Why we all share in the blame for mass shootings
I am an Adolescent Medicine specialist who works with “high-risk” teens every day. For years I have been reading stories about mass shootings and have hidden my opinion. I fear that people won’t understand the reasoning, or the subtlety of my view. I have the utmost sympathy for the victims and their families. And of course I support gun regulation. But more than anything, I am overwhelmed by sadness and sympathy for the shooters and their families. Because their story, albeit not always with such a horrific outcome, is one I see every day.
It’s clear who is accountable for the direct killing of innocent people – the shooter. They alone make that choice, however impaired it is by mental illness. As an immediate solution, we need to protect our society from what is a much larger, and complex problem. That solution is gun regulation. But gun regulation will not address the deeper, harder problem – our complete and utter failure as a society to address mental illness in a compassionate and comprehensive way.
We all play a role in the shooter’s journey to that day. We all, collectively, failed that shooter every day of their illness. The shooter’s parents, understandably, are not able to tell their likely story of years of unsuccessful access to mental health care and stigma. No one can absorb that in the context of the outcome. So I will tell their story, not because I know any one shooter personally. But because I believe their story is common to the millions of teens struggling with mental illness, only a small percentage of whom resort to violence at that scale.
***
Imagine you are a 16 year old teen boy and you have always been kind of an odd kid. You like gaming, never cared for sports, and mostly stick to 1-2 close friends. Middle school and high school have been hard because you never really fit in. You might have been bullied, but more than anything you felt alone and separate. You watch from the sidelines as everyone else progresses through typical adolescent development – friends, parties, relationships. Your friends are other outcasts – guys who like science, tech, and games.
And then slowly you start to not feel like yourself. It used to be that when you were rejected by a girl, not invited to a party, or teased at school you would be upset, perhaps withdraw for a bit, or laugh about it with your friends. But now you find yourself lashing out. You get angry and spiteful about little things. Your few close friends stop calling you because you are kind of unpredictable and are acting weird.
Things start to happen at school - fights, complaints about odd behavior. You head is full of “out-there” thoughts like worries that people are out to get you. It’s hard to tell if you are going crazy, or if this is just what happens after years of being an outcast. Someone offers you a joint after school and you realize it dims your thinking, which helps you get through the day. Soon you find yourself smoking every day, drinking alcohol, and perhaps dabbling in other drugs. Your new crowd is also self-medicating.
There is a minor incident at school. Your parents are called in. They have noticed the odd behavior, change in grades, and new friends. They always had you pegged as some kind of budding savant. A kid that just needed to find his niche. In a way, they are starting to grieve their dreams for you and you feel guilty about that. The school and your parents threaten you with expulsion if you don’t get your act together. Your social activities are restricted, which makes you more isolated. And now you are alone with your thoughts that seem to run further and further away from your control. The only outlet you have is your computer - where you connect with other outcasts who are grounded at home by parents with the best intentions.
At some point, your Pediatrician is informed of the drug use and school problems. They give your parents a hand out on adolescent behavior problems and resources on local drug programs. They recommend a psychological evaluation, but your parents (still hopeful you will turn around) are not ready to take that step.
You are now 17 and there is another incident at school. The school tells your parents that this is the last warning – next stop transfer to the alternative school. Or, perhaps they would like to consider home schooling? Your parents are now ready to seek a mental health evaluation. They see the need. Everyone is asking you why you can’t just get your act together. And you can’t find the words, or you are ashamed, to explain that your thoughts are no longer under your control.
You are now up most nights writing in your journal about the thoughts in your head. You feel like sometimes you have amazing insights into the future of the world, but it’s hard for you explain them to others. That’s why you love writing. It helps to put things down on paper. You know others will not understand your journal, so you keep it hidden.
It takes your parents 2 months to find a therapist who accepts your insurance. You meet with the therapist and for the first time tell someone about what’s going on in your head. The therapist tells your parents that she is concerned you might be experiencing prodromal symptoms of a psychotic illness. Your parents are devastated. This was their worst fear – as you have an uncle with schizophrenia. The therapist says your case is beyond her expertise and you need an evaluation by a child psychiatrist. It takes your mom another 2 months to find one that is covered by your insurance.
The psychiatrist has concerns that you are showing the early signs of schizophrenia and recommends starting medication along with specialized therapy. It’s hard for your parents to accept the diagnosis, but you all agree it’s the best thing. As soon as you start taking the medication, your thinking becomes clearer. But by now it is your senior year and your school has expelled you. Your Mom is home schooling you and money is tight. You are depressed and feel guilty about the impact you have had on your family. With the medicine, you no longer feel compelled to write in your journal, or isolate yourself as much. But your depression increases as now you realize more than ever the impact your mental state has had on your life. Your friends have moved on, you are not in school, and you are stuck at home with your Mom all day.
The medication has side effects. You gain a bunch of weight and you notice some tremors. You start to resent your parents in addition to everyone else. Your Mom in particular irritates you as she is the one always nagging you about your medicine, appointments, and school. Sometimes you just want to retreat back into your thoughts – it was kind of nice to feel like you had answers that no one else could understand.
It’s your 18th birthday. You finished your home schooling. You now have a right to consent for your own mental health treatment. Your relationship with your parents has deteriorated. You have to change psychiatrists because you are now an adult and they inform you that legally, it’s your choice if you get treatment. This new clinic doesn’t have social workers and “wraparound” services. They don’t offer support for your parents. They don’t call if you don’t show up. It’s all up to you. Now you are also a typical young adult. Your brain is still developing, and like most young adults, you may not see the long-term impact of your decisions. You decide to take a break from your medicine – maybe you are cured, maybe you can get by without it. It’s worth a try!
Off meds, your relationship with your parents deteriorates further. To live at home, you had agreed to attend community college and go to your psychiatry appointments. One month into college, you are kicked out for odd behavior and you lose your job. Your parents threaten to kick you out. They also start to investigate obtaining conservatorship because you are not making good choices.
It’s all so confusing to you and it feels like everyone is out to get you all the time. You just want to escape. You feel so alone, so misunderstood. Your mind is racing, you feel like you are losing touch with reality. You are not sleeping, up all night on the internet. The world seems against you. You start to hear voices, see things in shadows. You are so, so scared. And you feel so, so alone.
***
The story can take many directions from here, and I would rather focus on the journey vs. the outcome. The vast majority of adults with schizophrenia are not violent. If anything, they are likely to be victims of violence or attempt suicide. But my focus in telling this story is to not talk about outcomes, but instead about prevention.
At so many points in this story there are missed opportunities for intervention. On a 1:1 level, we as a society could be more accepting of difference. Focus on inclusivity vs. exclusivity. We need places and programs for kids who don't fit in to find an outlet.
We need to improve reimbursement for specialized therapy services so that mental health providers will be more likely to accept insurance. We could add more support for parents of young adults who are feel powerless once their child reaches the age of consent. Schools need to stop tossing kids aside who can’t thrive in a typical track.
Yes, we need gun regulation. Now. We need immediate protection for our society from our failure to meet our obligation to our youth with mental illness. But our kids also deserve so much more. Let’s change the conversation and start to get real about mental illness..
I am an Adolescent Medicine specialist who works with “high-risk” teens every day. For years I have been reading stories about mass shootings and have hidden my opinion. I fear that people won’t understand the reasoning, or the subtlety of my view. I have the utmost sympathy for the victims and their families. And of course I support gun regulation. But more than anything, I am overwhelmed by sadness and sympathy for the shooters and their families. Because their story, albeit not always with such a horrific outcome, is one I see every day.
It’s clear who is accountable for the direct killing of innocent people – the shooter. They alone make that choice, however impaired it is by mental illness. As an immediate solution, we need to protect our society from what is a much larger, and complex problem. That solution is gun regulation. But gun regulation will not address the deeper, harder problem – our complete and utter failure as a society to address mental illness in a compassionate and comprehensive way.
We all play a role in the shooter’s journey to that day. We all, collectively, failed that shooter every day of their illness. The shooter’s parents, understandably, are not able to tell their likely story of years of unsuccessful access to mental health care and stigma. No one can absorb that in the context of the outcome. So I will tell their story, not because I know any one shooter personally. But because I believe their story is common to the millions of teens struggling with mental illness, only a small percentage of whom resort to violence at that scale.
***
Imagine you are a 16 year old teen boy and you have always been kind of an odd kid. You like gaming, never cared for sports, and mostly stick to 1-2 close friends. Middle school and high school have been hard because you never really fit in. You might have been bullied, but more than anything you felt alone and separate. You watch from the sidelines as everyone else progresses through typical adolescent development – friends, parties, relationships. Your friends are other outcasts – guys who like science, tech, and games.
And then slowly you start to not feel like yourself. It used to be that when you were rejected by a girl, not invited to a party, or teased at school you would be upset, perhaps withdraw for a bit, or laugh about it with your friends. But now you find yourself lashing out. You get angry and spiteful about little things. Your few close friends stop calling you because you are kind of unpredictable and are acting weird.
Things start to happen at school - fights, complaints about odd behavior. You head is full of “out-there” thoughts like worries that people are out to get you. It’s hard to tell if you are going crazy, or if this is just what happens after years of being an outcast. Someone offers you a joint after school and you realize it dims your thinking, which helps you get through the day. Soon you find yourself smoking every day, drinking alcohol, and perhaps dabbling in other drugs. Your new crowd is also self-medicating.
There is a minor incident at school. Your parents are called in. They have noticed the odd behavior, change in grades, and new friends. They always had you pegged as some kind of budding savant. A kid that just needed to find his niche. In a way, they are starting to grieve their dreams for you and you feel guilty about that. The school and your parents threaten you with expulsion if you don’t get your act together. Your social activities are restricted, which makes you more isolated. And now you are alone with your thoughts that seem to run further and further away from your control. The only outlet you have is your computer - where you connect with other outcasts who are grounded at home by parents with the best intentions.
At some point, your Pediatrician is informed of the drug use and school problems. They give your parents a hand out on adolescent behavior problems and resources on local drug programs. They recommend a psychological evaluation, but your parents (still hopeful you will turn around) are not ready to take that step.
You are now 17 and there is another incident at school. The school tells your parents that this is the last warning – next stop transfer to the alternative school. Or, perhaps they would like to consider home schooling? Your parents are now ready to seek a mental health evaluation. They see the need. Everyone is asking you why you can’t just get your act together. And you can’t find the words, or you are ashamed, to explain that your thoughts are no longer under your control.
You are now up most nights writing in your journal about the thoughts in your head. You feel like sometimes you have amazing insights into the future of the world, but it’s hard for you explain them to others. That’s why you love writing. It helps to put things down on paper. You know others will not understand your journal, so you keep it hidden.
It takes your parents 2 months to find a therapist who accepts your insurance. You meet with the therapist and for the first time tell someone about what’s going on in your head. The therapist tells your parents that she is concerned you might be experiencing prodromal symptoms of a psychotic illness. Your parents are devastated. This was their worst fear – as you have an uncle with schizophrenia. The therapist says your case is beyond her expertise and you need an evaluation by a child psychiatrist. It takes your mom another 2 months to find one that is covered by your insurance.
The psychiatrist has concerns that you are showing the early signs of schizophrenia and recommends starting medication along with specialized therapy. It’s hard for your parents to accept the diagnosis, but you all agree it’s the best thing. As soon as you start taking the medication, your thinking becomes clearer. But by now it is your senior year and your school has expelled you. Your Mom is home schooling you and money is tight. You are depressed and feel guilty about the impact you have had on your family. With the medicine, you no longer feel compelled to write in your journal, or isolate yourself as much. But your depression increases as now you realize more than ever the impact your mental state has had on your life. Your friends have moved on, you are not in school, and you are stuck at home with your Mom all day.
The medication has side effects. You gain a bunch of weight and you notice some tremors. You start to resent your parents in addition to everyone else. Your Mom in particular irritates you as she is the one always nagging you about your medicine, appointments, and school. Sometimes you just want to retreat back into your thoughts – it was kind of nice to feel like you had answers that no one else could understand.
It’s your 18th birthday. You finished your home schooling. You now have a right to consent for your own mental health treatment. Your relationship with your parents has deteriorated. You have to change psychiatrists because you are now an adult and they inform you that legally, it’s your choice if you get treatment. This new clinic doesn’t have social workers and “wraparound” services. They don’t offer support for your parents. They don’t call if you don’t show up. It’s all up to you. Now you are also a typical young adult. Your brain is still developing, and like most young adults, you may not see the long-term impact of your decisions. You decide to take a break from your medicine – maybe you are cured, maybe you can get by without it. It’s worth a try!
Off meds, your relationship with your parents deteriorates further. To live at home, you had agreed to attend community college and go to your psychiatry appointments. One month into college, you are kicked out for odd behavior and you lose your job. Your parents threaten to kick you out. They also start to investigate obtaining conservatorship because you are not making good choices.
It’s all so confusing to you and it feels like everyone is out to get you all the time. You just want to escape. You feel so alone, so misunderstood. Your mind is racing, you feel like you are losing touch with reality. You are not sleeping, up all night on the internet. The world seems against you. You start to hear voices, see things in shadows. You are so, so scared. And you feel so, so alone.
***
The story can take many directions from here, and I would rather focus on the journey vs. the outcome. The vast majority of adults with schizophrenia are not violent. If anything, they are likely to be victims of violence or attempt suicide. But my focus in telling this story is to not talk about outcomes, but instead about prevention.
At so many points in this story there are missed opportunities for intervention. On a 1:1 level, we as a society could be more accepting of difference. Focus on inclusivity vs. exclusivity. We need places and programs for kids who don't fit in to find an outlet.
We need to improve reimbursement for specialized therapy services so that mental health providers will be more likely to accept insurance. We could add more support for parents of young adults who are feel powerless once their child reaches the age of consent. Schools need to stop tossing kids aside who can’t thrive in a typical track.
Yes, we need gun regulation. Now. We need immediate protection for our society from our failure to meet our obligation to our youth with mental illness. But our kids also deserve so much more. Let’s change the conversation and start to get real about mental illness..
No comments:
Post a Comment