Reply to Adam Lanza, Aspergers and the press-here we go again

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[quote=Anonymous][quote=Anonymous]Adam Lanza was an adult.  How were his parents supposed to "hospitalize him.[/quote]

+1.

What I thought was sad about the article was the ignorance that the father and the journalist displayed about the VERY COMMON problems that parents of the mentally ill have.  I was surprised the journalist didn't ask the father more questions about the medication issue and that the journalist didn't elaborate with more context in the article about these problems as experienced in society.  (The journalist certainly did elaborate about the medication in the individual case of Lanza.)  The journalist certainly knows, as he has written frequently on mental health issues.  Perhaps this is a result of the lasting stigma against mental illness.  For a long time we have segmented off certain brain-based disorders like Autism as "real" neurologically-based disorders from "mental illness" which we still stigmatize as deficiencies of character or morals.  Even the line between "real, brain-based" and "mental illness" is fuzzy because we know that many children with learning disorders or autism also come to experience depression, anxiety, etc. as a result of the social isolation and failure of society to properly treat and accommodate them and that "neurological" issues may also be co-morbid with mental illness (such as the OCD and anxiety in Lanza's case).

For example, medication is a major issue.  Most mentally ill patients have to try numerous medications, some with serious side effects, before they find one that works, if ever.  As a parent, I read the description of Lanza's medication attempt and understood why they might not have tried another medication.  The severe side effects described, including a loss of touch with reality, would have made me, as a parent, hesitant to try again, particularly when often the next medication to try is in a similar class of medicines.  I was also surprised to read that Lexapro was prescribed, which, IMO, was a totally inappropriate med to try in this situation (based on what I could see in the article).  Lexapro is an antidepressant, and while it's one of a number of anti-depressants that are often prescribed for OCD, it's side effects would only reinforce the anxiety and sleeplessness mentioned in the article.  (The sleeplessness, in particular, would have made me very wary of trying any antidepressant.)  Perhaps things would have been different if the psychiatrist had offered sleep and anti-anxiety meds first instead of the anti-depressant.

Parents often find that they are not able to "force" their children to accept or comply with treatment -- this issue arises particularly in the teens and early 20s, when the child has become big enough to refuse but is often still supported and/or living with the parents.  Many states will not "force" treatment or entry into a psychiatric facility unless the patient is a demonstrated imminent harm to self or others, and there was no history of this with Lanza (interest in violent games or events wouldn't be enough to meet the "harm to self or others" standard.  Few states have "assisted outpatient treatment options" which are basically treatment plans forced through the state courts.

It's easy to see how the Lanza's didn't look into hospitalization or further psychiatric treatment.  Autism and Asperger's are thought of as neurological disorders of the brain that result in, among other things, social dysfunction.  As a parent, it wouldn't have been clear to me that a psychiatrist or psychiatric facility would have known how to treat Adam, particularly if the social isolation was seen as a result of Asperger's and not some other diagnosis like schizophrenia (which often shows as a symptom "flat" affect and social isolation).

Finally, I was saddened to see the reference to how Lanza "refused to accept the diagnosis".  It is the experience of many family members of the mentally ill that their "refusal" to accept the diagnosis or accept medications is characterized as "denial" and this is often reinforced by physicians and other health professionals.  (I thought this outlook characterizing refusal as "denial" was clearly evident in the nurse's comments that "Adam likes to believe he's completely logical, in fact he's not at all and I've called him on it.") "Anosogonia" is the term that describes a patient's lack of comprehension of their deficits.  It is not denial, but rather a real, brain-based, inability to recognize the deficit in full and its implications.  How I wish Adam Lanza had had the good fortune to come across a health professional more familiar with anasogonia and prepared with appropriate techniques to guide Lanza toward medication trials and acceptance -- someone like Xavier Amador, perhaps.

It's vey easy to look at the situation and blame the parents for not "insisting" on medications, but the reality is more complex than that. [/quote]

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