Psychopathy vs. Psychosis & the case of Adam Lanza

Adam Lanza by the few accounts read, was brilliant, socially withdrawn and may have been unable to feel- pain, pleasure or anything in between. The picture at this point isn’t very clear. The comparisons and speculations run rife as we try to comprehend this awful tragedy, and as such anecdotal diagnoses from autism to schizophrenia to “wicked child” abound. We certainly cant say for sure what went wrong in the mind of Adam Lanza but we can already see there were distinct patterns of “abnormality”.

This abnormality culminated in the tragic murder of 20 children under the age of 10 and seven adults at Sandy Hook Elementary School in Newtown, Connecticut in the morning hours on Friday 14th of December.

Let me make it clear, those innocent children and heroes who gave their lives to save them deserve their own peace and are never to be forgotten. It certainly was not their fault and they did their best in the face of extreme chaos and murder. The parents who will never see their children again will bear this tragedy in a way unfathomable and I can only hope they find solace in the love they shared and experienced as they grieve. I myself have two small children and I cannot even begin to imagine what I would do in their situation. I know I would need sedation at the very least.

However, Im compelled to write as I see the familiar trend of trying to ascribe symptoms of psychosis to Adam Lanza, and blatantly erroneous comparisons to Jared Lee Loughner. Psychosis and the symptoms of not being able to differentiate reality from a dream are quite different from being unable to feel- empathy, pain or pleasure. Its quite different from , what some people with psychopathy report as, a disconnection between themselves and others and of a morbid curiosity with inflicting pain, watching death and causing destruction.

I’ve already written on the psychosis of schizophrenia and Jared Loughner, so I wont go over it here, you can feel free to read my blog post on your own. However we don’t want to make the mistake of squashing psychopathy into psychosis in an effort to understand as it makes this complex disorder even more difficult to parse.

Psychopathy is a mental illness of a different kind. In children, we see traits of fire setting, lack of empathy, pranks that purposely cause near death experience for their victims, threats to kill others and themselves and manipulation as hallmarks and high risk factors for future psychopathy. At this point we in mental health are reluctant to call any child a psychopath, but we know what we are looking for when parents and schools look to us for explanations.

When we look for the hallmarks in our patients we try to identify intent and means to determine risk to themselves and the public and believe me easy access to automatic weapons certainly makes the means well within reach of people with this disorder.

Although I’m tempted and believe we need stricter gun control laws and limited access to automatic weapons, this is not the forum for that discussion.

The child with these symptoms can hardly explain it themselves and some describe it as feeling as if they’ve blacked out and are taken over by this “other self”. They have their trigger hair temperaments at the ready and use their often brilliant minds to maneuver throughout their existence. Its as if the “remorse switch” is disconnected. Ryan Lanza could hardly explain his own brother either and described him to authorities as autistic or having a personality disorder. A curious but inaccurate and confusing diagnosis. But I suppose anyone would have great difficulty using the word psychopath to describe your sibling…right?.

The effects of psychopathic traits in our children include parents that feel afraid and helpless, classmates that feel scared, and broken mental health care systems that can only think of jail or high security mental institutions as solutions.

So what are personality disorders?
Personality disorders are pervasive maladaptive patterns of operating in life. Those who struggle with a personality disorder have great difficulty dealing with other people.
“They tend to be inflexible, rigid, and unable to respond to the changes and demands of life. Although they feel that their behavior patterns are “normal” or “right,” people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.”(

They can be dependent, narcissistic, borderline but they all include manipulation to a greater or lesser extent. There are three clusters of PD’s people can have:

Cluster A: Odd or eccentric behavior
Cluster B: Dramatic, emotional or erratic behavior
Cluster C: Anxious fearful behavior

Adam Lanza may have had a personality disorder, he may also have been psychopathic. Sociopathy and psychopathy can often be found in the cluster A and B types of personality disorders. However, I’ve never treated him or any of his family members and so my speculations remains just that- speculation.

Another possibility is that the little we know about the causes of psychopathy may implicate a disorder of the brain. A conflagration of developmental, genetic influences that react to an environment in a particular manner. I suspect, without getting too much into neuroanatomy, that the problem may be found in the pre frontal cortex and there may be disruption of the limbic system, structurally and in the neurotransmitters. I hope that fMRI and other advances in brain imaging will help us to really dig deep in this disorder in order to try to prevent or refocus it before it becomes unmanageable.

I’ve been asked about treatment but unfortunately there is no cure for psychopathy principally because the volition to change is mutable and our understanding of it at this time is severely limited. The best we can do at this moment is to try to help children and adults to manage their emotions and try to adapt in more proactive and socially acceptable ways through consistent training and retraining in environments with well trained clinicians and therapists.

Yes we need mental health care people, we need to expend significant resources in order to spot the issue and treat it as best we can as early as we can. It will take a tremendous amount of capital, facilities, schools, teachers, clinicians. We need continuous advances in detection and treatment. Though our sensitivities of right and wrong demand and eye for an eye, mental illnesses like psychopathy will not go away with medication and will be with all of us until we confront it and deal with it like we would any other chronic disease.

Finally, my point is, we need to be careful in our diagnosis, confront our real feelings about this horrific crime, and accept that people who are psychopathic are mentally ill, its not one or the other.
We need proper mental health care from birth to death ad infinitum.

Im sure this is not the last I will speak on this but for now I can only express deep sorrow for the parents, relatives and the Sandy Hook Elementary school.