GUEST: Richard A. Friedman, M.D.
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GUEST: Richard A. Friedman, M.D.
AIR DATE: 06/22/2013
I’m Richard Heffner, your host on The Open Mind. And I’d like our conversation today to focus on whether media violence contributes to real life violence.
Of course, full disclosure requires I indicate that for twenty years I chaired this country’s voluntary film rating system and spent much of my time commuting between Sin City East and Sin City West battling with film industry people who fought that obvious proposition tooth and nail.
Indeed, many industry appeals from some of our harsh ratings for film violence were bolstered by psychiatrists and psychologists retained by movie makers to insist professionally either that violence on the screen substitutes for real life violence…or that we just don’t and probably never will know enough about their causal connection to justify limiting violence as an ever-increasing staple of so-called “entertainment” in our films, on television, and now – with a vengeance – in our massively popular home video games.
But at this point I’m far removed from my “Hollywood years”… and my distinguished and disinterested expert guest today is Dr. Richard Friedman, Professor of Clinical Psychiatry at Weill Cornell Medical College and Director of its Psychopharmacology Clinic. You may know him from his frequent New York Times articles.
Dr. Friedman and Dr. Robert Michels, another eminent psychiatrist and former Dean of the Weill Cornell Medical College, have just written an editorial in The American Journal of Psychiatry about how their profession should respond to the recent mass killings with which we’re all too familiar.
To be sure, I would go further, asking my guest how psychiatrists might well respond to what I think is the larger question: Does media violence contribute to real life violence? And that’s the one I’d put to you today, Dr. Friedman.
FRIEDMAN: Right. Complicated, provocative question.
FRIEDMAN: Because we can’t experimentally prove that it does. But there’s no getting around the suspicion that there’s a relationship between them, for certain people.
You know, if you look at people like Anders Breivik, you know the Norwegian who shot and killed 77 kids. He said, during his trial, you know, “Look, I practiced for this massacre”, not in those words, but, “I practiced for this massacre by doing … by, by playing a commando video game”.
The Columbine killers also practiced using video games. On the other hand the Virginia Tech killer was noted to be strange and isolated because he wouldn’t engage in video games by his peers.
So, you know, you have anecdotes going in both directions. My own view is that for a small segment of the population … and we can talk about who they are … these games actually seduce them into acts of violence they ordinarily would not commit without practicing by using these video games.
HEFFNER: You’ve somewhere mentioned a parallel between pornography and violence in terms of the stimulation offered by television or videos or whatever games we may be playing.
FRIEDMAN: Right. In the sense that you basically would say that people who have the fantasies and impulses already have them before they start to engage in either pornography or violent video games.
So you would say the people most likely to play a violent video game already have interest in the material. The people who are drawn to a particular type of pornography already have this fantasy in their mind.
It’s not created de novo by either one of these media. On the other hand, you know, there are prominent theorists and feminists who argue pornography is responsible for violence against women because it encourages men to see them as objects and to degrade them.
And there are people who see violent video games in a similar fashion. That is the practicing of violence desensitizes people. So it doesn’t feel real, it feels like a game. You know, these, these violent video games appear so real that by practicing it over and over the hypothesis is you’re desensitizing people to the act of violence.
HEFFNER: Well, I remember that when we’d give an X, now an NC-17 to a film and the film maker would go on appeal before a board that was made up of other film industry people … there was so frequently the business of bringing in … if not a film critic … who loves violence, thinks it’s great … the late Roger Ebert did … would bring in a psychiatrist or a psychologist who seemed to revel in the notion of being able to say, “Our profession says we don’t know anything about a causal relationship”. And you say, “We don’t know anything for sure”, but you’re willing to make a bet.
Why do you think that was such an appealing thing … aside from the dollars paid to the professionals who testified?
FRIEDMAN: You mean why it was so appealing to be agnostic about whether these films actually cause violence?
HEFFNER: That’s a … a nice way of putting it.
FRIEDMAN: Well, I think … because people like to maintain a scientific position of being objective. And saying, “We can’t prove it”. This was for many years the position of the tobacco industry, by the way.
FRIEDMAN: They said, “Look these are simply correlations. There are many people dropping dead who smoke cigarettes. This is just a correlation.” Until, of course, they were crushed by the weight of the empirical evidence. And that it’s very easy to, you know, use an animal model and create cancer with smoking. It’s much harder to do that kind of a study with video games … obviously.
HEFFNER: But I, I think it would be not unfair to say that there were not as many medical doctors who were not in the psychiatric field who were willing to say about tobacco “We don’t know”, as there are psychiatrists … doctors of the mind who seem to revel in the “We don’t know, for sure, what the causal relation … whether there is a casual relationship between violence on the screen or in entertainment and in real life.”
FRIEDMAN: I guess … it probably depends on, on who you’re, you’re speaking to. If you’re talking to academicians who are used to ambiguity and want to do research and actually answer the question … they will say to you, “We can’t prove it one way or the other, but there’s no getting around the idea that we suspect that there is a small sub-group of people, who when they play these games, actually are seduced into violence.”
If you talk to clinicians who are out in the field, who don’t have the luxury of, you know, staying in an ambiguous state forever, but they have patience, like parents who say, “Listen, my son is hold up in the basement and he’s playing Commando video games. I’m worried about him. Should I be?”
And if I were treating this parent I’d say, “You bet you should be”. It may be that he’s actually thinking about these things and he might actually entertain doing them. Or maybe he’s depressed and he doesn’t want to see anybody else. Or maybe he’s harmless. But it definitely warrants your attention.
HEFFNER: In terms of the article you and Dr. Michels have just written … the editorial … what is the comment you just made about the parent who talks about the child in the basement? What does it lead you to conclude about public policy?
FRIEDMAN: What I would say is that we know that there are certain behavioral traits of people who are likely to be violent and that we should pay attention to them.
Now most people who have these profiles, you know, that have the risk factors for violence, when you look at a thousand of these people, probably 999 of them will never be violent. Because we’re so bad at predicting violence. But if you see, for example, a young kid who is isolated and alienated and lonely and is very interested in violent video games and has a very keen interest in guns and is very interested in the sort of violent sub-culture in this country … that’s something you want to pay attention to. Because this maybe the one needle in the haystack who becomes violent
HEFFNER: Now, you talk about one in a thousand, perhaps … this is a very large country and if you took only one in a thousand in our huge population, we’d had an immense, and enormous cadre of people we’d have to be worrying about. Isn’t that true?
FRIEDMAN: Yes. Yes. And to put it into perspective, actually in terms of, you know, overall violence in this country, you’re talking about the mentally ill people contributing about 4%. It’s tiny, tiny. So even if we could cure, like this (snaps fingers) … all mental illness in the United States, just take it off the table … as a risk factor, violence would barely go down at all. Go down by most … 4%.
HEFFNER: What’s the obligation of the mental health person, the psychiatrist, the psychologist who treats patients … what’s the obligation in terms of our newer concerns, our revised concerns, our very current concerns about …
HEFFNER: … violence.
FRIEDMAN: Well, up, up until this point, up until the shooting galvanized the country the, the obligation, strictly from a legal point of view was a clinician had an obligation to warn when and if a patient was an imminent risk to himself or others.
So that if you knew that a patient of yours was entertaining a threat to do something violent towards another person and it was a credible threat, it was something called the Tarasoff position, you were obliged to inform that party and the authorities that this was a patient who was at imminent risk.
So the threshold was always … it, it was imminent risk in terms of reporting and it was imminent risk in terms of forcing somebody to have treatment over their objection.
But now, New York State just passed a law … the Safe Law … right in the aftermath of the Newtown shooting in which clinicians no longer have to use imminent risk as their threshold, but just concern, clinical concern about safety, meaning the person is likely in their view to be dangerous to themselves or others and they have an obligation to report them now to the authorities who will go, presumably, and confiscate their guns and put them into the national instant background check system, so they can’t obtain a gun.
HEFFNER: In your opinion … good or bad?
FRIEDMAN: Good intentions. Bad policy.
HEFFNER: Tell me why.
FRIEDMAN: Well, what is going to happen is the system is going to be flooded with false-positives, patients who in fact are not dangerous, because most clinicians … we’re all terrible at predicting violence … so you’re going to get a lot of anxious clinicians who will over report.
It will also discourage patients from being candid. After all, if you’re a patient and you know now the law tells your doctor that if you reveal, honestly, how you feel … if you’re having thoughts of suicide or even homicide, and maybe they’re not even serious thoughts, but if you’re having them, you may not want to share them because you credibly, you know, worry that your doctor now has to report you to the authorities.
So it will discourage candid, I’m afraid, on the part of the patients and maybe discourage people from seeking treatment in the first place. Which would be the worst thing.
And by the way, most of the people that we’re really concerned about avoid the mental health system … they’re not even in our offices. They are out there. They stay away. They, the last people they really want to see are psychiatrists and mental health professionals.
HEFFNER: Yet in a number of instances we read about in terms of violence that’s so bad, so real that it makes the press and we read about it, we read that a therapist has been involved. There was a therapist on the scene. So when you say “most stay away”, yes, that’s like again saying “one in a thousand”, but there’s so many thousands of us in this country. You said before “good intention, bad policy”
HEFFNER: What would be “good intention, good policy”?
FRIEDMAN: Good intention, good policy would be a very, very substantial investment in mental health. Early screening and detection and treatment. Because most mental disorder actually starts early in life.
So by the time people have reached the age of 25, you’re talking about three-quarters of all mental illness has actually already had its onset.
So if want to do something to decrease the admittedly small risk of violence that are posed by mentally ill people … what we want to do is intervene early. We want to detect it early, you can make a very strong argument for screening all adolescents.
I mean after all we use vaccines to prevent diseases in kids. It’s accepted that kids get mumps, and rubella and polio vaccine to prevent illnesses, why wouldn’t we want to screen for treatable mental disorders that have their peak onset during young adult life.
HEFFNER: But you don’t really mean to compare screenings … psychiatric screening with an injection …
FRIEDMAN: Well, in a sense of …
HEFFNER: … in one’s arm.
FRIEDMAN: … no, in the sense of prevention, I do. Meaning you, you want to detect the mental disorders early to treat them, to prevent bad outcomes.
HEFFNER: But screening … what does that mean?
FRIEDMAN: It probably amounts to programs like Teen Screen, which is a program up at Columbia University where they go into schools, with the consent of parents and the assent of the teenagers and they give them a written questionnaire.
And there are a series of questions asking them things like, you know, “Have you … how has your mood been in the last couple of weeks, have you been depressed?” You know, “Are you having trouble sleeping, have you lost your appetite, do you feel like doing the things that are fun, have you thought about death, have you had any of these kinds of symptoms?”. And then these questionnaires are collected by, you know, the people that give the students the questionnaires and kids are screened.
And those who actually have answered positively to some of these questions are then further screened and treated.
HEFFNER: You feel this is a worthy pursuit?
FRIEDMAN: I think it’s an expensive, time-consuming, but worthy pursuit.
HEFFNER: And in times like ours … how likely … you’re saying that Columbia is doing it.
FRIEDMAN: Yeah. Columbia has done in, in a pilot project in several states. And now there are more and more states that are doing it. And there’s quite a bit of pushback.
Some, some communities don’t like it because it seems that it intrudes on the prerogatives of parents.
HEFFNER: Does it?
FRIEDMAN: To my mind it doesn’t, because young people are notoriously secretive and parents, although they will do what is in the best interest of their kids, usually … they may often be the last ones to know that they’re in trouble. It’s their friends and teachers who may get the signs of trouble before they do.
HEFFNER: I don’t want to take us off of this discussion, it’s too important. And this question relates to it. So much has been said and written about what we know about the mind, what we know about the chemistry of the mind, what we are now … President Obama’s program to learn so much more about the mind, the brain. Do you think we’re going to be able to do this screening in not such an intrusive way as the questionnaires, going into schools, getting parental permission, getting children’s permission. Do you think that’s on the horizon?
FRIEDMAN: Do you mean will we be able to do a kind of biological screening test …
FRIEDMAN: … to see whether somebody is likely to be a killer?
HEFFNER: Ah, you’re carrying it to that extreme … to tell us what the Columbia tests hope to tell.
FRIEDMAN: My guess is probably by one test … no … because there’s so much noise and redundancy biologically, meaning … let’s take fever, for example. You know there are hundreds of disorders that produce the same symptoms. We have a limited biological vocabulary. So, you know, unless you have a very specific marker for a particular, you’re likely to collect information that is uninterruptible. It would be like taking temperature and someone said, “Do you now … do you know something useful about the person?” And you’d have to say …
HEFFNER: Oh, I do …
FRIEDMAN: … they have a fever, and something is wrong. Now they could have a cold, they could have a flu, they could have rheumatoid arthritis, they could have HIV, they could be withdrawing from alcohol, you have no idea … it’s very non-specific. At this point, it’s a, it’s a dream.
HEFFNER: Okay, at this point it’s a dream. But here I’m talking to you as, as you direct the psychopharmacological clinic.
HEFFNER: You must have dreams about this.
FRIEDMAN: I do.
HEFFNER: Do you think it will come to be … to pass?
FRIEDMAN: I, I think that what we will have is more personalized treatment and diagnosis. So instead of having a system that’s based on your having to tell me “I’m having trouble sleeping, I can’t eat, I feel restless, I’m sad”, I will be able to biologically sub-type you and say, (Tsk) “You have a disturbance in this particular circuit in your brain and … involving these particular neuro-transmitters in those circuits and so we think that this is called … let’s say, seratonergic based depression and so you need an SSORI anti-depressant. Or some new neuro-modulator that hasn’t yet been defined.
And so, just like you go to your internist and get a throat culture with a sore throat and they grow out streptococcus and test it against antibiotics, we’ll be able to do something which is similar to that.
HEFFNER: Which makes you optimistic? Pessimistic? None of the foregoing about this whole question of the mass violence, or the individual cases of violence?
FRIEDMAN: Yeah, the mass violence is very hard and I think probably we’ll never be able to predict it. For one, it’s … it would be very hard to study because they’re so rare …
FRIEDMAN: … you know, they’re a handful of … in the history of, you know, the last fifty years … well, in 2011 it’s about point one percent of all homicide.
So you’ve got this very rare event and it’s very … it’s hard to study rare events. You need a lot of information, a lot of data to actually figure out what’s going on. And if something happens once a year, you can’t. You can draw profiles of people who seem to do these things and they do suggest certain profiles, but for all those profiles and I can tell you what they look like, most people who fit the profile don’t go on to commit mass murder.
HEFFNER: But might.
FRIEDMAN: But might. But, if you use those profiles to screen and, you know, drag these people in and test them, or screen them, you’d be pulling in thousands of people.
You know, in the aftermath of the Newtown shooting, someone from the NRA said something which if, if it weren’t said, it would be funny … which was “the mental health system is broken” … implying this was the root cause of violence in our culture … which is wrong …and that what we should do is draw up lists of people with mental illness.
And I thought to myself, “Well, if you asked yourself what percent of Americans get a mental illness or a drug problem in their lifetime, it’s about 45%, that would almost be half the country on this list.
HEFFNER: You would have started I guess with the NRA people themselves.
HEFFNER: Then … where are we? When you talked before about the new legislation in New York State … good intentions, bad policy … your idea of good policy along with good intentions has to do with something that I think you’d probably say we’re not going to see … a sufficiently financed or well enough thought out public policy toward mental illness.
FRIEDMAN: Right. But, but the larger picture … I would say that we need to change the focus and to say …and to say and to educate the public and to say, “Listen, it’s wonderful that you’re interested in improving the mental health system. We’re very happy about that and we’re delighted to accept all of the funds to do that. However, we want you to know that if we do everything we can to make this system better, it’s very unlikely to change the one thing you’re interested in changing. Which is the rate of murder, for example. It’s going to have almost no impact. What it will do is to decrease the risk of suicide and that’s a wonderful outcome.”
HEFFNER: You distinguish between the two?
FRIEDMAN: Well, yes, because if you treat mental illness and you stop people who are mentally ill from getting a gun, you’re much more likely to prevent suicide than a homicide because most homicides that are perpetrated by guns, are not perpetrated by people with mental illness … less than 4%.
But, of all the suicides committed by guns, the vast majority are people with mental illness. So if you took guns away from people with mental illness you surely would decrease the risk of suicide.
HEFFNER: Are you … mental health persons called upon to testify in questions of gun control legislation?
FRIEDMAN: Interestingly … no. And although I don’t know that this is the case, but I heard it … the new … for example the New York State Safe Law … was passed very, very quickly with almost no input from the mental health profession, the epidemiologists of violence … any, anybody who had a scientific knowledge about the subject, I don’t think was consulted.
HEFFNER: You know … I refer back to Hollywood … the only thing I know about, I guess, but the wagons used to be drawn around the community when anything happened … when Columbine happened and those kids had seen certain movies … we knew that. Ahh, well the film industry was afraid it was going to get hit. The gun industry is afraid it’s going to get hit …and hurt. Do you see any movement toward trying to put together all of these things on the apart of our public policy makers? I mean are we coming any closer to making sense?
FRIEDMAN: I think that the information is there … you know, the knowledge about the relationships between all of these factors is well known. I mean there’s no mystery about why we have this problem. The problem is practical and political … it’s not a scientific question any more about why, for example, the United States has the highest homicide rate in the world.
It’s because most countries have one thing we do not have … which is sensible limitation to access the fire arms. So, I would say we’re closer, because if you look at what’s happening now in Congress, we are on the verge of having something. You could say “It’s a half a glass”.
Half a glass is better than nothing. You know having something close to enhanced background checks is an excellent starting point.
HEFFNER: You’re talking about today, the day we tape this program …
HEFFNER: … with about 20 seconds left … I’m cynical enough to say “Let’s wait until tomorrow, or to the time this program is seen to say how far the Congress, this nation, will go, in doing those things.”
But meanwhile I want to thank you for helping us go rather far today in our discussion. Thank you so much for joining me.
FRIEDMAN: It was my pleasure.
HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as an old friend used to say, “Good night and good luck.”
And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.