Schizophrenia is linked with a different sort of impairment in cognitive empathy or "theory of mind," compared to autism. In autism, there can be
difficulty recognizing other people's thoughts or intentions, while in schizophrenia, there's a tendency to see intentional action where it doesn't exist.
For example, an autistic person might ignore someone who is crying because he doesn't realize that means that the person is upset-- while a person with
schizophrenia might see those tears and that emotional experience as part of an elaborate plot.
You might say autistic people have too little theory of mind -- while schizophrenic people have too much, seeing conspiracies, connected behavior and intent
in what are actually random coincidences. When this paranoia attaches to a particular person or institution, a real risk of violence can ensue.
As advocates point out, however, the vast majority of people with mental illness are no threat to anyone, except sometimes themselves. The mentally ill
and developmentally disabled are more likely to be victims of violent crimes than perpetrators of it.
So what about the psychiatric medications Lanza was said to have been taking: could they have spurred the killing spree? If he was on antidepressants in
the same class as Prozac, known as SSRI's, they could have been part of the problem, particularly if he had just started medication. "We do know that there
have been reports of idiosyncratic responses to SSRI's in adolescents and young adults suggesting increased suicidal and homicidal ideations," Perry says.
David Healy, a British psychiatrist who has studied the connections between medications and violence and testified in court cases related to the links,
says, "There is a general discounting of the possibility that psychotropic drugs could cause the kind of violence seen in Connecticuit or Aurora."
He adds, "Doctors and others stress that it is the illness not the drugs that causes violence and that we are grossly undertreating patients. But if we are
undertreating patients at least half of these school shootings should be perpetrated by individuals not on treatment when in fact comfortably over 90%
involve individuals on drugs."
Concludes Perry, "The bottom line is that we need to do a psychological autopsy on the shooter -- and other similar cases -- to see if there are reasonable
places where we can be better at identification of at risk individuals. And finally, the lethality of this kind of (almost incomprehensible) spree behavior
is magnified by the weapons used. 22 slashed Chinese school children is terrible -- but not as bad as 26 dead in Connecticut."
Moreover, a tragic irony of these cases is that the stigma they associate with mental illness actually contributes to the disorders themselves by deterring
the sick from seeking treatment and creating fear in others that adds to their isolation and depression. Says Bursztajn, "Stigmatizing people who are
already isolated makes it much more difficult for them to use their best social judgment and be able to distinguish between fantasy and delusion. The
highest risk factor for violence is social stigmatization." That's something we all need to keep in mind in coping with this complex, tangled tragedy in
light of our own emotions and the debate that will appropriately follow.