December 19, 2012

Predicting horrific acts still less science than art

Forensic psychiatrists have only begun to detect patterns in violent-prone offenders.

By MELISSA HEALY Los Angeles Times

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Pallbearers carry a casket out of St. Rose of Lima Roman Catholic Church on Tuesday after funeral services for Jessica Rekos, 6, who was among those killed when Adam Lanza walked into Sandy Hook Elementary School and opened fire.

The Associated Press

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Adam Lanza

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'Cutting Adam Lanza's hair was a very long half hour'

NEWTOWN, Conn. - As a teenager, Adam Lanza would come in for a haircut about every six weeks without speaking or looking at anyone and always accompanied by his mother, said stylists at a salon in the town where Lanza gunned down 27 people last week, including his mother, before killing himself.

He stopped coming in a few years ago, and the employees at the salon thought he had moved away, said stylist Bob Skuba.

The comments from him and his colleagues were among the first describing how the Lanzas interacted with each other. Investigators have found no letters or diaries that could explain the attack, one of the deadliest mass shootings in U.S. history.

Cutting Adam Lanza's hair "was a very long half an hour. It was a very uncomfortable situation," stylist Diane Harty said. She said that she never heard his voice and that Nancy Lanza also hardly spoke.

Another stylist, Jessica Phillips, echoed their descriptions of the Lanzas and added that Nancy Lanza would give her son directions about what to do and where to go.

Adam would move only "when his mother told him to," Skuba said.

"I would say, 'Adam, come on.' He wouldn't move," Skuba said. "And his mother would have to say, 'Adam, come on, he's ready.' It was like I was invisible."

He said Adam also wouldn't move from his chair after his hair was cut until his mother told him to.

If a stylist would ask Adam a question, Skuba said, his mother would answer.

"He would just be looking down at the tiles ... the whole time," Skuba said.

Former classmates have previously described Adam Lanza as intelligent but remote, and former high school adviser described him as anxious and shy. Several people who knew his mother have described her as a devoted parent.

Divorce paperwork released this week showed that Nancy Lanza had the authority to make all decisions regarding Adam's upbringing. The divorce was finalized in September 2009, when Adam Lanza was 17.

-- The Associated Press


After a person has committed horrific acts of violence, the signs often seem plain to see: He was always a loner, say fellow students; he may have been bullied, former teachers speculate; he was hit hard by a disintegrating family situation, neighbors suggest.

But predicting whether an individual is on a path toward violent behavior is anything but simple, say experts. Even for highly trained mental health professionals, assessing an individual's risk of becoming violent is an exercise in complexity, in probability -- and in humility.

Some advances have been made since 1983, when the Supreme Court said the mental health profession was "not always wrong" in making such calls -- "only most of the time."

Forensic psychiatrists and psychologists have begun to detect patterns in the histories, behavior and even genetic makeup of violent offenders. But if they rounded everyone up who fit the emerging profiles, the dragnet would draw in many more harmless individuals than it would murderers.

As law enforcement officials in Newtown, Conn., pore over the life of 20-year-old Adam Lanza for clues to what set off his murderous rampage, forensic psychologists and psychiatrists say they are getting better at near-term forecasting -- if the troubled individual steps forward to get help.

"Skilled and practiced mental health professionals have gotten a lot better at predicting short- term dangers," said Dr. Stephen E. Pitt, a forensic psychiatrist who consults with the Phoenix Police Department and directed the Columbine Psychiatric Autopsy Project after the 1999 school shootings in Colorado.

"But who's going to commit violence in some unspecified future? You might as well consult a Ouija board."

For psychiatric patients who show up in emergency rooms and doctors' offices, a recent study found that a simple checklist of five recognized risk factors for imminent violence could bring the judgment of newly minted psychiatrists nearly up to the level of far more experienced ones -- who can identify a potentially violent patient roughly 70 percent of the time.

Patients more likely to become violent in a health care setting were most often those with active symptoms of mental illness and impulsiveness, who lacked insight into their conditions or were disconnected from reality, displayed negative attitudes such as lack of empathy or remorselessness, and who responded poorly to treatments such as anti-anxiety medications.

In assessing an individual's propensity for violence beyond that, a few signposts have come to be recognized as reliable warning signs, even if they do not always point to trouble. Most important is a history of past violence, and not always violence that would rise to the attention of others. Animal cruelty or torture, or even an escalating history of fistfights, can send up a red flag.

University of Michigan psychiatrist Alan Teo, whose study of short-term risk assessment was published in September, noted that patients with "command auditory hallucinations" -- unseen things or people ordering them to do something -- are manifesting a "potent risk factor" for violence. At the same time, Teo warned that people exhibiting paranoia are at no higher risk than anyone with mental illness to carry out violent acts against others.

"The vast, vast majority of people with mental illness are never, ever going to be violent, and even schizophrenics with paranoia are not going to be," Teo said. "Paranoia in and of itself does not raise my rating of violence risk. The public should not assume a person with paranoia is actually a danger."

"A lot of people every day are walking around with many risk factors for engaging in violence who do not," Pitt said. "Other psychosocial variables have to come together" to move a troubled person to mayhem, he added.

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