Nov 26, 2013

Adam Lanza's suicide ignored by state report

The Connecticut State Attorney’s report on the Sandy Hook shootings details the horror but misses the point. Adam Lanza prepared and rehearsed for violent suicide, and obsessively studied mass murder. In the days leading up to the incident, it became clear that he was about to lose his way of life.  Sandy Hook was a suicide, with mass murder tacked on.

If the State Attorney sought help interpreting the mental health aspects of the case, the report does not show it. It displays shocking, almost willful disregard of mental health and suicide. The report is available here.

The report minimizes Adam Lanza’s problems. It states
He was undoubtedly afflicted with mental health problems; yet despite a fascination with mass shootings and firearms, he displayed no aggressive or threatening tendencies.
It ignores
In seventh grade, a teacher described the shooter as intelligent but not normal, with anti-social issues. He was quiet, barely spoke and did not want to participate in anything. His writing assignments obsessed about battles, destruction and war, far more than others his age. The level of violence in the writing was disturbing.
The report does emphasize Lanza’s inability to connect socially. For example, in 2005 (seven years earlier, at age 12 or 13),
[Lanza] was described as presenting with significant social impairments and extreme anxiety. It was also noted that he lacked empathy and had very rigid thought processes. He had a literal interpretation of written and verbal material. In the school setting, the shooter had extreme anxiety and discomfort with changes, noise, and physical contact with others.
Lanza had a mental health diagnosis, but no follow through. Even though in 2006 an evaluation noted
His high level of anxiety, Asperger’s characteristics, Obsessive Compulsive Disorder (OCD) concerns and sensory issues all impacted his performance to a significant degree, limiting his participation in a general education curriculum. Tutoring, desensitization and medication were recommended. It was suggested that he would benefit by continuing to be eased into more regular classroom time and increasing exposure to routine events at school.
The shooter refused to take suggested medication and did not engage in suggested behavior therapies.
Lanza lived a strange, weirdly isolated life. He appears to have been addicted to isolation. His mother enabled and perpetuated that life.
The mother did the shooter’s laundry on a daily basis as the shooter often changed clothing during the day. She was not allowed in the shooter’s room, however, even to clean. No one was allowed in his room.
The shooter disliked birthdays, Christmas and holidays. He would not allow his mother to put up a Christmas tree. The mother explained it by saying that shooter had no emotions or feelings. The mother also got rid of a cat because the shooter did not want it in the house.
Prior to the shootings, despite this enabling, codependent behavior, Lanza was rejecting his mother along with everyone else.
One witness indicated that the shooter did not have an emotional connection to his mother. Recently when his mother asked him if he would feel bad if anything happened to her, he replied, “No.” Others, however, have indicated that they thought the shooter was close to his mother and she was the only person to whom the shooter would talk.
A person who knew the shooter in 2011 and 2012 said the shooter described his relationship with his mother as strained because the shooter said her behavior was not rational.
Beyond the evidence of social disconnection, the report identifies clear evidence Lanza was preoccupied by self-inflicted violent death. He assumed suicidal poses, and memorialized them. Among the evidence found in his home were the following:
Three photographs of what appear to be a dead human, covered in blood and wrapped in plastic
Two videos showing suicide by gunshot
Images of the shooter holding a handgun to his head
Images of the shooter holding a rifle to his head
This collection of images is plain evidence of suicidal preparation and intent. As the incident approached, Lanza had become even more isolated. He knew his isolated lifestyle was threatened. He was about to be forced out of his place of refuge.
In November 2012, the mother … was concerned about him and said that he hadn’t gone anywhere in three months and would only communicate with her by e-mail, though they were living in the same house. …
The mother said that she had plans to sell her home in Newtown and move to either Washington state or North Carolina. She reportedly had told the shooter of this plan and he apparently stated that he wanted to move to Washington. The intention was for the shooter to go to a special school in Washington or get a computer job in North Carolina. In order to effectuate the move, the mother planned to purchase a recreational vehicle (RV) to facilitate the showing and sale of the house and the eventual move to another state. The RV would provide the shooter with a place to sleep as he would not sleep in a hotel. In fact, during Hurricane Sandy in October 2012, with no power in the house, the shooter refused to leave the home and go to a hotel.
Lanza may have told his mother he was willing to move, but his actions say otherwise. Without the context of Lanza’s world collapsing and his suicidal intent, there would have been no Sandy Hook tragedy.

Suicide risk involves three factors:

  1. Thwarted belongingness. A perception, belief, or feeling of disconnection or alienation from others.
  2. Thwarted effectiveness. A perception, belief, or feeling of failure or worthlessness, or that one has become a burden on others.
  3. Acquired capacity for self-harm. A kind of fearlessness, recklessness, or immunity to pain, which is gained through experience of painful injury, prior self-harm, or through practice of another sort.
Once a person gains the capacity for self-harm, it is difficult to lose it. Risk factors related to thwarted belongingness and thwarted effectiveness include the following.
  • Depression and other mental disorders, and/or a substance-abuse disorder. More than 90 percent of people who die by suicide have these risk factors. Family history of mental disorder or substance abuse. People with borderline personality disorder experience high levels of alienation and feelings of worthlessness, and have extremely high suicide risk.
  • Failed relationships, financial loss, or loss of status. Criminal behavior, impending lengthy incarceration. Other shameful circumstances. Disgrace. Shunning. Bullying. Religious or ideological failure.
  • Disability, aging, loss of autonomy. Reduced capacity for self-care. Inability to ensure safety of a dependent spouse or disabled adult child.
  • Cognitive distortions, delusions, paranoia, rage.
  • Frequent nightmares, lack of sleep.
Risk factors related to acquired capacity for self-harm include the following.
  • Prior suicide attempt (puts the person at highest level of risk).
  • Exposure to the suicidal behavior of others, such as family members, peers, or media figures.
  • Exposure to violence, including physical or sexual abuse. Exposure to the violent behavior of others. Family violence. Occupational violence, especially for public safety workers. Combat violence. Incarceration.
  • Pain and injury, especially self-injury. Multiple surgeries. Frequent tattoos and piercings.
  • Risky and reckless behavior, provocative experiences. Disruptive behavior.
  • Substance abuse. Medication misuse.
  • Firearms in the home (the method used in more than half of suicides). Firearms, suffocation, and poisoning are the most frequent means used to commit suicide.
  • Vicarious experiences. Opportunities to practice, plan, and contemplate self-harm. Violent media, video games.
  • Changes in mental health medication. People may become activated as medication takes effect or wears off.
These factors may be common and ordinary and shared by many people, nonetheless given the sheer quantity of risk factors accumulating around Adam Lanza, suicide stands out as the primary motive for the Sandy Hook tragedy.  The rest was theater, an attempt to create a memorable end. Because Lanza had no social connection with anyone, he was capable of taking on a horrific role, one that nonetheless fascinated him, the school shooter. Among the evidence seized from the Lanza home:
  • A New York Times article from February 18, 2008, regarding the school shooting at Northern Illinois University
  • The book Amish Grace: How Forgiveness Transcended Tragedy (about a school shooting).
  • The computer game titled “School Shooting” where the player controls a character who enters a school and shoots at students.
  • A document written showing the prerequisites for a mass murder spreadsheet
  • A spreadsheet listing mass murders by name and information about the incident
  • Large amount of materials relating to Columbine shootings and documents on mass murders.
It does no one any good to perpetuate the myth that suicide-murders are inexplicable. Willful ignorance endangers people, as the Sandy Hook tragedy shows.

Nov 20, 2013

America's Disparity Dust Bowl

In many Cincinnati neighborhoods, and in communities across America, people are suffering. Economic disparities, educational disparities, health disparities, drugs, crime, violence, and the gradual erosion of supportive cultures have left substantial numbers of Americans stuck where they are, unable to make progress in their lives.

This stuck point has the potential to become a starting point. However, existing social service and economic development models have not stopped the pileup of disparities and societal consequences, and have not proven capable of delivering health, peace, and prosperity to disadvantaged populations.

Consequently, America’s “stuck people” find themselves living in a devastated environment of trauma, crisis, and disorder. This is a Disparity Dust Bowl. Research tells us that this affects people in significant ways.

Thinking is affected. Trauma, medical issues, and adverse life events cause people to lose “executive function,” the ability to make plans or take action when there are no clear guidelines.

Feelings are affected. People who experience trauma early in life have difficulty regulating emotions. Poverty, separation, and loss generate shame, fear, sadness, loneliness, and anger. Unfortunately, American culture makes it difficult for people to rebuild the capacity to be vulnerable and trusting. This is a key step in resolving shame, overcoming the negative emotional burden, and achieving the level of emotional regulation essential to success in educational settings and the business world.

Relationships are distorted. Social relationships facilitate every type of learning, in part through the psychological process of modeling, but after generations of life in the Disparity Dust Bowl, there are few positive, capable models to be had. This distortion becomes magnified by insidious cultural forces. Once disparity-distorted thinking infects popular culture, positive people become social outcasts.

Information is missing. Time and technology move forward even if people are stuck in troubled circumstances. Resource disparities limit opportunities to travel and explore the larger world.

Marginalization increases exponentially over time. The inherent human process of labeling, social distancing, and stigma assigns people to disadvantaged or devalued categories, and dishes out unequal results. Teachers drawn from disparity-afflicted cultures share many disadvantages with the people they serve. Public resources are often withheld from low-income institutions. Even brilliant students remain disadvantaged compared to those outside the Disparity Dust Bowl, because they lack access to broader social context.

Today's Disparity Dust Bowl has become a complex system driven by negative thinking. It operates with relentless self-reinforcing logic. Once economic, health, and power disparities combine with the innate human processes of stigma and social distancing, people who experience disparities are labeled not only as less advantaged but inherently deficient.

The deficiency driven system constantly measures and reports the extent of personal deficiency. People come to adopt their labels as their core identities. This process drives cultures to a tipping point. Once enough individual people are labeled as failures, entire populations become blind to their strengths. Without strengths to draw on, people get stuck.

What is needed today are techniques that get people unstuck, methods that promote cognitive function, support emotional regulation, encourage healthy relationships, and motivate people to overcome barriers such as information deficits and marginalization. We need to help people rediscover the innate human problem-solving toolkit, so they can engage the world from a position of strength. And everyone who works to reduce the effects of the Disparity Dust Bowl needs tools that reveal the strengths of the people they serve.

I have spent the greater portion of my career trying to identify methods with sufficient power to address the effects of the Disparity Dust Bowl. Achieving “somewhat less deficiency” is not enough. In order to counter the effects of a deficiency-driven system, we must challenge the logic of the system itself. We must maximize and mobilize innate strengths, and develop capacities from there.

Nov 11, 2013

Changing whole cultures to stop addiction and achieve better health

I wrote a few lines for a massive new publication detailing what it takes to address the epidemic of heroin addiction and overdose death now playing out in Northern Kentucky. 

The story appeared in the Cincinnati paper yesterday. The 50-page report, one of the best analysis and action plans I have ever seen addressing addiction and overdose death, is available here. When I read the report I found to my surprise that an excerpt from my contribution was the last word, the call to action. 

Here's my whole essay.

Addiction and mental illness is personal, but when problems pervade whole cultures, we need a whole-culture solution too.

What does it take to create a culture of safety and good health?

Life is an immersive experience we are all adapting to. The culture of addiction and sickness is really a kind of narrative, a movie – and we are living in it. People act out the movie that’s running in their head. When the movie changes, people change, and their actions and relationships change.

Time and technology have changed how people experience the world. Through the 19th Century, the experience of the world was natural, concrete and local, bound up in family experiences, structured belief systems, and local cultural experiences. Today’s world is a different movie, with a narrative built from instantaneous communications and mass media. Even so, the genuine experiences of life continue to deliver the most powerful wallop.

Person-to-person interactions, genuine relationships, family life, travel, work, and neighborliness connect with our essential natures, and retain great power and influence. Pathways to personal change still involve relationships, transformative experiences, shared culture, stories, learning, and growth. Sustaining personal change takes motivation, an ideology or program of recovery, commitment, and mutual support.

The cultural environment shaping people’s stories can be influenced using all the tools of modern life. We can create a culture of safety and good health, built from positive stories of resilience and transformation. We can make it easier to build relationships with people who have overcome challenges, and are themselves transformed. This paves the way for the meaningful talk, person to person. Anonymity is proper for individual work or intensive work – but the larger world needs characters and a story line, a movie to walk into and live out.

We can build a cultural narrative of safety and sobriety using the same techniques that consumer products firms use to influence customer behavior. Make it understood, easy to do, desirable, rewarding, and a habit. Let people see the proof and payoff.