![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 32. Go back in thread:
Posted by 10derheart on December 14, 2012, at 16:15:53
In reply to horrid tragedy in CT - 27 dead in elementry school, posted by rjlockhart37 on December 14, 2012, at 14:16:47
Your post shows how much you care, M. You don't have your own children and I can read from your tone how horrified you are. I mention it just because sometimes it seems *some* people of your age group today are so disconnected and desensitized their empathy for others is damaged somehow. I personally don't want to believe that too much, but our society has changed so dramatically it is hard to understand anything any more.
I can't write or talk about this. I've turned off the news. You have to understand, it's too much. I am never one to say, "It will never happen to me, " or "it can't happen here." More the opposite.
And...
My granddaughter sits in a kindergarten class as we speak.
I can't.
PS: I know many won't understand and may vehmently disagree, but I will just get this out there: Unlike Scott, I don't see these nightmares as having much at all to do with controlling guns. I won't participate in the gun debate here, either. I may be a coward or a jerk, but I don't have the energy. Long term I want mental health detectors more than metal detectors. But neither type are infallible, and I can see the POV that if one fails we need the other. I see no real solution, as rj wrote.
I'm sorry. I am contradicting myself as I try to do whatever to not lose my f*&$ing mind right now.
Posted by Phillipa on December 14, 2012, at 18:26:01
In reply to yes. :.((((((((((((( » rjlockhart37, posted by 10derheart on December 14, 2012, at 16:15:53
l0der from CT and lots of my facebook friend lived near the area. I've not heard of Sandyhook about to google as at first they said Newtown. That is where Mia Farrow lives. The biggest State psych hospital it also there. It's a wooded area not a big city either. I've fot to get to facebook to see what those who live near the shooting have to say. One had two of her policeman nephews at the scene this am. It will not be forgotten. Half mast flags. Phillipa
Posted by SLS on December 15, 2012, at 7:28:43
In reply to Re: yes. :.((((((((((((( » 10derheart, posted by Phillipa on December 14, 2012, at 18:26:01
Has your perspective changed at all?
- Scott
Posted by SLS on December 15, 2012, at 7:56:37
In reply to yes. :.((((((((((((( » rjlockhart37, posted by 10derheart on December 14, 2012, at 16:15:53
Gun control might not have an influence on the number of people who attempt to commit mass murder, but it is very much harder to kill 20 kindergarteners in a few minutes with a knife than it is with a gun.
There is no reason why we can't attempt to remedy gun murders by addressing more than one contributing factor at a time. I think there is a better chance of removing all handguns and automatic weapons than changing the psyches of all of those people who would commit murder with them Neither prospect seems imminently attainable, but at least a scaffolding can be erected that could help build a safer society within a century or two.
What are the sociological dynamics that produce murderers? Can these be changed? Surely not by tomorrow. That doesn't mean that we shouldn't try.
- Scott
Posted by Deneb on December 15, 2012, at 11:02:30
In reply to yes. :.((((((((((((( » rjlockhart37, posted by 10derheart on December 14, 2012, at 16:15:53
RIP
I can't think about this without crying so I'll just have to avoid this story.
Something has to be done. I think this is like the 7th massacre in two years in the US?
Posted by herpills on December 17, 2012, at 18:50:21
In reply to yes. :.((((((((((((( » rjlockhart37, posted by 10derheart on December 14, 2012, at 16:15:53
I agree with 10derheart, this is a mental health issue more than a gun control issue.
I'm posting below a great article by Dr. Keith Ablow of Fox news. I usually disagree with Dr. Ablow when I read his articles, but this one hits the nail on the head in my view...herpills
Why can't America care for the mentally ill?Read more: http://www.foxnews.com/opinion/2012/12/17/why-cant-america-care-for-mentally-ill/#ixzz2FMN3oOlT
Adam Lanza, 20, who killed 20 children and 6 adults on Friday, has brought incalculable grief to dozens of families and stunned our nation.Now, the debate begins about what to do in the wake of his carnage in Newtown, Connecticut and the multiple murders in Aurora, Colorado and at Columbine High School, the Red Lake Indian Reservation in Minnesota and the West Nickel Mines School in Pennsylvania, Virginia Tech and Chardon High School in Ohio.
Some will say that gun control is the answer, but that ignores the obvious: Too many guns isnt the issue; too little mental health care is.
Focusing on gun control does more than squander the time and effort of our public officials and state resources and town police forces, it distracts us dangerously from the real work that must be done.
Americas mental health care system is shattered and on its knees.
After decades of deconstructing our inpatient psychiatric hospitals and community mental health centers and after decades of insurance companies demanding that they pay only for social workers and nurses to treat even the most extremely mentally ill and potentially violent individuals (rather than including psychologists and psychiatrists) we now have a mental health care system that simply ignores those among us who suffer with incapacitating symptoms of psychiatric illness and whose suffering canonly in a very, very small percentage of cases, thankfullylead to terrible violence.
What is wrong, exactly?
Here is the truth: Today, even a mentally ill young man with a known propensity for violence, or even a history of serious violence, is likely to receive just an hour a week of counseling (if that) by a social worker.
He is likely have an unclear diagnosis of his condition and to be on a list of constantly changing, very powerful psychoactive medications prescribed by a nurse.
He is also likely to be turned away -- repeatedly --by emergency room social workers who act as gatekeepers for insurance companies to restrict access to inpatient psychiatric treatment.
If admitted to a psychiatric hospital, he will likely be triaged quickly through an often-incompetent tune up of medications that might accomplish nothing and then be sent back home as soon as he contracts for safetysimply promising a social worker that he wont kill anyone.That young mans good parents might well pray that he be arrested for another violent crime so that the terms of his probation might (but probably still wouldnt) include mandatory visits to a mental health professional (though not always the right one for their childs needs) and mandatory drug testing. At least then he can be jailed if he refuses all treatment or gets hold of some heroin that could worsen his hallucinations.
Imagine the sort of anemic services made available to someone who clearly needs help, and might well be dwelling on very dark thoughts, but has yet to act out violently.
How could this be? What has happened to render such a great nation so incapable or unwilling -- or both -- of caring for the mentally ill?
The following list is not exhaustive, but, though short, it will give you an important window into just how bad our mental health care system has become and why I can only call it a national disgrace:
1) The essential art of helping understand the roots of psychiatric illness in emotion is not available to the vast majority most families, now being reserved for people who can find the small number of professionals who are expert in that skill set, many of whom would never be paid by insurance companies at all, or given only three or six or a dozen hours to treat a very disturbed patient.
Not only have insurance companies demanded that empathy be dispensed in tiny doses, in favor of ten minute medication appointments, but many, many American training programs for psychiatric residents have responded by curtailing education in that healing art such that most new psychiatrists have never even been in therapy themselves and have limited ability to perform it.
The mental health care system is now itself dangerously devoid of the ability to understand patients lives, empathize with their suffering and help them beyond their depression and rage.
The constantly changing, partly insurance-company driven, "Diagnostic and Statistical Manual of Mental Disorders"which pretends to accurately describe the range of psychiatric suffering through the use of 300 sterile diagnostic labels (conveniently ready for matching up to medications), is part of the problem, too.
2) The demands of insurance companies, including Medicare and Medicaid and every public insurance program, has been to cram down the educational level of clinicians more and more and more.
People with complex histories of abuse and neglect and extremely toxic interpersonal dynamics are now routinely in the case loads of mental health counselors with little more than college degrees (if that) and social workers and nurses, many of whom are very talented and extremely dedicated people, but many of whom simply do not have the ability or training to do what psychiatrists trained for at least 8 years in medical school and residency could do for them.
3) The holistic view of the patientessential to understanding his view of himself and others and assessing whether dangerous behavior could resulthas all but disappeared, having yielded to simplifying and splitting the patient into someone with some emotional problems who should talk to a counselor about his feelings once a week (or less) and someone who needs medicine to think clearly or stop hallucinating or stop being paranoid who should visit a doctor or nurse ten minutes a month for prescriptions. These two professionals often never speak to one another and never even compare notes via email.
Thus, the crucial subtleties of how medicines are impacting the psyche are ignored and the possibilities for bad results are exponentially increased.
4) The use of inpatient psychiatry units as healing environments in which more sophisticated assessments of psychiatric patients are performed is now mostly relegated to rare hospitals that can cost as much as $20,000 or $40,000 or $80,000 a month, which people must pay for themselves, since insurance companies will not.
Insurance companies will only pay for overcrowded psychiatric units, often in disrepair, in which the violent mentally ill are often lumped into one space (and share rooms) with depressed young adults, drug addicted homeless folks and the elderly suffering with dementia.
Most of these units are revolving doors where someone can assault his mother or threaten to kill her on a Friday and be discharged with a new prescription on Monday.
5) There is no system in placeat allthat routes very sick mentally ill individuals, especially those at risk for violence, to forensic psychiatry professions truly skilled to evaluate them. In any case, the numbers of such professionals are extremely low and their use largely limited to evaluating and treating those who have already committed sex crimes or very violent acts, including murder.
Clinicians in ERs and in clinics, whose resources are already stretched dangerously thinare loathe to file the paperwork that would force hospitalization on the unwilling or force medications on individuals who need them and refuse them, if they are lucky enough to get hospital care.
6) There is no effective, ongoing line of communication between law enforcement
officials and psychiatry professionals about the status of dangerous patients, even those who have broken the law, already, in very significant ways. The expectation of most probation officers for sex offenders or those mentally ill people charged with violent crimes including guns is a letter faxed to them once a month stating that visits are ongoingif that. And if the letter were not to arrive, many probation officials would not take notice or take action.7) In most communities, there are no real psychological/psychiatric resources available within the schools, nor any established and effective line of communication between the schools and outside mental health professionals or agencies.
When I was medical director of the Tri-City Community Mental Health Centers in Massachusetts, I appointed a clinician to act as a liaison to every school we could afford to reach out to. But that was too thin a safety net and a very rare one at that. And centers like Tri-City (where we had 10,000 clients) are so poorly funded that it is an embarrassment.
8) In most states there is no way to arrange court-ordered, involuntary outpatient use of medications (including antipsychotic medications) even if someone is very violent or has reported extremely violent thoughts in the hospital, even if that person is psychotic and also addicted to cocaine or heroin, and even if that person is court-ordered to take such antipsychotic medications in the hospital.
Once that person hits the streets he or she is too often free to never visit a psychiatrist, again, to never take another medication and to never be drug-tested.
That is where we are. And that defines what poses as a mental health care system, but does not merit that label.
It is a cruel ruse to suggest to American families struggling with mentally ill loved ones that they can receive effective and healing psychiatric care without spending tens of thousands or, more likely, hundreds of thousands of dollars to do it.
With the dehumanizing forces of media, entertainment and, especially, technology gathering steam every day, we can expect more and more horrific violence, until we come up with a real strategy and a real system to prevent it.
You might think that the system is so far gone that it cannot be rebuilt and built better than ever. But that is not true. All that stands in the way is a clear plan and clear resolve.
Psychiatry and psychology are amazingly effective disciplines, when properly harnessed and deployed. And it doesnt even have to cost billions of dollars to do that. Within the week, I will post the rough framework of such a plan here on FoxNews.com.Until then, when you hear well-meaning politicians or community leaders talk about gun control as a solution to school shootings, remember that Adam Lanza was mentally ill (in a way that I would label as violently ill) in a nation that has no real mental health care system at all, that he used firearms that were legally obtained by his mother and that he could just as easily have used other means to inflict horrible casualties.
We have no time for misplaced efforts. Our will to heal, not bluster, will define how much senseless, horrific, preventable violence we are yet to see in our schools.
Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com.
Read more: http://www.foxnews.com/opinion/2012/12/17/why-cant-america-care-for-mentally-ill/#ixzz2FMNBq38r
Posted by baseball55 on December 17, 2012, at 19:19:31
In reply to Re: yes. :.(((((((((((((, posted by herpills on December 17, 2012, at 18:50:21
Who says Adam Lanza was mentally ill and sought help but didn't get it? There's no evidence for this whatsoever. Most of the cases of this have no history of seeking help for mental illness and not getting it. Name one case where this was shown.
Posted by baseball55 on December 17, 2012, at 19:29:46
In reply to Re: yes. :.(((((((((((((, posted by herpills on December 17, 2012, at 18:50:21
while I'm on the topic, I have been hospitalized several times and have never been interviewed by a social worker (though I have great respect for social workers and many are better trained at therapy and assessment than many psychiatrists and psychologists). I have only been interviewed by psychiatrists, psychologists and psychiatric nurse practitioners.
I think this article is b**l. If Lanza hadn't had assault weapons, he wouldn't have killed 27 people. He might have fantisized killing 27 people, but he wouldn't have been able to do it. Nor would he have been able to shoot his way into a school with locked doors and a security system.
Most people intent on violence never seek any sort of help. They nurse their fantasies in secret. People who seek help are generally non-violent or have fantasies of violence only against themselves (suicidal ideation).
Posted by Phillipa on December 17, 2012, at 20:45:22
In reply to Re: yes. :.(((((((((((((, posted by baseball55 on December 17, 2012, at 19:29:46
Family was wealthy Mom an avid gun collector. Adam was said to have Asperger's Syndrome. Phillipa
Posted by sleepygirl2 on December 17, 2012, at 20:52:04
In reply to Re: yes. :.(((((((((((((, posted by herpills on December 17, 2012, at 18:50:21
Why isn't it both a gun and mental health care issue?
It's both, and complicated.
The writer is interesting in that he states that psychiatry programs curtail their programs' training in therapy, which goes along with the quick med check model, and he also seems to say that psychiatrists are always better suited than social workers to treat patients. In the medication realm that is of course the truth, but we know its more complicated than that. I agree with a lot of what is stated, but really disagree with a lot of it. And....this is from Fox News after all, which leans conservative (which tends to be pro gun)
I think these shooters tend to have contact with mental health professionals, but they're not the ones seeking it out.
Posted by herpills on December 18, 2012, at 10:40:55
In reply to Re: yes. :.(((((((((((((, posted by baseball55 on December 17, 2012, at 19:29:46
I guess I don't understand why it's OK for the anti gun rights people to use this horrible tragedy as a means to further their political agenda, but it's not OK to talk about mental health?
I am sincerely happy that you received the proper treatment that anyone with a serious mental illness deserves. Unfortunately my own hospitalizations have not been the glowing experience that you are reporting.
The last time I was hospitalized, which was for 10 days, I got to talk to a psychiatrist for maybe a total of 20 minutes the whole time I was there. That's right, 20 MINUTES during a 10 DAY inpatient psychiatric ward. I've heard of psychiatric nurse practitioners...I have yet to meet one in real life. I mostly get social workers and low level nurses. I once had a social worker tell me when I was in the hospital, that I should drop my professional career and work in something like retail because it would be less stressful. To this day I think its one of the most insulting things anyway has said to me.
I'll also never forget when I another social worker said "now that you've had multiple hospitalizations, more services are available to you..."
Why in the heck were those services not available before I got so sick?
The truth is that there are many things in that article that are 100% true because they happened to me or happened to people I know. When I read the comment about how healthcare workers are the gate keepers for the insurance companies it made me cringe because I know exactly what he is talking about. You would be AMAZED at how different you are treated as soon as the words "I don't have insurance" come out of your mouth. herpills
Posted by herpills on December 18, 2012, at 10:41:50
In reply to Re: yes. :.((((((((((((( » baseball55, posted by Phillipa on December 17, 2012, at 20:45:22
But the APA has decided that Aspergers isn't a disorder, so did he ever have it?
Posted by herpills on December 18, 2012, at 10:52:33
In reply to Re: yes. :.((((((((((((( » herpills, posted by sleepygirl2 on December 17, 2012, at 20:52:04
I agree with you, it IS about BOTH guns and mental healthcare. It just seems like all we're hearing about is the gun part.
Whenever I hear about a shooting, I never think about the gun issue first. My first thought is, what would make that human think it is OK to hurt/kill another human? What is going on in their head? What led them to feel this way?
It takes human intention to use a gun in the manner it was used at Sandy Hook. The trigger didn't pull itself.
I also don't like how the media is making it sound like these mass shooting are common. The truth is that they are very, very rare.
Thinking that getting rid of guns will end these types of incidents, is like saying that getting rid of marijuana, cocaine, and poppy plants will stop people from using drugs. herpills
Posted by SLS on December 18, 2012, at 12:05:02
In reply to Re: yes. :.((((((((((((( » baseball55, posted by herpills on December 18, 2012, at 10:40:55
> I guess I don't understand why it's OK for the anti gun rights people to use this horrible tragedy as a means to further their political agenda, but it's not OK to talk about mental health?
Everyone is talking about it. The two concerns (mental illness and gun control) are not mutually exclusive. Given the personal experiences you describe, it is obvious that the mental health system isn't working nearly as well as it should be.
> The truth is that there are many things in that article that are 100% true
That may be, but it doesn't follow from logic that 100% of the things in that article are true, or that the conclusions drawn are valid. The article is an opinion editorial, and not an objective inquiry of any sort. The author spends an awful lot of time and energy suggesting that gun control would cost too much time and energy. How many children did it cost in order to save time and energy?
"Focusing on gun control does more than squander the time and effort of our public officials and state resources and town police forces, it distracts us dangerously from the real work that must be done."
It doesn't say much about the author that he is distracted by the challenge of looking at more than one variable at a time. I seem to have no problem with it. It says even less about him if he is intimating that the populace is so challenged while he is not. How pretentious.
I wonder how much higher this author would advocate the debt ceiling be raised in order to cover the costs of the things that he suggests must be done. Perhaps cutting taxes is the answer - along with defunding Medicare and Medicaid. After all, it is FOX.
Guns don't kill people. People with guns kill people.
- Scott
Posted by SLS on December 18, 2012, at 12:17:40
In reply to Re: yes. :.((((((((((((( » Phillipa, posted by herpills on December 18, 2012, at 10:41:50
> But the APA has decided that Aspergers isn't a disorder, so did he ever have it?
This is disinformation.
The APA has decided to include Aspergers in the diagnostic category of autism spectrum disorder - something that nearly every mental health professional knows it is.
"The familiar "Asperger's," along with some similar disorders, will be lumped together under autism spectrum disorder, "to help more accurately and consistently diagnose children with autism," the APA said in a statement."
Anyway...
- Scott
Posted by hyperfocus on December 18, 2012, at 12:37:28
In reply to horrid tragedy in CT - 27 dead in elementry school, posted by rjlockhart37 on December 14, 2012, at 14:16:47
People are calling this kid evil and a psychopath and not to take anything from the incredible evil acts he did; but to me he is also a victim. I just wonder what combination of mental illness and circumstances drove him to this.
It sounds like he definitely had Asperger's but it's only a very small piece of the story. All autistic kids struggle with rage and some can be violent, but violence against family or innocent bystanders or weaker people isn't something that happens with Asperger's AFAIK -- in fact it's quite the opposite.
I mean I can't honestly say that I never had fantasies of getting revenge over the people in school who rejected and made my life miserable. But the people he shot weren't his peers. And his mother -- the person who loved him the most and who made him the center of her life? Was it some kind of psychotic break?
I'm just utterly and totally baffled by this. I grieve for a life that could have done a lot of good and helped a lot of people, in different circumstances.
Posted by SLS on December 18, 2012, at 12:53:38
In reply to Re: Adam Lanza, posted by hyperfocus on December 18, 2012, at 12:37:28
Hyperfocus,
I understand your perspective, and agree with you.
This thing is sad from whatever angle you look at it.
- Scott
> People are calling this kid evil and a psychopath and not to take anything from the incredible evil acts he did; but to me he is also a victim. I just wonder what combination of mental illness and circumstances drove him to this.
>
> It sounds like he definitely had Asperger's but it's only a very small piece of the story. All autistic kids struggle with rage and some can be violent, but violence against family or innocent bystanders or weaker people isn't something that happens with Asperger's AFAIK -- in fact it's quite the opposite.
>
> I mean I can't honestly say that I never had fantasies of getting revenge over the people in school who rejected and made my life miserable. But the people he shot weren't his peers. And his mother -- the person who loved him the most and who made him the center of her life? Was it some kind of psychotic break?
>
> I'm just utterly and totally baffled by this. I grieve for a life that could have done a lot of good and helped a lot of people, in different circumstances.
Posted by sigismund on December 18, 2012, at 13:38:01
In reply to Re: yes. :.((((((((((((( » sleepygirl2, posted by herpills on December 18, 2012, at 10:52:33
>On Saturday, in the wake of the shooting in Connecticut where 26 people were killed at an elementary school, Mr Turnbull replied to a tweet by Mr Murdoch.
Advertisement
Terrible news today. When will politicians find courage to ban automatic weapons? As in Oz after similar tragedy, Mr Murdoch said.
Mr Turnbull then observed: @rupertmurdoch I suspect they will find the courage when Fox News enthusiastically campaigns for it.There have been 7 shootings like this in the last 2 years. I think. If that is so it is not rare. And once it is imaginable and real it is repeatable.
You don't have to be mentally ill to want to kill innocent people do you? Idk.
Posted by herpills on December 18, 2012, at 16:12:22
In reply to Re: yes. :.(((((((((((((, posted by SLS on December 18, 2012, at 12:17:40
Scott, you are correct, I was misinformed. Thank you for the clarification.
I'm sorry the article is making people upset, that wasn't my intention and I wish I hadn't posted it.
I will continue to pray for the families as we all will. herpills
Posted by SLS on December 18, 2012, at 17:03:38
In reply to Re: yes. :.(((((((((((((, posted by herpills on December 18, 2012, at 16:12:22
> Scott, you are correct, I was misinformed. Thank you for the clarification.
>
> I'm sorry the article is making people upset, that wasn't my intention and I wish I hadn't posted it.
>
> I will continue to pray for the families as we all will. herpills
Gun control is a very contentious subject. It seems to be as divisive as politics or religion. Passions run deep. I am undecided as to how to approach gun control. Let's just hope that the Supreme Court doesn't allow stinger missiles. The Second Ammendment is an enigma and open to a wide range of interpretations. I think the ammendment should be viewed in the historical context in which it was written. If the British Crown had made gun ownership illegal in the Colonies, there would have been no American Revolution. It is no wonder that the framers of the Bill of Rights should have had a sentimental attachment to gun ownership. However, they could not have predicted the inventions to come two hundred years later in gun technology. Interestingly, the inventor of the Gatling gun, Dr. Richard Gatling, was motivated to design a rapid-fire (200 rounds per minute) machine gun during the Civil War as a means to end all wars. It was meant to be a horrific deterrent in the same way we like to view nuclear weapons now. It wasn't.
- Scott
Posted by sleepygirl2 on December 18, 2012, at 18:05:14
In reply to Re: yes. :.(((((((((((((, posted by sigismund on December 18, 2012, at 13:38:01
Sig!! Where have you been? How are you?
I don't know about that last question.
Posted by sleepygirl2 on December 18, 2012, at 18:19:20
In reply to Re: yes. :.(((((((((((((, posted by herpills on December 18, 2012, at 16:12:22
Doesn't upset me...
Don't worry herpills, the article has some valid points, it's just mixed with lots of stuff.
Btw, I think I got 20 minutes during my one and only hospitalization, a little over a week. And people have said moronic things to me too. Seems I never have a good comeback at the right moment, or maybe it isn't worth it??
We have to wonder how things can be better, in a lot of ways.
Posted by baseball55 on December 18, 2012, at 19:41:20
In reply to Re: yes. :.((((((((((((( » baseball55, posted by herpills on December 18, 2012, at 10:40:55
Well, I guess if you don't have insurance, they treat you differently. Everytime I was hospitalized (at least 8 times) I met with a psych, resident psych and social worker daily. The first time for an hour each, after that for 20-30 minutes a day. The nurses were amazingly well-trained and helpful. That's my experience. But I live in Boston, where most of the hospitals are non-profit teaching hospitals. The one time I was in a for-profit hospital, it was awful.
Posted by baseball55 on December 18, 2012, at 19:42:40
In reply to Re: yes. :.((((((((((((( » Phillipa, posted by herpills on December 18, 2012, at 10:41:50
There's no evidence he had Asperger's or anything else. The press has been all over this and has found no evidence of diagnosis or treatment for anything.
Posted by baseball55 on December 18, 2012, at 19:50:13
In reply to Re: yes. :.(((((((((((((, posted by baseball55 on December 18, 2012, at 19:42:40
I just finished reading an amazing book called Violence by James Gilligan, who was the medical director for the Massachusetts Corrections Department for a decade and worked as chief psychiatrist for the state hospital for the criminally insane for a decade before that. His understanding of what causes violent behavior is really interesting and is based on years of patient interviews and case studies. He does not mention mental illness once, except in the sense that killing people, in general, seems crazy to those without a propensity toward violence.
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