Science Isn't Golden

Matters of the mind and heart

The Hurry to Heal: Therapists Cannot Explain Everything

Reasons for the rush for answers to tragedy, and what to do instead

Someone dies. Even if they were very old or terminally ill, although we may not be surprised, the mystery, the incomprehensibility of death itself torments many.

When the deaths are utterly unexpected and totally unprovoked, and especially when they are unbearably young and innocent, a frenzy of "explanations" fills the airways, and neighbors and even strangers ask each other, "Why?"

Our nation perhaps more than any other seems plagued by pressure to seize instantly on explanations, and besides the all-American belief that we can find answers -- solutions -- for everything, there are, I think, two primary reasons. 

One is that even many of those who believe in an afterlife find their belief is inadequate to end their grief. Perhaps if there is something to understand, people hope, an explanation will make the grief easier to bear, for in the throes of grief, it is impossible to imagine it will ever be anything less than unbearable.

The other is that we live in a death-avoidant culture, where we often succeed in forgetting our mortality, but we are desperate to know what it is about. The horrible question that war veterans say is the most common first -- often only -- thing that civilians ask them is, "Did you kill anybody?" Those who have been near death, who have seen it happen or lost loved ones may, we hope, tell us something that makes us less afraid of it. Perhaps at some level, we believe that if we learn more about it from those who have been close to it, we will ourselves escape it.

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So we watch and listen and read nonstop, vulnerable to the talking heads' claims that the Newtown youth shot all those people, because he was mentally ill. But to say that the cause of the tragedy was his mental illness explains nothing. One reason is that the huge category "mental illness" has never been defined to the satisfaction of even the therapists with the greatest power to define it (the authors of the handbook of psychiatric diagnosis: see Caplan, Paula J. (1995). They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal.), and since hundreds of millions of people are labeled with one or more kinds of mental illness, but hardly any of them -- no matter which label(s) they have been given -- commits even a single murder, those who say "It's because he was mentally ill" are in fact explaining nothing. This cacophony of arrogant, unthinking "experts" in the media makes me wonder whether producers of these publications and shows ever learned the most minimal critical thinking skills or whether they are simply told to throw critical thinking to the winds in favor of offering apparent answers that hold no water. 

Undergraduate psychology students are taught about homunculus theories, theories that are presented as explanations but really explain nothing at all. The word homunculus means little man, and such a theory goes something like this: "Why do people do bad things? Because there is something in them (like a little man) that makes them do bad things." The "explanation" that mental illness was the cause of this school shooting is a homunculus theory. 

In a sense, we are saying, "There's something called 'X,' and we kind of, sort of know a little about what 'X' is, and we are experts, but yes, other experts disagree with how we define or describe it, and there is no good evidence that people with, um, 'X' are more likely than other people to do 'Y,' but in this case, 'X' did lead to 'Y.'" 

There are some things we do not understand. Not yet. Perhaps never. Must we stop trying to understand? Surely not. But we must beware of prematurely declaring we have found the answer on the grounds that that's what Dr. _____ said on television. 

Thoughts about What We Can Do

We cannot bear feeling helpless in the face of tragedy, and there are actions we can take, although one such action may at first seem like inaction. 

Two kinds of action are:

(1) to work hard to reduce the availability of guns and other forms of quick and easy killing, and

(2) to press for answers to the question of why most media play down the possibility that psychotropic drugs precipitated this tragedy and many like it. Consider that it is rare these days for anyone diagnosed as mentally ill not to be put on one, more, or even a great many psychotropic drugs and that, as Robert Whitaker documents in Anatomy of an Epidemic, (based on World Health Organization and National Institute of Mental Health data) even the allegedly "mild" ones significantly increase acts of violence against oneself and/or others. Consider the enormous and often rapid changes in personality and behavior that psychiatric drugs can cause (see, for instance, the short videos -- and more to come in the next week or two -- in the YouTube series, "Watch the Stories of Harm the APA Refused to Hear"), and it is hard not to conclude that this possible connection cries out for exploration. 

My own position about psychiatric drugs is this: For some people, some drugs can help more than they harm, but that the reverse is more often true (see Whitaker's book), and anyone considering taking such a drug has the right to make that choice, but professionals and Pharma must take responsibility for ensuring that the person is offered all available information about its known benefits and dangers and is also offered all available information about the wide range of kinds of help that have been shown to be effective for people who are going through what they are going through. This degree of disclosure is exceedingly rare. I say all this to make it clear that I have not yet seen proof that this school shooter or any other murderer was driven to violence by psychiatric drugs, but we must ask the crucial question, "Why do the media focus so much on 'mental illness' and so little on psychiatric drugs as a possible explanation for violence?" I know some individuals and organizations claim that all school shooters were on psychiatric drugs, and that may or may not be true. But hundreds of investigative journalists should be ferreting out the information and climbing all over each other in their haste to get that information out there if it is correct.

A Washington Post story (http://www.washingtonpost.com/local/crime/adam-lanza-is-recalled-as-a-rambunctious-kid-with-family-problems/2012/12/14/795ad0fe-4641-11e2-8e70-e1993528222d_story.html) includes as its only reference to these drugs that a former neighbor said the shooter was "on medication." It seems that he had been on medication for some period of time, though nothing is said about how long ago that neighbor had obtained that information. And now I am speculating, but here is one possible scenario, putting together the tiny fragments of possibly relevant information: In a photo, the shooter appears pale and drawn. There are many potential causes of that appearance, but certain drugs can cause it, and some have been shown to cause dramatic changes in thinking, emotions, and behavior, including sometimes in violent directions. I repeat: This is speculation, but it is the kind of thing that any talking head in the media ought to check out.

When we want to stop our pain or the pain of others, taking action often feels like a solution, and I do not advise against action. Political engagement and activism can help people heal, as can reasonable attempts to explain or comprehend. But in the presence of pain, a particular kind of inaction is essential and humane. Let me explain.

As many media people press for news angle after news angle, they ask the "experts" how people hit by tragedy can cope. I am stunned. Do we not understand that most or all of the grieving parents, other relatives, and friends of all the dead surely still feel at this early time that their spirit has been knocked out of them, that they can barely breathe? But in dominant American culture, we want to race beyond the pain as fast as we can: Let's get started right this minute on the coping and the healing. It is cruel to do so. Instead, Dr. Joanne Cacciatore of the Center for Grief and Trauma in her essay yesterday writes with her usual gentleness and sensitivity about what we can and ought to do instead. Rather than reprint her essay here, I urge everyone to read every word of it at http://drjoanne.blogspot.com/2012/12/no-words-for-such-tragedy.html It is meaningful and full of heart. 

And I highly recommend Dr. Phyllis Silverman's deeply insightful, humane work, such as her book, Never Too Young to Know, which is purportedly about talking with children about death in honest and compassionate ways but which applies to all of us. As one example of her wisdom, she warns us not to tell people who are mourning at any point that it is time to "let go and move on," detach from the one who has died; instead, she urges, the mourners can search for different ways to remain connected to those who have died, through memories, feelings and thoughts, and actions in keeping with what they would have loved.

I learned a few years ago about a custom of Orthodox Jews at a time of grieving, and it touched me deeply. I was told that when we go to see a mourner, we should do nothing but sit silently nearby, because the mourner's needs and wishes at any moment -- and they may change greatly from moment to moment -- should be paramount. In our silence, we wait to see what they need. They may need silence, a drink of water, a story of someone's memory of the one who has died, a story about anything except the one who has died. If we even say, "I'm sorry for your loss," that puts a demand on them to respond, when responding may not be what they need. Grief, as the wonderful Dr. Nina Murray told me years ago, is exhausting. At a time of, among other things, that exhaustion, it is respectful not to put mourners in a position of having to dredge up energy to speak. This is such a different approach from what most people do. How often have people heard from those who had been dear friends, "I wanted to call or come over, but I didn't know what to say." At times like this, the greatest gift we can give those struck by grief is to ask nothing of them at all and to make clear that we will sit with them through their sorrow and despair and rage, that we will bear silent witness, and that they can indicate to us what they need us to do. It means redefining inaction, respectful and caring silence, and waiting as the most important action we can take.

I want to close with a request that we consider ways to increase community. Stories about Adam Lanza and his mother, Nancy, have already included many references to degrees of their isolation from others. We may never know what drove Adam to kill his mother, then all those children and adults, and finally, himself. But it can do no harm for each of us to make it our mission to offer more connection to those who for whatever reasons reside walled off from the care and friendship that just might help reduce their pain.

©copyright 2012 by Paula J. Caplan

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Paula J. Caplan, Ph.D., a clinical and research psychologist, is an Associate at Harvard University's DuBois Institute and former Fellow in Harvard Kennedy School's Women and Public Policy Program. more...

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