First, Adam Lanza, age 20, killed his mother. Then he murdered 20 children and six adults, at the Sandy Hook Elementary School in Newton, Conn.
Why? Was he mentally ill? Could the tragedy have been prevented with early diagnosis and access to treatment?
In 1998, Kip Kinkel, only 14 years old, killed his parents and then murdered two students and wounded 25 others at an Oregon high school. Kinkel’s parents were also high-powered gun enthusiasts, as was Adam Lanza’s mother. There have been no substantiated reports as yet, whether Lanza had ever been treated for a mental illness but Kip Kinkel had seen a therapist, as have most school killers prior to his mass murder rampage.
As a forensic psychologist, I have tested/evaluated 30 teenage and young adult murderers, and almost all of them had been in some kind of “treatment,” usually short term and psychoactive drug-oriented, before they killed. In these cases, access to mental health care was available but did nothing to prevent the violence – despite current arguments in Congress re: proposals for gun control vs. mental health access/treatment.
After each episode of school killings or other mass shootings, such as the Aurora, Colo., Batman movie murders and Tucson, Ariz., killing of six and wounding of Rep. Gabrielle Giffords and 12 others, there is a renewed public outcry for early identification and treatment of youths at risk for violence.
Sadly however, most of the young people who kill had been in “treatment,” prior to the violence, albeit with less than successful results. To name just a few, Thomas (T.J.) Solomon, age 15, who shot six students in a Conyers, Ga., school, was depressed and taking prescribed Ritalin at the time of his rampage. Eric Harris, age 18, one of the Columbine high school killers, was seeing a psychiatrist and on psychotropic meds before the rampage. Kip Kinkel was treated with Ritalin and then Prozac, along with brief and superficial managed-care friendly psychotherapy, before he killed his parents and school mates.
Why were these “treatments” so obviously unsuccessful? Jeffrey L. Hicks, Ph.D., may provide the answer in Treatment Notes on Kip Kinkel, which is available online at PBS.com (Frontline, The Killer at Thurston High) In my opinion. Hicks’ documents should be studied for valuable clues they offer about how NOT to treat troubled, potentially violent young people – and, let’s hope, what can be learned to prevent such tragedies in the future.
His treatment plan for Kip follows a classic “managed-care friendly” format, conforming to the insurance companies protocols (to maximize profits, while reducing sessions) often at the expense of the patient’s psychological, emotional and real treatment needs. For example, Kip was seen only nine times over a six-month period.
Outside of a managed care system, it is obvious he was in need of intensive therapy (such as two visits per week, not just one visit every three weeks). And like most of the other young killers, Kip was on a psychoactive medication, Prozac, before his violent rampage and despite numerous research studies warning that these prescriptions can spark acts of violence (U.S. News and World Report, March 8, 2000).
Most of the young murderers I have personally examined had also been in “treatment” and were using prescribed stimulant/amphetamine type drugs before and during the killing events. These medications did not prevent but instead contributed to the violence by disinhibiting normal, frontal cortex control mechanisms.
To quote 18-year-old Jeremy Strohmeyer’s pre-sentencing murder trial statement; “There must be a tighter rein on the dispensing of mind-altering and mood-altering prescription drugs.” Prior to the violent event, for which he is currently serving a life without parole sentence, Jeremy, an honor student with no history of violence, was misdiagnosed with attention deficit hyperactivity disorder (ADHD) and “treated” with nothing more than a bottle of Dexedrine following a brief 20-minute “cost-effective” psychiatric consultation.
And so, despite ongoing congressional debates regarding stricter gun control laws vs. improved access to mental health treatment, our concern should be about the quality of mental health care, not just a societal safety net insuring treatment for all children and young adults. Almost all of them are covered by some type of managed care or insurance company, and the issue is not access to preventive treatment. The real problem, in my opinion, is the quality and competence of therapy for potential violent offenders when insurance companies are the gatekeepers.
David Kirschner, Ph.D., is a psychoanalyst and forensic psychologist with a practice in Woodbury, N.Y.. He founded and directed for 25 years a community mental health center – the Nassau Center for Psychotherapy. He has been an expert witness in many high-profile murder cases. He may be reached at firstname.lastname@example.org or www.adoptionunchartedwaters.com.