What Do We Want to Know About Adam Lanza and Why Do We Want to Know It?

The public is owed more information. We all want to know if there were opportunities to forestall such a gruesome tragedy. At the same time, we need to ensure that his story does not provide an insupportable platform for demonizing those with a mental illness.
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As we approach the anniversary of Adam Lanza's attack at Sandy Hook Elementary School in Newtown, Connecticut, we cannot help but ask if we have discovered anything that helps us understand why -- and how -- this horrible tragedy could have happened.

We know one part with certainty. Lanza grew up in a "gun family," with ready access to multiple, high powered weapons. Shooting was a family activity. He locked himself away in a black plastic garbage bag-shrouded room watching "shoot 'em up" video games and left us pictures of himself holding a gun to his head. America is obsessed with guns and Lanza more than shared that obsession.

We also know that countries with strict gun control have the lowest rates of gun violence. Both Great Britain and Australia suffered tragic mass shootings in the early 1990s. Both responded with the imposition of strict gun possession laws and both have seen significant reductions in the rates of gun homicides. Brazil, with one of the highest firearm homicide rates in the world, has been the latest to follow suit, already experiencing a significant drop in those rates following their stricter gun control. The surest way to reduce the risk of mass shootings may be to reduce the availability of guns in every state. That, however, seems to be a solution for another country.

Following the failure of President Obama's effort to pass even modest federal gun control measures in the wake of Sandy Hook, we turned to a "national dialogue on mental health." The supposition here being that shooters -- in addition to having guns -- must be mentally ill and that, if we could improve the mental health of the nation and somehow close the cracks in the mental health system that they must have fallen through, we will reduce the risk of mass killings.

This is rife with questionable assumptions. By no means do all shooters have a diagnosable mental illness, for one. For those shooters who are mentally ill, the illness may be only one of many factors enabling and driving the violence, including substance abuse and dependence, isolation and social disconnectedness, impairments in the capacity for empathy, festering grievances and political fanaticism, to name a few. What's more, our ability to predict who, amongst the mentally ill, will actually be a shooter (or exhibit other homicidal behavior) is terribly limited.

Nevertheless, there is a certain logic to our seeking to understand the role that mental illness plays. We have a desperate need to understand why these things happen, if only to experience the transient relief that a sense of control can deliver. We know there must be something very "wrong" with the shooter: not knowing what that is, we must examine every piece of evidence. Learning more about the mental state of the shooter is unlikely to ever complete the puzzle but it is a critically important trail to follow.

And now we have, long overdue, the "Report of the State's Attorney... on the Shootings at Sandy Hook Elementary School," issued by Connecticut State's Attorney Stephen J. Sedensky III. It is a report that leaves us asking for more, in particular about Lanza's mental health problems and treatments.

We read that Lanza had "significant mental health issues;" that he was given the diagnosis of Asperger's syndrome; that he had "obsessional and anxious traits" affecting "his ability to live a normal life and to interact with others." We are told that the contributions of these conditions to the Sandy Hook shootings are unknown. But we are given little of the detail that would help us to understand more about Lanza's troubled mental state and how this conclusion was reached. I wonder, as well, where did this diagnosis and these descriptions come from? Who assessed Lanza, at what points in his life? What were the conclusions and recommendations - made by whom, and delivered to whom? Did anything come of these? What, if any, were the opportunities for intervention and prevention that were there -- and missed?

Lanza wrote a grisly story of murder and mayhem at age 10, in the fifth grade, titled "The Big Book of Granny." Evidently this was not handed in to his teacher. But did any adult ever see it? Was there any response? Again, were there opportunities missed?

At one point he was "being followed medically for seizure activities." What kind of seizure disorder did he have? One type, temporal lobe epilepsy (TLE), is accompanied by pathological personality change and, rarely, with violent episodes. Did Lanza have TLE? If he did, was he treated? Did he refuse medication to treat this condition, as he had refused other suggested medications? Would that have made a difference?

The report leaves us far too much in the dark about these, and other, matters.

The public is owed more information. Mental health professionals who might be able to make sense of the details need more information. We all want to know if his condition(s) contributed to the killings. We all want to know if there were opportunities to forestall such a gruesome tragedy. At the same time, we need to ensure that his story does not provide an insupportable platform for demonizing those with a mental illness.

The Newtown killings are but one in a series of violent events that have shaken our communities and country. They all demand that we examine as deeply as we can every aspect of mental illness (including drug and alcohol abuse), school and gun safety, and family dysfunction that may have contributed to this and other school shootings. What we need are facts, the provision of full and unbiased information, in order to create knowledge and direction about what can be done, by whom and when, to reduce the risk of other such events.

Press reports suggest that a more complete report will be issued sometime in the (hopefully) near future. A report that tells us more about what we need to know would truly be in the public interest.

Harold I. Schwartz, M.D.
-- Psychiatrist-in-chief and vice president, Behavioral Health, Hartford Hospital/Institute of Living
-- Professor of psychiatry, University of Connecticut School of Medicine
-- Member, Connecticut Governor's Sandy Hook Advisory Commission