Criminal justice specialist Dr. Adam Lankford Conversation with Dr. Lankford on February 5, 2015.
rampage shooters, like suicide bombers Adam Lankford, The Myth of Martyrdom: What Really Drives Suicide Bombers, Rampage Shooters, and Other Self-Destructive Killers (New York: St. Martin’s Press, 2013).
Almost half of them died by suicide as part of their attacks. Forty-eight percent: 38 percent by their own hand, 10 percent “suicide by cop,” according to Adam Lankford, “A Comparative Analysis of Suicide Terrorists and Rampage, Workplace, and School Shooters in the United States from 1990–2010,” Homicide Studies, vol. 17, no. 3 (2013): 255–74, doi: 10.1177/1088767912462033.
mass shooters almost always follow Bryan Vossekuil, et al., “The Final Report and Findings of the Safe School Initiative: Implications for the Prevention of School Attacks in the United States,” www2.ed.gov/admins/lead/safety/preventingattacksreport.pdf, p. 21, accessed May 2015.
“suicide prevention is also murder-suicide prevention” Thomas Joiner, The Perversion of Virtue: Understanding Murder-Suicide (New York: Oxford University Press, 2014), p. 11.
planning with Eric for the rampage Conversation with Thomas Joiner, December 3, 2014.
“The difference is in what Eric thinks and how Dylan thinks” Langman, Kindle locations 947–49.
“They just don’t care” Conversation with Dr. Marisa Randazzo, February 19, 2015.
Dylan wanted to die Conversation with Dr. Dwayne Fuselier, January 29, 2015.
Chapter 13
An estimated one in five children and adolescents K. R. Merikangas, J. He, M. Burstein, et al., “Lifetime Prevalence of Mental Disorders in US Adolescents: Results from the National Comorbidity Study—Adolescent Supplement (NCS-A),” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 49, no. 10 (2010): 980–89, doi: 10.1016/j.jaac.2010.05.017.
Only 20 percent of those kids are identified US Public Health Service, “Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda,” US Department of Health and Human Services, Washington, DC (2000).
US Department of Health and Human Services, “Mental Health: A Report of the Surgeon General,” US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, Rockville, MD (1999).
A disease like depression can also have much more serious B. Maughan, S. Collishaw, and A. Stringaris, “Depression in Childhood and Adolescence,” Journal of the Canadian Academy of Child and Adolescent Psychiatry, vol. 22, no. 1 (2013): 35–40.
20 percent of teenagers experience a depressive episode US Preventive Services Task Force, “Screening and Treatment for Major Depressive Disorder in Children and Adolescents,” Pediatrics, vol. 123, no. 4 (April 2009): 1223–28.
A recent CDC report Centers for Disease Control and Prevention, “Youth Risk Behavior Surveillance—United States, 2011,” Morbidity and Mortality Weekly Report, Surveillance Summaries, vol. 61, no. SS-4 (2012), www.cdc.gov/mmwr/pdf/ss/ss6104.pdf.
teenagers (especially boys) tend to withdraw National Institute of Mental Health Depression in Children and Adolescents (fact sheet), www.nimh.nih.gov/health/topics/depression/depression-in-children-and-adolescents.shtml, accessed May 2015.
Losses and other events—whether anticipated or actual www.suicidology.org/ncpys/warning-signs-risk-factors, accessed May 2015.
unexplained somatic symptoms Dr. John Campo and colleagues published a study of children with unexplained recurrent abdominal pain in Pediatrics in 2001: 44.4 percent of the children they studied also met the criteria for major depressive disorder (MDD). They suggested that children who have recurrent abdominal pain might respond to life stress with physical symptoms. John V. Campo, et al., “Recurrent Abdominal Pain, Anxiety, and Depression in Primary Care,” Pediatrics, vol. 113, no. 4 (2004): 817–24.
the scratch read “Fags” Dave Cullen, Columbine (New York: Grand Central Publishing, 2010), p. 200.
Regina Huerter, director of Juvenile Diversion The report was not made public, although Dave Cullen shared his copy with me. Huerter’s testimony before the Columbine Review Commission was widely reported upon: extras.denverpost.com/news/col1202.htm, accessed May 2015.
Ralph W. Larkin independently confirmed Ralph W. Larkin, Comprehending Columbine (Philadelphia: Temple University Press, 2007).
Of the forty-eight shooters Peter Langman, School Shooters: Understanding High School, College, and Adult Perpetrators (Lanham, MD: Rowman & Littlefield, 2015).
“Apparently such behavior was common enough” Larkin, p. 90.
Larkin reports that throwing trash from moving cars Larkin, p. 91.
A 2011 study by the Centers for Disease Control Centers for Disease Control and Prevention, “Youth Risk Behavior Surveillance—United States, 2011,” Morbidity and Mortality Weekly Report, Surveillance Summaries, vol. 61, no. SS-4 (2012), www.cdc.gov/mmwr/pdf/ss/ss6104.pdf.
the number may be closer to 30 percent National Center for Education Statistics and Bureau of Justice Statistics, “Indicators of School Crime and Safety” (2011), nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2012002rev.
four times the risk of developing antisocial personality disorder W. E. Copeland, D. Wolke, A. Angold, and E. Costello, “Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence,” JAMA Psychiatry, vol. 70, no. 4 (2013): 419–26, doi: 10.1001/jamapsychiatry.2013.504. This Duke University study found that, compared with kids who weren’t bullied, those who were had four times the prevalence of agoraphobia, generalized anxiety, and panic disorder when they became adults. The bullies themselves had four times the risk of developing antisocial personality disorder.
a strong association between bullying and depression and suicide B. Klomek, F. Marrocco, M. Kleinman, I. S. Schonfeld, and M. S. Gould, “Bullying, Depression, and Suicidality in Adolescents,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 46, no. 1 (2007): 40–9.
Y. S. Kim and B. Leventhal, “Bullying and Suicide,” International Journal of Adolescent Medicine and Health, vol. 20, no. 2 (April–June 2008): 133–54.
The connection between bullying and violence T. R. Nansel, M. D. Overpeck, D. L. Haynie, W. J. Ruan, and P. C. Scheidt, “Relationships Between Bullying and Violence Among US Youth,” Archives of Pediatric and Adolescent Medicine, vol. 157, no. 4 (2003): 348–53, doi: 10.1001/archpedi.157.4.348.
bully-victims are at the greatest psychological risk T. E. Moffitt, A. Caspi, H. Harrington, and B. J. Milne, “Males on the Life-Course-Persistent and Adolescence-Limited Antisocial Pathways: Follow-Up at Age 26 Years,” Development and Psychopathology, vol. 14 (2002): 179–207.
D. Pepler, D. Jiang, W. Craig, and J. Connolly, “Developing Trajectories of Bullying and Associated Factors,” Child Development, vol. 79, no. 2 (2008): 325–38.
M. K. Holt, et al., “Bullying and Suicidal Ideation and Behaviors: A Meta-Analysis,” Journal of the American Academy of Pediatrics, (January 2015), doi: 10.1542 peds.2014–1864.
W. E. Copeland, D. Wolke, A. Angold, and E. Costello, “Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence,” JAMA Psychiatry, vol. 70, no. 4 (2013): 419–26, doi: 10.1001/jamapsychiatry.2013.504.
P. R. Smokowski and K. H. Kopasz, “Bullying in School: An Overview of Types, Effects, Family Characteristics, and Intervention Strategies, Children and Schools, vol. 27 (2005): 101–9.
the individual has seen a physician within the year before their death J. Pirkis and P. Burgess, “Suicide and Recency of Health Care Contacts: A Systematic Review,” The British Journal of Psychiatry: The Journal of Mental Science, vol. 173, no. 6 (December 1998): 462–74.
almost half of them Ibid.
Dylan’s arrest Recently arrested and incarcerated people are at higher risk for suicide. Thomas B. Cook, “Recent Criminal Offending and Suicide Attempts: A National Sample,” Social Psychiatry and Psychiatric Epidemiology, vol. 48, no. 5 (May 2013): 767–74.
Mary Ellen O’Toole, a former FBI profiler Mary Ellen O’Toole, “The School Shooter: A Threat Assessment Perspective” (Quantico, VA: FBI Academy, 2000), www.fbi.gov/stats-services/publications/school-shooter, accessed May 2015.
She warns against relying on a kid’s self-reporting Conversation with Mary Ellen O’Toole, February 23, 2015.
Chapter 14
Dr. Adrian Raine cites a study in which children Adrian Raine, The Anatomy of Violence: The Biological Roots of Crime (New York: Knopf, 2013), p. 171.
Chapter 16
“a place where no acting was required” Patrick O’Malley, “Getting Grief Right,” New York Times, January 10, 2015, opinionator.blogs.nytimes.com/2015/01/10/getting-grief-right/?_r=0, accessed May 2015.
Some of them were success stories, but some were not There appears to be a high risk of suicide in the weeks immediately after discharge from a psychiatric hospital. A. Owen-Smith, et al., “ ‘When you’re in the hospital, you’re in a sort of bubble’: Understanding the High Risk of Self-Harm and Suicide Following Psychiatric Discharge: A Qualitative Study,” Crisis: The Journal of Crisis Intervention and Suicide Prevention, vol. 35, no. 3 (2014): 154–60, dx.doi.org/10.1027/0227-5910/a000246.
H. Bickley, et al., “Suicide Within Two Weeks of Discharge from Psychiatric Inpatient Care: A Case-Control Study,” Psychiatric Services, vol. 64, no. 7 (July 1, 2013): 653–9, doi: 10.1176/appi.ps.201200026.
Chapter 17
clear brain differences between people K. Kiehl, et al., “Abnormal Brain Structure in Youth Who Commit Homicide,” NeuroImage: Clinical vol. 4 (May 2014): 800–7.
whether Dylan had a biological predisposition In The Anatomy of Violence (New York: Knopf, 2013), Dr. Adrian Raine has identified these as the leading causes of a biological disposition toward violence. In our conversation on March 24, 2015, he went so far as to ask me about our family’s fish consumption, as there is an impressive correlation between low omega-3 levels and violence. However, we ate fish at least once a week.
Too often, parents of seriously disturbed kids Liza Long’s son is bipolar. Her provocative blog post “I Am Adam Lanza’s Mother” went viral in 2012, and her subsequent book, The Price of Silence: A Mom’s Perspective on Mental Illness (New York: Hudson Street Press, 2014), is a searing indictment of how our education, juvenile justice, and mental health systems deal with brain illness in children.
“One cigarette won’t give you lung cancer” Conversation with Dr. Dewey Cornell, March 5, 2015.
“the public performance of violence” Mark Juergensmeyer, Terror in the Mind of God: The Global Rise of Religious Violence, third edition (Berkeley, CA: University of California Press, 2003).
“searching for a way to retire their public image” Conversation with Dr. Katherine Newman, March 16, 2015.
the immaturity of the adolescent brain Frances Jensen has written a fascinating book about adolescent brain immaturity and wiring: The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults (New York: HarperCollins, 2015).
Chapter 18
“a state of well-being” World Health Organization, “Mental Health: A State of Well-Being” (2014), www.who.int/features/factfiles/mental_health/en/.
RESOURCES
There are so many excellent resources out there that this list could easily be a thousand pages long. I’ve winnowed it down to the resources I recommend the most.
Suicide Prevention
If you or someone you love is in crisis (with or without thoughts of imminent suicide), call the National Suicide Prevention Lifeline for help.
National Suicide Prevention Lifeline
1–800–273-TALK (8255)
www.suicidepreventionlifeline.org
Your call will be automatically routed to a trained crisis worker who will listen and can tell you about mental health services in your area. The service is free and confidential, and the line is open 24/7. Everyone should keep this number handy.
The American Foundation for Suicide Prevention: www.afsp.org
Suicide Prevention Resource Center: www.sprc.org/Suicide
These two organizations provide amazing resources on a variety of topics, including how to recognize the warning signs of suicide and who’s at risk, what you can do to help the bereaved survivors of suicide loss, how to talk to children about suicide deaths in the family, and much more. Invaluable for survivors, educators, activists, and people at risk, as well as anyone concerned about this issue.
With so many programs available for suicide prevention and mental health, how do you know which one to use? A good place to start is the Best Practices Registry (BPR) on the Suicide Prevention Resource Center (SPRC) website. Programs are listed only if they meet “best practice” standards.
www.sprc.org/bpr
Mental Health First Aid (for Youth and Adults)
Mental Health First Aid, a national organization, offers hands-on training to help people recognize the signs of addiction and mental health distress. I’ve taken the course three times and think everyone should. It’s very powerful to know that for the price of one Saturday, you could save a life.
www.mentalhealthfirstaid.org/cs
Bullying
Bullying can be a problem with any age group; parents and schools can help.
www.stopbullying.gov
Peer Resources
Kids are more likely to talk to their friends than to an adult, so kids have to know what to do if a friend is struggling with suicidal thoughts. The “Save a Friend” tip sheet from the National Association of School Psychologists is a brief introduction to what every one of them should know. (Notice the importance of having access to a responsible adult or a crisis team member who has been trained to respond appropriately.)
Save a Friend: Tips for Teens to Prevent Suicide
www.nasponline.org/resources/crisis_safety/savefriend_general.aspx
School Response to Suicide
In the aftermath of suicide, the safety of other students can depend on how a school handles the tragedy. This booklet (created by the American Foundation for Suicide Prevention and the Suicide Prevention Resource Center) provides a practical road map for a difficult time. Aside from the Lifeline, I recommend this resource more often than any other.
After a Suicide: A Toolkit for Schools
www.sprc.org/library_resources/items/after-suicide-toolkit-schools
Violence Prevention
The Centers for Disease Control’s Division of Violence Prevention does important work. In particular, I would like to highlight the National Violent Death Reporting System, an invaluable tool in violence prevention.
www.cdc.gov/violenceprevention/nvdrs
This database offers comprehensive, anonymous reporting on violent deaths. Linking information about the “who, what, when, where, and how” from data on violent deaths helps us to understand why they happened. Over time, the database can show whether various efforts to prevent violence are working. Currently, only thirty-two states have the funding to participate.
Gun Safety
No matter where you stand on gun control and gun ownership, there is an undisputed relationship between access to firearms and increased suicide risk. The Means Matter program from the Harvard School of Public Health features informative and unique approaches to promoting gun safety for all. One of its initiatives, the New Hampshire Gun Shop Project, is a model for collaborative prevention without conflict.
www.hsph.harvard.edu/means-matter/means-matter
Media Guidelines
How the me
dia reports on incidents involving suicide can affect public health and safety in the aftermath of tragedy. These are some guidelines:
www.afsp.org/news-events/for-the-media/reporting-on-suicide
www.sprc.org/sites/sprc.org/files/library/sreporting.pdf
I would like to see a similar protocol developed for reporting on murder-suicide. Everything we do to increase knowledge, inhibit mythmaking, and minimize trauma makes our communities safer.
Threat Assessment
The Virginia Student Threat Assessment Guidelines provide schools with safe, structured, and efficient ways to respond to student threats of violence. This is a model for threat assessment that emphasizes early attention to problems such as bullying, teasing, and other forms of student conflict before they escalate into violent behavior. Now used in more than three thousand schools in eighteen states, this program trains multidisciplinary teams in a single day.
curry.virginia.edu/research/projects/threat-assessment
Threat assessment programs don’t simply reduce student violence. They can help teachers and staff identify kids at risk of many kinds of harm, including suicide, partner violence, and child abuse.
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Mother's Reckoning : Living in the Aftermath of Tragedy (9781101902769) Page 33