Opinion | Why Youth Violence Assessment Is Still Failing: The Semmelweis Reflex

“Tick-tock. Tick-tock. The fateful crocodile that has swallowed the clock in Peter Pan has found me and is in hot pursuit. I am beleaguered by the ticking clock, minute by minute, hour by hour, then tolling to signal another young violent death. Tick-tock. Tick-tock. This is the inexorable pursuit of the crocodile that continues to prey on us.” — Russell Copelan, MD

I recognize there is understandable fatigue in reading about suicide, suicide assessment, youth violence, and its congeners. As noted above, I am beleaguered by the crocodile. The U.S. adult and youth trends are grim. Yet, the most recent, revolting slaughter of 19 children and two teachers at a Texas elementary school highlights the persistent incongruity between society’s obvious mental health needs and what society chooses to do about it.

The media “experts'” painstaking and convulsive process of once again defining “mental illness” in this context is consuming and, more often than not, ineffective. Perhaps the attempt this time will help us think and communicate more clearly. Does the definition represent the presence of immediate distressing symptoms, as in hallucinations, or the absence of psychological health, such as bullying in school? Do so-called discoverable and obvious “red flags” help to distinguish one from the other? Can significant and current concerning behavior justify involuntary or competency commitment or community intensive care? The work is dark. These awful events cannot be willed away. Dreadful facts cannot be twisted into delusionary hopeful outcomes, for facts are the foe.

The title of this piece bears the “Semmelweis reflex:” a groupthink or an individual’s swift and often thoughtless alert to reject new evidence or knowledge because it contradicts or cautions against established norms, beliefs, or paradigms.

This spastic, upper motor neuron reflex is in essence rigid intellectual dishonesty — personal and/or professional failure, duplicity, unwillingness, or bias to apply high standards of fact. Poor Ignaz Semmelweis was caught in this reflex arc and could not offer an acceptable scientific explanation for his antiseptic procedures at the time. He was committed to an asylum and beaten to gangrenous death.

Unlike Semmelweis, I have offered acceptable and timely proof of my research findings. For the first time, irrespective of ideation, I have presented likelihood ratios and transition probabilities in a final common youth suicide and homicide pathway. I am thankful I have not yet been either involuntarily committed or physically crushed. However, like Semmelweis’ work, I hope someday my effort or some small aspect of my research may become standard assessment practice, and some may even “whisper my hidden song” to relieve suffering.

Suicide and predatory cruelty research with reasonable reductions in lives lost will only improve through the disciplined use of an organized and open system to exchange information. When valid and reliable objective evidence falls through the cracks, or worse, is intentionally disregarded, dismissed, minimized, or plagiarized, human-centered care will tragically suffer.

It takes a lot of battered confidence and depleted energy to continue this fight against adversity, even when you know you’re on the right track. I have taken the reader through some of these travails. Take a look at the difficulties faced by many physician scientists whose medical breakthroughs were criticized in their day but have since become accepted. I am confident that persons reading this post are similarly able to recount other controversial scientific innovations, some major, others less so, that were initially ridiculed and rejected.

We must all take the time to read the available works of others. Otherwise, we will never learn or evolve for the better. It is about listening in. It is about learning and understanding new concepts and vocabulary, and where competent clinicians teach inexperienced and experienced staff alike.

In particular, scientific understanding should be approached as a progressive unfolding of the basic introduction to denser stuff. It is often not easy or entertaining. But the effort is essential in what it takes to be technically skilled, emotionally fluent, and factually truthful. Remain focused. Intellectual honesty gives a firm basis for the smoother execution of thinking. In doing so, it connects observations and confirms or redirect life-saving investigations.

Lee Iacocca, former president of Ford Motor Company and the man behind the Ford Mustang and reviving Chrysler, said it best, “In times of great stress or adversity, it’s always best to keep busy, to plow your anger and your energy into something positive.” Evolve. Make Progress. Perhaps this could prevent the next tragedy.

“Tick-tock.” “Tick-tock.” The relentless march of carnage continues.

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry. He is a reviewer for Academic Psychiatry and founder of eMed Logic, a non-profit originator and distributor of violence assessments.