Newtown: An American Tragedy (26 page)

While today there is little debate in the mental health community over the merit of shuttering the large institutions, many of which were fraught with allegations of patient abuse and neglect, experts believe that the community mental health services that were supposed to serve in their place have in many ways failed and that a shortage of quality medical care is pervasive in the mental health community.

“Finding a good doctor is a tremendous problem,” said Dr. Michael Friedman, an adjunct associate professor at the Columbia University Schools of Social Work. “In this country we have a shortage of competent professionals to treat people with mental issues. It is very rare that people seeking professional help receive anything above minimally adequate service.”

Part of the problem lies in the fact that most general physicians aren’t properly trained to identify and understand mental health problems. “Doctors just aren’t equipped to deal well with the kind of complaints coming from parents who have children in the autism spectrum,” Friedman said.

Another problem is the tendency that still exists among some within the medical community to dismiss mental illness. Rates
of psychosis are higher in autistics and, in many cases, psychotic symptoms may go undiagnosed and untreated because they’re written off as just part of the autism spectrum.

“A doctor hears from a mother that her child is nonsocial and oftentimes there is no obvious prescription, so the parent is told the child will grow out of it. That doesn’t happen. These are conditions and need to be taken seriously for everyone’s sake,” Dr. Shorter said.

In most ways, the mental health system in America has never been better, according to Friedman, but the science of understanding the human brain is still in its infancy and asking doctors to appropriately identify mental illness is a challenging task. “It is very difficult for even good clinicians to make good mental health diagnoses. The best experts in the world have trouble in this area.”

While closing the mental institutions was a great idea in theory, the problem is that they’ve been replaced with jails, not the community outreach programs that were originally intended. “When the government came up with the idea to deinstitutionalize, the plan was to get these people out of the big institutions and into community outreach programs. But we don’t have adequate community outreach programs and instead we have jails,” said Liza Long. “We closed these institutions without an adequate community care system in place and now it is blowing up in our faces.”

In many states, insurance companies still don’t include treatment for autism in their coverage. “Getting access to care is still difficult. The fact that many insurance companies still exclude autism treatments is something that we’ve been working on changing,” said Peter Bell of Autism Speaks.

Finding solutions, like seemingly all aspects of mental health, is complicated. Dr. Sreedhar Potarazu, a medical expert and founder and CEO of VitalSpring Technologies Inc., believes that one of the contributing problems is the large number of young adult men who are suffering from depression and have no place to go. “If you were to survey the freshman class of many Ivy League schools you would find that forty percent are on some kind of medication for anxiety or depression,” said Potarazu. “There are so many young adults in need of care and very limited resources exist to help them.”

Potarazu worries that the medical community still hasn’t fully recognized the gravity of the mental health issue. “Depression or anxiety is no different from diabetes in many respects. It is a chemical imbalance in the brain and needs to be treated but there is often a failure to recognize that in the medical community,” he said. “We don’t do enough in terms of identifying and treating those in need. I believe we need to do more early screening in terms of understanding those who are at risk. We screen for a whole range of things, why not for mental illness?”

Potarazu believes that if mental illness had been spotted earlier, then perhaps some of these shootings could have been stopped. “If you look at these mass shooters, this isn’t their first incident. They all have histories. The warning signs were all right there for anyone to look at and see.”

There is a growing movement within the mental health community for pediatric primary care providers to attend to the developmental, behavioral, and mental health needs of children and adolescents in their practices. But that, too, would present
challenges. “The integration is a necessary step but it won’t be an easy one,” said Dr. Friedman. “The science of mental health is very complicated.”

The expansion of Medicaid, under the 2010 health care reform law, should expand access to mental health services to the previously uninsured. The law will require all health insurers to cover mental health services on a basis similar to other kinds of health care, and health insurance plans sold in the new state exchanges will be required to include mental health coverage.

“That’s a good place to start, but it won’t make any difference if the care people are receiving continues to be inadequate,” said Friedman. He wonders if perhaps people shouldn’t look to the mental health community at all to stop these kinds of shootings. “I don’t believe that any change or advances in the way of mental health in this country are going to have a significant impact on mass murders. These mass shootings are so rare, what do you change?”

Moving forward, Liza Long would like to see a mental health crisis team that parents can call instead of 911, and mental health centers where parents can walk in and their children can get treatment. “As parents we have a responsibility to fight for better treatments for our kids.”

But for Long, the first step comes back to acknowledging the problem. “I’m going to keep fighting until there is a change to our mental health system,” she said. “I may have written ‘I Am Adam Lanza’s Mother,’ but I’m determined that I’m not going to be Nancy Lanza.”

O
n June 3, President Obama delivered remarks at the National Conference on Mental Health to challenge the country to act on what he believes to be a mental health crisis. “The main goal of this conference is not to start a conversation,” he said in opening remarks at the White House. “Instead, it’s about elevating that conversation to a national level and bringing mental illness out of the shadows.”

He read off the statistics: one in five adults experience a mental illness and forty-five million Americans suffer from depression or anxiety, schizophrenia or PTSD. “We’ve got to get rid of that embarrassment; we’ve got to get rid of that stigma. Too many Americans who struggle with mental health illnesses are still suffering in silence rather than seeking help, and we need to see to it that men and women who would never hesitate to go see a doctor if they had a broken arm or came down with the flu, that they have that same attitude when it comes to their mental health.

“We see it in parents who would do anything for their kids, but who often fight their mental health battle alone—afraid that reaching out would somehow reflect badly on them.

“We see it in the tragedies that we have the power to prevent.”

I
t wasn’t mental illness that caused the horrors of December 14 but the work of a depraved psychopath, according to investigators. Adam Lanza knew exactly what he was doing as he carefully crafted his terror spree to maximize bloodshed and shock the world, said a law enforcement source familiar with the killer’s various journals and writings found inside the Lanza home at 36 Yogananda Street.

“It wasn’t mental illness that drove him to walk into Sandy Hook Elementary that day,” the official explained. “This was a young man who knew exactly what he was doing.”

The seven handwritten journals and numerous drawings and charts show a depraved indifference to human life that exhibited itself through psychopathic behavior. “Human life was nothing to him. Shooting up the kids wasn’t a cry for help. He didn’t break from reality. Killing these kids was fun for him. We are talking about a cold-blooded killer,” the official said.

If his initial attack proves to be Newtown High School, that could indicate a broader need to communicate his grievances and express his emotions that he felt he was wronged.

“Adam was angry. Newtown High School was his only real connection to the outside world and suddenly it was taken away from him and it must have seemed to him quite unfair,” said Richard Novia, Adam’s Tech Club advisor and former head of security at the school. “I believe he blamed the school and this terrible shooting was his sick way of telling the world.”

While the condition of “psychopathy” is not recognized by most mainstream medical journals, it is a common diagnostic tool used by law enforcement and criminal profilers to analyze behavior. In her work as a criminal profiler for the FBI, Mary Ellen O’Toole came face-to-face with countless murderers and serial killers who she believes fall under the label of psychopath. And based on what is known of Adam’s life and her knowledge of the crime scene, O’Toole believes that Adam Lanza displayed clear psychopathic traits.

“I would not classify this kind of behavior as that of someone who is mentally ill. Blaming this on mental illness conveys that Adam was out of touch with reality. There is no doubt Adam had serious issues, but we are talking about a crime that was extremely callous and deliberate, with all of the traits of a psychopath,” O’Toole said. “Adam made a conscious decision to go shoot those children in Sandy Hook Elementary. He knew it was wrong and the thought of the violence thrilled him.”

A psychopath is defined by the primary characteristic of an inability to show empathy for others. The sheer horror of the killing,
first with his mother then followed by the cold-blooded execution of six teachers and twenty children, was a textbook example of psychopathic behavior, according to O’Toole. “He was very self-focused. Over the course of time he trained his mind to view humans more as objects,” she said.

For most people, the idea that someone may enjoy violence for the sake of violence is a tough one to swallow, which is why it’s more comfortable for people to ascribe such incomprehensible acts to mental illness, O’Toole explained. “People have the tendency to look at such a horrific crime and say, ‘Whoever did this must be crazy,’ but when we look at the planning involved it tells a different story. How secretive was Adam? How strategic? Did it make sense or was it sloppy? Was the crime scene cold-blooded and predatory? Once you begin pulling out behaviors a pattern begins to emerge of good cognitive strategic skills that are maintained over an extended period of time.”

All violence is not equal, according to O’Toole, who believes the crime scene at Sandy Hook was instrumental violence, the preferred violence of a psychopathic individual. “It is cold-blooded violence. In these cases victims tend to be strangers. It is purposeful and well-planned out. It is goal-directed. That is what we have at Sandy Hook.

“You have children crying, screaming, maybe getting sick, and his shooting seems to get even more focused as opposed to all over the place. He was thinking clearly before the crime, during the crime, and after the crime. Adam’s crime was not sloppy. It was not disorganized. It was well thought out and well-planned. And he planned this for a long time. You just can’t go in and out of reality
for that amount of time. You really have to be analytical to do what he did,” said O’Toole.

In choosing Sandy Hook Elementary School as his target, Adam would be able to accomplish two goals: increasing his death count and exerting his control with very little resistance, O’Toole argues. “Control is a big issue for killers in mission-oriented cases. Adam was on almost a military-like mission to kill as many people as possible. He used the element of surprise. He was overly armed. There was no time to talk, just to kill as many people as possible.

“It gives them a sense of omniscience and God-like power they can take life away,” continued O’Toole. “He can make the world stop. Killing one or two people doesn’t get you the attention anymore. He chose something as terrible and awful as possible to ensure he would get maximum publicity.”

Under this scenario Adam would have chosen his mother as his first victim for a more practical reason. “He didn’t want her to interfere with his mission,” O’Toole said. “If she saw him packing his car with guns she could have called the police. For Adam, carrying out his mission was all consuming.”

Investigators also believe Adam’s obsession with mass killers wasn’t due to mental illness or autistic tendencies to become fixated, but instead a way for him to learn new killing tactics in hopes of topping them all to achieve a level of fame and glory. When Adam frequented Wikipedia, using the screen name “Kaynbred” to meticulously correct entries about mass killers, he was really trying to learn from their experiences, law enforcement believes. The seven-by four-foot-long chart discovered in Adam’s room that listed the names, number of kills, and weapons used by the most brutal mass
killers throughout history was likely a scorecard that he was hoping to top with his name.