Jolee J. Brunton, Ph.D.
Summer 2012 Newsletter

This topic was presented by Dr. Brunton at the June, 2012 meeting
of the Northern California chapter of ATAP

A common experience in our threat assessment work is to determine that an employee ­who has raised concerns about violence is ultimately evaluated as posing a very low or no risk to others or self, but remains a challenging and delicate management issue for employers.  Clinically there are two basic groups in this regard: those with major mental disorders such as schizophrenia, mood disorders, and delusional disorders; and those with personality disorders, or enduring patterns of problematic conduct and distinctly unreasonable demands – the “difficult employee” in extreme.  Not all individuals fall within these categories but many do, or manifest certain features consistent with these classifications.

In contrast to our usual newsletter features that address risk of violence issues per se, in this feature we explore understanding and managing the first group of psychologically symptomatic employees, who may display bizarre, irrational, or aggressive behaviors.  In a future edition we will address the latter group – the personality disorders.  In discussing these behaviors we are not suggesting that workplace-based practitioners should engage in diagnosing employees; but understanding the basis for some problematic behaviors is otherwise useful, as there are common errors and dos and don’ts in managing these scenarios.

Definitions of Some Disorders

First a brief review of some relevant terms and common conditions.  (In addition, please refer to previous related feature articles, posted on the home page of wtsglobal.com: “The Paranoid Employee” and “The Querulous Vexatious Litigant,” as well as the WAVR-21 manual.)

Psychosis is a general term used to describe a break with outside reality and adherence to a private, idiosyncratic, and bizarre internal reality. An individual may be acutely psychotic and fairly dysfunctional, or have ongoing psychotic beliefs but otherwise be fairly functional and organized in his day-to-day behavior.  Psychosis can be a manifestation of several mental disorders, including schizophrenia, bipolar disorder, and depression, as well as organic illnesses such as brain tumors.

Schizophrenia is a mental disorder characterized by delusions (fixed and false beliefs), hallucinations (false sensory stimuli that others do not perceive, such as hearing voices), disorganized speech, deterioration in personal hygiene, and isolation.  Schizophrenia is fairly treatable with medication, although it can result in markedly impaired general functioning.

Delusional Disorders are characterized by false, fixed beliefs based on incorrect inferences about external reality despite what virtually everyone else believes.  The beliefs are firmly sustained in spite of obvious proof or evidence to the contrary and involve situations that could occur in real life (such as being followed, poisoned, loved at a distance, or deceived by a spouse or lover).  Functioning may not be markedly impaired, which speaks to the appearance of this disorder in the workplace.  For instance, an individual with a persecutory delusional disorder (the most common sub-type) may come to the attention of HR when he or she requests an investigation into their perception of harassment or malevolent treatment by coworkers.  Delusional disorders do not typically respond to medication, although there is evidence of 50% effectiveness with some of the more recently developed “second generation” anti-psychotic medications.

Mania, usually associated with bipolar disorder, is characterized by very high levels of disruptive energy, strong moods including euphoria versus extreme irritability, rapid speech, impudent actions and poor judgment, decreased need for sleep, very inflated self esteem, and grandiose ideas and schemes.  Individuals experiencing mania can be extremely intrusive, domineering and irrationally demanding, and can become quite angry if thwarted.  Employees with mania have been known to engage in torrents of sending letters, emails, and parcels to senior executives and the media proclaiming their specially felt views or “groundbreaking discoveries.”  With some there is an assault risk if physically confronted.  Mania should be considered a psychiatric emergency and is ultimately a very treatable condition with medication and psychotherapy.  An episode can last several months if untreated.  Not surprisingly, the manic individual’s sense of euphoria and grandiosity makes him or her reluctant to accept treatment.  Manic individuals with bipolar disorder suffer from periods of depression, and can pose a suicide risk.  Bipolar individuals are often very bright and many have had job and career success.  A personal stressor can at times contribute to a manic episode.

Major Depression is marked by continuing and debilitating fatigue, loss of energy, impaired concentration, and loss of interest or pleasure in normal pursuits.  Feelings of worthlessness or guilt contribute to thoughts of suicide.  Anger and chronic irritability is especially evident in men, who may appear more disgruntled than “depressed.”  This is a treatable condition and the degree of depression may vary, but it is clinically distinct from normal experiences of despondent feelings that are commonly experienced as part of life’s ups and downs.  Personality traits such as passive aggressive behavior – indirectly expressing hostile feelings via negative behavior rather than directly addressing them – can also be seen in these cases, as demonstrated in the case presented below.

Case Management Strategies

Employees with the above-described disorders can be very difficult to manage – even when assessed as posing no risk or a very low risk – especially if they view themselves as “normal.”  The problem, as they see it, is with others.  They are usually reluctant to seek treatment and frequently are non-compliant with therapy and medication.  Further complicating case management is the need to be sensitive to privacy, ADA and HIPPA concerns.  Successful case management of these employees requires a coordinated effort among management, HR/ER, and legal representatives.

The course to resolution is to identify and address problematic behavior.

An impediment for employers is misunderstanding HIPPA, privacy and ADA regulations as they apply to mental illness in the workplace.  Supervisors and managers often believe that any discussion of health or psychological issues is strictly taboo, and so they avoid addressing problematic behavior if they feel a mental problem may be involved.  They also may feel like they have failed in their job and should “stay the course” with a particularly troublesome employee; or, that they have the personal skills to lift someone out of what are in fact serious conditions.  In consultation with HR and legal, and screening for risk when prudent, the key is to focus on the behavior rather than on the cause of the behavior.  Rather than ignoring the issue, supervisors are usually best to treat it as misconduct, “disruptive to the workplace”, and follow the usual counseling steps of progressive discipline.  The employer’s respect for and concern that there may be health issues affecting performance and conduct should be communicated, along with a referral to EAP or other appropriate services.  This gives the employee an opportunity to seek evaluation and treatment on their own.

If the employee is unable or unwilling to correct problematic behavior the employer has several options.  One is a mandated fitness for duty evaluation.  Distinct from a risk assessment, fitness for duty evaluations typically assess an employee’s mental (or physical) condition in a comprehensive fashion as it relates to job duties and accommodation.  This option involves complexities that require careful legal review.  (We note that some organizations request a “fitness for duty” exam when what they want, upon clarification, is a risk assessment.)

Other options exist for employees continuing to manifest symptomatic behaviors troublesome for the workplace, as experienced HR managers are fully aware.  Employees may be counseled about expectations and then monitored going forward.  Some situations result in adversarial and legal disputes.  Ultimately the employer must often face the necessity to manage unacceptable behavior to resolution.  The following case study, a composite, demonstrates some of the human issues and one course to resolution.  The scenario is not uncommon to us and demonstrates how complicated a situation can become, including for supervisors and a work group, raising concerns about risk and its management, and the necessity for multi-disciplinary input and continuing collaboration.

Case Study

John, a 25 year-old employee of 8 months, provided internal tech support at a software company.  He had worked as a contractor for six months prior to being hired.  His job skills were exemplary and he quickly became the “go-to guy” in his department.  After a holiday break John’s supervisor, Amy, came to her manager and revealed that for the past six months she had been “trying to help John with his problems.”   John confided in her that he was very depressed and often thought of suicide.  In fact, Amy had spent numerous evenings and weekends on the phone with John talking him through suicidal crises.  Amy explained that since she was much older, John thought of her as a mother figure and felt very comfortable confiding in her.  On several occasions she found John under his desk, crying.  He left work without telling her, texting her hours later that he was “too overwhelmed by his life” to stay.   His coworkers were concerned but felt that talking to John was “too personal”, so they dealt with it by leaving the office when he appeared upset.  Over the break John had another crisis, and Amy, feeling helpless to assist, told him he needed to seek professional care.  Upset by this, John cried and angrily told Amy she was abandoning him.  He came to work that morning, was quiet, and didn’t return after lunch, texting her, “It was too painful” to see her.

Amy’s manager contacted HR, who activated the company’s threat assessment team.  Their outside professional conducted a careful and thorough face-to-face risk assessment of John and concluded he did not pose an imminent risk for suicide, and had no significant indicators as a risk to harm others.  His suicidal threats and extreme emotionality were assessed as primarily manipulative and attention seeking.  However, the situation would require careful monitoring to see it to resolution.

John agreed to voluntarily seek treatment, and took two weeks off, after which he was cleared to return to work.  The employer was very accommodating of his time needed for continuing treatment, but also presented him with a written performance plan addressing the “inappropriate behaviors” of crying, lying under his desk, leaving work without permission, and making threats of suicide (a violation of the company’s workplace violence policy).  At the same time John was to contact HR if he felt his emotional distress was such that he needed to leave work.  As the supervisory relationship between Amy and John had become psychologically complex and muddled from a workplace and management perspective, John was transferred to a new supervisor in a different building.  The new supervisor was apprised of the background of the case so as to avoid repeating the same missteps, and to maintain liaison with HR.

HR and John’s senior manager met with him on his first day back to review expectations.  John accepted and indicated he understood the behavior guidelines for his return to work.  However, hearing he was to be transferred to a new building and a new supervisor he became angry and refused the transfer.  He abruptly left the meeting.  Later he texted to his senior manager, “You won’t have to worry about me anymore.”  The threat assessment team conferred and considered that although it “felt manipulative to us,” they could not discount it as a veiled suicide threat, and decided to call the police.  The police conducted a welfare check at his home and determined John was not a threat to himself.  His behavior was considered misconduct and a careful review of the case was again conducted – from a risk, legal, and ethical perspective.  John was offered the option to resign versus being terminated, which he accepted, and his health benefits were maintained for six months.  The risk assessment professional met with John at the conclusion of his separation meeting to re-assess his status and further counsel him in a respectful manner about his coping strategies, negative and positive.  John also agreed to allow the professional to notify his therapist of the termination.  Finally, believing him to not be a current risk to harm himself, the professional advised the team to continue to monitor for any further information coming from John or anyone else.

These scenarios pose challenging monitoring issues: the goal is for the parties to disengage, for John to move on, which is best for him.  The company’s desired strategy is to “leave well enough alone”, to not have to reengage with John and address whether his communications are manipulative or legitimate cries for help and possibly life threatening.   No conscientious organization wants to ignore a possible risk of suicide communicated by a former employee.  The team and stakeholders must also be aware of and manage their own frustration and anger at John – a very human and at times hidden reaction – and not act inappropriately.  The strategy was to contact the police if John contacted his former supervisor or anyone else.  In fact he did call Amy a week later, with similar statements as before.  The company again contacted the police who intervened.  John was hospitalized involuntarily for a brief period – the hospital apparently taking no chances.  In this case his family was engaged by the hospital, according to the police, leading to John’s finally taking serious advantage of professional care.  He made no further contact with the company.  Other situations are more troublesome and may continue for the employer for various reasons.

As this case illustrates:

1. An employee does not have to pose a risk to self or others to remain a serious behavioral and management issue;
2. Risk screening and assessment is still important to consider before “charging ahead” with symptomatic employees;
3. A myriad of legal and strategic issues demonstrate the need for close multi-disciplinary collaboration;
4. Post-termination monitoring and liaison with law enforcement and outside agencies may be necessary or beneficial until a matter truly appears resolved.

A final note – The spring and summer of 2012 has been the occasion for several horrific mass murders – including Koikos University in Oakland, California; the Aurora, Colorado theater shooting; and the Oak Creek, Wisconsin Sikh temple shooting.  Media attention is high.  Among other concerns, this reminds us of the possible contribution of a copy cat effect – a shooter being “inspired” to notoriety by a previous perpetrator, and the need to carefully review the risk factors and warning signs in situations of concern.  At the same time, opinions of risk, as in the case presented above, should neither be inflated or minimized, but based on the facts as developed and understood.  The devil is in the details, and “when in doubt, confer.”

 Stephen White, Ph.D.
Fall 2011 Newsletter

 “The company has refused to address my appeals and is hiding behind lies of eliminating my job due to a reorganization.  This is patently false and I will show that the CEO himself is behind this conspiracy to silence me and trample on the rights of suffering employees.  SOMEONE MUST CHAMPION THEIR CAUSE.  LET IT BE ME!  When the time is right I will reveal all the names of those behind this criminal conduct.  Heads will roll in high places!!!”

       … From our case files

Everyone has a right to his or her complaints being properly investigated.  A difficult scenario facing threat management teams and legal departments is the long-term, obsessively invested “querulous vexatious litigant.”  These individuals raise concerns about violence risk given their fixation, demands to be recognized, and increasingly grandiose list of complaints and accompanying insults.  On rare occasions these cases can indeed eventuate in violence committed against the grievant’s perceived persecutors and other “obstructionists.”  The angry, overtly paranoid or delusional litigant poses monitoring and security issues over an extended period of time.

We frequently consult on these cases to private or public organizations or academia, involving subjects who come to attention due to their communicated threats, bizarre presentations, or increasing agitation and desperation.  Even in cases that do not appear to pose a risk, it is important to understand the mentality and course of the puzzling and troubling vexatious litigant, as well as some case management principles.

A typical scenario

Anyone in the professions concerned with dispute resolution will eventually encounter the claimant – rigid and suspicious but perhaps initially ingratiating – who often appears with many documents, pleading or demanding that they be read.  On inspection the arguments are poorly constructed and often confusing and rambling.  Excessive highlighting and underlining are common, as well as many attachments, often of no relevance to the case or touting broad principles of human rights.  They may utterly deny obvious undisputed facts known to others.  Although they certainly may engage in conscious lying, fundamentally it is more the case of a passionate belief in the truth of their perceptions.  Personal blogs, chat room dialogue reinforcing their perceptions, and other internet activity will accompany their quest.  How to communicate effectively with helpers and agency representatives eludes them, although some can be quite cordial with a select few as part of their strategy.  Usually those engaged with them very quickly have their competence challenged and their patience sorely tried.  Some litigants may appear at corporate or legal offices, dramatically presenting their self-authored “briefs” to receptionists or support staff – a very disturbing or frightening occurrence for an office.

According to Australian psychiatrists Paul Mullen and Grant Lester and their associates, querulous describes “a pattern of behavior involving the unusually persistent pursuit of a personal grievance in a manner seriously damaging to the individual’s economic, social, and personal interests, and disruptive to the functioning of the courts and/or other agencies attempting to resolve the claims.”

The querulous litigant is different than simply a difficult complainant

Querulousness falls along a continuum, and is not generally considered to include “difficult complainants,” those campaigning for social reform, or most whistle blowers seeking to uncover real or perceived corruption, however mistrustful and disruptive such individuals or groups may be.  These subjects generally remain within normal legal structures, have a reasonably legitimate or at least understandable social agenda (such as economic reform), and/or ultimately accept some settlement.

Querulous behavior, according to Mullen and Lester, involves a  “totally disproportionate investment of time and resources in grievances that grow steadily from the mundane to the grandiose.”  Resolutions not only require “an apology, reparation, and/or compensation but retribution and personal vindication” – objectives beyond what courts can bestow.  As Western society and organizations have expanded the opportunities and avenues for individuals to present or appeal grievances and pursue justice, a side effect may be the enabling of abuse.  In our experience these individuals often reveal grand fantasies of their ultimate vindication unveiled dramatically at the highest judicial levels, accompanied by criminal punishment and public humiliation of their wrong doers.  It can start with a relatively minor issue.  Being bypassed for a promotion can eventually lead to a bizarre, life-engrossing campaign to uncover and bring down “global conspiracies.”

In meetings the querulous may insist on taking notes or recording the session.  Such individuals do not collaborate well with others, and will dismiss lawyers, union representatives, and other helpers.   They may even call for the disbarring of attorneys and the dismissal or prosecution of other officials.  In the courtroom they may make unruly remarks to the judge, inviting sanctions.  Some may show a keen awareness of the lines not to cross so as to avoid contempt charges or jail terms.  If an individual is declared a vexatious litigant by the courts, due to their accumulated frivolous lawsuits, they can be prohibited from filing further actions unless granted permission.

In the workplace or in academia these individuals will exhaust internal appeals processes, and are often eventually terminated for poor performance or misconduct, or denied tenure.  They are typically very suspicious of the option to resign or benevolent severance offerings designed to preserve their dignity and provide transitional support.  To accept them would be an act of weakness and a further humiliation.  (It is true that some paranoids, usually in the midst of a dispute with their employer, will resign, as a way to reduce their anxiety and perhaps with the belief or hope that “conspirators” will not follow them to a new job.)

Mullen and Lester also denote a subgroup termed “unusually persistent petitioners,” who pursue their quest with voluminous petitions for help from prominent public figures.  These individuals, who are usually more psychotic, regard standard response letters from politicians as evidence of support.  Attacks on public figures are rare but possible.

The root cause of querulous behavior

Querulous behavior is likely rooted in a mental disorder, especially where paranoia and delusional phenomena contribute.  In practice, without the benefit of a direct assessment, diagnostic distinctions are often difficult to make.  In our case experience paranoia and delusions are common and readily evident, and especially relevant to assessing risk.  Paranoia can range from vague feelings of being persecuted in the absence of any facts that support such perceptions, to a highly developed, organized, and fantastic set of beliefs that are clearly delusional.  A delusion is a firmly held belief lacking any basis in fact, uninfluenced by objective evidence or rational argument, and contrary to an individual’s educational or cultural background.

Many of these individuals are otherwise functional.  A good number have families and at least some friends, jobs and careers, and may even be technically talented.  However, the felt insult from their real or perceived grievance stimulates and reveals their underlying hypersensitivity and vulnerability, leading them to become completely consumed in a self-destructive quest for vindication.  Professional colleagues may be astonished and feel understandably betrayed to learn of accusations that they have violated policy or laws, or that their research is “fraudulent.”  With querulants there is frequently a history of losses and accumulated setbacks.  Often they have never felt truly appreciated, their disgruntlement amplified by a self-righteous and self-important narcissistic outlook.  A depressed mode may be in the mix, although their adamant and aggressive style may mask it.  Their requests move to demands, from there to recriminations, and then possibly to threats to harm others: “If I go down, the firm is going with me.”

How do we assess and monitor for violence risk in these scenarios?

The risk factors incorporated within the WAVR-21 (Workplace Assessment of Violence Risk) tap the domain of interest in assessing most instances of querulous behavior.  Whether or not the subject is or was an employee, the crux is fixation on individuals or symbolic targets within a workplace, including agencies or the courts.  We then look for a certain build-up of “perfect storm” ingredients:

• An intractable and unflinching belief in the rightness of their issue, with a desperate need for “total victory.”  This position leaves the subject psychologically trapped if their definition of “justice” is not bestowed on him or her.  The ultimate denial of their claim, appeals or official attention paid to them is the potential “triggering event” and humiliating loss that we always look for in threat cases.
• The withdrawal or end of key family support or at least tolerance during a prolonged campaign.
• The exhaustion of financial resources that allow survival and stability during a legal quest, in some cases related to the end of spousal support.  Their destitute state adds stress to the spiral of loss and can contribute to a depressed, angry mood.
• Failure to move on to future employment.  They are extremely attached to the “mission” versus a paying job.  Our current recession does not help, as some may initially try for re-employment, are unsuccessful, and then refocus on a previous employer or its legal representatives.
• Very critical is the paranoid or delusional perception of malevolence by adversaries with the possibility of an accompanying decision to carry out a preemptive attack against perceived conspirators and others who have failed the subject.  The motives, which can be complex and changeable, may be to either punish adversaries or protect oneself from physical harm.  Clinical assessment specialists will look for relevant diagnostic categories where paranoia or paranoid tendencies are common or predominant: delusional disorder persecutory type (the presence of non-bizarre delusions, i.e., events that could actually occur in real life, such as being followed, poisoned, betrayed, or having one’s computer hacked), paranoid personality disorder (excessive sensitivity and suspiciousness, tendency to bear grudges, and a combative sense of personal rights), paranoid schizophrenia, and in some instances the manic phase of bipolar disorder.
• A strong sense of entitlement, usually as a reflection of narcissistic traits or personality disorder.  The combination with paranoid or delusional beliefs fuels the risk.
• Beyond actual threats to harm, any communication stating or implying that “violence is justified.”  Threats may be directly communicated to a target, or more often “leaked” to a third party.  Hopefully these are detected and reported.  There may be allusions to others who have attacked court or other officials or executives, i.e., identification with previous perpetrators.
• In certain instances, health-related losses and life changing injuries that lead to a damaged personal identity, lowered self-esteem, and a sense of hopelessness.  Some cases originate with workers compensation disputes.
• Other evidence of behaviors indicative of a “pathway to violence”: weapons capacity, acquisition, or increased practice; probing for access to targets; final acts such as otherwise unexplainable expressions of  “good-bye.”
• The static factor of a history of violence and criminality.

An advantage of legal or litigious campaigns is the subject’s frequent written communications and documents that can serve as a window into his or her thinking, goals, and intent.  Increasing desperation can be sensed and triggering events anticipated.  At times it is very difficult to identify an individual posing an increasing risk, due to the querulant’s pattern of emotional outbursts and frequent use of dire-sounding language and ultimatums.  Careful study of his behavioral patterns over time, as well as watching for mounting personal stressors, can help make these distinctions more accurately.

Case management strategies

A case involving a vexatious employee litigant is first of all a legal matter, to be resolved through the organization’s usual protocols for addressing and resolving internal complaints.  Threat assessment will run parallel to these processes and will inform and influence the actions the organization takes in managing the complainant or litigant.   As always, “safety first.”  (A case could also involve a former employee or an outsider, perhaps a customer, patient, or plaintiff now fixated on the organization or its representatives).

An employer typically will be able to easily identify the querulous litigant through the traits and behaviors described above, such as the employee’s self-created voluminous “documentation” and feedback received from managers or HR personnel who have attempted to manage the employee.  These managers will often complain, “He just won’t listen to reason and now wants me off the investigation.  He’s accusing people who have had nothing to do with his case!”

Once identified, the organization will benefit from keeping the following case management strategies in mind:

• Those involved in defending claims by the querulous employee need to be briefed about the nature of querulousness and cautioned to resist becoming emotionally hooked and to avoid any form of disrespectful or demeaning response to the individual.  These cases are not for beginners.
• When querulous tendencies are detected employers should be especially careful with their due diligence since any factual error or procedural misstep will justify suspiciousness and fuel outrage.
• Professionalism at all times should be stressed.  Those communicating with the employee about his or her complaints should make statements such as, “My evidence does not support your allegations, but I respect your point of view and understand this is very important to you.”  Attempts to dissuade the querulous employee by pointing out the limits of what can be achieved through litigation may help, but often does not.
• Viable face saving exits should be offered where possible, but again, nothing short of millions of dollars in “damages” and public declarations of institutional wrongdoing may suffice to appease the employee.
• Ongoing threat assessment and appropriate monitoring is reassuring to case handlers.  However, direct face-to-face risk assessments by clinicians can increase the probability that the subject will then expand his claim to include discrimination.  In addition former employees are not compelled to cooperate with the process.  Notwithstanding these obstacles, the employer should always take the querulant’s threats seriously.  Depending on the circumstances of a given case, he should be confronted by well-prepared case managers and/or security or law enforcement officials.  Threatening communications and gestures may be just another way for the subject to keep attention focused on his plight, but that must be determined.
• In-person proceedings, such as depositions and hearings ­– normally tense – are hot points.  The subject often represents himself pro per either by choice or because no reasonably minded attorney cares to defend him.  A querulant will likely relish the occasion to attack deponents’ testimony and otherwise push the boundaries of proper conduct.  They may commence in a fairly organized fashion, to then unravel and ramble on, or regress to a personal verbal attack.  This causes fear, and the risk for assault or violence may not be zero.  The presence of security professionals should be considered, and with no apologies to the subject because “reasonable people are concerned and we routinely take safety precautions.”  Limit setting in general is always appropriate to counter the querulant’s sense of entitlement.
• Individuals prone to paranoia or delusions may decompensate, especially under high stress, and become acutely psychotic, agitated, and threatening.  This should lead to immediate measures to detain or hospitalize them involuntarily, or if this cannot be affected, to harden any targets and take other security measures.

Can querulants benefit from treatment?

By nature vexatious litigants do not typically seek treatment, due to their mistrust and fixed belief that the problem does not dwell within.  One exception is seeking treatment to justify or prove “emotional injury” but with no serious intent to use therapeutic help to overcome their symptoms.  Employers may also remind stressed grievants of the availability of employee assistance services (EAP) or other mental health resources.  To otherwise require treatment or frame the issue as a “fitness for duty” scenario is usually fraught with legal minefields, and in our experience offers little strategic case management advantage.

Querulous-related paranoid behaviors most readily treatable with anti-psychotic medications are paranoid schizophrenia and bipolar disorder.  However, in our experience the most common disorders related to strident querulousness are paranoid personality disorder and persecutory delusional disorder.  Individuals with either of these disorders are known as reluctant help-seekers if not outright rejecters of it.  Professional opinion has traditionally been that delusional disorders rarely respond to medication.  However, more recent evidence suggests that delusions can be successfully treated approximately 50% of the time with what are known as second-generation anti-psychotic medications.  Providers will empirically test which medication will help a particular patient, if the opportunity affords itself.  The larger problem is the inherent resistance to treatment.  Mullen and Lester note that atypical antipsychotics may be helpful in their treatment setting of mostly court-referred patients.  Unfortunately, the response is slow and improvement may take months to be evident.  Maintaining a therapeutic alliance is extremely challenging.  Providers need to avoid getting drawn into the right-versus-wrong of the patient’s claim.  The focus instead should be on the cost to one’s family and finances in continuing the pursuit.

If a vexatious litigant is convicted of a crime, such as for violence, threats or criminal stalking – due to a major mental disorder – he or she could eventually be entered into a mental or behavioral health court.  These courts combine judicial supervision with community mental health treatment where appropriate, and are intended to reduce recidivism and increase public safety.   Sentencing would depend on the seriousness of the crime and the subject’s history of previous convictions.  In more serious criminal cases, psychotic individuals may be evaluated in forensic or prison settings and possibly deemed unable to understand the charges against them or incapable of assisting counsel in their defense.

In conclusion, the querulous vexatious litigant is highly challenging for those managers who encounter these individuals, and for their threat assessment teams and professionals who become engaged with them.  The risk factors for violence can be identified and assessed, using the WAVR-21 or another structured professional guide or format.  Perhaps the biggest challenge is adequate but non-intrusive monitoring for “red flag” changes over what is frequently an extended period of time.  Enlisting case handlers and other stakeholders in this endeavor, as well as providing them coaching, is important in assuring safer outcomes and an anxiety-reducing process.

A final quote by Mullen and Lester is apropos in understanding the stakes for a querulent individual: “They are like gamblers with no way out of the devastation they have wrought but through a really big win.”  Watch for occasions when the dice are about to be rolled.

References

Manschreck, T.C., & Khan, N.L. (2006). Recent advances in the treatment of delusional disorder. Canadian Journal of Psychiatry, 51: 114–119.

McManus, F.B. (2008). The psychiatry of unusually persistent litigants.  Litigant in Person. Retrieved November 10, 2011 from http://litigant.blogspot.com/2008/03/psychiatry-of-unusually-persistent.html.

Mullen, P. E., & Lester, G. (2006). Vexatious litigants and unusually persistent complainants and petitioners: From querulous paranoia to querulous behavior. Behavioral Sciences and the Law, 24: 333-349.

Smith, D.A., & Buckley, P.F. (2006).  Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment. Behavioral Sciences and the Law, 24: 351-367.

Stephen White, Ph.D.      Bram van der Meer, MSc.      Reid Meloy, Ph.D.
Spring 2011 Newsletter

Collaborating with us on our feature this quarter is Bram van der Meer, a new colleague in The Netherlands.  Bram recently co-founded his own consulting service, Black Swan Forensics, after a 6 year career as a clinician in a forensic mental health facility, followed by an 11-year career as a  threat assessment professional  and profiler with the Netherlands National Police.

On a recent Saturday morning in the Netherlands a young man from the town of Alphen aan den Rijn went to a local shopping mall and staged what is rare for Europe – a public mass murder.  The shooter, Tristan van der Vlis, fired over a hundred rounds, killing six shoppers and injuring 17 others.  He then turned one of his firearms on himself.   As one of the town mourners said, ”A shooting like that, you only see them in the cinema or in America — not in the Netherlands.” The President of the Netherlands declared the event “a national tragedy.”

Indeed the Alphen shooter is all too familiar to those of us in the threat assessment field, as well as to the American public in general.  It could have been the description of a mall shooting in the US.  In media accounts 24 year-old Van der Vlis is described by family and his few friends as having a long history of violent delusions, anger toward police and authorities, and immersion in violent video games.  Diagnosed with paranoid schizophrenia, he was involuntarily hospitalized for a time in 2008 after a serious suicide attempt by poisoning.  A local prosecutor stated that Van der Vlis stopped taking his anti-psychotic medications about a year before the attack, and dropped out of treatment with his psychiatrist about seven months ago.  He owned several firearms, had five gun licenses, and was a member of a gun club.  He talked frequently about M16s and machine guns, the deadlier the better in his mind, and how to get them illegally in the Netherlands where firearms are more rigorously controlled.

Van der Vlis worked sporadically, mostly in supermarkets, but often provoked his being terminated by causing disruptive conflict.  He took his breaks in his car and his coworkers avoided him (Is it coincidental that he committed suicide near the mall’s supermarket cash registers?)  He had not worked for some time and was becoming increasingly disorganized and isolated.  He never dated or even discussed girls.  More than once he talked about “going into the city hall or a police station and shooting everyone.”  An old school friend when informed of the incident said, “I thought it must be Tristan.”  He lived with his father, but left a suicide note for his mother, who described it as spiritual and focused on his wish to die.  He planned and prepared for his killings.

Angry, delusional, immersed in weapons, preoccupied with violence, leaking his intent to attack to third parties, but not directly threatening; suicidal, underemployed, isolated and alienated – these are “perfect storm” ingredients and common precursors to a mass murder.  His father also may have enabled him by apparently allowing him continual access to firearms.  Research by Hempel, Meloy, Mohandie and others have found that the majority of adult mass murderers are delusional at the time of their killings; and paradoxically, the psychotic mass murderers kill more victims than the non-psychotic mass murderers.  Their delusions are often suffused with paranoid ideation, and their targets are often strangers to them, yet conspiring against them—at least in their bizarre and violent fantasies.

Although hardly immune from violence, the statistical picture has long suggested that Europe is less vulnerable to mass murder.  For instance, American corporations are well aware of the possibility of workplace violence at home, and report much lower levels of incidents of concern at their European work sites.  A 2010 report by the European Agency for Safety and Health at Work did note increasing incidents of workplace violence and consequent concern, but the typical focus is on non-homicidal aggression, such as harassment, bullying, mobbing, and assault.

But homicidal attacks – at workplaces, campuses, and against public figures – do occur.  For instance Finland, Germany, Belgium, and the UK have all experienced mass murder incidents in recent years, typically committed by lone individuals and unrelated to the global terrorist threat.

One of the findings of studies of school shootings in Europe is that the assailants are influenced by and familiar with previous shooters, and desire to create their own notoriety in the aftermath of their killings, often with a wish to outdo their predecessors in body count.  In our increasingly globalized and internet-driven world—with instant saturation news coverage on many platforms by the likes of CNN and the News Corporation– it is now quite conceivable that an attack on another continent will contribute to a “copy cat” shooting in a distant locale.  Perhaps Van der Vlis was influenced by Jared Loughner, the January, 2011, Tucson assassin and mass murderer.  In our instantly connected world it is wise to consider that any “local” incident can have global ramifications.

One implication is that areas of the world less familiar with such events need to understand that, “It can happen anywhere.”  There is an increasing interest in training for police and other first responders—most mass murders are completed within 15 minutes before special weapons and tactics (SWAT) teams arrive– and a more critical look at interagency cooperation.  Guidelines for detaining and treating the dangerous mentally ill are also easily accessed.   Although most people with mental disorder are more likely to be victimized by violence than to perpetrate it, there is a significant relationship between psychosis and general violence toward others.  “Active shooter” scenarios and training are also being increasingly utilized by both law enforcement and campus/corporate security professionals (see, for example, Active Shooter: How to Respond, by the U.S. Dept of Homeland Security).

The US may be the leader in targeted revenge or delusionally-driven violent attacks.  As a consequence US threat management “technology” is more developed than in other parts of the world.  Many incidents, however, have likely been prevented by interdiction, informed by knowledge of the static risk factors and the dynamic warning behaviors, with the help of increasingly knowledgeable professionals and an aware public.   Although it is virtually impossible to prove that an act of targeted violence was prevented—one cannot verify something that did not happen—threat assessment and its corollary risk management offer a systematic method to identify and successfully intervene with those individuals who appear to be at risk of targeted violence.

The Dutch Police are currently investigating the background of Van der Vlis and developing a reconstruction of the attack.  A final report and press conference will be released within the next few months.

Stephen White, Ph.D.
Winter 2011 Newsletter

Note: The following feature was composed prior to Saturday’s tragic Tucson, Arizona shootings, the very rare event of an attempted assassination combined with a mass murder. Was the copycat effect a factor in Tucson?  Clearly the Arizona shooter, Jared Loughner, was driven by serious mental illness that included anti-government, anti-law enforcement paranoid themes. Was he also further “inspired” and his time frame accelerated by the Florida public figures attack and the inevitable resultant notoriety for the perpetrator?  In any case there are now at least two relatively recent well-publicized events – and thus reminders of the need to be especially vigilant for subsequent incidents of concern that could foretell a next attack.  A third possible influence is the assassination of the governor of Punjab on January 4^th by one of his security guards with terrorist motives.  Both the Punjab and Arizona attacks were blitz assassinations at close range, of political figures in democratic societies, by individuals with extremist beliefs.  Potential assailants follow the news and identify with previous perpetrators. 

On December 14^th 56 year-old Clay Duke – disgruntled, broke, and troubled – held the members of a Panama City, Florida school board at gunpoint while pronouncing his grievances, eventually firing at them but missing.  When the school security guard fired on Duke, hitting him, he fired back and then killed himself.  Miraculously no one else was injured.  The incident gained national attention because it was recorded on video and posted, including the tension-filled exchange between Duke and the pleading board superintendent.

This is a workplace targeted violence incident: an outsider with conscious intent to attack the board members and what they presumably symbolized to him.   It could also be classified as an attack on public figures.  Local governmental representatives, who may regularly make controversial decisions, are not immune to public attacks by a citizen who may know them well-enough.  Although you have likely seen it, here is one of the links to view the incident.

With respect for his family members, we review here the case as an instructional exercise, and conduct a post-incident analysis with the WAVR-21.  Our purpose is always to educate toward preventing other tragedies.  This is not a critique of the actions of those who were subjected to or involved with the incident.

From media accounts (not always accurate and never complete) we can see which workplace violence risk factors were present or likely so, leading up to the attack.  Together the factors combine into a “perfect storm” of ingredients and Duke’s pathway to violence.  (For those unfamiliar with the WAVR-21, it is our scientifically based structured instrument for organizing risk-relevant information and assessing workplace violence risk.)

Item 1: Motives for Violence

Duke’s stated grievance was that his wife had been fired from the school district (she did not pass the probationary period and was released as a teacher’s aide last February, 2010).  He stated during the incident, “You fired my wife…Our benefits have run out. We’re broke. You see what I’m saying?”  He also criticized the board for being supportive of tax increases.  His stage – an official public meeting – suggests he was motivated to bring attention to his problems, and make a dramatic impression, which he did.  His Facebook posting on December 9^th points to his worldview, one of economic powerlessness, which plausibly contributed to his actions:

“My Testament: Some people (the government sponsored media) will say I was evil, a monster (V)… no… I was just born poor in a country where the Wealthy manipulate, use, abuse, and economically enslave 95% of the population. Rich Republicans, Rich Democrats… same-same… rich… they take turns fleecing us… our few dollars… pyramiding the wealth for themselves. The 95%… the us, in US of A, are the neo slaves of the Global South. Our Masters, the Wealthy, do, as they like to us…”

Item 2: Homicidal Ideas, Violent Fantasies or Preoccupation

Duke identified with the movie “V for Vendetta,” a 2006 film portraying a shadowy and charismatic freedom fighter who seeks revenge against those who disfigured him, and who uses terrorist tactics to fight against a totalitarian society.  At the time some political groups saw the film as presenting an allegory of intrusion and oppression by government.  Duke posted pictures from the movie on his Facebook page, including the circled “V” that he painted on the wall of the school board meeting room.  Such violent preoccupations may serve to compensate for opposing feelings of despair, powerlessness, and diminishing self worth.

Item 3: Violent Intentions and Expressed Threats

Duke stated to the board, “Somebody is going to die today.”  Given the attack the question of his intent is moot.  Or did he only intend to scare the six board members, as his wife claimed after seeing the video?  She stated in a credibly poignant and understandably protective television interview that he was a good shot and at such close range he could not have missed if he intended to harm others.  However he did fire back at the district security guard.  What is clear is his intent for the incident to end with his suicide, a common occurrence in targeted violence – especially in cases of intended mass murder–whether others are first harmed or not.  After initially telling everyone to leave the room except “the assholes” on the board, his next words were, “I’m going to die today.”

Item 4: Weapons Skills and Access

Duke’s wife stated he did two Air Force “tours” and received firearms training.   He used a 9mm Smith and Wesson pistol and was carrying an extra box of ammunition with 50 bullets and an extra magazine.  He also allegedly stockpiled weapons in preparation for Y2K.  Weapons access is a necessary but not sufficient ingredient for an armed attack, but skill is even more important.

Item 5: Pre-Attack Planning and Preparation

Obviously Duke planned the attack, but apparently leaving little concrete evidence of what was in store.  Police did find a telling sign: a calendar in his mobile home with the circled letter “V” marked on December 14th.  They also found references to military tactical books and anti-government literature.  Although they knew he was “upset” and struggling, Duke apparently kept his intent and planning completely unknown to his wife and family, who are described as “devastated and shocked.”  Alternatively those close to him could have subconsciously ignored the more serious signs and their implications.  This is not to judge them.  Denial is a very common and all too human mechanism in the service of protecting intimate relations.  Shooters often “leak” their intent to third parties, but not always; threatening communications of any kind are not always reported.  As the date of the attack approaches an individual may go into “tactical silence.”   Intriguing is that Duke opened his Facebook profile only a week prior to the shooting.  In the absence of other risk factor evidence, social network postings are most often not indicative of real risk: there is a high rate of false positive hyperbolic ranting.  But if other factors had been known, this recent act and the posting quoted above could have been interpreted as a sign of serious escalation and preparation.  The issue is always to know more of what is unknown at the time of the threat assessment, and to connect the dots in a meaningful way.

 Item 6: Stalking and Menacing Behavior

Duke apparently had no other criminal problems or incidents of concern in the year leading up to the attack.  However, in 1999 he was arrested for aggravated stalking of his ex-wife from his first marriage.  Four years after their divorce, but six months after his marriage to his current wife, Duke appeared at the first wife’s home with two handguns and wearing a mask and a bulletproof vest, according to an arrest affidavit.  He threatened to kill her and as she tried to leave, he shot out a tire on her vehicle.  By Duke’s own account he had been surveilling her for six months and told her details of her personal life to prove it.  He said he was going to kill her and several other people before he killed himself.  She’d seen him parked outside her home on previous occasions and a tree in her yard had been vandalized months earlier.  Duke eventually pleaded no contest to several felony charges and served five years in prison (According to the website of the Florida Department of Corrections, he was sentenced in 2000 for aggravated stalking, obstructing justice and shooting into a vehicle.).  Duke did not stalk the board members; why would he need to?  But this history suggests his inclination to obsess about and act out against others as the perceived source of his problems.

Item 7: Current Job Problems

Duke was unemployed and had trouble keeping a job.  “He couldn’t work.  He just mentally couldn’t make the connection for eight hours a day,” said one of his former attorneys.  Although he had no current job and thus no current job problem, we are concerned as well in our assessments with individuals who have a pattern of job losses or under-employment.  Work is a great stabilizer and provider, not only of income, but of social belonging and status.  This is especially true for most men in our society.

Item 8: Extreme Job Attachment

This factor does not seem relevant in this case, at least for Duke per se.  It refers to the strong emotional attachment and personal identification an individual may have to his current job, and that losing it against his or her will may trigger violent retribution.

 Item 9: Loss, Personal Stressors and Negative Coping

This seems to be a prominent factor for Duke given his mounting financial problems and resulting pressure, in the context of a work life that never seemed to “launch.”  His wife’s unemployment benefits were on the verge of running out.  She stated, “The economy and the world just got the better of him.”  In 2005 he sued the Social Security Administration, which had denied his application and five appeals for disability benefits and health insurance.  He had previously filed for bankruptcy while in prison.  Duke’s case represents the tragic extreme of our national issue with unemployment and high stress levels.  Some cope better than others.

Item 10: Entitlement and Other Negative Traits

On the one hand, those who were closest to him do not describe Duke as a distinctly negative character.  But a decision to attack does speak, by definition, to a striking sense of entitlement and lack of any empathy and consideration for the targets and other secondary victims of violence.  His former lawyer stated that one of the doctors who evaluated Duke included the diagnosis of a “personality disorder.”  This refers to enduring maladaptive traits and behaviors that are evident across different situations and are much more challenging to treat.

Item 11: Lack of Conscience and Irresponsibility

Obviously these qualities are present to some degree, but Duke’s lifestyle does not suggest an everyday pattern of antisocial behavior.  In conjunction with item 10, targeted shooters are not always individuals who present as malicious and callous across all aspects of their life and relations.  Many display a “good side”.  It is one reason we are careful to gather collateral information from various individuals when doing assessments, to see what darker motives and irreconcilable insults or wounds they may harbor.  We note that there are often discrepant accounts of an assailant’s nature offered by his friends, neighbors and coworkers after an attack: for example, he was “friendly and generous” vs. he was “hostile and ready to explode.”

Item 12: Anger Problems

Some relatives described Duke as angry and seething inside.  His cousin, who cared about him, stated that since his wife’s dismissal, his anger and alienation “rumbled and grumbled inside of him until he just couldn’t take it anymore.”  Anger may serve as a motivator for those who attack, and is another indicator of insufficient self-controls.  Yet as we see repeatedly, shooters are not feeling or displaying anger during the attack.  They are focused on “the hunt.”   The board superintendent described Duke as having “almost a smile on his face.”

Item 13: Depression and Suicidality

A cousin who saw him at the family’s Thanksgiving gathering said, “He hugged me a little tighter than usual.”  Had he made his decision by then?  His Facebook posting, written in the past tense, suggests suicide: “Some people (the government sponsored media) will say I was evil, a monster…”  Historically Duke is described as being subject to depression as a result of bipolar disorder, described more fully under the next item.  He also allegedly considered suicide to conclude the attack on his former wife that resulted in his imprisonment.  It is reasonable to speculate that despair was a common experience for Duke and a significant underlying contributor to his frustration, anger, and eventual decision to act violently.  His opening remark to the board after clearing the room – “I’m going to die today” – is uttered with a tone suggesting he had taken control over his circumstances.   Such lethal decisions, shocking and irrational to family members and others, are regarded as a solution by the individual.

Item 14: Paranoia and Other Psychotic Symptoms

One of his former attorneys, in defending Duke’s attempted shooting of his ex- wife, filed a notice with the court that he intended to prove Duke had been stricken with a “mania” associated with Y2K.  He remembered Duke as especially paranoid about the new millennium.  “He was one of these Y2K people,” referring to a computer bug that some thought was going to cause massive problems and economic chaos on January 1, 2000.  “He was one of those believers that the world was going to turn for worst and he was stockpiling weapons, assault weapons… He was competent but he was one of those people who had a mood disorder where they could be depressed one day and all excited another day.”  He allegedly received treatment and took medication in prison for what he told a judge was adult-onset bipolar disorder in a letter last year.  Another attorney of Duke’s stated he had been diagnosed by several doctors as bipolar, but no longer had enough money to buy the needed medication. “He was clearly in need of help.”  Although Duke may have had paranoid episodes and clearly lacked trust in government, the visible elements of the attack itself do not suggest it was driven by active and severe paranoia per se (nor by an agitated manic state).

 Item 15: Substance Abuse

No mention of substance problems was offered in the media.  This is not necessarily unusual for targeted shooters, in contrast to most single homicides.

Item 16: Isolation

Duke is described as “alienated from society” given his negative feelings about government.  To clarify, this is not what we mean by Isolation in the WAVR-21, as this item refers to individuals who eschew personal relationships and attachments, who prefer to be “loners.”  We are also looking for individuals who are increasingly isolated, perhaps indicative of movement on a pathway to violence.  Duke had attachments and with his current family members they appear to have been positive.

 Item 17: History of Violence, Criminality, and Conflict

Although they often reveal histories of repeated conflicts, reflective of their negative personality traits, the majority of workplace targeted attackers do not have significant histories of violence.  But Duke’s criminal history described above – the 1999 first-degree felony for shooting at his former wife while she was in a car – is very significant, and clearly suggestive of what he eventually could and did carry out.  In the ’99 incident he was wearing a mask and a bullet-proof vest – clear evidence of a planned, predatory act.  (He served 85-percent of his 60-month prison sentence and was released from probation last February.)

Item 18: Domestic/Intimate Partner Violence

Duke’s widow denied he was violent with her and described him as gentle and compassionate and “always wanting to do the right thing.”  However, his history of violence toward his former mate suggests another experience in intimate relations.  Perhaps he “learned” in one realm, even though he ultimately did not learn enough.

Item 19: Situational and Organizational Contributors to Violence

This item is more relevant to cases involving employees or former employees who have or had a real ongoing relationship with the subject of concern.  The item refers to factors such as malicious provocation by others, or denial of any violence risk by the employer – outside influences that may contribute to the mix.  Some may argue that denying Duke his requested $500 to $600 a month for his mental disability was an outside contributor.  It is a fair point regarding our overall social policies, if not in this particular case.  What are the ultimate unwanted costs of not making treatment available to those who want it and would benefit from it?

Item 20: Stabilizers and Buffers Against Violence

Whatever stabilizers may have been available to Duke through his family, it was not enough to dissuade him.  Some shooters perceive or decide their family “will be better off without me.”  We do not know.

Item 21: Organizational Impact of Real or Perceived Threats

Not a risk factor per se, this item is more relevant to unfolding or escalating cases with current or former employees, and addresses the impact – fear and disruption – of threat scenarios.

How can incidents like this be prevented?

Many public meeting places, especially courtrooms, use metal detection technology and other security measures. This is obviously and increasingly prudent given the lack of information about or awareness of potential perpetrators who may gain access.  To identify potential threats earlier in their development, the threat assessment model requires that information of concern be recognized, reported, investigated, and analyzed for its seriousness, then lead to viable interventions being considered.  Municipally sponsored multidisciplinary teams consisting of representatives from law enforcement, mental health, the legal profession, and other administrative resources can help to protect public figures from attacks.  And in our post-911 world, the citizenry now understands, or we should, that officials need help: “If you observe something suspicious, report it.”

If it had somehow come to official attention and been suspected that Clay Duke was contemplating an attack, he might have been helped, perhaps with a resumption of professional intervention, including medication.  His wife was allegedly seeking re-employment, which might have been further facilitated.   It is otherwise likely, given his history with the criminal justice system, that Duke knew better than to leave clues of his intentions, to avoid renewed detention and prosecution, and interruption of his plan.  He must have decided he was done with any help-seeking.

If this case were brought to attention in the days just prior to the attack, what would have given me most concern about Duke, as seen through the lens of the WAVR-21, is his chronic underemployment, economic bottoming-out, suicidal despair and anger, pronouncements rationalizing violence as justified, and especially his history of a serious premeditated armed attack (however strategically ineffectual).  A threat assessment interview of him would add significantly to the database, test the viability of defusing him, and hopefully lead to other risk-reducing options, whether benevolent, punitive and restrictive, or a combination of these.  His case presents the challenges of monitoring and managing an individual over whom outside controls are limited.  But at least he would be “on the radar.”

A final note: Duke also posted on Facebook the final passage from Percy Shelley’s 1819 “Masque of Anarchy”:

Rise like Lions after slumber
In unvanquishable number,
Shake your chains to earth like dew
Which in sleep had fallen on you- Ye are many — they are few”

Stephen White, Ph.D.
Summer 2010 Newsletter

One of the more valuable presentations this August at the annual meeting of the Association of Threat Assessment Professionals (ATAP) was offered by Dr. Mario Scalora of the University of Nebraska and Detective Bill Zimmerman of the United States Capitol Police.   For several years they have been conducting research on threats to members of the US Congress.   One advantage of their research is a substantial database of voluminous communications of concern by a large number of subjects.  What this line of research seeks to determine is, of those individuals who generate communications of concern, which of them may make a “problematic approach,” i.e., a potentially disruptive or threatening movement toward a target, or an actual lethal or near-lethal attack?

Recognizing certain limitations in doing so, their findings may be of use and extrapolated to the assessment of risk to other public figures.  This includes CEOs, senior executives, industry “celebrities,” and more local judicial and political figures – the recipients of flaming communications or internet postings from disgruntled or mentally disordered miscreants, as well as those who may just be “down on their luck” in our recession economy.

Among the findings of Scalora and Zimmerman:

• current trends show an increase in threatening language across all modalities of communication (emails, internet postings, letters, phone calls);
• increased threatening email and other electronic activity;
• more intense politically driven activity and rhetoric;
• more extremist language from a range of domestic and transnational sources;
• a significant presence of persons with probable mental illness.

I am not surprised by these findings, based on my current case work – there is an increase in the level of communicated discontent and it is becoming more extremely expressed.  But do these trends by themselves also indicate an increase in violence risk?  No – according to Scalora and Zimmerman: you need to look at the overall behavior of the individual, whether they show an intensity of effort, an intensity of focus on either the target or an issue, and whether their pattern of communication is escalating.

Those who eventually became “problematic approachers” were more inclined to:

• use multiple contact methods;
• display an intensity of focus;
• make more contacts;
• make demands;
• mention their stressors;
• focus on their personal themes;
• express their intent to approach.

Examining the content of communications, risk factors for approach included:

• personalized motives (for example, requesting help from a congressman to get a relative a visa);
• mental illness symptoms, particularly those indicating a threat to self or a lack of bodily or personal control (e.g., a subject with delusions that government officials are damaging his body with a dangerous laser instrument);

• expressed intent to approach (“I’ll be seeing you when you’re in town, Senator.”)
• language tied to the above content that violence is justified as a response – the old stand-by.

What about threatening language?  As we know, threats per se are typically not very reliable predictors of who poses an actual risk of violence.  But it depends on the population and, as usual the context and presence of other risk factors.  Scalora and Zimmerman found that threats to public figures should be taken more seriously if the subject is severely mentally ill, or if the threats emerge as part of a series of contacts or with a history of prior problematic approaches.

Doesn’t this all make sense to those of us who engage in threat assessment and threat management?  The risk factors are not dissimilar to those for workplace or campus targeted violence.  Case data must be examined in its totality, as much of it as we can reasonably obtain.  Cases often start with communications revealing anger, desperation, recent significant losses or setbacks, a strong sense of being wronged, and perhaps actual threats.  We then look at the overall context in forming opinions and action plans.  Much of what is originally communicated raises concern to the untrained eye, especially if it also includes or leads to malicious or provocative behavior.  But most communicators are “false positives” – troubled and troublesome indeed, but not posing a risk of harm to others or self.  This finding, however, does not diminish the need to monitor, de-escalate, and to redirect subjects when possible to viable mental health and other resources.

The findings of Scalora and Zimmerman are also consistent with the serious research underway by my colleague and WAVR-21 co-developer, Dr. Reid Meloy, who also presented at ATAP on this subject.  His recent analysis of six public figure studies, soon to be published in the Journal of Forensic Sciences, revealed that problematic approachers were:

• more likely to exhibit serious mental illness;
• engage in multiple means of communication;
• involve multiple contacts or targets; and
• incorporate requests for help into their communications;
• and less likely to use threatening or antagonistic language, except in those cases involving security breaches.

Public figure problematic approachers have different motivations for their actions, but in common they share fixations – intense pathological preoccupations with a person, idea, activity, or cause, including a strong personal grievance or quest for justice.  Research attempts to better define who will be on an actual behavioral pathway to violence – a concept central to our work in assessing and preventing targeted violence.

Research to develop more refined classifications of perpetrators and “individuals of concern” may seem irrelevant for case management operational decisions, but they are not.  They increase our efficiency and wisdom when choosing interventions.  When you go to your doctor with a persistent cough it makes a big difference if he tells you it’s “just a virus going around,” versus pneumonia, emphysema, or lung cancer.

And yet we must be very thoughtful and careful when applying large group data to an individual subject, because membership in a class does not always imply predictive accuracy in an individual case with its unique mix of relevant risk and violence-buffering factors.

Our work is unfortunately increasingly necessary, and ultimately humbling.  That’s why we always add this reminder, “When in doubt, confer.”

Reid Meloy, Ph.D.
Spring 2010 Newsletter

When U.S. Army Major and psychiatrist Malik Hasan committed a mass murder at Ft. Hood, Texas, in November, 2009, it was the culmination of a pathway to violence that began several years earlier.  It was not impulsive nor reactive.  It was planned and purposeful, and may serve as a harbinger of future acts of workplace violence which are motivated by religious and political extremism.

Now a paraplegic who will begin his criminal trial in the fall, Dr. Hasan self-radicalized.  Although he had e mail contact with a Yemeni imam named Anwar Alwaki who may have sanctioned his extremist desires–and has been officially targeted by the U.S. to be either captured or killed–the personal psychological change that Hasan underwent is most critical to understanding the potential threats that may be posed in the workplace.  In this first in a series of articles, I want to frame some ideas that may be helpful to those tasked with maintaining workplace safety in the face of the self-radicalization threat.

First, the numbers.  Although US intelligence analysts estimate that violent Islamic extremists probably number in the thousands throughout the world, a recent international Gallup poll in the majority of Muslim countries found that 7% of those interviewed would be considered radicals:  they believed that the 9/11 attacks on the U.S. were fully justified, and also endorsed the use of violence to bring about immediate political change.  Although there are over a billion Muslims in the world, and the vast majority condemn both attacks against civilians in any context, as well as violence to deliver political change, this still represents millions of believers, some of whom will be employed by you.  Although the risk of acts such as the Ft. Hood massacre will remain extremely rare, the beliefs that motivated Hasan to act are not.  How do we identify those who are self-radicalizing?

Over the course of the past decade, I have spent time developing the concept of the “violent true believer:” an individual who intends to kill himself and others to advance a particular religious or political belief system.  Although this term could attach to various individuals and movements throughout history—Christians were executing heretics less than 400 years ago in Scotland—it is most applicable to Muslim extremists in our contemporary times.

One pathway toward radicalization that has emerged from my work with different government agencies begins with rejection from a chosen occupation, such as a career or a course of studies, which results in anger and humiliation concerning the loss.  This is followed by a period of social drift in which the individual becomes increasingly depressed and withdrawn from others, and increasingly angry and alienated from the predominant economic and political forces around him.  Most interestingly, young Muslim males who take this path often tend to disavow any affectional or sexual relations with young women, and the first to complain about the change in the young man are these young women.  He is converting to an extremist and politically charged version of Islam that promotes a rigid and absolutist belief, derogates critical thought, and blames others for all his troubles.  He becomes more intolerant of difference, and hatred of others is more palpable.  Paranoia begins to emerge, and hints of an entitlement to kill others who do not believe become evident.  In several of our cases, his friends, acquaintances, and fellow employees described him as increasingly intense, humorless, angry, ideologically rigid, dogmatic, and strident before the mass murder.  A very recent case that may partially fit this profile is Faisal Shahzad, the so-called Times Square Bomber, who failed in his attempt to kill civilians on May 1, 2010; he appears to have self-radicalized—with help from extremists in Pakistan—following both economic and marital failures.

In another line of research, Daveed Gartenstein-Ross and Laura Grossman studied 117 “homegrown” jihadist terrorists in the US and UK.  Their sample either participated in or provided illegal support for jihadist terrorist plots.  These subjects spent a significant portion of their formative years in the West, or their radicalization was closely tied to connections in the West.  They found six manifestations of radicalization:

1. He adopts a legalistic interpretation of Islam.  This is a rules-based approach to the Koran in which the holy book provides strict guidelines for virtually every aspect of one’s life.  This is necessary but insufficient for radicalization, and by itself, may only represent a very conservative Islamic tradition.

2. He begins to trust only select religious authorities.  He puts his complete faith in a certain select and ideologically rigid set of religious authorities.  All other moderate and scholarly interpretations of the Koran are considered inauthentic or watered down.

3. He perceives a schism between Islam and the West.  He comes to believe that there is an irreparable separation between Islamic and Western beliefs, and they are fundamentally incompatible.  The concept of loyalty is critical, and even participation in Western democracy may be suspect.  He is likely to socially withdraw from former friends, acquaintances, or employees who do not share his beliefs.

4. He has a low tolerance for perceived theological deviance.  All religious disagreements becoming immediately personal, and are met with a large amount of anger, if not fury.  There is absolutely no willingness to listen to another’s religious view.

5. He attempts to impose his religious beliefs on others.  He will typically try to convert family members and friends first, but this will not be limited to the home, and will likely spill over into the workplace.

6. He becomes politically radicalized.  He comes to believe that Western powers are conspiring against Islamic believers and want to subjugate them both physically and morally.  Muslims worldwide have lost their faith, and do not have the strength they possessed during the reign of Muhammed.  The only proper response is violence.

Through these various approaches, we begin to see the internal world of the self-radicalizing individual.  Next we will look more carefully at the warning behaviors that may indicate a self-radicalized individual is on an intended and targeted path toward violence.

Stephen White, Ph.D.
Summer 2008 Newsletter

Who hasn’t encountered the troubled and troubling employee who seems to be saying, “I need your help, but I don’t trust you, and you may even be part of the problem!”

Recognizing the Paranoid Employee. The hallmark of the paranoid individual is a pervasive suspiciousness, mistrust, and great sensitivity to any negative feedback.  Perceived slights are exaggerated as signs of the malevolent intentions of others. Challenging and perplexing for managers, HR and security professionals – the paranoid employee’s irrational fears and beliefs are entrenched and not easily subject to reason or problem solving interventions. Preferring emotional distance, they may function better in individual positions that require as little team interaction and customer relations as possible.  Many paranoid individuals will keep their idiosyncratic thoughts to themselves, act fairly normally, and perform their job adequately.  It is when their “issue” comes to the fore that the frank irrationality of their beliefs is apparent.

Because they can be demanding, arrogant, and angry it is easy to forget that paranoid individuals are basically very uneasy and fear being exploited or harmed.  To reduce their own anxiety and unable to get their way, some of them will retreat, regaining control by quitting or abandoning their job.  Others will persist adamantly, sometimes for a long period of time.

The Range of Paranoid Behavior in the Workplace.  Where “highly suspicious” ends and true paranoia begins is not always clear.  Paranoia can range from vague feelings of being persecuted in the absence of any facts supporting such feelings, to a highly developed and fantastic set of beliefs that are clearly delusional. Paranoid delusions may be bizarre and implausible (e.g., that aliens from another planet have surrounded an employee’s home), or actually quite possible, such as one’s spouse being unfaithful, or that managers are conspiring to assign someone to projects that will cause him to fail.  Paranoid thinking may surface as an off-handed or odd comment and be dismissed as something misheard or a brief moment of strangeness.  However, the comments usually continue, especially under stress, provoking concern and fear among coworkers and managers. more…

Stick to Problem Behaviors, Not Diagnoses.  Paranoid thinking has different causes, some of them quite treatable, and some of them decidedly not.  By nature most paranoid individuals are resistant to treatment, especially medication.  Of course it is not the role of in-house professionals to diagnose anyone who appears to have mental issues.  Managers should stick to observable problem behaviors that disrupt the workplace or interfere with productivity.  When the paranoid individual starts accusing coworkers of hostile actions, fear can quickly spread within a work group.  Management is compelled to act in these situations, but must do so carefully.

Threat assessment consultation may lead to a more effective course for resolution, reducing concerns, and preventing missteps.  Emergency mental health assistance is essential if someone is clearly out of touch with reality, out of control, and highly agitated.  Including legal guidance before making employment status decisions assures that the rights of all involved parties are given careful consideration.

Litigiousness and Unreasonable Demands.  Paranoid and delusional individuals may demand special investigations or the firing of “conspirators.”  Some keep detailed notes of their “evidence” of others’ perceived maliciousness, and are very litigious, requiring due diligence and careful documentation by managers and human resource professionals.  Extensive letter writing or email campaigns to senior management, highly placed authorities or the media are not uncommon.  Some paranoid current or former employees may evolve into long-term vexatious litigants, righteously pursuing their cause in the courts, however self-defeating and draining of their financial and personal resources.

Interviewing Challenges.  Establishing rapport and trust with a paranoid individual is crucial, but inherently very difficult.  Honesty and fairness are especially important, no less so than with other employee disputes.  Procedures for investigations should be clearly explained, and expectations for conduct respectfully defined.  Dismissing or confronting a paranoid or delusional person’s beliefs to his face is usually met with strong resistance.  It only confirms for them that the doubter is part of the “conspiracy.”  But it is a mistake to appear to agree with the paranoid’s beliefs in the interest of maintaining rapport.  It is preferable to acknowledge that the person is sincere in his beliefs, and to respectfully indicate the lack of evidence to support his views.

Demonstrating patience, keeping commitments to follow through, and being available, may reduce suspiciousness and anxiety.  Nevertheless an inevitable self-fulfilling prophecy often occurs – the individual’s insistent or disruptive behavior forces managers or threat management teams to take limit-setting actions.  This further increases the paranoid employee’s fears that the employer or others are “out to get me.”

It is easy to get frustrated and emotionally hooked dealing with overly suspicious or paranoid individuals.  Remember to confer with more experienced colleagues or professionals, especially if you feel threatened.

Paranoia and Violence Risk.  Only a small subgroup of paranoid individuals presents a risk for workplace violence.  When they become violent it is usually for two reasons:

1. They are attempting to pre-emptively eliminate a perceived imminent threat to their safety.  This will often take the form of an apparently impulsive assault.
2. They are acting on years of resentment concerning criticism, rejections, and defeats (such as in litigious campaigns), and now believe that it is “payback” time.  Such attacks are carried out in a planned, predatory manner.  In the workplace paranoid individuals are most likely to become violent in the hours or days following a shameful or rejecting event, such as a reprimand, loss of a job promotion, or loss of a relationship.

When threat assessment professionals interview the paranoid individual the important questions they seek to answer are: Does he feel a need to launch a self-protective attack to stave-off being harmed?; and, how will or would he otherwise respond to those who have “wronged” or “harassed” him?

Assessing violence risk in an individual case – its nature, severity, and likelihood – should always consider an analysis of the risk factors for workplace violence in toto.  A fuller explanation of the relationship between paranoia and workplace violence can be found in the WAVR-21 – workplace assessment of violence risk.  For more information on the manual go to wavr21.com.