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Saturday, December 22, 2012

Mental illness, medications and school shootings: Preventing another Sandy Hook

image source: WhatReallyHappened
Gregory Patin

In the aftermath of the horrific school shooting at Sandy Hook elementary school in Connecticut, the debate regarding preventive measures is focused on stricter gun control laws. While sensible gun regulations are in order,addressing the root causes of the mass shootings is more important if real preventative measures are to be taken.

What caused the gunmen to act is more relevant in terms of prevention than the weapons used. With or without stricter gun control laws, firearms will be accessible to potential mass murderers in the U.S. because there are over 310 million firearms in civilian hands that are not going to magically vanish with more gun control laws.

One common factor in nearly every school shooting and many other crimes is that the perpetrators were being treated for some sort of mental illness with mind-altering medications.

Sandy Hook Tragedy

Adam Lanza, the Connecticut shooter, is reported by multiple sources to have been suffering from Asperger’s syndrome, a form of autism, as well as other personality disorders and a rare condition in which he was unable to feel physical pain. He was taking medications early as age 10, according to his former babysitter, Ryan Kraft.

A friend of his mother told the New York Daily News that she said he was prone to hurting himself, including burning himself with a lighter. “I asked her if she was getting him help, and she said she was,” the friend recalled.

Joshua Flashman, a 25-year-old Marine who grew up near the Lanza’s home, told that Lanza’s mother, Nancy, had been petitioning the courts to gain conservatorship over Adam in order to have him committed to a psychiatric ward and that Adam was “really, really angry about this.” Flashman also said that Nancy had volunteered to work with kindergartners at Sandy Hook, who would be first-graders now, and that Adam believed “she cared more for the children than she did for him.”

While much of this is unconfirmed because medical and court records are confidential, one thing is clear. If Adam Lanza was being treated by a psychiatrist for Asperger’s syndrome and other personality disorders, part of that treatment usually includes psychotropic medications, in particular, selective serotonin reuptake inhibitors (SSRIs). And according to statistics on gun violence, these drugs may be even more dangerous than the firearms.

School Shootings and Violence
There have been 31 school shootings since Columbine, in which Eric Harris, age 17 and Dylan Klebold, age 18, killed 12 students and one teacher, and wounded 23 others. An assault weapon ban (1994-2004) was in effect at the time. Harris was known to be taking Zoloft, then Luvox. Klebold’s medical records have never been made available to the public.

A website called SSRI Stories has compiled a sortable database that lists over 4800 incidents of suicide, violent crimes and other incidents between 1988 and 2011, including school shootings that involve people that were prescribed SSRI medications. Here is a short list of a few more school shootings that involved SSRIs:

  • Steve Kazmierczak, age 27, inexplicably went on a shooting rampage on Feb. 15, 2008 in a Northern Illinois University Lecture Hall before taking his own life. He had been on Prozac, Xanax and Ambien, but had stopped taking Prozac a few weeks before the shootings. Toxicology reports showed traces of Xanax in his system. Five dead, 20 wounded.
  • Jeff Weise, age 16, had been prescribed 60 mg/day of Prozac (three times the average starting dose for adults) when he shot his grandfather, his grandfather’s girlfriend and many fellow students in Red Lake, Minnesota on March 24, 2005. He then shot himself. 10 dead, 12 wounded.
  • Cho-Seung-Hui, age 23, showed signs of anger before he went on a shooting rampage on the Virginia Tech campus that ended only after a police officer shot him dead. Officials said prescription medications related to the treatment of psychological problems had been found among Mr. Cho’s effects, but no details of his treatment or the medications have been released to the public. 33 dead, 17 wounded.
  • Michael Carneal (Ritalin), age 14, opened fire on students at a high school prayer meeting in West Paducah, Kentucky on Dec, 1, 1997. Three teenagers were killed, five others were wounded.
Violence involving SSRIs does not always involve firearms:
  • Jeff Franklin (Prozac and Ritalin), Huntsville, AL, killed his parents as they came home from work using a sledge hammer, hatchet, butcher knife and mechanic’s file, then attacked his younger brothers and sister.
  • Jarred Viktor, age 15, (Paxil). After five days on Paxil he stabbed his grandmother 61 times.
  • John Odgren, age 16, stabbed a 15-year-old student to death at Lincoln-Sudbury Regional High School in MA on Jan. 19, 2007. Odgren was being treated for Asperger's syndrome, a form of autism, as well as attention deficit hyperactivity disorder, depression and anxiety. The defense said changes in Odgren's clothing habits, as well as changes in his sleep and speech pattern, may have indicated a problem with his medication that could have lead to a manic, paranoid state.
The list of incidents like the above on SSRI stories is seemingly endless and all of the circumstances are different except for one – all of them involve a mentally ill patient on some sort of SSRI medication. Some have claimed that up to 90 percent of school shootings have involved a shooter on prescription medications.

While that is impossible to verify without the release of medical records in all cases, enough have been confirmed to establish a link between SSRIs and violence, especially when the black box warnings on the medications mention the potential for violent side effects.

Mental Illness and Medications

Many psychiatrists and physicians use the physician’s desk reference (PDR) in determining which medications to prescribe for patients. A hospital pharmacist with over 20 years of experience had this to say:
First of all, any real pharmacist knows that the PDR doesn’t stand for physician’s desk reference, it stands for poor drug reference. It’s useless. SSRIs increase the effect of serotonin in the brain. Atypical anti-psychotic medications do the reverse in terms of serotonin release. They are dopamine-2 and serotonin receptor antagonists which mean that instead of regulating the release of these chemicals to brain cells, they allow the release, but block the reaction of brain cells. In both cases, these drugs artificially manipulate the chemistry of the brain. 
The black box warning on many of these drugs list side effects such as, akathisia, aggression, apathy, sexual dysfunction, even death in the elderly – to name a few. Another known side effect that the FDA does not require in the black box is suicidal tendencies. Drugs like that drive me nuts, mostly because of the overuse of them. Standard practice is to give patients a ‘drug-free holiday,’ meaning that psych patients and Ritalin patients should periodically be taken off their meds to see how they are doing without medication, but only under close medical supervision. In other words, don't try that at home.
According to Lawyers and Settlements, an online legal news source, akathisia is the side effect “most likely to drive people to suicide or violence against others.” The DSM-IV acknowledges the association of akathisia with suicidality and states: "Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts."

While it is uncertain exactly which personality disorders Adam Lanza had in addition to Asperger’s syndrome, a registered nurse with 14 years of experience working with psychiatric patients speculates that it is most likely a form of fractured identity:
A part of personality lives in the shadow of the psyche due to its perceived trauma. That creates anger and feel for the need of vengeance. A person with fractured identity personality disorder should not be given a drug that allows integration of personality through opening a path in the brain without proper therapy. Any trauma at a young age, however seemingly minor to adults, is extreme when away from the security base of parents and home, such as a school. 
Drugs that integrate the psyche without a healing for that part of what it suffered do not heal anything – they bring that out, create insanity and are insanity. Patients need healing and therapy that is integrated with medication in order to prevent their violent personality from taking over. A personality put it in the shadow for so long is not controllable by any medication alone. 
When I was in high school, I may have prevented a school shooting. I sat through a gym class with a misfit that had been incessantly picked on by boys and mostly girls. He was so distraught that all he could say was that he was going to bring a gun to school the next day and kill them all. I pleaded with him that it is not the solution and we can work it out in other ways. I insisted other students leave him alone as I talked to him. I convinced him not to bring a gun to school the next day. I then went to the gym teacher and told him that this guy is planning to bring a gun to school and kill people if the other students did not leave him alone. The gym teacher told me to 'go play in the street.' This was in 1987. Now I watch over patients that are overmedicated and I rarely have more than a few moments to speak with them.
Several inferences can be made from the above information. Adam Lanza and many other school shooters were being treated with medications for mental illnesses. That treatment is usually heavy on medication and light on therapy. The medications commonly prescribed in the treatment can cause violent behavior. Despite gun control laws already in place, the school shooters had relatively easy access to firearms.

Preventative Measures

It is clear that preventative measures need to be taken that reach much further than more gun control laws in order to reduce gun violence. It is also clear that some sort of compromise between firearm owners and those demanding stricter gun laws must be achieved.

President Obama acknowledged that authorities must work to make "access to mental health care at least as easy as access to a gun," and the country needs to tackle a "culture that all too often glorifies guns and violence." Lawmakers in Congress have proposed reinstating the assault weapons ban that expired in 2004 and banning the sale of high capacity magazines.
Wayne LaPierre of the NRA argued in a press conference today that bringing more guns and armed police officers into schools is the solution. He suggested that the problem is children exposed to violence in movies, video games and music and guns are the solution. Some states have gone as far as to propose requiring or allowing teachers to bring weapons into schools.

The assault weapons ban did not prevent the Columbine massacre. The more guns in schools approach ignores statistics that have proven more guns lead to more gun violence. America does not need more militarization of public institutions, such as turning schools into virtual prisons with armed guards.

Americans and their leaders need to use common sense in dealing with this issue, not knee-jerk reactions. Sensible gun control laws are already in place and a few more may not necessarily infringe on 2nd amendment rights, but the link between psychotropic medications and gun violence must be acknowledged and addressed in any new legislation.

Atypical psychotropic and SSRI medications are what really need more regulation. Drug companies need to improve the black box warnings or face liability if a patient commits a violent crime due to a side effect that is not listed. Psychiatrists, psychologists and physicians need better information on these medications. Patients that are prescribed these medications could be entered into a national database.

With all legally registered gun owners and all mentally ill patients on medications in national databases, the information could then be cross-referenced. A regulation that no prescriptions for psychotropic medications can be filled if firearms are kept at the residence of the patient could then be enacted and enforced.

That still leaves Americans a choice: Either have your guns or your meds, but not both. If a gun owner wants themselves or a member of their household to be treated with psychotropic medications, then they should have to remove their guns from the residence or opt for inpatient care. Inpatient care could be made more accessible in these cases through an expansion of Medicaid.

The same regulations that are in place for automobile ownership could also be a model for firearm ownership. Every firearm could be registered, licensed and details such as where the firearm is kept stored in a national database. States could have the option of yearly renewals with updated information.

Mandatory minimum liability insurance could be a condition of gun ownership just like most states require for automobile owners. Gun owners do not seem to have a problem with those requirements in order to own and operate a motor vehicle. There should be no reason to have a problem with that regarding firearms either, since guns are not as important to own as a car.

Law-abiding firearm owners in a good state of mental health, with no one on psychotropic medications in their household, would not be subject to any “gun-grabbing.” They can have assault weapons with high capacity magazines, as long they have liability insurance on their weapons. Most gun-owners would to retain all of their 2nd amendment rights – it would just cost them more money to own firearms.

People on psychotropic medications would then have more difficultly accessing firearms, which could eliminate spontaneous actions, just as the waiting period for handguns does. Liability would keep more guns under lock and key or at least carefully monitored by owners. Choosing between firearms and medications may also provide an incentive for patients and their families to seek real therapy that in many cases has proven to be more effective than medications. Two new laws – two problems solved.

While laws like that would raise compliance issues, law enforcement does not seem to have a problem with enforcing similar firearm restrictions in cases of domestic violence, or with anyone on probation or parole. Law enforcement can and will verify compliance in those cases and if firearms are not removed from the residence voluntarily, law officers will come by and pick them up.

Of course, gun lobbyists and pharmaceutical lobbyists would scream bloody murder on Capitol Hill, but surely there would be some insurance company lobbyists behind this sort of initiative. Gun owners would also complain about the higher cost of ownership, but unlike an outright ban, it still leaves them a free market choice with their rights intact.

What is most important, however, is that any new approach in terms of preventive measures is worth a try if it does not infringe on the rights of law-abiding citizens, does not lead to further militarization of public institutions and prevents the death of even one child or teacher like the 26 that died last week in Connecticut.


Madison Independent Examiner - Stricter Gun Control Laws are not the Solution

Congressional Research Service (pdf)

LA Times

New York Daily News

SSRI Stories

New York Times

Lawyers and Settlements


AP via Yahoo! News

The Washington Post

CBS News

The Washington Post – Twelve facts about guns and mass shootings…

Gregory Patin writes for the Examiner where this article first appeared. Patin earned a B.A. in political science from U.W. - Madison and a M.S. in management from Colorado Technical University. He is currently a freelance writer residing in Madison, WI who considers himself politically independent.
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