Psychiatry to the rescue? Maybe.
Dec 19, 2012
We’ll never know what better psychiatric care could’ve prevented at Sandy Hook Elementary – especially if we aren’t willing to invest in it.
By Dr. Scott Bienenfeld, M.D.
The recent events in Newtown, Conn., are shocking, horrific, difficult to come to terms with and unfortunately becoming familiar. While mass shootings remain extremely rare events – lightning strikes, really – the magnitude of their impact on society is huge, both physically and mentally, especially when the details of the event are so gruesome as to include the death of helpless, innocent children and the families that have lost so much.
In addition to the mass-trauma that the world is experiencing, there is also a massive public dialogue taking place. From anonymous tweets all the way up to executive levels of government, questions are arising as to what can be done. The most common and logical questions in the wake of an event like Newtown are: ‘Why did this happen?’ and ‘How can we prevent it from happening again?’ The answers we hear in the media always seem to be the same: gun control, prevention through improved mental health care and better security.
As a practicing psychiatrist, the problem of lone-gunman mass-killings is particularly vexing. To put it bluntly: the world understandably looks to me and my field for answers and, to be brutally honest, I struggle to find them. We psychiatrists are taught early on that we have a legal responsibility to assess risk and then to both warn and protect identifiable targets of patients we believe are at high risk for acting violently. Failure to do so can result in claims of medical malpractice.
That said, it is tempting in hindsight to look at the little we already know about Adam Lanza and say that it’s obvious that this troubled young man should have been under more intensive psychiatric care and that someone should have been worried to the point of alarm that he was imminently going to slaughter innocent children.
Unfortunately, the truth is that we know very little about why those who commit mass killings do it, even when there is evidence of mental illness. For every Adam Lanza with the psychiatric profile he had, there are thousands with the same profile who never act out violently, even among the severely mentally ill. That fact, combined with the extreme rarity of events like what happened in Newtown, make it especially difficult for psychiatrists to predict the type of person that is likely to commit such horrible acts. The bottom line is: There are many “troubled” people in the world and most are not violent.
However, just because we as psychiatrists are limited if not unable to reliably predict who among our potentially dangerous patients will go on to commit mass-murder, we are relatively good at evaluating, diagnosing and treating people with mental illness. This is an important point because while mental illness on its own is by no means a meaningful predictor of violence, allowing people better access to ongoing mental health and addiction treatment, with an emphasis on mental illness as a chronic, public health crisis, could reduce the chance that the next Adam Lanza goes on to kill.
Regarding the relationship between mental illness and violence, here is the little we do know: According to the 2011 article “Explaining Rare Acts of Violence” by Dr. Jeffrey W. Swanson, Ph.D., in the journal Psychiatric Services,“The ‘absolute risk’ message is that the vast majority of people with mental illness in the community are not violent. The ‘relative risk’ message is that people with serious mental illness are, indeed, somewhat more likely to commit violent acts than people who are not mentally ill. And the ‘attributable risk’ message is that violence is a societal problem caused largely by other things besides mental illness (ready availability of guns, for example).”
Untreated and under-treated mental illness continues to be one of, if not the biggest public health problems we face, yet the costs of the problem show up far more often as lost employment dollars (in the billions), broken families, chronic medical illnesses, addiction etc… rather than, as many people erroneously assume, as mass killings. But mass killings do occur, and the perpetrators are usually males with a history of being “troubled” if not suffering with diagnosed mental illness.
Dr. Scott Bienenfeld, M.D. is an Addiction Psychiatrist board certified in General and Forensic Psychiatry and certified by the American Society of Addiction Medicine as well as The American Board of Addiction Medicine.
Bienenfeld serves as the medical director at the New York Center for Living. He maintains a private practice in Manhattan and has previously held positions as clinical director of the Community Orientation and Re-Entry Program (CORP) Unit at Sing-Sing Correctional Facility and consulting psychiatrist to the student counseling center at Pace University in New York.