What should be the impact of the Newtown massacre on American psychiatry?

When America tries to make sense of irrational acts, very often, the question of mental illness arises. This question certainly arose after Adam Lanza committed the atrocity at Sandy Hook Elementary School in Newtown, Conn.

Typically, what happens after these kinds of horrific events is that commentators and others begin searching for clues to a diagnosis. In this case, Lanza’s older brother told authorities that his brother was autistic or had Asperger’s and a personality disorder.

Then came observations from people who actually knew nothing. They used words and phrases to describe the shooter such as "nonconformist," "distant," "couldn’t get to know him." Inevitably, others wondered whether Lanza suffered from undiagnosed schizophrenia. We have other diagnoses for people who act out violently and don’t need to lump everything into schizophrenia. And we try to treat these violent patients with a combination of drugs and psychotherapy.

The point is that such speculation allows the diagnosticians to begin to put together a story. What is the result of this speculation? Inevitably, it results in the stigma of mental illness and disdain for American psychiatry.

This is how the speculation goes: Why can’t we screen everyone and know who the potential killers are – and get the potential killers into therapy? We are elevated to the position of having the power to determine who is dangerous and who will hurt America. This back and forth usually sets off a rash of wise cracks about psychiatry. Once this ball gets rolling, no one is laughing.

The truth of the matter is this: The mentally ill are our weakest, most vulnerable citizens. And research clearly shows that they are more likely to be the victims of violence than are the perpetrators.

I’ve been fighting stigma for 3 decades, and I always think that we are making progress – until it starts all over again.

When some questions arose about the Virginia Tech and the Columbine shootings, we had to dig our way out of the castigations that took place at that time. I was invited to sit on a committee with all the presidents and deans of the 19 Pennsylvania universities. And I told them that the best they could do was to decide who was suspicious and watch that person for undue, negative behavior. They were frightened because after we are blamed, they are blamed.

What does it mean to fight stigma? One important lesson is that the mentally ill should be treated with as much dignity as any other human being is. I’m sad to say that we in the medical profession stigmatize the mentally ill, and we teach our students to do the same.

But the overarching problem is that people are afraid. They imagine that one of these horrific incidents will happen next in their neighborhood, and their parental instincts make them wonder how they might protect their children from the "crazy people" or lunatics. Once the stigma finger is pointed in our direction, we begin to see cartoons, late-night comedians, newspaper articles, and blog posts mocking our methodologies.

And what do we do? We defend ourselves by extolling our virtues, as well as the power of our new drugs and various therapies. Television news magazines broadcast exposés about our successes, perhaps with the help of medications. In the first 2 weeks after Newtown, we began to hear whining about cuts that psychiatry had sustained over the last 4-5 years in the recession, including budget cuts and the elimination of 3,222 psychiatric hospital beds.

Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association, addressed the access problem right after Newtown: "We have some treatments for mental illness that are highly effective, but they are not universally available," he was quoted as saying. "People don’t have much access to them."

Always on the defensive, that’s American psychiatry.

Indeed, a huge percentage of Americans are taking psychotropic drugs, but people want to hide their disabilities and avoid letting anyone know about them. Why? Because of stigma.

One idea that is becoming almost cliché is that our largest mental health facilities are the county jails. Why do we keep locking up people who are mentally ill? We could screen them in court and find far-less-expensive ways to help them with their basic problems, but we don’t. Instead, we blame.

Much can be done, but it will take committed, motivated people, including legislators and superintendents of prisons. I suppose that the only way to ever get a real collaborative effort is to experience the heartbreaking fallout from mass killings from time to time. We’ve seen the impact of Newtown on the gun-control debate, although the urgency of taking decisive steps on this front seems to be receding with the passage of time.

Again, one fact upon which all psychiatrists agree is that most seriously mentally ill patients are neither dangerous nor violent. But as I said above, generally, we can’t predict which ones will do something violent. We do know that patients with serious mental illness who are using alcohol and are provoked are more likely to act out in violent ways. If people know that a classmate or work colleague tends to act a bit strange, they don’t befriend or help him. Instead, they tend to isolate the person and avoid him, which further exacerbates his sense of isolation, paranoia, and anger.

It is imperative that we advocate for more psychiatric services. We need to train more psychiatrists. Our common goal must be to develop a true mental health system that works on behalf of patients with mental illness and their families.

Dr. Fink is a consultant and psychiatrist in Philadelphia and professor of psychiatry at Temple University. He can be reached at [email protected].

When America tries to make sense of irrational acts, very often, the question of mental illness arises. This question certainly arose after Adam Lanza committed the atrocity at Sandy Hook Elementary School in Newtown, Conn.

Typically, what happens after these kinds of horrific events is that commentators and others begin searching for clues to a diagnosis. In this case, Lanza’s older brother told authorities that his brother was autistic or had Asperger’s and a personality disorder.

Then came observations from people who actually knew nothing. They used words and phrases to describe the shooter such as "nonconformist," "distant," "couldn’t get to know him." Inevitably, others wondered whether Lanza suffered from undiagnosed schizophrenia. We have other diagnoses for people who act out violently and don’t need to lump everything into schizophrenia. And we try to treat these violent patients with a combination of drugs and psychotherapy.

The point is that such speculation allows the diagnosticians to begin to put together a story. What is the result of this speculation? Inevitably, it results in the stigma of mental illness and disdain for American psychiatry.

This is how the speculation goes: Why can’t we screen everyone and know who the potential killers are – and get the potential killers into therapy? We are elevated to the position of having the power to determine who is dangerous and who will hurt America. This back and forth usually sets off a rash of wise cracks about psychiatry. Once this ball gets rolling, no one is laughing.

The truth of the matter is this: The mentally ill are our weakest, most vulnerable citizens. And research clearly shows that they are more likely to be the victims of violence than are the perpetrators.

I’ve been fighting stigma for 3 decades, and I always think that we are making progress – until it starts all over again.

When some questions arose about the Virginia Tech and the Columbine shootings, we had to dig our way out of the castigations that took place at that time. I was invited to sit on a committee with all the presidents and deans of the 19 Pennsylvania universities. And I told them that the best they could do was to decide who was suspicious and watch that person for undue, negative behavior. They were frightened because after we are blamed, they are blamed.

What does it mean to fight stigma? One important lesson is that the mentally ill should be treated with as much dignity as any other human being is. I’m sad to say that we in the medical profession stigmatize the mentally ill, and we teach our students to do the same.

But the overarching problem is that people are afraid. They imagine that one of these horrific incidents will happen next in their neighborhood, and their parental instincts make them wonder how they might protect their children from the "crazy people" or lunatics. Once the stigma finger is pointed in our direction, we begin to see cartoons, late-night comedians, newspaper articles, and blog posts mocking our methodologies.

And what do we do? We defend ourselves by extolling our virtues, as well as the power of our new drugs and various therapies. Television news magazines broadcast exposés about our successes, perhaps with the help of medications. In the first 2 weeks after Newtown, we began to hear whining about cuts that psychiatry had sustained over the last 4-5 years in the recession, including budget cuts and the elimination of 3,222 psychiatric hospital beds.

Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association, addressed the access problem right after Newtown: "We have some treatments for mental illness that are highly effective, but they are not universally available," he was quoted as saying. "People don’t have much access to them."

Always on the defensive, that’s American psychiatry.

Indeed, a huge percentage of Americans are taking psychotropic drugs, but people want to hide their disabilities and avoid letting anyone know about them. Why? Because of stigma.

One idea that is becoming almost cliché is that our largest mental health facilities are the county jails. Why do we keep locking up people who are mentally ill? We could screen them in court and find far-less-expensive ways to help them with their basic problems, but we don’t. Instead, we blame.

Much can be done, but it will take committed, motivated people, including legislators and superintendents of prisons. I suppose that the only way to ever get a real collaborative effort is to experience the heartbreaking fallout from mass killings from time to time. We’ve seen the impact of Newtown on the gun-control debate, although the urgency of taking decisive steps on this front seems to be receding with the passage of time.

Again, one fact upon which all psychiatrists agree is that most seriously mentally ill patients are neither dangerous nor violent. But as I said above, generally, we can’t predict which ones will do something violent. We do know that patients with serious mental illness who are using alcohol and are provoked are more likely to act out in violent ways. If people know that a classmate or work colleague tends to act a bit strange, they don’t befriend or help him. Instead, they tend to isolate the person and avoid him, which further exacerbates his sense of isolation, paranoia, and anger.

It is imperative that we advocate for more psychiatric services. We need to train more psychiatrists. Our common goal must be to develop a true mental health system that works on behalf of patients with mental illness and their families.

Dr. Fink is a consultant and psychiatrist in Philadelphia and professor of psychiatry at Temple University. He can be reached at [email protected].

When America tries to make sense of irrational acts, very often, the question of mental illness arises. This question certainly arose after Adam Lanza committed the atrocity at Sandy Hook Elementary School in Newtown, Conn.

Typically, what happens after these kinds of horrific events is that commentators and others begin searching for clues to a diagnosis. In this case, Lanza’s older brother told authorities that his brother was autistic or had Asperger’s and a personality disorder.

Then came observations from people who actually knew nothing. They used words and phrases to describe the shooter such as "nonconformist," "distant," "couldn’t get to know him." Inevitably, others wondered whether Lanza suffered from undiagnosed schizophrenia. We have other diagnoses for people who act out violently and don’t need to lump everything into schizophrenia. And we try to treat these violent patients with a combination of drugs and psychotherapy.

The point is that such speculation allows the diagnosticians to begin to put together a story. What is the result of this speculation? Inevitably, it results in the stigma of mental illness and disdain for American psychiatry.

This is how the speculation goes: Why can’t we screen everyone and know who the potential killers are – and get the potential killers into therapy? We are elevated to the position of having the power to determine who is dangerous and who will hurt America. This back and forth usually sets off a rash of wise cracks about psychiatry. Once this ball gets rolling, no one is laughing.

The truth of the matter is this: The mentally ill are our weakest, most vulnerable citizens. And research clearly shows that they are more likely to be the victims of violence than are the perpetrators.

I’ve been fighting stigma for 3 decades, and I always think that we are making progress – until it starts all over again.

When some questions arose about the Virginia Tech and the Columbine shootings, we had to dig our way out of the castigations that took place at that time. I was invited to sit on a committee with all the presidents and deans of the 19 Pennsylvania universities. And I told them that the best they could do was to decide who was suspicious and watch that person for undue, negative behavior. They were frightened because after we are blamed, they are blamed.

What does it mean to fight stigma? One important lesson is that the mentally ill should be treated with as much dignity as any other human being is. I’m sad to say that we in the medical profession stigmatize the mentally ill, and we teach our students to do the same.

But the overarching problem is that people are afraid. They imagine that one of these horrific incidents will happen next in their neighborhood, and their parental instincts make them wonder how they might protect their children from the "crazy people" or lunatics. Once the stigma finger is pointed in our direction, we begin to see cartoons, late-night comedians, newspaper articles, and blog posts mocking our methodologies.

And what do we do? We defend ourselves by extolling our virtues, as well as the power of our new drugs and various therapies. Television news magazines broadcast exposés about our successes, perhaps with the help of medications. In the first 2 weeks after Newtown, we began to hear whining about cuts that psychiatry had sustained over the last 4-5 years in the recession, including budget cuts and the elimination of 3,222 psychiatric hospital beds.

Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association, addressed the access problem right after Newtown: "We have some treatments for mental illness that are highly effective, but they are not universally available," he was quoted as saying. "People don’t have much access to them."

Always on the defensive, that’s American psychiatry.

Indeed, a huge percentage of Americans are taking psychotropic drugs, but people want to hide their disabilities and avoid letting anyone know about them. Why? Because of stigma.

One idea that is becoming almost cliché is that our largest mental health facilities are the county jails. Why do we keep locking up people who are mentally ill? We could screen them in court and find far-less-expensive ways to help them with their basic problems, but we don’t. Instead, we blame.

Much can be done, but it will take committed, motivated people, including legislators and superintendents of prisons. I suppose that the only way to ever get a real collaborative effort is to experience the heartbreaking fallout from mass killings from time to time. We’ve seen the impact of Newtown on the gun-control debate, although the urgency of taking decisive steps on this front seems to be receding with the passage of time.

Again, one fact upon which all psychiatrists agree is that most seriously mentally ill patients are neither dangerous nor violent. But as I said above, generally, we can’t predict which ones will do something violent. We do know that patients with serious mental illness who are using alcohol and are provoked are more likely to act out in violent ways. If people know that a classmate or work colleague tends to act a bit strange, they don’t befriend or help him. Instead, they tend to isolate the person and avoid him, which further exacerbates his sense of isolation, paranoia, and anger.

It is imperative that we advocate for more psychiatric services. We need to train more psychiatrists. Our common goal must be to develop a true mental health system that works on behalf of patients with mental illness and their families.

Dr. Fink is a consultant and psychiatrist in Philadelphia and professor of psychiatry at Temple University. He can be reached at [email protected].