Dr Reef

Dating while coping with a mental illness can be difficult though it can be rewarding at times. But even dating without a serious mental illness diagnosis can also impact your mental health.

Mental health experts explain just how close the relationship between dating and mental health can be. If you're interested in how that relationship becomes more complex with a mental illness, you can read my other article about the topic at http://www.empowher.com/mental-health/content/mental-health-issues-datin...

Reef Karim, a board-certified psychiatrist and author of “Why Does He Do That? Why Does She Do That?” said in an email that dating and mental health are deeply intertwined.

“When you date and you have feelings for another person and have to deal with each person’s needs and resolving conflict, you are forced to deal with your own ‘stuff’ - how you handle stress, how you deal with anger, how you deal with love, etc.,” Karim said.

“How we handle emotions is a very big piece of mental health and it’s often front and center when we are in dating or in a relationship.”

Dating can actually be part of a self-discovery process, and encourages people to look at themselves in a deeper way. People have to start asking questions about how they function and what their weaknesses or faults are, since that could affect relationships with other people.

“Your chances of being in a healthy relationship depend on many factors, including who you’re dating, where you are in your life, the timing and particularly your ability to be in a relationship,” Karim said.

“Your mental health doesn’t have to be perfect but you do need to know/learn some basic things about yourself, your partner and how to deal with stress, conflict and compromise.”

He added that although there can be a diverse combination of couples, and there is generally someone for everyone, people with the same level of mental health generally do end up together. Also, once people find love, they need to learn how to maintain it and develop a lasting relationship.

“We all desire connection with each other - as family, friends or love interests,” Karim said. - Empower Her

In 2002, Tom Cruise and Nicole Kidman announced they were divorcing after 10 years of marriage.
On Friday, Katie Holmes announced she was seeking a divorce from Cruise after five.
What's with the multiples of five, many wondered, as the “marriage contract” rumors that have plagued Cruise for many years heated back up.
In the all-important Twitterverse, “Katie Holmes Tom Cruise Divorce” instantly became a trending topic, with fans weighing in with such tongue-in-cheek tweets as “her contract must have only been five years,” “the contract didn’t get renewed” and “I wish them the best upon completion of their successful completion of their five-year contract.”
READ: Katie's lawyer dad helped her escape.
Prior to their November 2006 nuptials, reports ran rampant that the then-rising actress would receive $3 million a year for each year she was married to the mega movie star. However, no outlet has seen any contract, and its existence has previously been shot down vehemently by the Cruise camp.
“I’ve heard from different sources that there was a contract, but I never got my hands on a contract,” veteran celebrity entertainment reporter Michael Cohen told FOX411’s Pop Tarts column. “The pictures of Katie and Tom never looked authentic to me; there is something not right about the way they pose. Either they are ‘let’s do the photo,’ or they are too distant. And Katie hasn’t looked happy in a very long time. She does not look like the happy mom married to Hollywood’s leading man."
According to Hollywood psychiatrist and relationship therapist, Dr. Reef Karim, the constant “contract” hearsay – whether true or false – could have added pressure to the marriage.
“Money can make the world a happy place or a miserable place, and when you have money and fame and the deals, competition and often times ‘contracts’ that go along with it, you now have many potential areas of conflict that will ultimately stress a relationship,” he explained.
Holmes' attorney, Jonathan W. Wolfe, confirmed the divorce news and released a statement, saying: “This is a personal matter and private matter for Katie and her family. Katie’s primary concern remains, as it has always been, her daughter’s best interest.” Meanwhile, a rep for Cruise put the ball in his soon-to-be ex-wife’s court: “Katie has filed for divorce and Tom is deeply saddened, and is concentrating on his three children. Please allow them their privacy to work this out.”
Despite their crumbling marriage, the couple hasn’t shied away from the limelight in recent weeks. Cruise was all-smiles at the recent “Rock of Ages” premiere in Hollywood last month, where FOX411's Pop Tarts column overheard co-star Malin Ackermann ask him if Katie was around.
“She’s in China,” he told her. “But she sends her love.”
Two weeks ago, Cruise was snapped wearing his wedding ring and looking focused while filming scenes for “Jack Reacher” in New York City. This past Wednesday, the high-profile actor was spotted donning a silver spacesuit in Iceland with his eldest son Connor, where he is filming the sci-fi movie “Oblivion.” On that same day, Holmes was sighted looking drained and a little worse-for-wear while out with their daughter in Manhattan, but was also still wearing her ring.
Holmes also visited her husband on his Iceland film set on June 16, but prior to that, the last time the two were spotted together was way back on April 1 in Baton Rouge, La., where they strolled hand-in-hand while sightseeing with Connor, Suri and Holmes’ parents.
And while the Cruise/Holmes divorce seems to be peppered with more mayhem and mystery than most Hollywood style divorces, some say we’ll probably never really know the whole story.
“The fact that Katie filed for divorce while Tom is as far away as Iceland, begs the question of how dominated she must have felt both by his stardom and his presence around the house. One can only speculate that one way or another that Tom must have broken a hell of an important rule for her,” added celebrity life strategist, Suzannah Galland. “What happened between Tom and Katie, we will probably never know. But we can guess with certainty that the source of the rupture is very serious.”
Reps for Cruise and Holmes did not respond to a request for further comment.

- Fox News

If you Google “wealthy people psychology” you’ll find a lot of articles declaring that the “wealthy lack empathy,” the “wealthy are different,” and “rich people are mean.” In fact, a well-researched article in New York magazine this week dove deep into the relationship between economic status and negative psychological characteristics such as a dearth of empathy, insensitivity to and unregard for other people, the tendency to cheat and even to be a jerk while driving.

The evidence is fairly convincing that people of higher socioeconomic status can be somewhat lacking in the kindness department. And some have rightly pointed out the chicken-or-egg element to the issue: Does being rich make you mean, unfeeling, less humane, or do you need to have these characteristics in the first place, to help you climb the ladder? And even more pertinent is the question of whether rich people can cultivate more positive psychological traits, at least in their personal lives. That is, can we learn to be nicer?

One might speculate that the connection goes both ways – that certain characteristics are needed to achieve wealth, but that wealth itself has some distinct (read: negative) effects on a person once he or she has “made it.” But it’s very difficult to get at why these phenomena exist. In some ways, the links seem counterintuitive: The rich should be kinder, more giving, and more empathetic, since, after all, they have it good. Even though it may have taken a lot of work to get where they are, they’re essentially the lucky ones – so they should be grateful for it and nice to everyone as a result. Unfortunately it doesn’t seem to work that way, if you look at the vast literature on the subject.

One issue is that certain psychological biases seem to be at play: For example, some have argued that the “self-serving attribution bias” may make rich people less likely to see the role that luck plays in their rise to the top, so they credit their own work – and only their own work – for their rise. On the other hand, the “fundamental attribution error” may also make them more likely to believe that the lot of the less fortunate (poor) is not due to luck, but to tangible mistakes that the less fortunate have made. These phenomena may in part explain why as wealth increases, the tendency to be charitable does not rise along with it.

Going back to the chicken-or-egg issue, it may be more likely that the negative psychological traits that are linked with the rich may have been present all along, or at least honed for the purposes of ladder-climbing, and it’s actually these qualities that get people to the top. After all, it takes a lot of elbowing to make your way up.

“In order to gain that monetary wealth,” says Dr. Reef Karim of the Control Center in Beverly Hills, “and to move up in the world, this often requires manipulation, a high focus on financial means, and relationships with others that are agenda-based. What do I have to do? What can I get of out this relationship?” Dr. Karim has treated a virtual who’s who list of celebrities, politicians, and royalty, for everything from addiction to, well, just dealing with the psychological fallout of being rich. “The issue is that these attitudes can bleed over into other areas of your life.”

That’s really the crux of the problem: The same personality traits that can foster business success and wealth can damage other areas of one’s life. “When you massage that money-making muscle for so long, it doesn’t go away,” says Dr. Karim. “It informs all of your relationships. CEOs of big companies have some of the most sociopathic traits – this is quite well-illustrated – because it’s those personality traits lend themselves so well to business. But the down side is that they’re very hard to shut off, and they can destroy your ability to have healthy relationships.”

The other issue is that many of the studies on wealth and psychology don’t seem to address is a basic one: That one’s past has an awful lot to do with one’s present psychological state, money or not. “We always talk about Attachment Theory: How you were raised, whether you were neglected or doted on, whether there was a ton of conflict. But you need to add to this your family’s attitudes toward wealth, because this will influence your attitude now. Were you given everything growing up? Was money viewed as something always going to be there? Were you manipulated by money? If so, you’re going to view the world as money-based.” And this can pose major problems for people socially and psychologically.

There is, luckily, some evidence that empathy can be learned and developed over time, particularly through methods like meditation and mindfulness. Dr. Karim has found that experiential methods like these work better than talk-therapy (unless you have a real “Aha” moment through talking, which can certainly happen, he says). He works with very wealthy people using mindfulness and other means to develop the empat - FORBES

Adrian Miller, founder of sales consultancy Adrian Miller Sales Training in Port Washington, NY, says she’s always been a networker—but not always for her own good. In 2008 when the economy took a turn for the worse, Miller became nervous about the future of her business and went into extreme networking mode. “I started going to events morning, noon and night for five days a week hoping I would meet new clients,” she recalls. “I did it for months and was getting overwhelmed and just exhausted.”

On a vacation to Istanbul, Miller started thinking seriously about all the time she had committed to networking. She calculated how much revenue she’d gotten out of months of running around exchanging business cards and realized it was next to nothing. “When I saw I wasn’t getting a return on my time, I knew I had to get the compulsive behavior in check,” she says. “I had turned what was a pleasant activity into a nightmare.”

While career coaches and success gurus expound on the virtues of networking—especially in a down economy—some professionals take it too far. Management and addiction specialists say they are seeing more people compulsively attending events, obsessively growing the number of their connections online and wearing themselves out with little too show for it.

“Initially people want to promote their careers, but it can become obsessive,” says Dr. David Sack, an addiction psychiatrist and head of the Promises Treatment Centers in California. “Some people are looking for validation and recognition. It may be partly a self-esteem issue that gets gratified by numbers.”

Yet the compulsive pursuit of more and more connections will not ensure better networks. In fact, it will degrade them. “There’s an upper limit to the number of connections you can maintain of around 150 people,” says Columbia Business School professor Rita McGrath, noting that many people too aggressively pursue initial connections without investing the necessary time to strengthen and maintain those relationships. “In whatever format, more than 150 and the relationships are impersonal and the connections are weak.”

The quantitative approach to networking has been exacerbated by technology, says psychiatrist Dr. Reef Karim, an assistant clinical professor at UCLA and director of The Control Center in Beverly Hills, CA. Social media networks like LinkedIn, Facebook and Twitter offer a continuous feedback loop, where success may be graded by follower counts and rabid updating. - FORBES

As everyone from politicians to parents of slain children search for answers in the Colorado shooting, many observers say the high-profile event is just the latest example of both the progress and problems in dealing with violent, media-driven events.
We live in a society driven by increasingly sophisticated and powerful information technology that allows us to know details about everything virtually immediately, says UCLA assistant professor and psychiatrist Dr. Reef Karim, adding, “and this has a good and a bad side.”

Cell phone video clips from the Aurora movie theater provided a nearly instantaneous real-time window into events as they unfolded. Television coverage has blanketed everything from Monday’s court appearance by shooting suspect James Holmes to the personal stories of the victims and survivors.

Comfort in response to the shootings in Colorado

The positive side of such immediate, up-close contact, he says, “is that we collectively can respond as a society, we can send money and relief and bring people in to help because we can relate right away.”

The downside, he says, “is that we are seeing it all through the lens it is being presented to us in.” This means we are being drawn through the event according to the biases and prejudices of the technology and the people behind it.

“By and large,” he points out, “these media are driven by ratings and the need to attract the largest audience,” not educate or uplift them.

We have shifted from a cool medium that provides some distance to the “hottest possible,” says Bernard Luskin, president-elect of the media psychology division of the American Psychological Association in Washington. “This means we are right in the midst of events now,” he says.

But as technology progresses, he says he sees little progress in the ability to respond and handle the deeper implications of violence.

“The information is geared towards the needs of the people delivering the information rather than the deep, emotional needs for empathy and sympathy that the victims of real violence require,” he says.

At the same time, there has been marginal progress in certain areas, points out Dr. Karim.

Compare the coverage of the victims in the Colorado and Arizona shootings to the focus of the coverage in the Penn State scandal. - The Christian Science Monitor

I’m not one to get into political scandals, so I’ll leave that discussion to the experts. But what’s interesting about the recent developments in the Petraeus case is that it’s just one of many sagas of high-visibility people whose poor personal-life decisions are made public – and, of course, result in speedy and humiliating falls from grace. You have to wonder what’s going on in the minds of the highly-visible and highly-accomplished that makes them engage in the risky business of cheating, sexual email exchanges, sexting, and cyberstalking. We can’t get into their heads to find out, but here are some pretty good guesses.

The Insecurity Element

Very powerful or accomplished people may have a touch of insecurity in them. Actually, they may have a lot of underlying insecurity, says Dr. Reef Karim, who heads the Control Center in LA, and treats celebrities, political figures, and royalty for everything from addiction to dealing with reality of their achievements. The internal insecurity of the power players is common, since it can actually be a driving force to accomplish great things in the first place. “The ‘insecurity element’ in risqué behavior is more common with women than it is with men,” says Karim. “It’s the woman who dresses way too sexy to the party, or the guy who acts like an idiot to get noticed. It’s all based in desiring attention and validation.” This theory is an interesting one and may play some role in the behavior of the bold and the beautiful, but it doesn’t explain it all.

Self-Destructive Element

Another explanation, which may be even more relevant, is the self-defeating tendencies that some high-power people may have. “A lot of the power figures fall into this category,” says Karim. “When you’re on top, the only place you can go is down. I can’t tell you the number of people I’ve treated who can’t handle the pressure. It’s almost like they have to tempt fate.” The issue is that once people achieve an initial big success, the game changes. It’s one thing to get to the top, but staying at the top brings on a whole other level of stress. “It’s a human quality to want to do well… but then when you do well, now what? Maintaining that level of high success is very trying on someone’s brain. For a lot of people playing at this level, you don’t see a nervous breakdown, you see self-destructive activities in other realms of life.”

The Gratification Element

And then there’s the pleasure factor. There’s something about sending nude pictures of yourself that just gives a person a little brain rush. In fact, a study earlier this year at Harvard found that people were so eager to reveal information about themselves that they often declined money in order to do so. In other words, there’s something innately rewarding about self-revelations, and this was actually seen in the “reward centers” of the participants’ brains. Karim explains that some people’s brains have naturally low “dopamine tone” – dopamine being the brain chemical associated with our feelings of pleasure and reward. “These folks have either decreased levels of dopamine or fewer dopamine receptors. It’s like the person who tries cocaine and says, “doc, for the first time in my life I felt normal. Some people just get the rush from sending out risqué pictures of themselves.”

Power Plays Tricks on the Mind

In the end, there’s no definitive explanation as to why presidents, generals, congressmen, or CEOs cheat and get caught. They may not do it any more than the general population, but their fall is harder and a lot more public. Karim suggests that in the end, their sometimes-outrageous (or at least mindless) behavior can be a combination of factors, and there may be a feeling of invincibility that accompanies high power. It doesn’t hurt that high-power people often have slightly sociopathic tendencies, and rise to the top not in spite of, but because of, these traits. “Theoretically, when you get power, you feel like not all the rules apply. Power can make you careless. But I also tend to think that having that mildly sociopathic side – I gotta watch my back, and be careful to dot my i’s and cross my t’s – is common among some of the power figures. These traits can be healthy in regards to running a big organization, but when it comes to personal life, it can be a destructive mess.”

Today Reuters reported that Defense Secretary Leon Panetta called for a review of the military’s current ethics training. That might not be a bad idea. Will people in other areas follow suit?

- FORBES

What do Elvis, Heath Ledger and Michael Jackson all have in common?

Yes, they are celebrities, super talented and died before their time. That's true.

But they also, per reports, had doctors "involved" in prescribing or over-prescribing medications that were found in their system during their fatal overdose. These were legal medications given to a patient by a physician or various physicians.

Which leads us to the introduction of...Dr. Feelgood.

Most physicians are smart, ethical and actually care about their patients. And the process of pre-med, medical school, internship, residency and fellowship is long, painful and costly with large amounts of stress and sleep deprivation. It's not fun. But, many doctors get through it because they love the cutting edge science, healing, stability and helping people.

But, to be a good physician, you have to be street smart as well as book smart. You have to know when you're being conned. You have to be strong enough to "just say no" to a medication seeking patient who is out "doctor shopping." You have to not care if the patient gets angry or stressed out because you know you are doing the right thing. And you can't fall prey to the celebrity bartering of riches, fame and friendship for the power of your prescription pad.

Dr. Feelgood comes in 3 varieties. Shady, Naive & People Pleasers.

The shady ones are just trading pills for cash. They are literally legal "drug dealers." The naive doctors don't know they're being manipulated and just go along with it when the patient describes symptoms (that they just looked up on their phone in the hallway) to score pills. And the people pleasers are physicians who are unable to "just say no" because they want to be liked by their patients. Doctors are people too and many of us were pretty nerdy growing up. As a result, some doctors desperately want to be liked especially by important people like celebrity politicians, actors and musicians.

Many clinicians have referred patients to me at The Control Center because they developed an addiction to prescription pills. And many of these patients were getting them from a few of these Dr. Feelgoods. These doctors make it much harder for addiction medicine physicians, psychiatrists and therapists to treat their patients.

Celebrity treatment can be really challenging. It's a unique subculture. As a doctor, you need a strong backbone. You have to set limits. You can't use alias names on prescriptions. You can't be intimidated by the entourage/enablers/handlers who are making money off the celebrity client and don't want that person to stop working for six months to get better because they won't get paid. You have to be street smart and most of all, you have to remember that we are in a prescription pill epidemic and doctors must inform our patients which medications are easily abused.

Ultimately it's every individual's responsibility to know what they're putting in their body.
But, we are slowly becoming a pill-popping society. And Dr. Feelgood is getting more and more popular.

"One nation under sedation"?

I hope not.


For more info, visit the Web site of Dr. Reef Karim.



Follow Reef Karim, D.O. on Twitter: www.twitter.com/drreef - Huffington Post

What price do you pay to be a professional football player?

Initially we thought it was the price of creaky, lingering musculoskeletal injuries suffered during old age.

But it's so much more.

We are witnessing one former player after another committing suicide. The reports about Junior Seau are just the latest. Players are suffering from dementia, neurodegenerative disorders, post-concussive syndrome, mental health disorders and substance abuse disorders. Many current players and former players are suffering from head and body trauma from their playing days in the NFL. And many also suffer from the mental health symptoms associated with those blows in addition to the emotional stressors of not being prepared to deal with life after giving up the game.

Many people aren't aware that concussions and head trauma make you more vulnerable to dementia, brain disorders and mental health disorders during and after the blow to the head.

The professional icons we put on a pedestal during their playing days are paying the price later.

I have worked with many former NFL players and some are really suffering; symptoms such as memory loss, recurrent headaches, bouts of confusion, dizziness, rage, uncontrolled anger, domestic violence, drug and alcohol abuse and problems with impulse control... the list goes on and on. And we're not just talking about current players, we're talking about men who haven't played the game for years or even decades.

The Junior Seau tragedy is so very sad. But I'm afraid it won't be the last. Until something is done to protect a player's brain from trauma (that means rule changes and suspensions), many won't be equipped to handle life after they leave the game. And a mental health evaluation should be mandatory when leaving the game to see who may need mental health, neurological treatment or further medical care.

I love the NFL but..

"Game over" should not mean "Life Over." Let's protect the players.

Dr Reef Karim
Psychiatrist, Relationship Expert
Director: The Control Center
@DrReef
Thecontrolcenter.com
Doctorreef.com - Huffington Post

Have you twittered today? Is your Facebook page repeatedly bugging you about updates awaiting your attention? Can’t stop texting and driving?
Just reading information from social media sites can send some people’s stress levels soaring, says Reef Karim M.D., board-certified psychiatrist, assistant clinical professor at the UCLA Semel Institute for Neuroscience and the director of The Control Center outpatient rehab in Beverly Hills.
As a medical specialist in addiction and menta I health, Dr. Reef normally sees patients with chemical and behavioral problems, mood and anxiety difficulties, relationship problems and self-destructive habits.
Lately, however, he’s encountering more and more patients desperate to get the social media monkey off their back. They seek his help at the center, 9777 Wilshire Blvd., because that social media monkey has now turned into an obsessive, all consuming 800-pound gorilla.
“His problems began when he broke up with his girlfriend, became totally stressed out, got
hooked on Facebook and couldn’t stop. That’s how it started. A few months later he was online gambling, sports betting on college teams and spending way too much time looking at porn. Again, he couldn’t stop. Then he started popping Xanax for anxiety and eventually Vicodin.”
The Control Center was developed to deal with addiction, mental health and relationship problems in an integrated, non-judgmental way where neuroscience meets holistic healing. Dr. Reef assembled a diverse team of high caliber professionals – mental health doctors, addiction psychologists, relationship experts, trauma experts and experts in meditation, acupuncture, yoga, Chinese medicine, nutrition and others – to teach patients how to control their impulses. There’s no template for treatment. Each program is individualized to the patient’s specific needs.
“With ever increasing technological advances, our lives are supposed to get easier. Yet, more and more people are complaining about problems with life satisfaction and feeling more anxious than ever before,” says Karim.
Indeed, an influential doctors’ group recently warned that “Facebook depression” can affect those who already have poor self-esteem. In-your-face tallies, status updates, relationship status and photos of people having great times can make people feel even worse if they feel they can’t measure up to this new standard of being successful.
“If you view social media as a popularity contest, then you’re setting yourself up to fail,” says Dr. Reef.
The Control Center already has a national reputation for dealing with impulse control, relationship problems and obsessive-compulsive behavior of all stripes, and has been profiled on Or. Phil, CNN and ABC’s Nightline.
Karim, or “Dr. Reef” as he’s best known to TV audiences, is himself no stranger to the media. He’s a frequent guest on KTLA and has appeared nationally on most broadcast and cable news networks including Oprah, Dateline and The Today Show. He can currently be seen as the host of Discovery Health & Fitness network’s new show Broken Minds, which profiles disorders of the brain and underscores how fragile mental health can be.
Karim emphasizes that no one should think using Facebook or other social media will automatically turn them into addicts. ” It can enhance social connectedness, which is a healthy thing especially in a car-oriented cities, where it’s easy to feel isolated. But electronic relationships are not real relationships. And a vulnerability to a mental health problem or addiction can be uncovered or expressed through social media.” - Beverly HIlls Courrier

As a psychiatrist, my job is to understand the intricacies of the human mind.
The purpose may be to help strengthen a relationship, assess why someone is self-destructive, diagnose a mental health problem or understand how someone could be dysfunctional enough to commit a mass murder. I've worked with individuals who are neurotic, emotional, impulsive, psychotic, self-destructive, suicidal, homicidal and even serial killer mass murderers.
At this very moment, everyone is asking the same question of James Holmes. WHY?
In the world of psychiatric medicine, we often have to play the role of emotional detective.
So let's go through what kind of questions need to be asked to gain a better understanding of who we're dealing with and why they may have committed such a tragic and terrible act.
Background Questions:
1) Do they have a history of violence?
2) Do they have a history of mental health impairment? Seen a professional? On medications? Received a diagnosis?
3) What is the family unit like? Abuse history? Violence history? Mental health dysfunction?
4) What was the individual like as a child? Oppositional? Fire setting? Cruelty to animals? Were they violent? FIghts?
5) Is there a criminal record? Terrorist affiliations?
6) Were they loners? How did they interact with others? Did they have intimate relationships?
7) Did they have any obsessions? Pop Culture references? Videogames obsessions? Specific people? Dark figures?
8) Did they abuse drugs/alcohol/pills?
9) Was their behavior erratic? With family? School? Work? Do they isolate? Are they a loner?
10) Were they ever lost in fantasy? With a difficult time assessing reality from fantasy?
The Act:
1) Was it pre-meditated or did it seem impulsive?
2) Was kind of preparation was there? Weaponry? Explosives? What was the plan?
3) Was there any evidence of communication beforehand? With others? A note? Family?
4) Was there any odd presentation during the act? Clothing? Statements? Costumes?
5) Was there any reference to society, police, authority figures, family members, specific individuals?
Now let's focus on what we know and don't know about the deadly mass shooting and James Holmes.
WE DON'T KNOW if he had a mental health history. We don't know if he's ever seen a psychiatrist or been in a psychiatric facility or was on psychotropic medications. We don't know if he acutely stopped any medications and we don't know if he has a history of violence or intent to hurt others prior to thursday night. We do know that people describe him as a loner type, quiet and "standoffish."
WE DO KNOW he has no criminal record, no terrorist affiliations and he was able to complete his undergraduate degree and at least start a PhD program in Neuroscience.
We know that, thus far, nobody has stated (counselors, teachers, parents, friends) that he has a history of violence or mental health disorder or a plan to hurt others. We also know he painted his hair red and claimed to be like the Joker from the Batman series. And he bought an assault rifle, Remington shotgun and two handguns along with explosives found in his car and apartment.
Conclusions:
In most cases of extreme violence and erratic behavior, there is an underlying mental health problem. The most common mental health problems seen are: a psychotic disorder from drugs, bipolar mania with or without psychotic features, schizophrenia or schizoaffective disorder with command auditory hallucinations, an individual suffering from difficulties interpreting reality and fantasy and lastly, the anti-social personality. Most people with mental health disorders are not violent but when there is violence, it's often an individual with an untreated mental health disorder.
This tragedy raises many societal questions. Is the family accountable for the actions of their kids? How did our schooling system fail to recognize the mental health dysfunction? Should there be more mental health screening done? What was the role of pop culture and fantasy based movies/brands in this? Should there be stronger gun control laws? How do we further de-stigmatize mental health diagnosis and treatment?
It's likely we'll find out that James Holmes either suffered from a mental health disorder or was in the process of having a first break of a mental health disorder (recent onset) as many disorders reveal themselves around 17-25 years of age or he had some history of anti-social personality disorder. There really can't be any other explanation as we are not programmed, as human beings, to kill others. Particularly like this.
I plead with any family members who are concerned about someone they know and love. PLEASE get your loved ones evaluated by a mental health professional. There is nothing wrong with seeking help. Nothing good can come of this tragedy. Only more awareness of mental health treatment.
A frequent contr - Monsters and Critics

I rolled my eyes when I first heard a rehab show was about to air on television. "Oh, that's great -- a producer-driven inpatient rehab show. Healing on television. Good luck with that."

I had no doubt it would be "faux" treatment riddled with inherent conflicts including: sensationalistic production tactics trumping what's right for the client, a total lack of confidentiality, no private time for the clients and also exposure to stressors that are absolutely unnecessary in the process of healing from drugs/alcohol and/or mental health issues. My other immediate concern was, "What happens when the cameras shut down and the lights turn off? What do those people do then? And are you doing more harm than good?"

I thought the problem was primarily ethical with a potential for medical consequences. And although I didn't expect great results, I never expected the recently-reported five deaths of participants from just one television rehab show.

Respect the disease!

As a double board-certified medical physician in both psychiatry and addiction medicine, I know firsthand the clinical treatment and research associated with addiction and mental health issues.

And having published, treated and worked as a director at inpatient rehab facilities, I can say with authority that it is common knowledge that addiction is a chronic and relapsing illness that cannot be cured. An addict is vulnerable to stressors, triggers and cravings throughout their lifetime, and continued aftercare and meetings are imperative to achieving continued sobriety from drugs, alcohol or out of control behaviors. An individual could be sober 20 years and then one day the wrong acute stressor sends them off-track.

Which begs the question regarding television rehab. Why expose these individuals to a "faux" rehab experience chock full of dramatic television experiences that favors ratings over treatment?

The proponents of television rehab state that these clients/people/celebrities didn't have the financial resources or motivation to enter a "real" rehab, or they needed to be tricked into doing rehab. But here's the problem. When you're in rehab, you need to feel safe, cared for, focusing on yourself, looking at your specific internal way of feeling and thinking and working on changing your lifestyle and behavior. You simply can't do that when your day's activities are set up by a production team and you have cameras, sound guys and lighting guys around you all day long. The negatives outweigh the positives, and it's not even close.

And don't forget motivation. Are these participants motivated by money (being paid to be on the show), fame (of being on a television show), validation (of being picked to be on the show) or do they genuinely want treatment? It's common knowledge that narcissism and self-centered behavior are definitive obstacles in the recovery process, and that's why service to others is such an important part of treatment.

And guess what you're doing when you treat someone on an inpatient basis on television? You're potentially making that behavioral obstacle more difficult.

Fame trumps reasonable thinking. Many addicts can't think for themselves when under the influence. The drugs, alcohol and behaviors do the talking. So aren't you taking advantage of these individuals when asking them to be on an inpatient show that may overlook serious psychiatric and addition concerns (because there's not a true team of clinicians) and thereby increasing the risk of potentially negative health consequences?

Want to help? Send them to a real inpatient rehab experience instead of the reality show version. And if they are on a show, send them to legitimate aftercare, paid for by the network, after the show is over. And keep them there for an extended period of time.

I'm all for discussion, debate, information exchange and entertainment. Talk shows do this well. And they should continue to discuss these issues. Even some reality shows make us think about other people, issues or even ourselves in a different way. And one could debate whether outpatient counseling, when the individual is not in an acute crisis, is problematic on television.

But when you're dealing with a potentially life-threatening disease and that person needs inpatient treatment, don't make it worse than it already is. Especially if you're a clinician.

These people need real help.

Respect the disease! Lights, camera, action. For serious addiction issues, let's limit the "action" to a legitimate inpatient rehab experience.

Dr. Reef Karim,

Psychiatrist/Addiction Medicine Specialist

Doctorreef.com
Follow me on Twitter: @DrReef
Like my Facebook Fan Page: - Huffington Post