students or predict behavior.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting FBI looked at 18 school shootings UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting FBI looked at 18 school shootings including 4 thwarted attacks and determined several common risks factors including poor coping skills, access to weapons, depression, drug and alcohol use, alienation and unlimited television or internet use. The U. S. Secret Service for the Dept. of Education investigated 37 school shootings since 1974 and discovered that 75% of attackers had told someone of their plans.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Individual: Kandel found that 80% arrested for UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • Individual: Kandel found that 80% arrested for violent offenses had a significant hx of birth and delivery complications compared to 30% of property offenders and 47% of nonoffenders. Genetic contribution to violence? Monozygotic twins are higher than dizygotic twins but relationship appears more variable among children, suggesting that common environment may play a more important role. Hypothesized mechanism for genetic transmission of a vulnerability to developing violent behavior include serotonergic neurotransmission that modulates impulsivity. Narcissism, mental illness, hyperactivity, drug and alcohol use, distortions in socialcognitive processes, antisocial behavior, early pattern of aggressive behavior*, etc.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Media Coverage UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Media Coverage

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Media Violence -Children in U. S. have unprecedented UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Media Violence -Children in U. S. have unprecedented access to both new and traditional media. -By 18, the average American will have viewed 200, 000 acts of violence on TV.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Short and Long-term Effects of Media Violence • UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Short and Long-term Effects of Media Violence • Short-term: ↑ HR and BP & other physiological signs of arousal. Children who observe aggressive behavior are more likely to perform the same act immediately. • Even brief exposure to media violence can reduce physiological rx to real-world violence. • Long term-effects: more enduring. Observational learning is extension of imitation, which may explain how children develop a view that the world accepts aggression as an appropriate response. These beliefs are reinforced with chronic exposure to media where violence is perceived as acceptable & without consequences, & these behaviors are resistant to change. • Fear & anger can become linked through classical conditioning with repeated exposure to violent images leading to diminished emotional rx so that violent scenes become less arousing over time.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting • Between 65 -86% Students, teachers, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING School Shooting • Between 65 -86% Students, teachers, administrators who are victims of catastrophic school shootings will most likely experience Posttraumatic stress and not PTSD.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Individual Risk and Protective Factors • Internal resources: UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Individual Risk and Protective Factors • Internal resources: problem-solving skills, cognitive function, intelligence, etc. • Resilience: ability to use natural healing processes like talking with others, journaling, play, dreams, and community rituals to celebrate life and to mourn loss. • Past experiences: previous exposure to aggression and violence and parental responses to familial aggression and violence • Spiritual Beliefs • Psychological well-being: depression, grief or loss issues, major mental illness. • Physical factors: fatigue, illness, previous use or abuse of alcohol and drugs.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Family, subsystem, and individual family members’ risk factors UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Family, subsystem, and individual family members’ risk factors • Availability of personal, family, and community resources • Culture or subculture • Gender • Economic considerations • Age and developmental level.

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UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Addressing the Development of PTSD • CISD, EMDR, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Addressing the Development of PTSD • CISD, EMDR, group treatment, individual and family therapy as well as the positive influence of stress buffers should not be overlooked. • The behavioral, cognitive, and psychological impact of catastrophic school violence and the needs of the victims and families should be addressed.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Prevention and TX of PTSD • Psychoeductional groups, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Prevention and TX of PTSD • Psychoeductional groups, single case groups, CBT, REBT, and family therapy. • Prevention programs like, FAST Track, Positive Adolescent Choices Training, and Viewpoint Training Program. • ? Prevention and treatment, such as Roberts’ seven -stage crisis intervention model, stress/crisis/trauma model, and CISD.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Stress Buffers • Impact of stress, such as UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Stress Buffers • Impact of stress, such as a catastrophic school shooting, depends on the presence, absence, or level of buffering factors. • Examples: social support, appraisal support, positive automatic thoughts, physical fitness, sense of humor, optimism, self-esteem, self-complexity, efficiency, coping style, type A characteristics, and health practices.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Resiliency • Individual’s ability to cope, bounce back, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Resiliency • Individual’s ability to cope, bounce back, & keep growing, emotionally and psychologically in challenging and traumatic situations. • Secure attachment serves as primary defense for trauma-induced psychopathology for children & adults. When mature, they are able to selfregulate aroused emotions as well as receive comfort from others.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Resiliency continued • Serves as a defense for UNIVERSITY OF WASHINGTON SCHOOL OF NURSING Resiliency continued • Serves as a defense for long-term behavioral and emotional problems. • For a resilient person, a catastrophic school shooting serves as a psychic organizer.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • I was making a statement about America, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING • I was making a statement about America, and it was definitely part of my reaction for being blamed for something like Columbine. I thought the title 'Crop Failure' was appropriate for several reasons. Columbine, some people might know, is a flower. And, obviously, ['Crop' represents] raising up your children and harvesting them properly. Something did go wrong here, and I think the farmers should be blamed, not the entertainers. "

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING I Don’t Like Mondays http: //www. youtube. com/watch? UNIVERSITY OF WASHINGTON SCHOOL OF NURSING I Don’t Like Mondays http: //www. youtube. com/watch? v=GCml d. ZM 2 ZK 4

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References • • • Anderson, M. , Kaufman, UNIVERSITY OF WASHINGTON SCHOOL OF NURSING References • • • Anderson, M. , Kaufman, J. , Simon, T. R. , Barrios, L. , Paulozzi, L. , Ryan, G. , et al. (2001). Schoolassociated violent deaths in the United States, 1994 -1999. Jama, 286(21), 2695 -2702. Brener, N. D. , Simon, T. R. , Anderson, M. , Barrios, L. C. , & Small, M. L. (2002). Effect of the incident at Columbine on students' violence- and suicide-related behaviors. Am J Prev Med, 22(3), 146 -150. Foa, E. B. , Stein, D. J. , & Mc. Farlane, A. C. (2006). Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry, 67 Suppl 2, 15 -25. Jordan, K. (2003). A Trauma and Recovery Model for Victims and Their Families after a Catastrophic School Shooting: Focusing on Behavioral, Cognitive, and Psychological Effects and Needs. Brief Treatment and Crisis Intervention, 3(4), 397 -408. Lickel, B. , Schmader, T. , & Hamilton, D. L. (2003). A case of collective responsibility: who else was to blame for the Columbine high school shootings? Pers Soc Psychol Bull, 29(2), 194 -204. Prothrow-Stith, D. (2007). Keynote address: making campuses safer communities for students. J Am Coll Health, 55(5), 300 -303. Rose, S. , Bisson, J. , Churchill, R. , & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev(2), CD 000560. Stueve, A. , Dash, K. , O'Donnell, L. , Tehranifar, P. , Wilson-Simmons, R. , Slaby, R. G. , et al. (2006). Rethinking the bystander role in school violence prevention. Health Promot Pract, 7(1), 117 -124. Verlinden, S. , Hersen, M. , & Thomas, J. (2000). Risk factors in school shootings. Clin Psychol Rev, 20(1), 3 -56. Williams, K. , Rivera, L. , Neighbours, R. , & Reznik, V. (2007). Youth violence prevention comes of age: research, training and future directions.

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING QUESTIONS? School of Nursing UNIVERSITY OF WASHINGTON SCHOOL OF NURSING QUESTIONS? School of Nursing