After Sandy Hook: Why mental illness matters

The tragic shootings at Sandy Hook have sparked debate ranging from gun control to bulletproof windows at elementary schools.

I suggest the more important issue is to prioritize our national discussion of mental illness.

There seem to be two problems with the discussion at present.  The first is a lack of understanding about the terms and their meanings. To illustrate, here’s the complete text from a two-sentence article from Fox News:

Ryan Lanza, 24, brother of gunman Adam Lanza, 20, tells authorities that his younger brother is autistic, or has Asperger syndrome and a “personality disorder.”  Neighbors described the younger man to ABC as “odd” and displaying characteristics associated with obsessive-compulsive disorder.

One might consider it impressive to embed so many problems into such a concise article.

First, the phrasing of the first sentence appears to suggest that autism is something like a sum of Asperger’s and a personality disorder.  That’s incorrect. Asperger’s is simply a milder form of autism: both are different degrees on a single autistic disorder spectrum, a broad-ranging developmental disorder characterized by problems in relationships and communication. Importantly, there is no known link between autism and pre-meditated violence. 

Let’s turn to the item at the end of the first sentence. A personality disorder is a pervasive and inflexible pattern of behavior that causes distress or limits social progress. Because the term personality disorder is standard clinical nomenclature, there is no reason for a reporter to put that term in quotation marks. Perhaps he was simply quoting Ryan? But we wouldn’t expect a reporter to write that Ryan’s “younger brother” is “autistic”.  The quotation marks around personality disorder could suggest to the uninitiated reader that the concept is simply a colloquialism, which could—in the worst case—promote dismissal of the important issues around it.

Finally, let’s consider obsessive-compulsive disorder, in which people suffer anxiety from recurrent thoughts and compulsions toward repetitive behaviors. Is its mention in the article an important clue?  Probably not: as with autism, there is no known relationship between obsessive-compulsive disorder and violence.  

In sum, the two-sentence report uses four mental health terms, two of which are different degrees of the same disorder, one of which is wrapped in quotation marks, and most of which have no plausible bearing on the Sandy Hook shootings.

Did these problems arise from the brother’s misunderstanding, or the neighbors’, or the reporter’s?  Whatever the case, the readership is given poor information (and potentially misinformation) about important mental health issues.

Does a public understanding of mental illness matter? Very much. A deeper understanding can fuel early detection, resources, prevention, rehabilitation, and cures.  Adam Lanza is dead, and we may never know what pathologies were lurking in the patterns of his neural circuits. But he’s not the point anymore.  It’s the next Adam Lanza, growing up now, lurking in the wings of the future.

I suggest we take this tragedy as a wake-up call about how we want to address mental illness in our society.  Research and care programs for those with mental problems are continuously under-funded. And as we head for the fiscal cliff, scientists funded by the National Institutes of Health are bracing themselves for the plunge from an already tight budget.

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But here’s a question: how do we know whether the public has a misunderstanding of mental illness? As a clue to this question, let’s return to the two-sentence Fox News story. Beyond the description of Lanza’s presumptive mental health problems, something else caught my eye: the comments section. Here are a few examples:

jacsonhole

Is this supposed to be an excuse??  I do not buy it!  Have you noticed how things, at all levels, have gone to hell in a hand basket since we removed God from schools and communities??  There is a lesson of life here.

coachdidi

It is time to go back to the old ways of raising kids. There are winners and losers, not everyone gets a trophy for showing up. Also parents need to be in charge again, not be their buddy. And school systems need to teach and SHUT-UP.

LadyMustang

I really don't care what was wrong with him, there is NO EXCUSE for this. I believe that if parents/schools/communities would never have started this whole "let's not grade them" "let's not let them lose" "everyone is equal" bull.  Parents & schools actually discipline them and if parents actually would spend quality time with their kids, they wouldn't be running wild now a days.  Come on parents, bring your kids up to be responsible members of society, not hand them $20 to get out of your hair.

These viewpoints represent a potentially disastrous misunderstanding about mental health illness.  At the time of this writing, it is far from clear what was wrong with Adam Lanza—but his behavior alone is sufficient evidence that something was abnormal about his brain.  Millions of 20-year-olds on this planet play video games, have divorced parents, are eccentric, have access to guns, and so on—but Lanza tops the news because his actions are so exceptionally rare.  Such abnormal decision-making unmasks abnormalities in brain function.  To assume that prayer in schools and tough-love parenting is a meaningful solution to brain abnormalities is to miss the boat entirely. It represents unfamiliarity with the long history of brain science.  I’ve written about this issue before in Incognito, so I’ll take an excerpt here:

The study of brains and behaviors finds itself in the middle of a conceptual shift. As recently as a century ago, the prevailing attitude was to get psychiatric patients to “toughen up,” either by deprivation, pleading, or torture. The same attitude applied to many disorders; for example, some hundreds of years ago, epileptics were often abhorred because their seizures were understood as demonic possessions—perhaps in direct retribution for earlier behavior. Not surprisingly, this proved an unsuccessful approach.

Indeed, the past century has witnessed a shift from blame to biology. But why? Continuing the excerpt:

Perhaps the largest driving force is the effectiveness of the pharmaceutical treatments. No amount of beating will chase away depression, but a little pill called fluoxetine often does the trick. Schizophrenic symptoms cannot be overcome by exorcism, but can be controlled by risperidone. Mania responds not to talking or to ostracism, but to lithium.

I’m not a great fan of the purely pharmaceutical approach, but its successes underscore the idea that mental problems can be approached in the same clear-eyed manner with which we might approach diabetes, cancer, or an inflammation.  More from Incognito:

The more we discover about the circuitry of the brain, the more the answers tip away from accusations of indulgence, lack of motivation, and poor discipline—and move toward the details of the biology. The shift from blame to science reflects our modern understanding that our perceptions and behaviors are controlled by inaccessible subroutines that can be easily perturbed.

In this light, consider this series of provocative questions from my neuroscience colleague Robert Sapolsky:

Is a loved one, sunk in a depression so severe that she cannot function, a case of a disease whose biochemical basis is as “real” as is the biochemistry of, say, diabetes, or is she merely indulging herself? Is a child doing poorly at school because he is unmotivated and slow, or because there is a neurobiologically based learning disability? Is a friend, edging towards a serious problem with substance abuse, displaying a simple lack of discipline, or suffering from problems with the neurochemistry of reward?


To the newsreaders who feel that mental illness is best viewed as an excuse, let me suggest instead that we might more effectually recognize it as a national priority for social policy.  If we care to prevent the next mass shooting, we should concentrate our efforts on getting meaningful diagnoses and resources to the next Adam Lanza.  There is no advantage in imagining that all brains are the same on the inside, because they’re not. There is no point in concluding that your own child did not perpetrate a school shooting solely because of your terrific parenting.  This is not meant to diminish the importance of excellence in parenting—but mental illness is real, and online tips about parental discipline and school prayer will remain insufficient solutions.

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David Eagleman directs the Initiative on Neuroscience and Law

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