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Selective Mutism

The tragic Virginia Tech shooting rampage by Seung Hui Cho is forcing a re-examination of mental health treatment systems and underlining a key issue of individual privacy vs. public responsibility. Brigid Schulte and Tim Craig write that Fairfax County school officials determined that Cho suffered from selective mutism, an anxiety disorder so severe that they put him in special education and devised a plan to help. But Virginia Tech was never told of the problem because, officials say, federal laws don't let Fairfax County tell or Virginia Tech ask. This report has generated a lively discussion among our readers who comment, expressing the wide range of opinions all too familiar to those who deal regularly with mental health questions and the profoundly complex problems of how to deal with them. The comments range from blame the system to blame the parents to this must be fixed and include a debate on whether special education or mentally distressed students should even be in public schools.

Let's start with ag1976, who wrote, "I hope that the one thing we take from this tragedy is that mental illness needs to be spoke about, needs to be addressed and that it is an illness. It is not the person who is ills fault and we, as a society, need to learn that mental illness is just like any other illness. Those who suffer from mental illness have the same needs of support, understanding an caring as someone who suffers from cancer. This young man suffered and our ignorance and stereotyping of mental illness cost innocent people lives everyday. This event was preventable..."

qrsi said, "We have lost all common sense in America and this loss has been caused by psychologists and parents of special education children... Accommodations for physical disabilities are legitimate and required to allow those who need help, such as wheelchair access. Mental and emotional "disabilities" are disturbances that are not normal and do not allow children (or adults) to behave normally nor can they be treated normally. These need special care and do not belong in public school. Period."

To which nbahn replied, "qrsi--Your bigotry is so breathtakingly shocking and raw that I don't quite know where to begin... Do you mean that such children should be denied an education at the public's expense???!!! Or do you 'merely' mean that they should be taught one-on-one at their home???!!! Either way, you are deliberately seeking to marginalize one of our societies most unfortunate individuals..."

marmac5 added that, "The poster who commented on special education parents being a source of problems might want to consider the parents of the children who taunted Cho. I would hope that all parents would teach their children to be compassionate towards those who may be different. Children don't have to be cruel, yet many of them have learned to taunt and reject other people."

seanmg said, "I find it disturbing that the pastor mentioned in the article spoke of a 'demonic mind' posessing Cho. He was clearly ill, yet the pastor of a place perhaps fittingly called the "One Mind Church" tries to oversimplify his mental state.We do not live in a black and white world,and we can't so easily explain everyone's behavior..."

vuac wrote "...I think there needs to be some post-SAT and post-acceptance communication between high school and college regarding disabilities."

ComfortablyDumb said, "It would seem there's a fundamental flaw in the 'honor system' regarding disclosure of mental illnesses: the type of person terrified to speak up in class is the last person who's going to seek out administrators on his own and ask them for special treatment."

chan2 dealt with the gun acquisition isssue, writing, " 'A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.' Especially for mentally incompetents, who have just as much of a right to blow people away as any other homicidal goofball with a credit card who can get through the door of a Virginia gun show..."

And Administrator1 said, "According to the article, it took the Fairfax School System until Cho's sophomore year in high school before they considered that he had a problem beyond just being painfully shy... The school system must bear a high degree of responsibility for this...I hope in this investigation they speak to all of Cho's former teachers to see if he was referred. If so, and nothing was done, those responsible should lose their teaching licenses due to malpractice."

The last word goes to farrarc who said, "The above posts seem to be ignoring the fact that 32 people are dead because of ignorance of the mental health issues, political correctness, abdication of responsibility on the part of the parents and education personnel. Regardless of the problems involved, there should be some form of checks and balances to prevent such a thing from happening. It was a terrible tragedy."

All comments on this article are here.

By Doug Feaver  |  August 27, 2007; 9:25 AM ET
 
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Posted by: Clara Ferrell | October 7, 2007 4:16 PM | Report abuse

I have a 4 yr old son who has been dx with Selective Mutism and an ASD. Although not common, you can have both. Our son receives Occupational Therapy, Speach Therapy, Socialization and Behavioral Therapy. We see a psychologist 1x a week. We have educated ourselves and will continue to do so. Please educate yourself on the topic before stating your opinions. A good website www.selectivemutismcenter.org. Dr. Elisa Shipon Blum's website,books and conference's have helped our son tremendously. It takes a lot of work from parents and educators to help a child overcome this dx but it can be done.

Posted by: vyskocil3@aol.com | September 24, 2007 3:35 PM | Report abuse

It's interesting that original reports claimed that the parents were told that Cho was or might be autistic. If the reports were wrong, I still find it interesting that such speculation was made. Given that, according to the Selective Mutism website, there is 'no relationship between autism and selective mutism.'

It seems though that they have some things in common. Both are caused either by genetics, or else by the behavior of the parents. In the case of autism, it would be the refrigerators moms, in the case of Selective Mutism, it would be the overly nervous ones. Oh have the 'experts' changed their claims about causation regarding autism? It is so hard to keep up with that.

It was suggested that my oldest child might have autism when she was three and having developmental issues as well as gastro intestinal problems. Her GI specialist suggested the possibility to us, altho she was never subsequently diagnosed. My youngest son, who doesn't speak to anyone in school unless he has to, could possibly have Selective Mutism, or so his teacher once asserted a few years ago.

I'm sure that this is just a coincidence. Since there is no relationship between autism and selective mutism.

I'd be curious to know how the incidence of Selective Mutism compares with the incidence a decade or two ago. Has it increased, as autism has? I'd also be curious as to the incidence of the two disorders combined. I wonder how much diagnostic substitution there's been, of cases of autism which have been misdiagnosed as selective mutism. Perhaps I could, with no evidence to back up my claim, suggest that any decrease in autism rates in recent years is due simply to diagnostic substitution, as so many have done when proclaiming that autism rates haven't increased in recent decades along with the increased vaccination schedule.

Posted by: Robin Nemeth | August 31, 2007 2:28 PM | Report abuse

The problem of dealing with clients such as Cho is that civil psychiatric clinics are usually not allowed to agressively pursue a clients' failure to adhere to "ordered" treatment. Numerous statutes are erected in order to "protect" the mentally ill client.
Cho, however, had committed crimes and his criminal charges were not dealt with---he had stalked fellow students as well as having placed numerous others in fear of him due to his numerous verbal tirades/assaults and his psychopathic/sociopathic behaviors.
Virginia has a problem, apparently, in its lack of state-wide forensic psychiatric pre and post trial examinations and treatment for those who should be in the care of the Virginia criminal courts. Forensic clients/patients who do not comply with court orders to attend clinic appointments or accept other ordered treatments are considered in violation of court ordered conditional release and are subject to court ordered bench warrants for their apprehension and return to maximum security forensic psychiatric facilities.
Virginia Tech students, faculty, and administration brought this situation on themselves by failing to bring charges against the client and thereby admit him into the criminal court system. He should have been examined in a maximum security Forensic Psychiatric facility. Civil facilites are inappropriate for Forensic clients. Civil psychiatric facilites are not constructed to house Forensic clients. Too many opportunities abound for escape, as well as the use of common everyday items that can be used as weapons. Other civil patients and/or staff may also be made victims of psychopathic/sociopathic clients.
Also mere 72 hour examinations are easily passed. Many jurisdictions admit pre-trial examination clients for periods of one to three months.
They also failed by avoiding full pre-college admission medical exams so that client disabilities can be better discovered and accomodated. Prior schools should release special education records once they have obtained the appropriate release of medical (or other special education) records forms.
The safety of students, faculty and staff is better protected when full pre-admission protocols have been completed.

Posted by: shambley | August 30, 2007 6:26 AM | Report abuse

"However, it seems to me that students with a history of mental illness should be identified by their high school to their college after they have been accepted"

That is a good idea, but in some cases the high school may not even know. There are probably a lot of people that have mental illnesses but aren't in special ed or anything, and are being sent to a private counselor by their families. I also don't think the high school is in that much communication with the college. I don't think that my university sent any correspondence to my high school letting them know that I was accepted.

Also, at my university the website for students with disabilities says that they have to go to the office themselves to request accomodations, and they also have to go to their doctor and/or psychiatrist to get proof of their conditions. Since Cho didn't seem to want the help that was offered to him, it's highly unlikely that he would have sought out accomodations on his own. Based on the other stories I've read about how he acted in his high school and college classes, it seemed as if none of the teachers or professors knew that he had selective mutism. I got the impression that they thought that he was refusing to talk or participate and that he was being rude, belligerent or something like that. I also saw a few stories that he had been ridiculed when he had to read out loud because of his accent and difficulty speaking English. I wonder if that might have caused or exacerbated the SM?

Posted by: Meredith | August 30, 2007 2:13 AM | Report abuse

Sounds like Cho's family failed him, and his victims. It was their duty to their child to get him the help he needed and was receiving, apparently, in High School.

Here's more.

http://hymes.wordpress.com/2007/08/27/shame-on-every-psychiatrist-and-psychologist-who-gave-an-opinion-on-chos-diagnosis-without-knowing-him/

Posted by: Tom James | August 27, 2007 10:02 PM | Report abuse

Let's everyone remember that Cho was identified as a student with a history of mental illness. He was involuntarily (but uncooperatively) committed to outpaitent treatment in December 2005. It's not that the system is broken. It's that the system didn't perform its duties. Sadly, the missing records which may have included Cho's explanation of his own medical history are... missing.

Posted by: blasmaic | August 27, 2007 7:18 PM | Report abuse

I would like to be upfront about my viewpoint: my child was on the second floor of Norris Hall at the time of the 4/16 attack. He was not physically injured. I do not want to demonize the huge majority of mentally ill people who are able to live as law abiding citizens. However, it seems to me that students with a history of mental illness should be identified by their high school to their college after they have been accepted, and colleges should be able to require that students get mental health care if they demonstrate dangerous behavior. We should change liability laws to make this happen.And they should be subjected to the legal system when they break the law as the shooter did when he harassed female students. This may infringe on the rights/privacy of some college students but not compared to the rights of the people who died on 4/16, or the students who were injured or the students who witnessed the attack.
Also, we need to understand that being mentally ill does not excuse anyone from the obligation to not harm others- our sympathy belongs with the students and teachers who were innocent on that terrible April morning.

Posted by: Fay | August 27, 2007 6:50 PM | Report abuse

If we start sending psychological evaluations to universities and other institutions, then it's only going to cause people to become more reluctant to seek help.

Posted by: Tirade | August 27, 2007 6:30 PM | Report abuse

Thanks to everyone for such a thoughtful discussion on a most perplexing and important subject.

Posted by: doug_feaver | August 27, 2007 4:12 PM | Report abuse

"Mom . . . "

I don't disagree with you about that. I haven't said anything about selective mutism because I honestly don't know that much about it. It certainly doesn't sound like the type of problem that would lead to violence.

(Though I can imagine that the way people treated Mr. Cho as a result of it could have contributed to other problems that ultimately played out so tragically - if so, we should all learn a lesson from it.)

I haven't intended to say anything hurtful, and I apologize if I have. As a parent, one of my concerns is that we can maintain political correctness at the expense of our children. My dearest wish as a parent is to see my children become completely independent and responsible adults over the next four to eight years. But if they need help, it would break my heart to be prohibited from providing it - or even knowing about it.

Posted by: Demos | August 27, 2007 3:53 PM | Report abuse

I understand what you are saying Demos, and you seem very level headed. My real point is just that the Washington Post is hyping this SM thing without talking to real people living with SM in their lives.
They give you the impression that is some HUGE news - as if this disorder caused the shooting. But everyone knew he didn't talk. This is just putting a label on it and also showing he got some treatment while at school.

I also want to say that while SM is surely a piece of his character, it is not everything. Okay, he had this disorder, but it is not the type of disorder that creates people who kill. Cho must have had a lot more going on and lots of anger.

Simply knowing he had SM would never be enough to keep him out of college or enough to know this was going to happen. Nobody is going to lock up a person for having this mental disability (as some people seem to suggest). It just isn't that severe. People with SM do talk at home, completely normally!

Kids with SM are anxious, timid, fearful, have trouble participating at school.... There was a lot more going on with this guy for sure, to undertake this enormous plan.

Posted by: Mom of a child with SM | August 27, 2007 3:20 PM | Report abuse

Suke,

take a deep breath and calm down. No one is advocating that we "warehouse" the mentally ill. No one is saying that every individual with a mental illness, or even every individual with a severe mental illness, is a threat to public safety.

But we can say with 20/20 hindsight that Cho was a danger - and that there were many, many warning signs that he was a potential danger to both himself and to others. We also know, to our regret, that failing to intervene was a mistake. He was a threat to his community just as surely as if he were carrying a virulant form of tuberculosis.

We don't "warehouse" people with tuberculosis these days. We do intervene, however - whether the patient welcomes that intervention or not. Why? Because we can't afford to do otherwise.

Should that intervention be as limited as possible while adequately addressing the potential threat? Absolutely. Should the focus be on encouraging patients to voluntarily seek care? Yes, of course.

Would the VT community, Mr. Cho, and his family all be better off if he's been taken out of that environment and given the care he really needed? I say yes - do you really disagree?

Posted by: Demos | August 27, 2007 2:45 PM | Report abuse

The idea that we should segregate the mentally ill is appalling. We are regressing back to the uncivilized times when we warehoused the mentally ill. What most people who cavalierly pass judgement on the mentally ill ought to relaize that they have a 25 percent chance of haviing a major mental illness (usually major depression) during their lifetime. If they think they can predict their actions under those circumstances they do not understand the nature of mental illness.
The NRA that's so busy blaming others for selling guns to people with mental disorders, if they really care about gun safety (that's meant to be flippant), would require everyone buying a gun to sign a statement declaring that they guarantee that they would never suffer from mental illness ever in their lives under penalty of perjury if they fail. That might give people a pause before buying their weapons.

Posted by: suke | August 27, 2007 2:28 PM | Report abuse

To "Mom . . ."

I don't think anyone in the conversation intended to attack your child, or to tar them as some sort of psychotic killer.

It does seem very clear, though, that Cho was a deeply disturbed young man. I would go further and say that he was either severely mentally ill, or thoroughly evil - and all of the evidence tends to suggest the former.

Even though we would prefer it otherwise, there are some severe mental illnesses that can make an individual a threat to themselves and to others. That is not to say that it is inevitable that they will kill, or that we should blame them (or their parents) for their illness. It does, however, make it critical that we get them the help they need, and that we take any and all precautions necessary to prevent them from harming themselves or anyone else.

On another note, I'm struck by your comments "I don't know that would have prevented him killing, but sending him away was crazy considering his history of SM. Maybe he insisted - maybe he wanted to get away from his family. Young people don't always know what is best for them. I really don't know about his situation."

Once he turned 18, there was nothing the family could do against his will short of moving to have him declared incompetent and gaining guardianship over him. They couldn't even ask school officials or medical personnel about how he was doing! Speaking as a parent of a college student, this truly is wrong - parents need to push hard for some common sense in our legal and educational systems.

Posted by: Demos | August 27, 2007 2:01 PM | Report abuse

I thought we just needed more guns?

More guns for everybody, whether or not you have a treatable, non-treatable, ignored, fully-disclosed, non-fully-disclosed mental, physical or emotional disorder.

It's that simple. What's wrong with everybody all of a sudden? We just need more guns, that's all, right?

You people aren't toeing the NRA party line. I'm telling...

Posted by: the real tony | August 27, 2007 1:00 PM | Report abuse

I am almost too upset to comment. Some commenters are assuming that Selective Mutism (SM) is a disorder of potentially psychotic killers. This particular quote is vague and easily misinterpreted: "selective mutism, an anxiety disorder so severe that they put him in special education and devised a plan to help."

The very nature of selective mutism - a condition where a child who talks completely normally at home, but cannot speak at school and possibly in other social situations - requires that there be a special plan in the school in order to help the child! You cannot help this problem at home - you have to work on it where it's happening. You cannot simply give a drug and make it go away. You have to work on it at school, where it takes place. That is all that "so severe" really means. It's not this horrible thing where the kid is demented. It's a child who has fear of speaking. That's all. Severe fear of speaking, to the point of being frozen. If you have no experience with it, you might assume it's the child's choice. If you had my SM child, you'd know otherwise. The treatment is simply to make the child more comfortable at school. It sounds as though Cho had made some progress, once they took away the pressure to speak and asked people to treat him with respect.

These are the characteristics of Selective Mutism. This helps with diagnosis.

-Child does not speak in certain places such as school or other social events.
-But child can speak normally in other settings such as in his/her home or in places where he/she is comfortable and relaxed.
-Child's inability to speak interferes with ability to function in educational and/or social settings.
-Mutism has persisted for at least one month.
-Mutism is not part of a communication disorder and is not due to other conditions such as autistic spectrum disorders (e.g., autism, Asperger's syndrome, Pervasive Developmental Disorder) or schizophrenia or psychosis.
Selective Mutism is a childhood anxiety disorder.
-It is much more than just shyness, and it is not a child willfully refusing to speak.

That is all!!! It is not a disorder of killers. Either something else was going on with Cho, or he felt so isolated, so frozen and unable to reach out to others, perhaps he felt people hated him. I am not blaming it on others... I am just saying that he was without the help he needed and he dug himself deeper and deeper into a hole of his own thinking. Maybe he had another disorder we are unaware of.

It bothers me that my child is now lumped into a category with this same guy. My kid is lucky, because I am not in denial about the real help she needs. I really don't know how Cho ended up at a live-away college. He needed to be near someone who cared about him. I don't know that would have prevented him killing, but sending him away was crazy considering his history of SM. Maybe he insisted - maybe he wanted to get away from his family. Young people don't always know what is best for them. I really don't know about his situation.

I do not neglect the memory of those who are dead. I feel deeply mournful about them. My purpose here is to discuss the sad situation's relation to Cho being SM.

Posted by: Mom of a child with SM | August 27, 2007 12:25 PM | Report abuse

Amen to farrarc. Some mental illnesses can be very different from most physical disabilities, in that they can create a mortal threat to other individuals in the community. The correct analogy for Cho was not to a paralytic, but to a smallpox carrier. In either case, protecting the community has to be a priority.

We've also made it almost impossible for family and friends to help troubled young adults. Privacy rules make it impossible for a parent to force an 18 or 19 year old into treatment - and if can convince them to seek treatment, can't learn what the diagnosis is unless the child tells them!

The parents of a child like Cho can know what was going on when they are minor, and can help - once they reached majority, our government and legal system cut parents out of the picture entirely. We absolutely cannot blame parents like Cho's, who do everything they can while they are still in control, unless we're willing to give them access to information and some influence over their young adult children.

Perhaps one approach would be to create an intermediate legal category for young adults who are still legally dependents (the tax code definition would work just fine) of their parents. If you still live in my house, and are dependent on me for support, then I have at least some limited access to information on your health and academic progress (particularly if I'm paying the tuition bill!). After all, who do we trust - the parents, or some student counselor at a state school?

Posted by: Demos | August 27, 2007 11:59 AM | Report abuse

Selective mutism used to be called elective mutism, because it was thought to be a choice. I agree with this earlier idea: Cho's silence was a choice made by a shy person, not a condition forced on him by a disease-like disorder. The DSM doesn't identify any chemical or neurological causes, they describe the essential symptoms as basically extreme shyness.

I don't believe Cho deserves any sympathy, and I believe those who blame his actions on "selective muteness" should recognize that his actions were under his control. He was a very shy kid who handled that fact very very badly, and we should not mitigate our condemnation or allow Cho a pseudo-scientific excuse.

Posted by: Matt | August 27, 2007 11:51 AM | Report abuse

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