Armchair Diagnoses Mislead Us About Sandy Hook Shooting

Health and medicine explained.
Dec. 20 2012 3:25 PM

Will We Ever Know What Was Wrong With Adam Lanza?

Even if we do, it won’t help.

James Holmes makes his first court appearance at the Arapahoe County.
James Holmes makes his first court appearance on July 23, 2012 in Centennial, Colo.

Photographs by RJ Sangosti-Pool/Getty Images.

As a medical correspondent on TV and the medical director of “Doctor Radio” on Sirius/XM, one of my most important roles is to analyze medical news but stop short of giving diagnoses over the TV or radio. Unfortunately, in coverage of the killer in the tragic Sandy Hook school shootings, this need for restraint has been violated repeatedly by others in the news media.

The diagnoses and explanations and motives that have been bandied around have been speculative and mostly hearsay. Experts have cited everything from Asperger’s to personality disorder to sociopathy to psychopathy. These armchair diagnoses are not only irresponsible—showering people with information they don’t fully understand—they also completely obscure the fact that none of the commentators or analysts actually know the first thing about who Adam Lanza actually was or what he suffered from.

The constant analysis and controversy has built on itself and created the false impression of a known mental-health history. First it was Asperger’s syndrome, a social disorder that involves poor communication skills and occasional meltdowns. So-called experts mischaracterized this condition as including a tendency for violence, upsetting autism advocates and experts all across the country. Keep in mind that no one in the media knows whether Lanza even had this diagnosis. Next came analysts and criminologists who called Lanza a sociopath, without defining the term (it means a lack of understanding of right from wrong). Finally commenters started mentioning schizophrenia. Although Lanza’s age, 20, is characteristic for a psychotic break (when the patient loses the ability to judge reality and lives in a world of delusional beliefs or hallucinations), no one knows whether this diagnosis actually pertained to him or not. The vast majority of patients with psychotic disorders such as schizophrenia or bipolar disorder are not violent.

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The shootings were heinous, but the motivation or mental state of the shooter will remain largely unknown. The recent news that his mother may have been about to have him committed to a psychiatric institution represents more hearsay. The fact that no medications were found in Lanza’s house by no means shows that he didn’t have a major psychiatric disorder or even that he had one that wasn’t being properly treated. No matter how many details come out, it will be impossible for experts to tell exactly what caused the murders.

The effects of violence in the media and guns in the home on potential murderers will also never be directly linked to this crime. Research by the CDC has shown that having guns in the home increases the risk of homicide by a family member and studies on the effect of violent videos and movies have concluded that they increase violent thoughts and aggressive behaviors, but this is far from the same thing as proving that videos or the availability of guns caused the mass killing in Sandy Hook.

We just don’t know, and we will never know. And even if we could know all the disturbing details of a killer’s psychiatric history—as we know some of the details about James Holmes, who killed 12 people in an Aurora, Colo. movie theater—it still wouldn’t likely help anyone prevent a future crime from happening. These cases are outliers, hardly typical. Unless a psych patient literally tells you of a homicidal plan that he intends to act on, it is often impossible to predict who is actually a threat and who isn’t. Many psychiatric experts have said that this shooting represents a deficiency in our mental health care system, but though we certainly have such deficiencies, it hasn’t been shown that Lanza was resisting treatment or even that if he was being treated properly, he wouldn’t have committed the murders. One of my colleagues, a top psychiatrist and psychoanalyst, had one of his patients jump out the window of his office a decade ago. My friend spent the next 10 years trying to figure out what he had done wrong before concluding that no matter what he had done, it wouldn’t have prevented this tragedy from happening.

All the current attention to the shooter’s pathology obscures the sad truth that we will never know exactly what was wrong with Adam Lanza. And even if we could know, this knowledge almost certainly wouldn’t help us stop even a single crime in the future. Modern psychiatry, with all its tools, is not and never will be a crystal ball.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at New York University’s Langone Medical Center.

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