Posted by Michael Kennedy on December 15th, 2012 (All posts by Michael Kennedy)
There is information still coming to light about this awful case. Early reports, such as the name of the shooter and the alleged murder of the father, were predictably wrong. It turns out that the shooter, named Adam Lanza, a 20 year old with a history of odd behavior and some evidence of mental illness, such as autism, was living with his mother who was his first victim. There are a number of suggestive reports, that she decided to “stay home to care for” her 20 year old son.
The treatment of severe mental illness in this country has been altered for the worse by a movement that began in the 1960s when mental illness began to be described as a “civil rights ” issue. Several books and movies described abuse of power in commitment of the mentally ill. The first such movie was “The Snake Pit” in which a young woman is committed for what sounds like schizophrenia. The treatment of the time (1948) can be seen as barbaric but there was nothing else available. She did recover, although we know that without adequate treatment, recovery from schizophrenia is unlikely.
The movie that really devastated the mental hospital system was called “One Flew Over the Cuckoo’s Nest” and starred Jack Nicholson.
The movie was powerful in showing the Nicholson character as a guy who just is “different” and harmless.
The film was the second to win all five major Academy Awards (Best Picture, Actor in Lead Role, Actress in Lead Role, Director, and Screenplay) following It Happened One Night in 1934, an accomplishment not repeated until 1991 by The Silence of the Lambs.
In 1963 Oregon, Randle Patrick “Mac” McMurphy (Jack Nicholson), a recidivist anti-authoritarian criminal serving a short sentence on a prison farm for statutory rape of a 15-year-old girl, is transferred to a mental institution for evaluation. Although he does not show any overt signs of mental illness, he hopes to avoid hard labor and serve the rest of his sentence in a more relaxed hospital environment.
McMurphy’s ward is run by steely, unyielding Nurse Mildred Ratched (Louise Fletcher), who employs subtle humiliation, unpleasant medical treatments and a mind-numbing daily routine to suppress the patients. McMurphy finds that they are more fearful of Ratched than they are focused on becoming functional in the outside world. McMurphy establishes himself immediately as the leader; his fellow patients include Billy Bibbit (Brad Dourif), a nervous, stuttering young man; Charlie Cheswick (Sydney Lassick), a man disposed to childish fits of temper; Martini (Danny DeVito), who is delusional; Dale Harding (William Redfield), a high-strung, well-educated paranoid; Max Taber (Christopher Lloyd), who is belligerent and profane; Jim Sefelt (William Duell); and “Chief” Bromden (Will Sampson), a silent American Indian believed to be deaf and mute.
Here is the picture of mental illness as a matter of civil rights. It was shown in 1975 when the deinstitutionalizing was already well along and it convinced the public, few of whom know anything of psychology, that mental hospitals should be closed. State governors, like Ronald Reagan in California, were only too happy to oblige. This is why I was not a Reagan fan before he was elected in 1980.
The new drugs, like Thorazine made all this possible. Patients on Thorazine made almost miraculous recoveries. at least until the side effects appeared.
The introduction of chlorpromazine into clinical use has been described as the single greatest advance in psychiatric care, dramatically improving the prognosis of patients in psychiatric hospitals worldwide; the availability of antipsychotic drugs curtailed indiscriminate use of electroconvulsive therapy and psychosurgery, and was one of the driving forces behind the deinstitutionalization movement.
Actually ECT or “shock therapy” was, and remains, effective for severe depression. When used on psychotics like schizophrenics, it often provided a period of a “lucid interval” that lasted for hours when the psychosis seemed to relent. The symptoms recurred but the hope of longer intervals resulted in repeated sessions. It was often depicted with convulsions and other horrendous effects but, in reality, anesthesia and muscle relaxants were used to avoid such scenes. Even insulin coma, which has a risk of damage from low blood glucose, was effective for periods when nothing else worked.
The alternative offered was outpatient centers, in California authorized by The Short-Doyle Act of 1957. There was never enough money and governors saw the closing of state hospitals as a budget issue, not a medical issue.
Throughout the 1970s and 1980s counties contended that the state was not providing adequate funds for community mental health programs. In addition, several counties were receiving less funds on a population basis than other counties. This disparity was addressed, with varying levels of success, in both the 1970s and the 1980s with the allocation of “equity funds” to certain counties. Realignment enacted in 1991 has made new revenues available to local governments for mental health programs, but, according to local mental health administrators, funding has lagged behind demand.
And As a result of declining hospital population, three hospitals (Modesto, DeWitt, and Mendocino) were closed. Legislative intent was to have the budget savings from the closures go to local programs. The “money was to follow the patient.” This did not happen in 1972 and 1973 as a result of the Governor’s veto.
The patients released from state hospitals ended up living in the streets as “the homeless problem” exploded. Others filled the jails. In 2000, I was told by directors of homeless shelters in Los Angeles that 60% of the homeless were psychotic, 60% were drug addicts and half of each group was both. About 10% of the homeless are neither and are quickly moved to shelters and “SRO” hotels, especially if there are children.
What percent of shizophrenics are violent or capable of it ? A national study suggests that the number may be higher than we are usually told.
The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. “Positive” psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while “negative” psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization.
Since schizophrenia is life-long, usually beginning in teenage years in males and a bit later in females, the total period of exposure to the risk of violent behavior is high. Treatment with modern drugs reduces this considerably but most schizophrenics who are not under good supervision do not take their drugs.
The mother of the shooter was the registered owner of three guns, two of them pistols and one a “bushmaster” rifle. These are military lookalikes that are mostly in 5.56 NATO round calibres. They are also very expensive rifles.
He did not use the rifle anyway but what was the mother doing buying this for her autistic son? Pistols might have been for her own protection but the rifle doesn’t make sense except as evidence of enabling behavior by the mother.
The mother is now being described as a “survivalist” and used to target shooting. That does not explain why she had guns around her psychotic son. “Autism” does not develop during teenage years. It is a phenomenon that is recognized in infancy. The term may have been used by the older brother as it is a less “disreputable” term for schizophrenia. If this represents a form of denial by the family, it may be significant.
I will add to this post as more information comes out. This looks to me like an incident of mass violence by a schizophrenic 20 year-old male with possible assistance by his mother in allowing him access to guns. Her assistance would be in the form of enabling, not active assistance.
The gun control talk is totally useless. It will not affect the risk of similar events as re-examination of the deinstitutionalization of the severely mentally ill might do.
I should add that, in my opinion, psychiatry has been its own worst enemy since about 1920. The adoption of Freud’s theories by psychiatry in the 1920s and 30s was disastrous for the mental health field. Freud himself said that his methods did not work but they were educational in learning what didn’t work.
In the early part of the 20th century, “the fever cure” was used in the treatment of psychosis after success was found in cases of advanced syphilis with psychosis. Alas, syphilis was the only infectious cause of psychosis we know of. Even so, there are recent reports of success. There has been increasing interest in the possible role of Toxoplasmosis, a very common parasite, in schizophrenia.
The team from the University of Leeds’ Faculty of Biological Sciences has shown that the parasite may play a role in the development of these disorders by affecting the production of dopamine — the chemical that relays messages in the brain controlling aspects of movement, cognition and behaviour.
Toxoplasmosis, which is transmitted via cat faeces (found on unwashed vegetables) and raw or undercooked infected meat, is relatively common, with 10-20% of the UK population and 22% of the US population estimated to carry the parasite as cysts. Most people with the parasite are healthy, but for those who are immune-suppressed — and particularly for pregnant women — there are significant health risks that can occasionally be fatal.
Dopamine plays a role in schizophrenia and bipolar disorder. The side effects of thorazine and other anti-psychotic drugs are due to dopamine deficiency and are similar to Parkinson’s Disease which is a dopamine deficiency condition.
Autism is a fertile ground for research and a week ago I suggested to a student who is interested in pediatric neurology that she think about autism as a topic. I think it may well be successfully treated during her professional career. Schizophrenia is more complex.
Psychoanalysis is interesting and may represent some of the process of thinking, but it is not an explanation of serious mental illness and has no use in therapy. The actions by analytic therapists have brought the field into disrepute. The “recovered memory” phenomenon was a similar blind end for the psychology profession. Psychologists have often resented the role of psychiatry in being able to prescribe drugs and benefit from insurance payments.
The appearance of insurance coverage for psychiatric care has not been an unalloyed benefit for the profession. It has resulted in many questionable diagnoses and fads in treatment such as ADHD and medicalization of some simple behavior patterns. For example, Nick Kristoff of the NY Times, no conservative, has a column about the abuse of SSI in Kentucky for children.
THIS is what poverty sometimes looks like in America: parents here in Appalachian hill country pulling their children out of literacy classes. Moms and dads fear that if kids learn to read, they are less likely to qualify for a monthly check for having an intellectual disability.
Many people in hillside mobile homes here are poor and desperate, and a $698 monthly check per child from the Supplemental Security Income program goes a long way — and those checks continue until the child turns 18.
“The kids get taken out of the program because the parents are going to lose the check,” said Billie Oaks, who runs a literacy program here in Breathitt County, a poor part of Kentucky. “It’s heartbreaking.”
This is painful for a liberal to admit, but conservatives have a point when they suggest that America’s safety net can sometimes entangle people in a soul-crushing dependency. Our poverty programs do rescue many people, but other times they backfire.
This is what medicalization of behavior can do.
The recovered memory fad was quickly ended when a psychologist and a hospital in Orange County lost a lawsuit filed by a father who had been accused of abuse. Once the suit was lost, psychologists could not get malpractice insurance for this therapy. The diagnosis vanished.
Psychotic patients have not been as lucky as innocent fathers. They are still suffering because of the Freudian delusions of psychiatry before the 1980s.
UPDATE: The medical examiner gave a press conference and said the victims were shot with a rifle. The early reports said the rifle was still in the shooter’s car. This will have to be clarified. The .223 round is a high velocity round and causes terrible wounds.