A month has passed since the tragic school massacre in Newtown, CT. Most of the response has focused on controlling sales of assault weapons. This is a good thing. It can limit the lethality of violence -- automatic guns do more damage than knives, for example. But it will do nothing to prevent violence.
To get at the turning points in the years-long chain of events that led a young, isolated, desperate man to kill his mother, 20 six- and seven-year-old children, six adults and then himself, we need to ask more questions. Questions about what happened to Adam Lanza when he was a child. Questions about his relationships with his mother, Nancy Lanza, and the rest of his immediate and extended family. Questions about whether the community that he grew up in was aware of his troubles and his troubled family, and if and how they helped.
The last 15 years of research on how adverse childhood experiences cause adult onset of chronic disease, mental illness, violence and being a victim of violence is unequivocal. To understand what happened to Adam Lanza, we have to ask difficult questions. Dr. Vincent Felitti, one of the two principal investigators in the CDC's groundbreaking Adverse Childhood Experiences Study, noted: "Most of us have been well-taught that it would be terribly rude to inquire, thus often allowing monstrous events to proceed unrecognized."
Here are the questions, with short explanations of why each is important. At the end, a larger view of how asking these questions can help us prevent another school massacre.
Was Adam actually diagnosed by a psychologist or psychiatrist?
It has been reported that Adam Lanza had Asperger's (now officially referred to as being on the autism spectrum), which by itself does not lead to violence. So, something else was going on. Did a trauma-informed professional do the diagnosis, i.e., someone who understands that some symptoms attributed to Asperger's -- depression, anxiety, suicidal thoughts -- can also indicate a child's normal response to trauma? In this case, trauma can be something as simple as a car accident, or physical, verbal and sexual abuse and physical and emotional neglect. It also includes a parent who's an alcoholic or addicted to other drugs, a mother who's battered, a family member in prison and loss of a parent through abandonment or divorce. (It can also include war, natural disaster, witnessing violent crime, being homeless, and moving many times, but those factors don't seem to be relevant in this situation.) Did that person consider other possibilities -- fetal alcohol spectrum disorder, which is caused by a mother's excessive drinking during pregnancy?
Another reason to find out who diagnosed Adam Lanza is to identify people he had relationships with -- and if they were supportive, abusive or neglectful.
Did he see a pediatrician?
This also gets at finding the people who had close relationships with Adam Lanza. Reports so far identify a paltry few. That isolation raises a red flag. As Drs. John T. Walkup and David H. Rubin noted in their editorial in the New England Journal of Medicine: "For the withdrawn and isolated and the angry and alienated, there are deep-seated barriers to care, and there may exist a small subgroup that is uniquely vulnerable to the seductive power of violence in our culture."
Knowing if he saw a pediatrician would also reveal if Adam Lanza suffered something as simple as a concussion, if he had neurological assessments, if a pediatrician referred him to other specialists or advised the family to see a therapist, or called in social services, noted Dr. Robert Moore, a corporate and family trauma specialist with Peace4Tarpon in Florida. Did the pediatrician make one or more of those recommendations and follow up? If not, why not?
Was the pediatrician trauma-informed? i.e, someone who understands how adverse childhood experiences affect brain development, cause some children to be withdrawn and others to be hyper-active?
What was the problem when he was in grade school that caused his mother to remove him?
What happened to Adam at that time? What symptoms was he showing? Was he bullied by teachers or other students? Was he not getting the attention he needed (see this very revealing story on Atlantic.com -- "How My Autistic Son Got Lost in the Public School System")? Or was he exhibiting symptoms of relationship issues with his mother or father that school staff asked about, which led Nancy Lanza to remove him from school (a common occurrence with dysfunctional families)?
Did the school follow up with Adam and his family?
If not, why not? If so, what was the result? Was his school trauma-informed? i.e., did the teachers, staff and administration understand how childhood trauma prevents a child from being able to focus enough to learn, to trust adults or to make healthy relationships with other children? If so, did the school take steps to help children who were experiencing trauma?
Who home-schooled him?
And what type of relationship did he have with that person? Was it nurturing? Abusive?
Did he participate in any play groups?
Adam Lanza has been described as withdrawn, and could become so overwhelmed that he disengaged from people around him. How was he encouraged to develop his social skills? Or did his mother isolate him so that he never saw anyone or had any friends?
What was the state of his parents' mental health? Did they have childhood trauma?
If they were over-anxious, suicidal, depressed, etc., then that would have put severe stress on Adam Lanza. This question is pertinent because it has been reported that Nancy Lanza was anxious, bought guns because she believed that an economic collapse was likely, and that she would have to defend herself.
Did his parents abuse alcohol or any other drugs?
If they did, that would have put severe stress on Adam Lanza, and led him to fear for his safety. This question is also pertinent because Nancy Lanza was reported to have spent two or three evenings a week at a local tavern. Little has been reported about Adam's father.
Why was Adam Lanza so angry at his mother that he killed her?
What kind of abuse would have triggered this? Physical? Sexual? Verbal? Neglect? What was his relationship with his mother, who seemed to be the only person in his life for the last two years?
Why was Adam Lanza estranged from his father and his parents' families?
This question is relevant because it has been reported that Adam Lanza had not seen his father for two years, and Nancy Lanza's brother had not seen Adam Lanza for eight years. It is another red flag indicating possible harmful isolation.
Was Adam Lanza's family involved with a church, community group, volunteer group, youth group, or any other social organizations?
It's another piece of the puzzle -- was the whole family isolated, thus never giving Adam Lanza the chance to learn social skills, have friends and trust other people?
To simply say that mental illness is to blame is to avoid looking at the series of events that Adam Lanza experienced to reach his state of mind on December 14, 2012, which at the very least was extreme anger and likely despair and hopelessness. In a recent op-ed in the Miami Herald, Robin Karr-Morse, author of Scared Sick: The Role of Childhood Trauma in Adult Disease, and David Lawrence, president of the Early Childhood Initiative Foundation, asked: "How and why can a baby develop into a vicious killer? And what can we do about it?"
Contrary to what many people believe, killers aren't born, they're created... by the people around them, by their communities, and the experiences they have as children. When Adam Lanza was born, he was not destined to be a mass murderer. Just like a physical accident, childhood trauma such as physical, sexual, or verbal abuse leads to toxic stress that damages a child's developing brain. Brain damage caused by psychological trauma causes people to become incapable of being able to control themselves when they're angry or to solve problems -- such as how to become less isolated.
Some people don't think anything can be done to prevent violence. But it is possible, and it's being done now, in trauma-informed schools, trauma-informed hospitals, by trauma-informed pediatricians, in trauma-informed public health departments, by trauma-informed judges, and in trauma-informed mental health clinics. So far, not one community can claim that all of its institutions and businesses are trauma-informed, but there are a handful of communities that have stated that as a goal. And that's what it will take to move our national conversation beyond only gun control and mental illness to the prevention of violence in all our communities.
In the 1990s, when I was reporting on the epidemiology of violence, one of the things that bothered me was why one child from a troubled family would commit murder, while his sibling did not. We thought the child who did not commit violence escaped unscathed; perhaps s/he was more resilient. But the CDC's ACE Study shows that children are not as naturally resilient as most people assume. Unless resilience in the forms of love, support, attention and solid attachment is provided for them by their caregivers and their community, they do not escape the consequences of severe trauma. They choose -- often unconsciously -- alcohol or food or tobacco or inappropriate sex or overwork or thrill sports instead of violence to temporarily dull their anxiety, depression, hopelessness, etc. The consequences of the overexposure to toxic stress appear later, often decades later, as depression and other mental illness, violence and being a victim of violence, and/or chronic diseases such as diabetes, heart disease, autoimmune diseases and cancer.
The current state of research is such that it's fairly easy to identify children who are at risk for unhealthy behaviors that have these severe consequences. The part that's unknown is how to distinguish the child who will become 300 pounds overweight from the child who will become a murderer.
But if we ensure that all children are raised in healthy families and healthy communities, making a distinction between two miserable outcomes wouldn't be necessary. Wouldn't we want all institutions and people in those communities to be ready to step in and help families when they show early signs of trouble and not wait until it's too late?
Jane Ellen Stevens is writing a book about ACE concepts and how organizations, agencies, businesses, communities and individuals are implementing them.