The dramatic series of recent school shootings in nearly every region of the country has forever altered the way American society views its children. Fueled by media accounts that convey the drama of kids out of control, politicians, public policymakers, school administrators and parents now struggle for answers. For psychiatrists the killings almost come as no surprise. They are the eerie culmination of ongoing parental and societal neglect, and an abject failure to address children's mental health, not only in impoverished neighborhoods but in middle-class and wealthy areas as well.
In an interview with Psychiatric Times three years ago, James P. Comer, M.D., a child and adolescent psychiatrist, and a professor of psychiatry at Yale University's Child Study Center, warned that without fundamental changes in the way we care for and nurture children, Americans could look forward to "a rapid downhill course" by the turn of the century. The spate of shootings over the last year is Comer's prediction come true; the deadly consequence of our culture's inability to adjust to dramatic social and technological changes.
"But we still have a chance to do something about it...if we really pay attention now," said Comer in a recent interview with Psychiatric Times. Warning that it is folly to consider these events solely as problems with the individual, he urged all adults to recognize that the violence reflects deeper and broader cultural problems that have to be rectified.
"We're going to have to work at systematically recreating the critical elements of community that once existed naturally," Comer said. "We can't go back to the past, but there was a time when people cared about each other and would look out for each other."
What should be happening now is a rethinking of how our social institutions, and especially schools, work to develop children into good citizens. "Schools are not just about raising test scores a few points," Comer said. Concepts such as zero tolerance disciplinary codes, daytime curfews for students as a means of controlling truancy and back-to-basics programs that eliminate enrichment programs are symbolic of efforts to restrict children's behavior. They actually represent an abdication of adult responsibility to teach the value of disciplined behavior to children. This abdication, coupled with the increasing isolation of children caused by fewer-at-home parents, and increased technology such as television, computers and video games creates a vacuum in our values system.
"What is happening is the kind of control, contain and punish mentality that is so pervasive in our society, and it's not a growth, development and individual responsibility mentality," Comer said. "The notion that individual responsibility isn't something you're born with is something that must be promoted." As a result, he added, schools ought to be working with parents and the community on ways to develop kids into responsible citizens and adults who are disciplined.
Psychiatrists and other professionals "who know about people" are often excluded from the process of developing public policy when it comes to child-rearing, Comer said. This has to change, Comer said, and psychiatrists need to become more involved in their communities.
It is too early to tell whether the adjustments Comer urges will take place, but if they don't, he said, the "situation can become more dire and more violent and more random." Meanwhile, national media coverage of shootings in places as diverse as Paducah, Ky., Jonesboro, Ark., Edinboro, Penn., and Springfield, Ore., has produced a contagion effect of increasing concern. When the Chicago Sun-Times, the nation's eighth largest daily newspaper, chose to report the Oregon shooting on page two, however, the move sparked controversy among journalists anxious about censorship.
In a note to its readers, Sun-Times editor in chief Nigel Wade expressed concern that "prominent reports of each successive incident could be contributing to the phenomenon." Later, reflecting on what he had said, Wade told Psychiatric Times that he had no evidence to support his view, but that his "feeling was there might be linkage between the coverage and the daily cycle of incidents. So I thought, let's take a new approach. We ran the story fully inside the paper...and it had the effect, I hope, of giving parents a chance to decide whether they wanted their children to see the paper or not."
David Shaffer, M.D., professor of psychiatry and pediatrics at Columbia University's College of Physicians and Surgeons in New York City, has participated in groundbreaking research on the subject of suicide clusters, and he agrees that there are analogies to be drawn to the repetition of school shootings. "We're really caught between a rock and hard place, because there is no question that when these things happen, it's news," Shaffer said. "We're all stuck with it being a highly reportable event, and the consequence is that it will be imitated by children of the same age because...this is the most vulnerable age."
Shaffer's colleague, Madelyn Gould, Ph.D., an epidemiologist at the College of Physicians and Surgeons and Columbia's School of Public Health agreed, saying that there "are kids out there who are walking time bombs" who will be set off by reports of violent acts elsewhere.
Even though "there are a lot of kids across this country who have very serious psychiatric problems," and who would have done "deviant things," Gould said that without the publicity given to the school shootings, she doubted these children would have done "this particular deviant act."
Without more attentive interventions that attempt to root out the reasons a child is acting out, these types of events could recur, Gould said. Just having a zero tolerance disciplinary policy for weapons, furthermore, does little to determine whether there are more serious emotional and psychological conditions that require attention.
"There are school health programs that need a boost in terms of mental health services," Gould said. "I don't mean they need to provide the treatment in schools, but at the very least they should do more systematic screenings to identify at-risk kids."
Lois Talbot Flaherty, M.D., is the chairperson of the American Psychiatric Association's committee on psychiatry and mental health in the schools. A child and adolescent psychiatrist in private practice in Blue Bell, Penn., she is also a clinical associate professor of psychiatry at the University of Pennsylvania School of Medicine in Philadelphia.
Although she agrees that contagion is a factor in the recent school shootings, she is also concerned by the host of other underlying factors that leads to these tragedies. The ready availability of weapons, along with excessive portrayals of violence in the media and in video games, for instance, are factors that teach deadly methods for handling conflict. Meanwhile, there are droves of troubled children and teen-agers who aren't receiving appropriate services, and the mix becomes volatile.
"The bottom line is that these kids can be identified, so what's needed is better identification and coordinated efforts between the schools and the community, including the mental health profession, criminal justice and the police," Flaherty said. "What you often find is that there has been some concern but the various pieces didn't get together to address it effectively."
Ultimately, psychiatry won't be able to have much effect on the way the media portrays school violence, according to William M. Buzogany, M.D., a Madison, Wis.-based child and adolescent psychiatrist who is the chair of the APA's committee on juvenile justice issues. "What psychiatry can do is try to educate people to be aware of the kinds of things that are happening so that they can hopefully spot problems," he said. "Psychiatry's responsibility is to help and educate people."
Ultimately, the job for psychiatrists is in the trenches, particularly in the schools where children spend so much of their time, said Marilyn Benoit, M.D., a private practice child psychiatrist in Washington, D.C., and a clinical associate professor of psychiatry at Georgetown University School of Medicine. Despite the often negative influences emanating from modern culture, psychiatry must be more successful at providing information to offset their destructive force.
"The message that needs to go out is that psychiatry needs to link up with the school systems because that is where the kids are. The teachers are like the foot soldiers and they are on the front lines," Benoit said. "We need to educate them about child development and the signs to look for in children that should raise concerns. We also need school-based health programs that include mental health."