The Big Picture

A man named Edward Charles Allaway walked into a college library at California State University in Fullerton, Calif., and, using a .22-caliber rifle, killed seven people and wounded two others in 10 minutes. One of the few individuals who was successfully defended with a plea of insanity, Allaway was ultimately committed to a state psychiatric institution. This incident is not ripped from today's headlines, but from newspapers with a 1976 dateline.

With the recent spate of similar shootings, experts and society wonder if anything has changed. The answer is yes, things have actually gotten better. Over the past several years, crime statistics, with few exceptions, have shown a dramatic decrease in murders and other violent crimes. Despite a 9% increase this year, the 569 murders in New York City as of Oct. 31, 1999, is way off the pace set in 1990, when there were nearly 2,250 murders. The country, it seems, has become a safer place.

So why, then, is there an upswing in the sensational, often bizarre mass shootings that present heart-wrenching images of desperate victims fleeing the carnage? In schools, churches, day care centers and places of business, some outrage occurs almost monthly. In the time it took to research and write this article, for instance, workplace shootings took place in Hawaii and Seattle, leaving multiple dead and wounded victims. It is no longer just the quantity of violence that disturbs the experts, it is the quality.

Paul J. Fink, M.D., a professor of psychiatry at Philadelphia's Temple University School of Medicine, chairs the American Psychiatric Association's task force on psychiatric aspects of violence. "There is a real epidemic of intermittent disasters that are difficult to classify and to lump into a single definition," he told Psychiatric Times. "There is a fabric of multiple reasons why we are looking down the barrel at these various mass murders."

Part of the reason for this epidemic, Fink said, is the increased predilection of individuals to respond violently to problems and frustrations. He blamed, to a significant extent, the news and entertainment media, which "glorify gratuitous violence, and have made it part of the American culture." These images have become commonplace, he explained. Adults see them regularly and, more worrisome, so do children.

Fink also said that over the past several decades there have been growing numbers of "disaffiliated kids" without two parents. They either have "multiple parents" or only one, and that is a disaster for many children who need an intimate, family-based support system. In addition, too many children in America are brutalized, either physically or through neglect, and they grow up to repeat these violent acts.

Children who are traumatized by witnessing or experiencing criminal or family violence often go untreated, said Fink. Meanwhile, these shootings are committed by adults and children who have grievances and frustrations but not the life skills to deal with them, so they are only left with revenge as a motivation. Although revenge has been around for a long time, Fink added, the hundreds of millions of readily available guns in the United States allow ready access to the means to accomplish savage payback.

As a result, Fink said he believes firmer gun control and greater attention to children when they are young are keys to ultimately resolving the problem. He emphasized that it is critical to assure that mothers and children bond, that preschools and Head Start programs get kids off on the right foot, and that children at risk are identified and provided with access to mental health care services.

As children age, Fink explained, more dramatic interventions may become necessary. In Philadelphia, a 30-hour educational program for juveniles caught for the first time with a gun includes a visit to the morgue. He said the object lesson has been successful in dramatically reducing recidivism. Of 50 participants during the last year, only three have been rearrested.

"One of the big problems is that instead of looking for why kids are bad or doing things that are terrible, people think that applying punishments is the only way to deal with this," Fink said. "I think that's wrong. Maximal punishments and trying children as adults is crazy without some effort to actually figure out why a particular kid is doing a particular thing at this particular time."

James P. Comer, M.D., is the Maurice Falk Professor of Child Psychiatry at the Yale University School of Medicine's Child Study Center. Comer is also the founder of the Comer School Devel-opment Program, which has spent over 30 years promoting the collaboration of parents, educators and community to improve the social, emotional and academic outcomes for children. His concepts have spread to more than 450 schools throughout the United States. Referring to himself as a "pessimistic optimist," Comer told PT there is still time to avert the factors that lead to violence, but he warned that the failure to take the necessary steps could yield a more dangerous and less free society.

"There has been a change in communities and life created by the application of science and technology," Comer said. He foresaw an upsurge in violent incidents years ago, predicting their arrival at the end of this century. "Nobody wanted to hear what science and technology advances were going to do," he said, "so I took it out of my speeches and concentrated on my education work."

Adopting an ecological perspective that looks at how all the elements of society interact to create an impact, Comer said that our culture has a tendency to believe that everything that happens is primarily due to the actions of the individual. In reality, he asserted, it is both the individual and the environment that are responsible for behavior. Since the 1950s, profound advances in mobility and in our ability to transmit ideas and images have undermined community closeness. Along with parents, children were once embraced by local churches, schools, civic organizations and businesses, and they were imbued with strong values and accepted ways of behavior. Without an adequate replacement for these societal institutions for guidance and development, the opportunity for children to learn to act inappropriately has increased. "As a result, we're getting more and more psychopathology among young people who become adults with the same types of problems.

"Crime is down in general because of the tone prosperity sets and the age cohort of individuals 18 to 35 years old, where most crime is committed, is a smaller group now," Comer said. "But they're coming back, and they will be back. If we are going to become a society that depends on police for order, we're in deep trouble, because they can never provide a tradition that will create safety."

Rather, Comer urges parents and teachers, along with community, economic and political authority figures, to create a tone in which individuals learn to control themselves. Ultimately, punishment and control won't work, but addressing the underlying factors that lead to violence can avert the current trend. Comer added that schools are the best institution at this point to organize the resources to assure that children grow to adulthood with proper values and behavioral controls.

Sandra J. Kaplan, M.D., is also a member of the APA's task force on psychiatric aspects of violence and chairs its committee on family violence and sexual abuse. After spending time in the Manhattan courts working with lawyers for juveniles, she is concerned by the lack of mental health care services for children who commit violent or criminal acts.

Substance abuse and depression are still underdiagnosed, she said in an interview with PT, thus leaving many children untreated. Combining social stresses, family breakups, media influences and the availability of guns, a volatile situation develops that inevitably leads to violence. She also believes it is likely that there is a contagion effect influencing young people, and to a lesser extent adults, with news stories about mass murders encouraging copycat techniques.

"As a society, we don't value each other enough and don't value human relationships or family relationships," Kaplan said. "We should be teaching much more about social behavior and relationships to children, including kindness, empathy and mechanisms for controlling emotions. We also need to work harder at destigmatizing mental illness so that it's viewed no differently than other health problems."

Ultimately, there will most likely need to be an expanded role for psychiatry, Joe P. Tupin, M.D., professor emeritus of psychiatry at the University of California, Davis, School of Medicine told PT. "Psychiatry has historically looked primarily at individuals who are identified as patients and who are considered to have some sort of illness," he said. "But our future contribution may not only be to identify and treat people to forestall some future violence, but to also collaborate with others in a variety of fields to create cultural changes that will diminish the impact of negative societal forces."