I wonder if our best chance at preventing this horrific event would have been to carefully listen to these parents, including the father, when Adam was a young child, to understand their experience and find meaningful help for the whole family.
The piece I Am Adam Lanza's Mother originally published in the Blue Review, that has now gone viral, offers a striking up-close view of how parents suffer in the face of a troubled young child. It offers evidence for the need for intensive help for parent and child together. Simply labelling the child with a psychiatric disorder and prescribing medication is grossly inadequate care.
For the families who lost children, their world as they knew it has effectively ended. Yet somehow the sun rises again and the next day is here. For the rest of us grieving along with these families, the only way to move forward is to take what President Obama called "meaningful action." I interpret this to be action that is radical and significant enough that it will somehow give meaning to this unimaginable loss.
The first and most obvious front is gun control. Without access to guns, apparently the same rifles used by troops in Afghanistan and Iraq, one individual could not have done this degree of harm. The politics of gun control is not my area of expertise, but certainly the politicians must now be motivated to, as Obama said, "put aside differences" and honor these children with dramatic changes to gun control laws.
The second front is preventive mental health care. This event is the result of a deeply disturbed individual with access to guns. My inbox this morning was full of emails from mental health colleagues referring to pieces they had written for other massacres such as Virginia Tech. I hope that this unspeakable horror will be the one that will finally lead to real change in access to preventive mental health care.
One of these colleagues wrote of how these events are often perpetrated by young adults who have not been "acting out," but rather have been quietly bullied for years and seriously neglected at home. Their symptoms may be more subtle. Yet it is difficult to imagine that there were not people in this family's life who did not recognize that this boy/young man was mentally ill.
The emerging information speaks to a deeply troubled relationship between the shooter and his mother as being at the root of the event. Apparently he first shot his mother and then went to the school to deliberately kill the children at the school where she worked. I wonder, was the hurt he experienced in his relationship with her magnified by his witnessing of the care she gave her young charges at her job? Of course I don't know, and this is only theory as I struggle to make sense of something that doesn't make sense.
As I said to my editor when she asked for our thoughts on this event, the trauma is perhaps too fresh for an in-depth discussion of theory and policy change. However, I am hopeful that the coming weeks and months will be filled with meaningfully dialogue of how we as a society can honor the dead children, both through gun control and improved access to quality preventive mental health care.
Last Sunday I awoke to a news story in our local paper, The Berkshire Eagle, about the vote by the American Psychiatric Association the previous day approving massive revisions for DSMV, the newest version of the Diagnostic and Statistical Manual of Mental Disorders. The article stated:
Board members were tight lipped about the update, but its impact will be huge, affecting millions of children and adults worldwide (italics mine.)Figuring that this would be big news, I asked my husband if we could delay our morning hike while I wrote a blog post about it. I was sure there would be an active public discussion on the subject.
But I was wrong. Mainstream media had virtually nothing on the story. There was not one word about the DSM vote in the New York Times. The Boston Globe similarly did not cover the story. There was a brief mention on NPR's Morning Edition on Monday. Boston.com had my piece as well as an article about Asperger's being dropped from the new version.
There was news on the blogs. Most striking was from Allen Frances, MD, professor of psychiatry at Duke University, who was chair of the DSM IV task force. On his Huffington Post blog he wrote:
This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM-5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public -- be skeptical and don't follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication.While he defends his colleagues against accusations that they have been influenced by big pharma, he writes that:
The APA's deep dependence on the publishing profits generated by the DSM-5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM-5 public trust and DSM-5 as a best seller... The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only -- so that DSM-5 publishing profits can fill the big hole in APA's projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM-5 preparation.When MGH psychiatrist Joseph Biederman was found guilty of violating conflict of interest rules in accepting large amounts of money from the pharmaceutical industry, the news was announced on July 2nd 2011, a Saturday of a holiday weekend. A number of bloggers suggested that this timing was deliberate: an effort to bury the story.
Some may suggest that the weekend DSMV vote and lack of media coverage is related to the power of the APA and big pharma to squash controversy. For the sake of children, families and adults who struggle with mental illness, I hope that there is a more benign explanation.
Because DSM V, the newest version of the Diagnostic and Statistical manual, sometimes referred to as the "bible of psychiatry" set to come out in May 2013, makes no mention of relationships, the relational perspective is that it is a flawed instrument. The whole discussion about what categories should and should not be included is off the mark. Nonetheless, as it currently dictates who will and who will not receive treatment, it is a force to be reckoned with.
Psychiatrist Daniel Carlat, in his book Unhinged: The Trouble with Psychiatry writes:
The tradition of psychological curiosity has been dying a gradual death, and the DSM is part cause, part consequence of this transformation of our profession. These days psychiatrists are less interested in ‘why’ and more interested in ‘what’.
In an excellent NYT piece on the subject, Not Diseases, but Categories of Suffering, the author states:
And as any psychiatrist involved in the making of the D.S.M. will freely tell you, the disorders listed in the book are not “real diseases,” at least not like measles or hepatitis. Instead, they are useful constructs that capture the ways that people commonly suffer.
The MRM(mutual regulation model) stipulates that caregivers/mothers and infants/children are linked subsystems of a dyadic system and each component, infant and caregiver/mother, regulate disorganization and its costs by a bidirectional process of behavioral signaling and receiving.