Dr. Mark Komrad on What We Can Learn From Lanza's Story

  • Even if someone is brought to a psychiatrist for evaluation and treatment, a doctor cannot reliably predict violence; there are far more false positives than false negatives.
  •  A patient often doesn't stay in treatment, and the family often feels helpless to keep them in treatment
  • Families of violent mentally ill are also victims; in fact a family member is more likely to be a victim than is a stranger.
  • Most mental illnesses do not appear in childhood but later--typically during early adolescence and later. Sometimes there are developmental oddities or irregularities as young kids, but usually not. Whether certain developmental irregularities presage development of later serious mental disorder (like Lanza) cannot yet be reliably predicted.
  • Except for the most horrid and severe abuses, parenting doesn't cause major mental disorders (just neuroses). But, once disorders begin, parenting can be crucial for managing them, ensuring treatment compliance, providing consequences and limits that help optimize outcomes (not cure). But parents can be drawn into a pathologically intense protective bond with a severely ill child.
  • Autistic symptoms may resemble sociopathic symptoms on the surface, but they are different (eg. cognitive empathy vs. emotional empathy impairment). The two together can be particularly problematic and risky.
  • Sometimes the most important mental health treatment intervention that could make a long term difference is to treat/help the parent. (We're not clear if there was very much hep for Lanza's parents; we know at least one psych recommendation was made, but not followed.) 
    Towson-based psychiatrist Dr. Mark Komrad