Monday Morning Crisis Quarterback

The details of yesterday's shootings in Newtown, Connecticut were just starting to trickle in when my Facebook feed began to light up with posts from friends saying what they thought this story was really about. These sorted fairly clearly into a number of categories:

• It's really about the need for gun control.
• It's really about the need to allow responsible people to carry weapons to protect themselves and those around them.
• It's really about the state of mental health care.
• It's really about the need to be better parents to our kids.
• It's really about what we have become as a society.

I have seen other commentators opine as well that this is really about the need to put God back in our schools, although that particular one hasn't shown up on my Facebook feed. The Westboro Baptist Church apparently is going to picket the funerals, because it's really about tolerance of homosexuality in our country.
While each of these thoughts have their own argument behind them, and while I certainly have my opinions about the relative validity of those, I'd like to suggest that all of them are red herrings.

All of these theories help us (or at least those who believe them) feel better, because they all boil down to one message: this could have been prevented. And we desperately need to believe this could have been prevented, because otherwise this could happen again, and it could happen to us. If these theories are right, however, we can make the world safe and neat again, and sleep better at night.

In addition, we are drawn to stating what this story is "really about" because, frankly, we can't stand to really contemplate what this story is really about.

What this story is really about is that 27 people, 20 of them young children, were brutally murdered in a senseless act of violence that we will never truly understand.

We need to let ourselves sit with that reality and feel the feelings that go with it. Only then will we be ready to have reasonable discussions about what, if anything, can be done to stop it from happening again.

Photo courtesy Reuters.

I am a mental health professional, a former principal and teacher, and an expert in responding to school traumas. But today, more than anything, I am a mom. Like moms and dads and other human beings today, my feelings about the shootings in Connecticut are complex and painful.

I came home tonight wanting to hug my child, and struggling with what to say. I offer my words here (followed by some description of how he responded and why I said what I did) not because they are the only or even the best way to approach this horrible incident with children, but because they are a way, and we have to start somewhere.

Here's what I said:

I need to tell you about something that happened today. It's kind of scary, but I think you're probably going to hear about it so I wanted to tell you so you can understand it and ask questions if you want.

Today something really scary happened in a school in Connecticut. There was a teacher there, I think she taught 1st grade, and she had a grownup son who had a very bad sickness in his brain. His brain was making him think very weird things. And he decided he wanted to kill his mom. But unfortunately, when he went to kill his mom, he went to her classroom where she was teaching, and after he killed her he also killed a bunch of the kids. It was very sad and everybody is talking about it and very sad and scared.

Every kid and every parent is different, and every conversation like this happens in a specific context. In our case, my son is 7 years old. He and I have had very recent conversations about mental illness in the context of the work I do as a clinician in Community Mental Health, and the terminology "sickness in the brain" is how we've described that. Another kid might need a different or more thorough explanation.

Of course, my son did have a few things to say:

• Where's Connecticut?
• Was the sickness like a concussion, or like people who don't know what day it is or think things are true that aren't?
• I don't want to talk about it.

To this last comment, I said, "That's fine, but if you do want to talk about it, or you have questions, you know where I am."

So, why did I choose these particular things to tell my son? There is method to my madness:

I need to tell you about something that happened today. It's kind of scary, but I think you're probably going to hear about it so I wanted to tell you so you can understand it and ask questions if you want.

Kids need to know it's OK to be scared, and that you can be scared and still function and be in control. As adults, we model this and open the door to talk about emotions. Also, this opener tells him that his understanding and processing is important, in general and to me.

There was a teacher there, I think she taught 1st grade, and she had a grownup son who had a very bad sickness in his brain. His brain was making him think very weird things. And he decided he wanted to kill his mom.

This begins to point out how unusual and out of the ordinary this incident is. Kids don't know, as adults do, that this kind of violence is rare. But they do have a sense that a very bad brain disease and thinking weird things is rare. Also, the focus in this description is not on the children as targets. By giving the shootings some background and context, my son is less likely to think of this and think, "the bad guys are coming for me."

It was very sad and everybody is talking about it and very sad and scared.

Here, again, the door is open to the idea that everyone -- not just kids -- has feelings about things like this. Scared and sad are OK, as is talking about it. Telling him about this is not specifically to make him talk or to make him scared, but to include him. He is important.

I don't know what questions or comments my son will make in the days and weeks ahead. I know if he has something to say, he'll say it. We talk about these things at my house. Hard as it is, that's how it should be.

More guidance on talking to children about violence and trauma is available here.

Update: Since I wrote this yesterday, we have learned that the shooter's mother died before the shootings at the school, and was not a current teacher. My son hasn't asked about the details today, so I haven't had occasion to correct what I said yesterday, and I'm not going to unless he brings the topic up. If I had it to do over again, I would still say largely the same things, except adding that after he killed his mom, he went to the school where he used to go when he was little to kill people. Note that I would not say he went to kill kids. We don't know that, first of all, and second of all it adds an emphasis that is unnecessarily scary.

For the last six days, the man responsible for the bombing and mass shooting that killed 77 people in Norway last July has been testifying at his trial. He admits that he was the person who carried out the attacks -- there is no question or controversy about that. This trial is being held to determine whether what he did was a crime and, if so, whether he was sane at the time he committed it.

The shooter's view is that this was not a crime. He has an elaborate and fairly paranoid political ideology which, he believes, justifies the attacks as part of a war against Muslims and multiculturalism. Since he was defending his people, he claims, this was not a crime. As far as I can tell, no one expects this argument to win the case.

The question of whether he is -- or was at the time of the attack -- sane is somewhat more complicated. There are two psychiatric reports in play. One says that the shooter has paranoid schizophrenia and was unaware of reality when he committed the crime. The other says that he is a narcissist, but he knew what he was doing and is responsible for his actions. The shooter, for his part, says he is sane.

This case points out some of the big problems with legal discussions of sanity. "Insanity" is a legal term, not a medical or psychiatric one. There are millions of people in the world at this very moment who have a disorder that is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) right along with paranoid schizophrenia, and they are legally sane. That is, they know right from wrong and can appreciate the consequences of their actions. In fact, there are millions of legally sane people with paranoid schizophrenia.

In fact, one of the mental disorders listed in the DSM is narcissistic personality disorder. In other words, both psychiatrists who have evaluated this man think he has a disorder. What they disagree about is which one, what type (personality disorders are considered to be in a different group or "Axis" from other mental disorders) and whether it impacted his ability to know right from wrong. (In another high profile case, the man who kidnapped and repeatedly raped Elizabeth Smart was found legally sane in part on the basis of a report that said he had narcissistic personality disorder as well.)

On an intuitive level, most of us have a sense that you can't be all there and do what this man did. You'd have to be "sick" or "crazy." But those aren't medical terms either. And obviously your view of right and wrong has to be pretty messed up to think this is OK. But most people who commit murder are legally sane, and most legally insane people don't commit murder.

Where is the line between wrong or bad or evil and insane? Where do messed up values and priorities cross the line into not responsible for your actions? I think that's a question that doesn't have an answer. We have legal standards, and we hope we'll know the difference when we see it.

In my next post, I'll take a look at the impact of the trial on the families of those who died. Stay tuned.

Frequent quarterbacker Alan (who blogs over at Poor Mojo) shared a new Time column today about Etan Patz, the New York City first grader who disappeared in 1979 in New York City. The case is in the news lately because police in search of clues have recently been digging up a basement near where the boy lived. The column talks about the ways we have come to expect that we can prevent bad things from happening to our children, be they stranger abductions or broken bones.

Alan comments,

The fact is your child is far more likely to die young in a motor vehicle accident than to be kidnapped by a stranger and murdered. Tens of thousands of times more likely. But car accidents are quotidian and kidnappings are good copy and so we live in terror.

I agree with Alan. We tend to vastly overestimate the chances of a child being abducted by a stranger (about 115 cases a year, with 60% surviving and only 4% remaining unsolved) and vastly underestimate their chances of being killed in a car crash. And car crashes are, indeed, "quotidian" (which I had to look up -- it means mundane or every-day). I suppose that kidnappings also make good news stories. But that begs the question, why do they make good news stories? And why don't car crashes make good stories, too?

First of all, the news tends to cover things that are unusual. If they covered everything, we'd never do anything but watch the news. This is why there is a real dearth of "good news" on as well. Good news -- or at least neutral news -- is actually much more common than bad news. For the most part, if good news is about something common, we don't expect to see it covered. There are no stories about your kid's birthday party, or the lovely bike ride you took last weekend. That's common.

Second, we also expect to see news that affects us, and this is where it gets complicated. Most of us, because it is common, are aware of the risk of traffic accidents. We believe, however, that we can master those risks. Those accidents happen to someone else -- someone not being careful, not wearing a seat belt, under the influence or otherwise foolish. We know what is dangerous about driving a car, and we don't do those things.

We also believe that we can master the risks to our children. We give them bike helmets and put them in car seats. We don't let our toddlers have small toys. We take them to the doctor. For the most part, in fact, we are right. Kids get hurt, sure, but most kids don't get killed in this country.

Stranger abductions make the news because they bring to our attention something that we don't want to admit. About 115 times a year, parents just like us have kids who are abducted. Those parents also had helmets and car seats and medical care. They kept an eye on their kids as best as they could. And someone took them anyway. They didn't master the risk. We want to know what they could have done differently so we can.

Etan Patz's story is compelling because it has to do with a child, because it was the first case to appear on a milk carton, and because it is unsolved. It is also compelling because he disappeared walking to the school bus alone for the first time ever. We all make that decision for our kids at one point or another. We all know it's a risk. We don't read about Etan because it's sensational. We read because we want it to be different for our kid.

Yesterday morning, a teenager walked into the cafeteria at Chardon High School in Chardon, Ohio and opened fire, apparently targeting a particular group of students. One died immediately, another at the hospital, and several others were seriously wounded.

The news coverage about this attack has repeatedly mentioned that the school had practiced for this kind of an event. Students say they didn't know whether this was a drill or the real deal. Teachers knew how to lock down their rooms. There's no way to know how many lives were saved by this training, or whether the shooter never intended to kill more people than he did.

The news coverage also mentions that parents outside the school were alerted to the situation through text messages from their kids, and kids inside the school spread information among one another via text. Since the Columbine attacks almost 13 years ago, most states and most schools have allowed cell phones in the classroom for just this reason -- to allow kids to communicate in a life-threatening emergency.

So, here's what's bugging me. If a school is in lockdown -- if they are trained to be in lockdown -- one of the things they should know is that, during a lockdown, you turn off your cell phone.

This may seem counterintuitive. After all, isn't the entire point of having a cell phone so you can communicate in an emergency? But during a lockdown you are locking yourself inside a dark room and hiding. You are trying not to be noticed, in case the gunman comes looking for more victims in your general direction. You are silent.

And if you are silent, that means turning off your cell phone. A ringing phone -- or even the sound of one vibrating -- can be the thing that tips off the bad guys to where you are and makes you a target. And you know that if the word gets out to parents that there's a gunman in the building, phones are going to start ringing. In a situation where a shooter may be looking to shoot anyone he can easily find, you just made yourself easy to find.

When I have been at schools that practiced lockdowns, the staff always are aware that getting kids to turn off their cell phones is going to be the hardest thing because it is so counterintuitive. But it has to be done.

There is a place for cell phones in these situations. A quick 911 call can mean the difference between life and death. But then the phone goes off. While contacting your parents or your friends may feel reassuring, it's not nearly as useful as staying alive.

In a story that made everyone's blood run cold, a resident physician specializing in pediatrics at the University of Michigan was arrested in December after investigators found child pornography on his computer. If that wasn't bad enough for you, it now turns out that another doctor found child pornography on a thumb drive at the hospital last May, determined to whom it most likely belonged, and reported it to her superiors, who assured her it was being dealt with according to protocol. It wasn't reported to the police until November.

So, let's get the righteous indignation out of the way first. If you're thinking, "Penn State," you're not alone. There seems to be a complete inability or unwillingness in certain circles to recognize that you report this sort of thing not because you are absolutely sure who did it or to whom, but because you want the police to try to make sure they don't do it to anybody again. Child porn is not a victimless crime. Not reporting it because you're not completely sure whose it is is like not reporting a burglary because you didn't see the burglar.

One of the huge mistakes leaders and organizations tend to make at moments like this is to think solely about what information they want to transmit, without thinking about what the recipient needs to hear. In this instance, the University could have issued a statement that said, "We were not required to report this under Michigan law. We followed procedures. We are now reviewing our procedures to see if they need to be revised." All of that would be true, and it would only serve to make people more angry.

But Michigan did something different. They appear to have recognized that, in addition to factual information, the public needs to know that the University knows this was wrong. Today, the CEO of the University of Michigan Health System wrote a blog post addressed to employees. In part, she wrote:

Early findings have identified significant problems with how initial reporting of these allegations was handled. . . . In situations like this when there are mistakes in how such a situation was handled, human nature makes us want to quickly identify and resolve the problem. However, jumping to quick conclusions and making assumptions with partial information isn’t the answer. That’s why the University is engaged in a comprehensive review into what went wrong in this particular case. This review and taking appropriate action are top priorities. . . . We will make improvements to prevent this from happening again.

This is crisis communication done right. It doesn't make excuses. It doesn't say we were right and the public is wrong. It doesn't try to downplay the significance of the problem. It takes responsibility and gives a plan for future action. It includes both what they want to say and what we need to hear.

I can't excuse this situation, and neither can the University of Michigan. It makes me nervous that someone suspected of having child pornography was treating children, in the hospital my family uses, for 6 months after the suspicion first occurred. But let me tell you, I'd rather bring my kids to a hospital that knows that was a mistake and is working to fix it than to one that doesn't.

Go blue.

Everything about this story is wrong.

Based on as yet very sketchy reports, here's what we know:

An 8th grader at Cummings Middle School in Brownsville, Texas, showed a gun in the hallways at school this morning. Police were called. They ordered him to drop the gun. He didn't. He appeared to aim it at them. They shot him. He died. The gun turns out to have been an air pellet gun.

When I say that everything about this is wrong, I don't mean to imply it's not true. It's just wrong. It doesn't fit the model of a good day at middle school, certainly, but it doesn't even fit the model of a bad day. A kid is either armed or he's not -- none of this pellet gun stuff. He either wants to die and kills himself or doesn't and puts down the gun. The violence is either threatened or real. This entire episode occupies this weird no-man's land between the possibilities our brains know how to deal with.

Given that , perhaps it's not surprising that everything about the press coverage is wrong, too. The headlines read things like, "Brownsville police kill teen at middle school." While technically accurate, it sure leaves a lot of important information out.

Whose fault is this? The kid, for bringing the gun in the first place and refusing to drop it and aiming it towards police? The police for shooting when the kid wasn't actually lethally armed? The school for calling the police? The parents for this kid having access to the pellet gun in the first place?

I don't think I've ever seen a case that both so clearly begs you to blame someone and so clearly illustrates why blame gets in the way of healing. Now that this incident is over, we can all point to numerous places people "should" have done things differently. But by "should," we mean "if they had, this probably would have had a different outcome." That's really different than saying that the outcome is their fault. It's so easy to confuse "should have" with "I wish they would have" or even "next time, I hope they don't."

This happened. Period. It will never have not happened. Everyone involved in it has to make peace with that fact. While preventing it in the future may be a priority, accepting it as part of the past has to happen, too. The messy question of whose fault it was can only get in the way of that process.