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Miriam Carey

Miriam Carey

The more we learn about the automobile rampage and fatal shooting of former dental hygienist Miriam Carey in Washington last week, the more tragic overtones the whole episode takes on. And now, quite predictably, a public debate has been enjoined over whether police actually had to shoot her.

The sad fact, I’m afraid, is that they did. And it is a very sad fact indeed.

First, I think we can reasonably establish, from her sisters’ accounts and all other available evidence, that Ms. Carey was suffering from a discernible mental infirmity characterized originally by post-partum depression and evolving into delusional and perhaps paranoid ideation. The condition, apparently, had been at least partially controlled by prescription psychotherapeutic medication that, for whatever reason, she had stopped taking. There is little question that, but for this severe but possibly transitory psychiatric infirmity, Carey would not have driven to Washington and tried to ram her car through barricades at the White House and Capitol building. In other words, available evidence suggests that Carey was not a “bad” or “evil” person, merely a sick one.

That acknowledgement notwithstanding, her actions and repeated attempts to avoid being stopped had the outward hallmarks of a terrorist incident directed at the two most significant and symbolic targets in the nation. Knowing in retrospect that she had neither a gun or a bomb is irrelevant. Police officers and security officials have to make split second decisions with the information or observation of the moment, and the consequences are monumental. I don’t believe anyone who has not been in that situation and has not had that kind of responsibility is in any position to second guess the decision to shoot and kill her.

Were it shown that security officials suspected (which they had no way of doing in actuality) that Navy Yard shooter Aaron Alexis had a weapon and appeared to be about to use it, would any of us have faulted them for trying to take him out? By the same token, would any of us have praised them for reasoned judgment had they waited to see if he actually intended to kill people?

We can wish that mental health screening and treatment were better and more more effective than it is. And we can believe that Miriam Carey didn’t have to die. But placing the responsibility on those who killed her is not only wrong, it misses the point.

17 Responses to Snap Decisions

  1. mdricex says:

    Dr. J:

    I know what you mean. As the saying goes, A little knowledge is a dangerous thing. When it comes to psychology and mental health, somehow, just about everyone imagines themselves an expert with very little information. And honestly, I have some very close friends who are lawyers, but they can be REALLY bad about doing this.

    MD Rice

  2. watson says:

    Police officers/ security guards…. ‘have to’….react in split seconds (and there I think is the answer), and often with deadly force. If they don’t act it’s ‘likely’ people or they will die and more crime/ mayhem be committed. They react almost automatically by their training and physical prowess if they want to do and survive their job.
    If anyone was a trained soldier on the combat line and saw someone in an enemy uniform charging at him to jump into his fox hole and apparently attack the bunker he was assigned to protect….would anyone NOT shoot?
    The fact this person turned out to be an insane lady that really meant no harm is a tragedy….I put it down to the US continues to have the lack of a mental health system.
    P.S. By ‘enemy uniform’ I mean she was driving a unmarked car at racing speed and refused to stop.

    • mdricex says:

      Exactly. In many cases, to hesitate is to die or cause someone else to be killed. And you know, this hypervigilance does not come without a cost. There is good reason that first responders have PTSD diagnoses in numbers nearly on par with combat survivors. Every day is a battlefield when you are a law enforcement officer. And as a wife or husband or partner of an LE officer, there is not a second of a day that goes by that you don’t think, Today could be the day that he (or she) doesn’t come home.

  3. Thank you both for this intelligent and stimulating dialogue. I appreciate your views and compliments and as you both suggest, I am continually sensitive to the problems and challenges in treating mental health in the United States and around the world. My late father, Bennett Olshaker, M.D., who John Douglas also knew well, was a psychiatrist who spent years working at St. Elizabeth and other hospitals in addition to his private practice and there is no one in the world I look up to more than him.

    As I have noted, I consider both the Aaron Alexis and Miriam Carey cases to be great tragedies all the way around, as well as many others. And in that vein, I just wish to make two points:

    First, police on the scene have to make snap decisions, and the determining factor is often what course of action – or inaction – has the greatest potential to save life and avoid catastrophe. There was too great a chance that Ms. Carey was either armed or was carrying a bomb and there was no way to know her intentions. Any SWAT operator will tell you that shooting out tires will not necessarily stop a vehicle, and runs the risk of exploding the gasoline tank. You go with the information you have, which is why I continue to support the actions of the police and Secret Service.

    Second, while you can make a good case that anyone whose intent is to commit murder is “mentally ill,” I and others in the criminal justice field draw a distinction between those with character disorders who enjoy the predatory act or those who are willing to kill for the benefits of “criminal enterprise” and those who are clearly suffering from the kind of delusional ideation that alters their “normal” thinking. To oversimplify but put it as plainly as I can, I don’t “blame” Ms. Carey the way I blame Ted Bundy.

    John and I very much appreciate your feeling that we provide a sense of safety that permits free expression. That’s what this should all be about – learning and gaining perspective from each other.

    • mdricex says:

      Mr. Olshaker:
      Well said, sir.

      • drJ says:

        Thank you for your compliments and thought-provoking responses as well. I shall enjoy addressing some of your questions too. I often wonder about many of the same things and have come across some research that has provided very interesting evolutionary theories about similar topics that you touched upon.
        In regards to your note on “word whoring” I know exactly what you mean and understand how frustrating it can be. My pet peeve is when professionals in the media attempt to describe the mechanics of an extremely complicated defense, Projective-Identification, in the act of committing murder. It gets me every time.
        I can’t tell you how much I appreciate sharing this sort of dialogue.
        Dr. J

    • drJ says:

      Thank you for your kindness, once again. Prior to sending my note to Mdricex, I gave a great deal of thought to the points that were raised and did my homework too. It did not take long, due to the level of transparency, for me to realize that I neglected to look at both sides of the situation. Only through self-examination will I come to understand the defenses that set in to inhibit me from promptly seeing otherwise. Regardless, this has been a learning opportunity and a good experience for me to have before writing from my own platform which I intend to do very soon.
      I appreciate the time you took to share your thoughts on the issues raised in the dialogue. I enjoyed reading them very much. If you don’t mind me taking another minute or two of your time, I’d like to clarify my thought processes regarding the culpability of violent offenders. I am aware that your method in determining responsibility lies in the distinction between offenders who are predators and those who suffer from psychosis. This method makes perfect sense to me. I think it gets complicated for me when I apply attachment theory to my understanding of character disorders and criminal behavior. Whenever I do so, the process is often rewarded by invaluable insights that I gain into the relationship between violent behavior and intra-psychic conflicts. To me, there is nothing more fascinating than the challenge of establishing the manner in which the repetition compulsion or projective identification gets illuminated in a crime scene. But, along with the rewards of insight, comes the harsh reality that the origin or root cause of an individual’s capacity to commit homicide can always be traced back to early childhood trauma, neglect and, or, abuse, that was endured by the child at the hands of their attachment figures. This always raises questions for me. If the severity of psychopathology, i.e. character pathology, is inversely proportional to the amount of empathy received in early childhood by attachment figures, and, if, the risk of developing disorders of character depend on the child’s phase of development at the time trauma occurs, then, isn’t it safe to assume that the violence exhibited by offenders, whether affective, predator or psychotic in nature, is due in large part to an evil that was forced upon them? They were once victims too, correct? Since they had no control over their abuse, how does that apply to the capacity to control their own destiny? Isn’t it possible the homicidal maniac that we all love to hate, could be the infant who was raped repeatedly and lacking words to express the trauma, grew into an adult, cursed with the perpetrator’s sin, only to become a psychosexual serial killer?
      Thanks to the advances in neuroscience we know of the epigenetic changes that take place in the frontal cortex and the limbic system in the brains of children exposed to early childhood trauma. When a child is exposed to horrific abuse, that is, evil, without the support of attachment figures to mitigate its intensity, the structure and function of the child’s brain will change and can later manifest itself in disorders of emotion regulation. Two worth mentioning because they are characterological in nature are; borderline and antisocial personality disorder. The former is incapable of containing their emotions while the latter is incapable of accessing theirs. Having to live with either is likely to be devastating. The individual with BPD will go to great lengths just to feel stable, calm and well-regulated, while, the individual with APD will go to great lengths to feel anything at all. If correct, both may even commit murder in a desperate attempt to regulate their emotions. These character traits in the adult are the result of extremely rigid defenses that were first employed by them as children to protect them from experiencing intolerable pain associated with the connection between their abuser and attachment figure.
      Perhaps once again, this is simply a drift into existential thought, as Mdricex put it the other day. I hope that what I’m saying is not misconstrued. I do not condone criminal behavior. I am a trial watcher and always route for the prosecution. I do not think the punishment of violent offenders should be buffered or that they should be hospitalized. That is not the point. What is worth pondering, in my opinion, is the notion that the origins of many forms of violence, affective or predatory, can be traced to early attachment relationships which, provides crystal clear evidence of the importance and potential of early childhood prevention. Thanks for considering!
      Dr. J

      • mdricex says:

        Dr. J:
        I know you were addressing this to Mr. Olshaker and Mr. Douglas, but I did want to reply. I have spent many years researching the exact concepts you have mentioned, and I applaud your insight into the intricacies involved in psychopathology. The evolution of a serial killer is, indeed, an evolution. There is not one characteristic nor one environmental factor that has been found that fully explains or can predict their creation. There are many, many researchers who have tried to isolate the factors (not just of serial killers, but of psychopathy in general) and some ascribe to the nature theory, some to the nurture theory, some to a mix. I, for one, think that–as you mentioned–the lack of healthy attachments is a major factor. I have come to no conclusions and only have questions, the main ones being: Is the lack of healthy attachments the decisive factor in the development of pathological narcissism, and then the pathological narcissism itself the source seed of the psychopathy? Or is the underlying lack of attachment somehow not related to outside factors but pre-existing factors internal to the person before abuse even exists? Or, is psychopathy itself merely a symptom of a more global yet insidious disorder such as a high functioning form of autism or some as yet unidentified sort of “apathy” disorder? Or, even scarier, is the isolation and lack of attachments to others due to some sort of evolutionary warning system within others that somehow recognizes the danger potential in these persons? I only have questions.
        I will say, though, that I I definitely agree with your assessment that many forms of violent aggression do have their origin in mistreatment. Indeed, the only exceptions that I have found (with the premise standing that neglect and non-interaction is just as much abuse as violence) is in those instances where organic brain dysfunction has occurred through accident or disease.

        Thank you for your thought-inspiring post,
        MD Rice

      • mdricex says:

        Dr. J:
        One additional note I forgot to include in previous post:
        I am extremely frustrated sometimes with how certain psychological/psychiatric terms are used interchangeably (I call it word whoreing, LOL) anyway, just to clarify, I do not consider APD and psychopathy to be the same thing. I ascribe to much of the philosophies/interpretations of research of Dr. Michael Stone in that I believe that APD and psychopathy are completely different things, and that psychopathy is truly a scalable characteristic. In other words, every person who may have psychopathic traits (or who is even a full blown psychopath) may not meet the diagnostic criteria for Antisocial Personality Disorder, however, every person who has been diagnosed as having APD does have some sort of psychopathic traits because it is inherent to the diagnostic criteria. Their are many, many people who would be considered high on the social scale who could also be considered as having at the very least psychopathic tendencies and at the very worst all the way up to full blown psychopathy. Plainly, you will find many persons with psychopathic tendencies who have never had contact with the law, but it is not very likely to find someone with APD who hasn’t. To further muck things up, some also confuse psychopathy with psychosis/psychotic and even use them interchangeably. Add to this the sociopathy and psychopathy interchangeability (this one even clinicians can’t seem to agree on). Myself, I do consider a difference in psychopathy and sociopathy in psychopathy I think that sometimes the person may honestly not be aware that they are doing or behaving or having cognitions that are “wrong” (often due to socialization into the behaviors by loved ones) but the sociopath is very well aware, they just don’t care. That is my distinction–and by no means a proven semantic.

        MD Rice

      • Like MDRICEX, I find your comments perceptive and insightful. All I can add is that we can take every action to its physic-psychological reductionist conclusion, at which point we live in a completely deterministic and behaviorist universe. This seems somehow too simple to me, and though we would certainly use behavior modification techniques, no one would really be responsible for anything. And though I agree with you completely about the early development of most serial predators, John and I have also noted that most of them have brothers who did not turn out to be criminals. At this point in our understanding, I think we still have to distinguish between those who understand that what they are doing is wrong, and those who cannot. This is certainly an oversimplification, but it may be the best we have to work with at this point.

  4. mdricex says:


    As you say you are a clinical psychologist, you should be aware that you have a duty to ensure no harm where there is possibility of harm–either to the patient or to others. This is the same duty that the law enforcement officers have. They are not your enemy. If you wish to express some philosophical existential musings about life and the human race in general, it would be better service to your arguments to not set targets on specific persons (e.g. the officers involved in particular acts) and ascribe to them motivations and guilt that are pure speculation on your part.

    M.D. Rice

    • drJ says:

      Good day Mdricex:
      I wholeheartedly admit you are absolutely correct. What I said was insensitive and inappropriate. My comments regarding the shooting at the Capitol were impulsive and unjustly polarized. I did not consider the experience from the agent’s perspective nor did I give them the amount of thought they clearly deserved.
      It is evident to me now that Ms. Carey’s behavior was extremely dangerous. She posed a serious threat to the President, the Capitol and the public as well. It is also clear that her actions took away the agent’s ability to choose which, in doing so, led to the tragic unfolding of events that day. This tragedy, undoubtedly, placed a terrible burden on the agents, then and now, that no one should have to endure. It was obviously an extremely difficult decision for them to make, no matter how forced they were to take action and now that it has past, it must be equally difficult for them to work through the emotional stress that comes along with its’ aftermath.
      With that said, I wish to extend my apology to you and to anyone my words may have harmed. With utmost sincerity, Dr. j

      • mdricex says:

        For law enforcement agents everywhere and their wives and children, I sincerely thank you for your sensitivity and kindness.

        MD Rice

      • mdricex says:

        Woops, I should have said “For law enforcement agents everywhere and their husbands, wives, significant others, and children, I sincerely thank you for your sensitivity and kindness.” There are plenty of awesome officers who are female and or have a non-traditional partner or family and I certainly did not mean to leave them out.

  5. drJ says:

    I just wish to share a few initial thoughts in response to your commentary “Snap Decisions”. Firstly, I am curious to understand why you chose to identify Ms. Carey’s illness as an infirmity. She was not old, nor was her condition due to old age. If anything, she was quite young. Not only was she young, she was a mother about to embark on a lifelong journey of parenthood, a God given gift to all children, in order that they have the basic human right by nature to succeed in life, their mother’s love. From the reader’s standpoint, the word seems to pathologize her condition, so it left me feeling a bit confused by use of the term. And yes, this was indeed a tragedy, an unnecessary loss of life is one thing, but I cannot even begin to tell you about the impact this loss will have on the infant, witnessing her mother’s death and losing her mother’s love, as well, I don’t think a trauma runs deeper. This is sad, you have no idea of the heartache this baby, then toddler, child and adult will forever endure.
    The other comment concerns the incident in the Navy Yard, perhaps if you asked, if Mr. Alexis was a female holding an infant, would the circumstances have been different when it came to a response. What harm did they really think this could be caused at the point of shooting her? I mean really? She had a baby in the car! Couldn’t the sharpshooters just blow out her tires? They would know exactly when and where to shoot to deem her powerless but to kill her? They are not mentally ill. What is their excuse? Finally, you mentioned that she is not a bad or evil person but does this mean the others are? Mr. Alexis, for all practical purposes, appeared to be in the midst of a full blown psychotic episode! The onset of his psychotic break likely occurred on Aug 7, it’s documented. He wasn’t assessed or treated. I am sure you know that his initial paranoia, although harmless as it seemed, could easily have erupted into psychotic proportions within a month, if the illness isn’t treated promptly. My point is that many individuals who commit mass homicides are seriously ill mentally, not necessarily antisocial, like we want to believe, especially crimes committed by the young. Mental illness is the fuel driving a lot of evil, it is scientifically proven, we know a great deal now about the causes of evil, of mental illness, psychologically, emotionally and biologically, and yet we do nothing to prevent it. I just don’t get it. Really I don’t. This is the backlash from it all, there’s always consequences for our actions. There’s no one to blame but ourselves. Maybe someday proper action will be taken, denial won’t work so well anymore. Sure hope so.

    • mdricex says:

      With all due respect:

      ” Firstly, I am curious to understand why you chose to identify Ms. Carey’s illness as an infirmity.” and then “From the reader’s standpoint, the word seems to pathologize her condition”

      A.) Mental illness, by definition, is abnormal pathology which inherently denotes infirmity. If you doubt this, look up the definitions.

      “This is sad, you have no idea of the heartache this baby, then toddler, child and adult will forever endure.”

      B.) Both Mr. Olshaker and Mr. Douglas know more about human heartache from the point of all ages than you will ever know–and you should be glad of it.

      “My point is that many individuals who commit mass homicides are seriously ill mentally, not necessarily antisocial, like we want to believe, especially crimes committed by the young.”

      C.) That is very easy to say when you do not deal with those who are psychotic and psychopathic, and you are not the one in their path of destruction.

      “There’s no one to blame but ourselves.”

      D.) Nope. I’m not taking the blame for either of these. I did not try to ram a car through a barricade and I did not shoot anyone. I will not assume some sort of socialistic blame for either of these actions. Both of these people were mentally ill and both overstepped the bounds of legal behavior to the point that they were a direct threat and had to be dealt with. Mental illness does not cancel out threat salience, if anything it compounds it.

      Additionally, the two situations are both sad, but the fact that Ms. Carey was shot is not the blame of the officers, but the blame lies directly with her behavior to which they reacted properly. Regardless of her reasons, those officers were doing their job and they had no idea what she might be trying to do. The fact that a child was in the car is not their fault and, honestly, it should not have any weight in the decision they made even if they had known it. Law enforcement cannot be forced to second guess every decision they make in order to try to account for things that they have no way of knowing. They are there to do their job.

      Finally, you are entitled to believe whatever you wish, but please be more informed when trying to ascribe motives and guilt to other people. There are bad, bad people in this world, and some poor few are forced to deal with them to protect everyone else. There are also some very ill persons in the world whose delusions lead them directly into the harming of others, we have to be protected from these people too. I find it disturbing that such fault was found in such a well-written article, that, if anything, acknowledges the sadness of the situations, and somehow blame is being put on the officers who were only doing their job, which is to protect.

      M.D. Rice

      • drJ says:

        Thank you for sharing your opinion. All your points are well taken. Although I would like to believe, as seasoned clinical psychologist, most of the hypotheses I tend to draw, are drawn from a well informed background in psychoanalytic psychopathology. That being said, I am human first, and if my life long passion to help reduce the impact of mental illness diluted the point of my comment, its regretful. The point I was trying to make, and the point still is “We are in the midst of a mental health crisis and there is nothing being done about it, despite the rise in mass homicide, and senseless loss of life we are witnessing before our very eyes almost on a daily basis. ”
        I believe Mr. Olshaker is aware of my frustration. I also believe this website, Mr. Olshaker’s open-mindedness, wisdom and sense of humor promotes a sense of safety for me that permits a freedom to respond authentically even if, at times, its opposition to his.
        The anger and frustration I feel is due to the mounting mental health crisis our nation is in, not because of one thing specifically or another, its the cumulative effect, we see the fall out. do not hold Mr. Olshaker responsible for the crisis.
        I am grateful, Mr. Olshaker, provides a platform to share my thoughts and feelings in a manner, that I doubt, given the level of his knowledge and experience of human behavior, would be challenged to look beyond just the comment and not be affect by them personally.
        Thank you for your polite provocation to continue a dialogue. Dr j

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