The Mental Health Bandwagon after Sandy Hook

I’m not a psychiatrist or a clinical psychologist, and I have no claim to expertise in the field. That said, as an amateur, I know more than most of my fellow amateurs, and I’ve been struck by particular aspects of the way that onlookers have talked about mental illness in the wake of the Sandy Hook shootings.

Mental health is jostling for space alongside gun control in the headlines this week. The Christian Science Monitor: Sandy hook shooting glare illuminates cracks in mental health care. The St Louis Post-Dispatch: Mental Health a better focus than gun laws post-Newtown. I can’t remember mental health being so much a part of the discourse after the Aurora shooting, or after the Sikh Temple shooting in Wisconsin in August.

What do we know about Adam Lanza, the shooter at Sandy Hook? What do we know about his mental state? Fox News reported: ‘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.’

Never mind the paucity of evidence of whether he has actually been affected by these conditions. As neuroscientist David Eagleman says in a thoughtful article, there is no known link between autism (including Asperger’s Syndrome) and premeditated violence; neither is there a known connection between obsessive compulsive disorder and premeditated violence. Eagleman doesn’t commit on the potential impact that the personality disorder, if it exists, may have had on Lanza and his behaviour.

I don’t feel qualified to comment on the difference between personality disorders and mental illnesses, and, it seems, even scholars have trouble: see Kendell in the British Journal of Psychiatry, 2002. I feel, however, that the answers sought by the grieving and shocked lie, at least partially, within this distinction.

One of the things we do know about mental illness, though, is that they are much less violent than people assume they are. In the UK, 34% of the general public think that someone with a mental illness is likely to be violent. But less than 1% of murders in the UK are random attacks by the mentally ill, and, according to another article in the British Journal of Psychiatry, 99.97% of those diagnosed with schizophrenia (the mental illness with the most realistic connection to violent behaviour) would not be convicted of serious violence in a given year. There’s a lot of work to be done on the public understanding of mental illness, and the desire to understand the shooting comes with the risk of shifting the blame onto a poorly understood and largely blameless group.

What Eagleman does say, rightly, is that “his behavior alone is sufficient evidence that something was abnormal about his brain.” I think that we all need to be careful about how we define and characterise “mental illness” in response to the shooting, and to avoid turning to mental illness as a way of preventing these incidents in the future, especially given the dire chances for substantial changes in gun law. If this happens in an insensitive way, the damage to the innocent population with mental health problems will likely far exceed the benefit in lives saved from premeditated violence.

This shooting has provoked so many to call for increased investment into mental health treatment and research, in the hope that we can avoid more bloodshed, and avoid the deaths of another 27 innocent schoolchildren and teachers. I don’t disagree with this. But I would contend that the millions of livelihoods and countless lives lost to schizophrenia, bi-polar disorder, depression and other mental illnesses are equally powerful reasons for a call to action. We should be careful in associating mental illness with astonishing brutality or even simple criminality, and we should recognise that, as a society, we owe an unpaid debt to provide better for, and better understand, those among us with mental illnesses, and we owe that solely for their sake.

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