Sunday, December 22, 2013

After Newtown, Seeking Psychiatric Solutions to Mass Shootings

Forensic psychiatrist Dr. Michael Welner discusses the preventative measures that may stop mass killings from taking place.

Photograph courtesy of Pete Marovich and The Forensic Panel.

By: James Swift

One year after the Sandy Hook Elementary School massacre, many Americans still find themselves asking why the tragedy occurred. As a forensic psychiatrist, Dr. Michael Welner finds himself asking how a young man like Adam Lanza became so gripped in homicidal thought -- and especially what interventions could have deterred him from embarking upon a pathway to destruction.

Welner, the founder and chairman of The Forensic Panel and lead researcher of The Depravity Scale, has been the lead forensic psychiatrist and consultant in numerous highly sensitive criminal investigations and cases. Among others, he’s profiled Andrea Yates, Chris Benoit and Jayson Williams. His portfolio also includes evaluations of several mass shooters, including Byran Uyesugi and Richard Baumhammers.

“It’s clear that Adam Lanza had some kind of developmental disability,” Welner told Uncommon Journalism. Also apparent, Welner said, was that Lanza’s mental state at the time of the shooting “was a deterioration from his baseline.”

Even now, however, Welner believes it is too early to pinpoint a specific catalyst for the Dec. 14, 2012 massacre. “We do not yet know why the mass killing happened the day it did,” he said. “The key is the killer’s own assessment of whether events have rendered his prospects hopeless; in my professional experience, that is the step preceding the trigger.”

A Deadly Mixture

Among mass killers, Welner said the two most common emotional symptoms are hopelessness and paranoia -- both of which may arise without pre-existing mental health conditions.

“Homicidal fantasies develop in parallel to hopelessness and paranoia,” Welner said. “A person who respects destructiveness, values it and even identifies with it may interlink those fantasies with the advancement of his own nihilism and resentment of his surroundings.”

Such can occur, he said, whether or not a person is developmentally disabled. However, he notes that developmental disabilities may affect one’s ability to communicate, which may lead an individual to becoming more isolated.

“When that someone is invested in being alienated to the point of homicidal fantasy,” he said, “a worse outcome is understandable.”

When the children become adults, Welner said many parents may be hesitant to access their child's private life -- such as their computer activities and writings -- in an attempt to promote their child's independence. The parents of children with anger issues, he said, may also avoid deep scrutiny; the child's volatility, Welner added, may even prompt parents to accommodate their fears in order to feel safe.

As to how the relationship between Nancy and Adam Lanza could’ve factored into the Sandy Hook massacre, Welner is hesitant to make any assumptions. “All I can see is that she was accepting of him and of the responsibility of parenting him, and at a time when he had no one else,” he said. “He was aware of this, and those stakes have been known to contribute to dangerous insecurities.”

Missed Intervention Points?

Much debate has centered around Nancy Lanza’s decision to use firearms as a bonding mechanism with her son. Despite his anger and social difficulties, Welner believes Nancy may have been trying to better connect her so via a shared hobby.

“I am not excusing her introducing her son to guns,” he said, “but I am considering it through the lens of watching a devoted mother trying to find common ground with a fatherless boy.”

Welner said Adam’s familiarity with, and access to, weapons is unlikely to be the primary catalyst for the shooting. Nor does he believe that’s generally the main factor in most mass shootings.

“So many mass killers who do not have the history of early-life introduction to guns came to define their manhood by destructiveness later on,” he said. “If you cultivate gun enthusiasm as a leisure activity it stays that way; the more guns’ destructive potential defines a role model, the more it becomes modeled by the impressionable male defining his own manhood.”

In terms of mental health care, Welner said a major problem is that young men with severe disorders frequently deny they have any illnesses. And even among those with diagnoses, Welner said there is no guarantee that the families can insure their children will actually comply with therapy or medications.

“Unless they prove to be dangerous,“ he said, “families are unable to force them into treatment.”

Welner has voiced strong support for the Helping Families in Mental Health Crisis Act of 2013, a piece of legislation recently introduced by Rep. Tim Murphy (R-Penn.), which seeks to expand caregiver access under HIPAA and FERPA regulations.

"Concerned families are the most motivated to get help for their loved ones in crisis," Welner said. "But despite embracing emotionally and materially costly responsibilities, families are the least supported and legally are deprived of the standing to protect public safety while they protect their loved one’s interests."

From Ideation to Enactment

Many mass shooters, Welner said, have a tendency to blame others for their own frustrations. Many times, that tendency is piqued by social rejection, in particular, rebuffed romantic interests.

“These elements cycle to a mentality that embraces alienation,” he said. “In tamer forms, it is a quietly resentful cynicism. Some such people, however, may be impressed with the power of destructiveness, with the potency it represents to them.”

Homicidal fantasies, he said, are most likely borne out of “transcendent media coverage” of mass killers, which humanizes murderers in a manner that is relatable to the alienated. “Their guns at that point, and only that point,” Welner said, “may become available tools that make it easier to entertain such fantasies long before one undertakes serious planning.”

Those who graduate from fantasizing about killing to actually engaging in homicide, Welner said, often believe their victims are justified losses.

“This callousness is enabled by isolation and alienation that feeds on itself,” he said. “At the end of that continuum, the aspiring killer believes people deserve to die.”

The final step in the pathway, Welner said, is when an individual -- “who has never developed the resilience that comes from learning to take responsibility” -- decides that conditions in his life will never improve, and are likely to get even worse.

Preventing Homicidal Fantasies from Emerging

Many young boys, however, do tend to inform others about their homicidal thoughts. Addressing these youths’ sense of hopelessness, Welner believes, could be a crucial intervention point.

“Kindnesses extended through contact penetrate a bubble of angry isolation that feeds into and off of paranoia that fuels a sense that potential victims deserve their fate,” he said. “Contact forces the aspiring killer to see the humanity in others…mass killing can only happen when a person is sufficiently cut off to not care about who gets victimized.”

By teaching children to “internalize their responsibilities in life disappointments,” Welner believes parents can increase their children’s resiliency. He also encourages parents to help their children identify creativity, as opposed to destruction, as an expression of masculinity.

“Avoid giving or facilitating your child’s appetite for destructive and homicidal video games and violent movies,” he said. “Redirect your child into creative role models…and teach children about stories of tenacity and coming back.”

A New Mental Health Model

As a response to mass shooting incidents, Welner has long advocated for the formation of new, aggressive outpatient treatment (AOT) services. He refers to his own concept of an adaptation to AOT -- which involves specially-trained social workers who, as part of law enforcement, can engage and defuse the high-risk aspiring killers -- as the metal health equivalent of Navy SEALs.

"Redirecting someone away from mass killing when that person is homicidally motivated," he said, "is a matter of homeland security."

He also believes that greater incentives may be necessary to get qualified personnel to work with individuals who decline psychiatric treatments -- a population he considers one of the most difficult in mental health.

"If we can agree that those who reject treatment, are broadly resentful and who have community homicidal fantasies are a risk to life, then we should approach such patients the way we would any other way in medicine," he said, "By getting them to the most talented doctors. And in this case, a discipline in crisis psychiatry needs to develop to attract those best and the brightest.”

As aspiring mass killers actively conceal their plans, Welner also believes simply talking to individuals who may be at risk is sometimes enough to avert bloodshed.

“Penetrating the bubble of contemptuous isolation does not replace treatment,” he concluded, “but it may prevent tragedy by keeping a person connected while waiting for the high risk individual to come around to getting help.”

Uncommon Journalism, 2013. 

1 comment:

  1. Bearing in mind the close linkages between self destructive suicide tendencies of a homicidal mass killer, and the association with societal values for individual freedoms, isn't it a wonder then that we may associate negative freedom, or negative license, within the subconscious, with the unbridled Freudian id. The individual would feel compelled to transition from the ideation of violence behaviour and or notions (or fantastic notions of violent action), and through premeditation to manifestly enact the violent fantasy of mass homicide which in the end is a self destructive suicidal action by the individual.

    Individually, negative freedom, in this context, otherwise considered as perceived negative license, has enabled the nihilistic individual, to consider freedoms to bear arms and to wantonly commit to unlawful violence, particularly within societies which value unfettered freedoms for the individual to not feel socially responsible for their unfettered negative freedoms. Negative Freedoms has, in this context been, mistakenly considered as an enshrined cultural element of individual freedom, which has much to be blamed for unleashing the Demons. and the id. from within the individual.

    The Devil from within whispers and some individual think that, he or she, has the freedom and license for unleashing violence and wanton self destruction.