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After Newtown: Why Amateur Diagnoses Are Dangerous

Speculating fuels stigma 

Harold S. Koplewicz, MD

President
Child Mind Institute

As we struggle to come to terms with the tragic shootings in Newtown, Connecticut, Friday, the hardest thing to grasp is why anyone would be moved to murder small children and the teachers trying heroically to protect them. We search for clues that would make this horrific act understandable, and we do not find them.

We do know that whatever was going on in the mind of 20-year-old Adam Lanza, when he went on this appalling shooting spree, it did not come from a place of good mental health. But to blame this violence on Asperger's or a personality disorder, as many media outlets currently are, is a serious mistake.

At this point, any comment on the psychiatric profile of Adam Lanza, the 20-year-old man responsible for these murders, is complete hearsay. We don't know whether he had a history of psychiatric illness or if had been exhibiting signs of a psychotic breakdown. Unfortunately, that hasn't stopped extensive speculation that Lanza had Asperger's disorder, or a personality disorder, and even obsessive-compulsive disorder. Much has been made of the reports that Lanza was a smart but quiet kid who carried a briefcase to class instead of a backpack and felt at home with computers, perhaps more so than with his peers. By themselves these traits do not indicate any diagnosis at all, although we have been quick to dissect them in the search for meaning.

These amateur diagnoses based on unconfirmed information are very harmful. To my mind perhaps the worst is the suggestion that the unimaginable nature of this violence—the fact that children were targeted—somehow indicates a lack of empathy that can be associated with autism spectrum disorders. This is completely untrue. Individuals on the spectrum are in no way predisposed to this kind of violent behavior. Ample research proves otherwise. And while individuals with autism may be less adept at picking up nonverbal social cues, they are just as capable of experiencing emotional empathy as anyone else. I have known many autistic children who would be crushed knowing that a sibling, a parent, or even a spider was suffering.

Trading in rumors and misinformation sensationalizes real disorders and leads to stereotypes and bigotry. It fuels the stigma that mental disorders are dangerous or scandalous and prevents people from seeking the life-changing help they need. And because untreated psychiatric disorders are more likely to result in violence, it makes tragedies like this one more likely to happen again. So let's stop speculating about the things we don't know and start focusing on what we do know.

We know that when we see someone suffering we shouldn't look away. And when we see young people coughing, wheezing or bleeding, we insist that they get attention. But when we see young people with disturbing behavior, or young people in clear emotional distress, we ignore them and hope these problems will go away.

The first signs of 75% of all psychiatric disorders appear by the age of 24. We need to be on the lookout for signs of distress in young people to get them help as soon as possible. Research shows that early intervention improves the outlook for anyone with a psychiatric disorder—and drastically reduces the likelihood of violence.

As a nation we need to change our attitude about mental illness. We need a better plan for giving mental health care parity with other medical care. Improving access to the best evidence-based interventions should be a national priority. The economic cost as well as the human cost of untreated mental illness makes that clear.

Finally, we know our first graders should never fear for their lives when they sit down in a classroom. We know we need to do everything we can to make sure this never happens again.

Published: December 16, 2012

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katherine.collmer@verizo · Dec 19 2012 Report

Dr. Koplewicz, Thank you so much for this article. I am sharing it with my clients and readers. I have been heartbroken these past few days, not only because of the tragedy at the school, but because of the rampant gossip and speculation about the dangers of having and/or being around a child on the spectrum. It bothers me so because it clearly highlights the lack of awareness in our general population for children with these conditions. As an occupational therapist, I have witnessed the deterioration of our mental health services, as well as the backward slide in the fair and compassionate consideration of those with mental illnesses. I hope that by sharing your article, I can help to increase awareness and spark action for the return of our attention to the assessment and remediation of mental illness.

doctorankenman · Dec 18 2012 Report

Indeed, Autism is NOT violent. However, many parents now getting into this national discussion talk of aggressiveness in their children that is adrenaline fueled, rather then meditated such as Newtown. There is new information available for it at "Hope For The Violently Aggressive Child".

redstockinggrandma · Dec 18 2012 Report

It is not helpful to diagnose all evil acts as symptoms of mental illness. Perhaps rampage killers are more similar to suicide bombers, although their motives might be different. Many killers do not have a diagnosable mental illness. I do feel passionately that our treatment of the emotionally troubled is disgraceful. I feel equally passionate that too early diagnosis, as opposed to treatment, of children and young teens is destructive. Once upon a time, children in treatment were diagnosed with "adjustment disorder." There is little evidence to impose a lifelong diagnosis on young children. For example, childhood bipolar disorder was discovered less than 20 years ago by psychiatrists in bed with big pharm. There is some speculation that overprescription of ADHD meds results in bipolar symptoms.

redstockinggrandma · Dec 18 2012 Report

What an excellent post. I am a former psychiatric editor, a psychiatric social worker, and someone who struggles with bipolar disorder. I feel strongly that troubled kids desperately need family therapy. In most cases the problems of the kids I see are not located in their brains.

hope59 · Dec 18 2012 Report

Please USE this tragedy and take the case of mental illness to our government to begin EDUCATING people about all forms of mental illness and personality disorders. Educate YOURSELF also! Many psychopaths have OTHER mental illnesses present - co-morbid diagnosis for "depression, OCD, ADHD, and bipolar disorder CAN and DO exisit along with psychopathy! Just because these people do not subject themselves to therapy does NOT mean educated and well informed people are not able to recognize these other forms of mental illness. I educated MYSELF because personality disorders are given ONE day in psychology education programs - ONE DAY1! I bet I know almost as much as YOUR phd staff does about psychopaths! We do not know the mental illness that this young man was living with but he DEFINITELY was ill. We need to educate EVERYONE about the signs of mental illness and move FORWARD NOW with education and HELP for families that have children that are not behaving "normal". Who knows - we just might prevent ANOTHER mass killing of innocent people!

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