Sandy Hook Elementary School Research Articles

Emergency and disaster readiness must consider unique needs of children

With the devastation of Hurricane Sandy and the unimaginable tragedy at Sandy Hook Elementary School still painfully fresh, the Commentary by Lurie and Kahn, published in this issue of The Journal, takes on special poignancy and urgency. The “take-home” message of this Commentary? Emergency and disaster readiness are important public health concerns. Until recently, efforts to promote preparedness for both natural and “man-made” disasters, and more recently, terrorism, typically were not targeted to address the specific needs of special populations, such as children. This Commentary demonstrates how the creation of awareness (through advocacy and education) within key Federal departments and agencies can result in productive collaboration between the public (government, public health) and private (hospitals, physician groups) sectors towards improving our readiness for the unique needs of children. The authors make a compelling case not only to consider the needs of children as survivors, but how youth can be empowered to be part of a whole community response. Article page 274▶ Ensuring the Health Security of America's ChildrenThe Journal of PediatricsVol. 163Issue 1PreviewThe US Department of Health and Human Services (HHS) has made ensuring the safety and well-being of the nation's children in the wake of disasters and public health emergencies a priority. More than one-quarter of the US population is younger than 20 years of age,1 and addressing the unique physiologic and developmental needs of children must be an explicit part of preparedness and response activities. The American Academy of Pediatrics (AAP) and the National Commission on Children and Disasters (2008-2011) have advocated for comprehensive planning and policies regarding emergency preparedness for children. Full-Text PDF

Media Spectacle and Domestic Terrorism: The Case of the Batman/Joker Cinema Massacre

With the brutal massacre of children and administrators at the Sandy Hook Elementary school in Connecticut on December 12, 2012, following the killing of innocents in an Oregon mall shooting earlie...

Childhood Grief Related to the Death of a Sibling

Unfortunately, children die each day, many leaving a childhood sibling survivor. Events such as those at Sandy Hook Elementary School or inner city violence bring the plight of the childhood sibling survivor more to the forefront. Although previous literature and research have focused on the grief process of adults or teenagers, an urgent need remains to understand the grief process of the younger sibling survivor. This article examines the grief process of a sibling survivor within the framework of childhood developmental stages to assist the family nurse practitioner in caring for the sibling survivor on the grief journey.

Laws That Bit The Bullet: A Review of Legislative Responses to School Shootings

The recent mass shooting at Sandy Hook Elementary School in Newtown, Connecticut sparked an immediate discourse calling for a review of gun control legislation. However, this discourse was not new; rather, it was one that routinely follows this type of tragedy. In the wake of school shootings such as Columbine, Virginia Tech, and Jonesboro, a similar discourse appeared which prompted policymakers to introduce a number of pieces of legislation aimed at more efficient firearms regulation. While a few of these bills were enacted, many never made it past introduction. The flurry of legislative responses to such incidences warrants further discussion as to whether these bills are effective, or rather simply “feel good legislation.” Further, public opinion is a driving force behind such policy, but how can this change in the wake of school shootings? This paper examines both considerations and proposes directions for continued research in this critical and understudied area.

Understanding Breivik and Sandy Hook: sin and sickness?

In a recent issue of World Psychiatry 1, I. Melle attempted to make sense of the case of Anders Breivik, the Norwegian convicted of killing 77 people in 2012. Sadly, in the same year, Adam Lanza stormed Sandy Hook elementary school in Connecticut and killed 26 people, including 20 children.

The Need for Appropriate Use of Involuntary Commitment

Back to table of contents Previous article Next article LettersFull AccessThe Need for Appropriate Use of Involuntary CommitmentJeffrey L. Geller, M.D., M.P.H.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H.Published Online:1 May 2013https://doi.org/10.1176/appi.ps.640501AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In an article in the February issue, McGarvey and colleagues (1) reported the results of a study of factors that play a role in decisions to initiate involuntary commitment among emergency evaluators employed by community service boards in Virginia. The authors conclude, “The findings provide a sound empirical basis for the claim that investing in a continuum of crisis stabilization and other intensive outpatient services would reduce the need for involuntary interventions.” But the article does not provide data to support this conclusion.And what was this study? It was a questionnaire completed by emergency clinicians throughout Virginia after they had conducted an evaluation. The questionnaire asked whether certain currently unavailable services would have better addressed the individual’s needs. Well, sure. We didn’t need a study to find that out. This study basically says: “Here’s what you currently have for resources. Now fantasize about all these other possible resources. If one of them were available, would this have better met the needs of the person you evaluated?” Is nirvana better than reality?I have fantasized about, designed, and implemented services, and I have also evaluated the relationship between the conceptualized service and reality and examined outcomes (including outcomes in Virginia). And, like others, I know that it is a big stretch from conception (fantasy) to the delivered service.In the study by McGarvey and colleagues, respondents were not asked: “Would you actually have been able to access the service for the individual? What would have been the impediments to obtaining the service? If it took three to four times longer to obtain the service than to involuntarily commit the individual, would you have been able to wait? Would the patient have been willing to use a proffered service voluntarily? Would there be financial impediments to using some of the alternatives?”I am not saying that expanded, well-provided community services would not divert individuals from involuntary hospital admission to voluntary community services. But these community services might do such a good job at case finding that more individuals would end up being involuntarily admitted after the development of the community services than before. This was our conclusion when Massachusetts doubled its mobile crisis capacity with no subsequent decrease in inpatient hospitalization rates (2).Finally, if psychiatrists don’t figure out how to appropriately use involuntary services, others will tell us what we must do. In the wake of Seung-Hui Cho’s massacre at Virginia Tech in 2007, many thought that too few involuntary treatments were available (3). The same has occurred in the wake of Adam Lanza’s shooting spree at Sandy Hook Elementary School (4).We need to be at the table both to design effective involuntary interventions—those that we can actually use—in the hospital and in the community and to expand intensive community services. These can be complementary. They must be.Dr. Geller is facility medical director, Worcester Recovery Center and Hospital, and professor in the Department of Psychiatry, University of Massachusetts Medical School, Worcester.References1 McGarvey EL, Leon-Verdin M, Wanchek TN, et al.: Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatric Services 64:120–126, 2013Link, Google Scholar2 Fisher WH, Geller JL, Wirth-Cauchon J: Empirically assessing the impact of mobile crisis capacity on state hospital admissions. Community Mental Health Journal 26:245–253, 1990Crossref, Medline, Google Scholar3 Fisher M: When laws create barriers to care, the consequences should be no surprise. Washington Post, April 20, 2007, p A12Google Scholar4 Change law on mental health (editorial). New Haven Register, Jan 12, 2013. Available at www.nhregister.com/articles/2013/01/12/opinion/doc50f20aae873fc487952997.txtGoogle Scholar FiguresReferencesCited byDetailsCited ByNone Volume 64Issue 5 May 2013Pages 496-496 Metrics PDF download History Published online 1 May 2013 Published in print 1 May 2013

The Twin Children of Auschwitz–Birkenau: Conference on Nazi Medicine/Research: Genes and DZ Twinning; IVF Versus Spontaneous Twinning; Gender Identity Disorder; Royal Protector: Danish and Australian Twin Registries/Human Interest: MZ Twin Co-Principals; Twin Loss at Sandy Hook; Twin Documentaries; New Twin and Twin-Like Reunions; Prominent Twins’ Passing

The twin children who survived the Holocaust and the horrific medical experiments conducted by Nazi doctors are sometimes overlooked in the relevant literature. This topic and more were discussed as part of an annual conference hosted by students from Yeshiva University's Medical Ethics Society in October 2012. A selective summary of this meeting is followed by summaries of recent twin studies concerning genetic influences on twinning, in vitro fertilization versus spontaneous twin pregnancies, gender identity disorder, and royal support for twin registries. Several human interest stories are also worth noting. They include identical twin school principals, twin loss at Sandy Hook Elementary School, timely twin documentaries, new twin and twin-like reunions, and the passing of two prominent twins.

Firearm Injuries as a Public Health Issue

The full article is available online (Open Access). In 2011, firearm injuries accounted for 32 163 deaths in the United States, nearly as many as the 34 677 fatalities from motor vehicle traffic accidents. The total includes 19 766 suicides, 11 101 homicides, and 851 deaths from the accidental discharge of firearms... Yet federal law prohibits all Department of Health and Human Services (DHHS) agencies, including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, from using funds, “in whole or in part, to advocate or promote gun control.” The ban has applied to the CDC since 1996, and, more recently, to the entire DHHS. The meaning of the clause is not clear—preventing firearm injuries and gun control are related but are not synonymous—but it has effectively ended federal support of gun research. Kellerman and Rivara note that at the CDC, “no federal employee was willing to risk his or her career or the agency's funding to find out [what the clause meant]. Extramural support for firearm injury prevention research quickly dried up.” The federal government's neglect of firearm injuries as a public health issue is a national shame that should be urgently corrected. Reducing lives lost to gun violence is a public health issue about a major mechanism of fatal injury, not a Second Amendment to the US Constitution issue about “the right of the people to keep and bear arms.” Following the mass shooting of school children and educators at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012, the CDC's website offered little information to people trying to understand and prevent such violent events. The CDC's “A-Z Index” has no listing for either “guns” or “firearms,” and the 24 topics on the “Injury, Violence & Safety” web page include explosion and blast injuries and fireworks, but not firearms. Indeed, federal health officials rarely speak about any aspect of firearms injury, violence, and safety. The mass killing in Connecticut shows once again the high price our society pays for ignoring legal reforms and other measures, including improvements in the mental health system, which would help to reduce gun violence and save lives.... These and many other long-overdue reforms do not require further study, only the political will to implement them. In 2011, Florida enacted a law that impeded physicians' ability to talk to their patients about the risks of guns, whether they own guns, and if so, how the guns are stored at home. Unfortunately, after a federal district court judge blocked enforcement, the state appealed, and the case is still pending. Physicians routinely ask patients potentially sensitive questions so they can help them to protect their health, and legislation should not inappropriately interfere with the physician-patient relationship. In the aftermath of the carnage at Sandy Hook, the Obama administration and Congress should act quickly to make the prevention of firearm injuries a pubic health priority....All federal health agencies, including the National Center for Injury Prevention and Control at the CDC, should regain the ability to fund research aimed at reducing injuries and deaths from firearms, regardless of whether some might label such research as “gun control.” Funding should be substantial for specific projects, as well as for research infrastructure and the training of investigators. President Obama should make a concerted effort to get the restrictive language about using federal funds “in whole or in part, to advocate or promote gun control” out of future appropriations bills.... President Obama should empower federal health officials to speak and provide leadership about firearm injuries and violence, the potentially intimidating legislative language in current law notwithstanding. The secretary of Health and Human Services, the Surgeon General, the director of the CDC, and the director of the CDC's National Center for Injury Prevention and Control should be allowed to protect the public health by working to reduce injuries and deaths from firearms, in the same way that they work to reduce injuries and deaths from poisonings, motor vehicle traffic accidents, and falls.... Research and policy efforts to prevent injuries can make a big difference. The federal government has invested billions of dollars to better understand motor vehicle fatalities, and hundreds of thousands of lives have been saved. However, as traffic fatalities have steadily declined, gun-related deaths are trending upward, from a recent low point in 2000. If the United States were to get serious about preventing firearms-related injuries and deaths, thousands of lives could be saved each year. We can wait no longer to protect the public health. This article is open access. Language: en

Fatal school shootings and the epidemiological context of firearm mortality in the United States.

Background The December 14, 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, USA, vaulted concerns regarding gun violence to the forefront of public attention. This high-visibility incident occurred within the epidemiological context of U.S. firearm mortality that claims more than 88 lives daily.Methods National epidemiologic data on firearm deaths over two decades were analyzed along with data registries on school shootings in order to place the tragedy at Sandy Hook in perspective. School shootings were classified as random or targeted.Results The U.S. has the highest rates of firearm deaths, suicides, and homicides among the world’s 34 “advanced economies.” Seventy percent of U.S. homicides and more than 50% of U.S. suicides are committed using a firearm. U.S. firearm homicide rates first declined, and then stabilized, during the past 23 years, 1990-2012. “Shooting massacres” in school settings, a new phenomenon within the past 50 years, are extremely rare events. Over 23 years, 1990-2012, 215 fatal school shooting incidents resulted in 363 deaths, equivalent to 0.12% of national firearm homicides during that time period. Most episodes were “targeted” shootings in which the perpetrator intentionally killed a specific individual in a school setting. Only 25 of these 215 events (11.6%) were “random” or “rampage” shootings, resulting in 135 deaths (0.04% of national firearm homicides). Among these, just three shooting rampages – Columbine High School, Virginia Tech University, and Sandy hook Elementary School – accounted for 72 (53.3%) of these 135 deaths. The frequency of random/rampage shooting incidents in schools has remained within the narrow range of 0 to 3 episodes per year.Conclusions Each year, more than 32,000 Americans die by firearms and more than 70,000 are wounded, representing a volume of preventable deaths and injuries that the U.S. government describes as a “public health crisis.” School massacres, such as Sandy Hook, occur periodically, galvanizing public reaction and bringing forth a collective call for intervention. Epidemiological analyses position these rare, but uniquely compelling, incidents within the broader national patterns of gun violence. The intention is to inform the selection of a balanced, comprehensive set of effective remedies to address the daily death toll from firearm suicides and “targeted” firearm homicides that account for more than 99% of firearm fatalities; as well as the rare, random, and sporadic rampage shootings in school or community settings.

The Sandy Hook Elementary School shooting as tipping point: "This Time Is Different".

Among rampage shooting massacres, the Sandy Hook Elementary School shooting on December 14, 2012 galvanized public attention. In this Commentary we examine the features of this episode of gun violence that has sparked strong reactions and energized discourse that may ultimately lead toward constructive solutions to diminish high rates of firearm deaths and injuries in the United States.

Mental Illness and New Gun Law Reforms

The December 2012 tragedy in Newtown, Connecticut, transfixed the nation in a moment of shared grief for 20 small children and 6 adults who died in a merciless hail of bullets. The weeks since have brought numerous federal and state policy proposals to curb gun violence. Whether these crisis-driven reforms can help inch society toward the goal of reducing firearm-related deaths, the new laws' broader social consequences could long outlast the memory of what happened at Sandy Hook Elementary School. Policy makers would do well to pause and think them through.

Capitol Hill Gets Straight Story On Gun Violence, Mental Illness

Back to table of contents Previous article Next article Government NewsFull AccessCapitol Hill Gets Straight Story On Gun Violence, Mental IllnessAaron LevinAaron LevinSearch for more papers by this authorPublished Online:1 Mar 2013https://doi.org/10.1176/appi.pn.2013.3a5AbstractCongressional staff members listen to experts discuss the state of the mental health system in the United States at a hearing on prevention of gun violence.The popular association of homicidal violence and mental illness is tenuous at best, Thomas Insel, M.D., director of the National Institute of Mental Health, pointed out to congressional staff members at a Capitol Hill briefing in late January.Thomas Insel, M.D., addresses congressional staffers at a briefing on Capitol Hill about mental health care. Aaron Levin“Suicide, not homicide, is the most urgent public-health problem associated with gun violence,” said Insel. About 90 percent of suicides involved individuals with mental illness, but that was true for only 5 percent of homicides.The briefing was one of several held in the wake of the mass shooting at Sandy Hook Elementary School in Newtown, Conn. The session on mental health aspects of gun violence prevention was led by Rep. Mike Thompson (D-Calif.) and Rep. Grace Napolitano (D-Calif.), chair and co-chair, respectively, of the House Democratic Gun Violence Prevention Task Force.Despite common public perceptions, there is little connection between gun violence and mental illness, said Insel. Only 6 percent of violent crimes were committed by someone with a diagnosed mental illness.However, certain subgroups presented higher than average risks, he pointed out.The approximately 100,000 people (most of them aged 16 to 20) who become newly psychotic each year but who are not diagnosed or being treated are at increased risk of violence, he said. “About 38 percent of those within or before a first episode of schizophrenia may become violent,” he said. “But once they are treated, the rate of violence decreases 15-fold.”Furthermore, people with mental illness were 11 times more likely to be victims of violence than its perpetrators, he noted. “We can do better if we get involved sooner with early detection and early intervention.”“Behavioral health, mental illness, and substance abuse are not social problems,” added Pamela Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration. “They are public-health problems and should be tackled and solved that way.”Napolitano and Sen. Al Franken (D-Minn.) told the briefing that they will introduce the Mental Health in the Schools Act in the House and Senate, respectively. (At press time, both had introduced the bill in their respective chambers.) The proposed act would provide resources for schools to work with mental health care providers and offer comprehensive training to parents and teachers about warning signs of mental illness, said Franken.“It’s not just about preventing violence,” he said. “It’s about making sure kids have access to mental health services.”Napolitano has introduced similar legislation in previous sessions of Congress, but the program she has advocated has received only pilot-stage funding. She said she is concerned that fiscal wrangles in Congress lie in the way of final passage.“Unless we find the money, the likelihood of passage is quite low,” she told Psychiatric News after the briefing.Nevertheless, she and other speakers said that the tragic shooting at Sandy Hook Elementary School might spur action to reduce gun violence and increase access to mental health services for young people.Insel also sought to inform his audience about the biological substrate of mental illnesses, which should be viewed as disorders of brain circuitry, he said. “We should be rethinking how we talk about these disorders.”He added that “the behavioral changes occur before the first changes are observable in the brain itself.”Early detection and intervention have reduced morbidity and mortality in other illnesses, he emphasized. “Science can transform the way we think about these disorders, too.” ■A press release from Napolitano regarding the Capitol Hill briefing is posted at http://napolitano.house.gov/press-release/press-release-rep-napolitano-co-hosts-gun-violence-prevention-task-force-mental-health. ISSUES NewArchived

Working in Europe to Stop Truancy Among Youth (WE‐STAY) Project: Preventing truancy and promoting mental health of adolescents in different European countries

Dear Editor, With the recent events in Sandy Hook Elementary School in Newtown, Connecticut and my experience assessing higher functioning youth within the autism spectrum (HFASD), I have become convinced of the need for early diagnosis and intervention. Those who have received little support around social learning and self-regulation prior to adolescence are more difficult to treat and some are at risk for acting out their anger with no sense of the social restraints that might inhibit violent expressions of rage. Although many children with HFASD present challenges from a young age, many parents simply consider their “difficultness” as just “who they are.” They can cope with the “meltdowns” of the two to four year old. Their obsessive interests are also tolerated as many of them appear gifted with their fund of knowledge about dinosaurs, insects, cars or math. Stressed parents may find themselves quite frustrated by the child’s resistance over minor requests, the “melt-downs” that can last hours or the extreme fussiness around food and aggression directed at younger siblings or family pets. Despite appropriate efforts at helping their child understand the importance of “using their words and not their hands” and how others feel when they react aggressively, parents often report that the child doesn’t “get” why this is important, especially when frustrated. Most children with autism spectrum disorder (ASD) have difficulties with self-regulation and are often diagnosed as having attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). They may even respond to stimulant medication reducing the impulsivity but this does not treat the difficulties with social understanding. With well supported parents these parenting challenges can be manageable, but for stressed or poorly supported parents the relationship with the child can begin to become very strained, increasing the child’s anxiety and anger. Many of our typical parenting interventions are relatively ineffective in managing the behavioural issues. In the school system, children with HFASD often have difficulty complying with the teacher’s directions, not fully understanding the difference between adult and child roles. Interaction with peers is often compromised by their poor understanding or approach behaviours, and difficulty with sharing and turn taking. This regularly results in peer rejection and a sense of confusion in the child who really does not understand why their peers don’t want to play. Lastly, the stimulation in the classroom may overwhelm their hypersensitive sensory system. With good teachers who understand their difficulties they may receive support with peers, opportunities to take breaks when overstimulated and strategies like visual cueing to deal with difficulties with change. In other situations, interaction between child and teacher becomes strained, leading to angry and sometimes inappropriate reactions that reinforce the child’s resistance. This is obviously compounded when the interactions with peers result in frequent rejection. This more negative trajectory often results in school refusal and increasing demoralization, often made worse by bullying. At this point, many children with HFASD begin to withdraw from peers and family, feeling that, no matter what they do, others get frustrated and angry with them. This pattern becomes even more painful for them as they advance through the later grades of elementary school. Their withdrawal may include preoccupation with video games with themes of violence not always understood as “a fantasy world.” Earlier difficulties differentiating reality from fantasy may make them more vulnerable to acting out these fantasies, especially when very angry. School refusal may allow escape but results in conflict with parents and more anger and frustration on both sides. Depression and threats to kill oneself or others become frequent. Visits to emergency departments produce more frustration as the system is seldom designed to support these youth who continue to feel misunderstood and unfairly treated. Residential treatment can be an option but is often rejected by the youth. Jail is threatened but resisted by all involved as inappropriate. Early diagnosis can abort the negative spiral of family conflict and peer rejection when these youth receive adequate support around self-regulation and social learning. Many find friends with shared interests and can begin to understand their social world better. Although we have less research evidence about the success of our social skills interventions with high-functioning youth, many professionals working with these children see significant improvements. Further, parents who understand their social comprehension difficulties can take a different approach and work harder at staying calm in their interactions with them. Having such youth identified in school as needing special help with social learning also may increase teacher’s efforts to prevent bullying and peer rejection. I cannot argue that such interventions will prevent the horrible tragedies that we have witnessed at New-town, but I know that we can do more when we recognize the difficulties early than when we try to address the problems in an out-of-control adolescent.

Language and Addiction: Choosing Words Wisely

Two recent articles in the American Journal of Public Health discussed the importance of educating trainees in social work1 and medicine2 in screening, brief intervention, and referral to treatment (SBIRT) technique for approaching patients with substance use disorders. In both articles the terms “substance use” and “substance abuse” were used somewhat interchangeably. Both articles contribute to the important recognition that training in addictions must be an integral part of any medical or social work training program. However, the language used to convey this educational content is important. In medicine we use words as tools. Just as we utilize the bell and diaphragm of the stethoscope to transmit the inner landscape of cardiac pathology, we synthesize and communicate our clinical assessments with the language we choose. Every day, medical students and residents give patient presentations to the attending physicians who serve as guides, teachers, and role models. Trainees are coached explicitly and implicitly, guided to choose the proper terms to express their thoughts with the recognition that language shapes our medical judgments. Firefighters salute as a hearse passes for the funeral procession of 7-year-old Sandy Hook Elementary School shooting victim Daniel Gerard Barden, at the firestation outside of the entrance to the school, on December 19, 2012, in Newtown, CT. Photograph ... In recent years, as cultural competency has been recognized to be a key component in reducing health disparities, curricula on this topic have been required for medical schools to retain accreditation.3 Teaching culturally sensitive language is now an expected component of medical training. Professionalism, another trait identified as crucial in physician development, hinges on communication. One suggested means of assessing professionalism is whether trainees “communicate in culturally appropriate language with a variety of different patients.”4(p1364) To teach professionalism, the most effective approach is faculty role modeling of ideal behavior.4 And yet within the medical community we have done a better job of this for some topics than others. When it comes to addiction, we describe patients as “substance abusers”; we refer to urine toxicology screens as “dirty” with drugs; with our language we imply patients are inflicting the morbidity of the disease on themselves and are thus undeserving of care. “Abuse” is arguably the most pernicious and poorly chosen word in our medical addiction vernacular. No other syndrome in medicine in its very naming explicitly labels the patient as the perpetrator of disease. From a purely semantics approach the word is also technically incorrect. To suggest that the addict mistreats the object of his or her deepest affection is a ridiculous notion. Alcoholics do not abuse alcohol… nor do addicts abuse drugs. Addicts, more than anyone, treat these potions with the greatest devotion and respect.5(p4) While “abuse” is defined in the Oxford Dictionaries as to “use (something) to bad effect or for a bad purpose,”6 which arguably could apply to addiction, the term “abuse” carries with it a history of moral condemnation. From the Latin word abusus, meaning “an abusing, using up,” the word has been used to reference shameful and willful commissions since the 14th century when abusion referred to a “wicked act or practice, a shameful thing, a violation of decency.”7 “Abuse” is a term anchored in our collective minds in association with behavior such as rape, domestic violence, and child molestation. To use such a term to refer to a chronic, treatable brain disease ignores decades of scientific research indicating the role of genetics, trauma, and exposure in the neurobiology of the illness. It favors instead a moralistic view that individuals “choose” such an outcome. Even highly trained mental health professionals are more likely to think that a patient is personally culpable and deserving of punitive measures when they hear the patient is described as a “substance abuser” as compared with having a “substance use disorder.”8 Thankfully, in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, “substance use disorder” will take the place of “substance abuse” and “substance dependence.”9 Historically, language has been used as a tool for alienation and the identification of out groups. But the reshaping of language has also been important in the recognition of equality and as a means of liberation from prior disenfranchisement. Patients with addiction continue to suffer from the stigma associated with the disease. Not surprisingly, they fear judgment and mistreatment when they encounter the medical system. That expectation often results in an interpretation of even subtle clues as evidence of a physician’s condescension and hostility.10 Using language that demonstrates an understanding and acceptance of the disease model of addiction will go a long way toward improving the medical treatment of patients struggling with this challenging disease.

Disaster Psychiatrist Fills Niche In School-Shooting Aftermath

Back to table of contents Previous article Next article Community NewsFull AccessDisaster Psychiatrist Fills Niche In School-Shooting AftermathAaron LevinAaron LevinSearch for more papers by this authorPublished Online:1 Feb 2013https://doi.org/10.1176/appi.pn.2013.2a7AbstractAn experienced emergency psychiatrist helps residents of Newtown, Conn., cope with the aftermath of the mass murders at Sandy Hook Elementary School.“I’ve worked with survivors of disasters from 9/11 on, but this was the toughest thing I’ve ever done,” said Anthony Ng, M.D., after returning home to Maine from five days helping out in Newtown, Conn., after the December 14, 2012, shooting at Sandy Hook Elementary School.Disaster psychiatry specialist Anthony Ng, M.D.: “No amount of medical school or psychiatric training prepares you to see this.”Anthony Ng, M.D.On ordinary days, Ng is the chief medical officer at Acadia Hospital in Bangor, Maine, and chief of the psychiatry service at Eastern Maine Medical Center in Bangor. He has also served on APA’s Committee on the Psychiatric Dimensions of Disasters.Within a day of the tragedy, Ng got a call from Rob Yin, L.I.S.W., manager of the disaster mental health program for the American Red Cross, asking him to go to Newtown. Besides his long experience helping people cope with the psychological aftermath of disasters, Ng previously worked closely with the Red Cross and knew how the organization manages the mental health side of its response.“You need to be trained and prepared for disasters,” Ng told Psychiatric News.Ng arrived in Newtown on the Sunday following the shooting and worked with family members of victims at a center set up in a local mental health clinic. (Other people in need of counseling were seen by Connecticut Psychiatric Society members and others working with the Red Cross at the Reed Middle School [Psychiatric News, January 4].)At one point, Ng met with the father of a boy who was killed in the attack. What the man needed, however, was not sophisticated psychiatry.“Just simple things,” said Ng. “Support, psychological first aid, simply being there.” The man talked a lot about his son. At one point he pulled out photographs of the boy. “I want you guys to see how he looked,” he said.“I’m a parent, and so this really hit home,” said Ng.The man did not seem to have a lot of outside support. On learning that the man didn’t have a suit to wear to his son’s funeral, Ng and someone from the FBI’s Victims Assistance Program took him to a store to buy one. Later, the man also asked Ng and a Red Cross worker to go with him to the funeral.“No amount of medical school or psychiatric training prepares you to see this,” said Ng. “The whole town was suffering though funerals, memorials, and wakes.”Ng is concerned about the future of the people he saw in Newtown, and not just regarding clinical issues. The well-intended donations or possible financial settlements that come in the wake of tragedies may create new problems, as became apparent after the Exxon Valdez and BP oil spills, he said.Deciding which recipients or aid agencies should or should not get funds and how much each receives can be a messy process. “In my experience with other big disasters, the sudden surge of financial donations in support of the response and recovery efforts can easily generate a lot of tension,” said Ng. “So it is important that psychiatric leadership be aware and even be involved in the postdisaster financial response, too.” ■ ISSUES NewArchived

Front and Back Covers, Volume 29, Number 1. February 2013

Front and back cover caption, volume 29 issue 1Front coverDesert Melon (2012) by Christian Thompson. Courtesy of the artist, Gallery Gabrielle Pizzi, Melbourne, and Michael Reid Gallery, Berlin.‘Over the course of 2011–12, the acclaimed Australian Aboriginal artist Christian Thompson made several research visits to view historic photographs of Aboriginal people at the Pitt Rivers Museum, University of Oxford. The experience of working with this collection has been an emotional and yet productive one for Thompson and a very welcome innovative collaboration from the museum's perspective. Although not explicitly quoted in the work made as a result of this engagement, both the experience of looking at the historical images, the modes of representation they carry, and the painful histories they hold, can be understood as lying at the heart of the work. Rather than directly invoking or re‐presenting historic imagery, Thompson has chosen to take the history of photographic representation of Aboriginal people as a starting point for the spiritual repatriation of the archive through the redemptive process of self‐portraiture. Importantly, this process has not involved drawing on those historical markers of entity which are so prevalent in ethnographic imagery, but rather his own fluid and evolving transcultural identity, as well as biographical markers of another recent identity, that of an Oxford student in formal dress. Although archival imagery is a key inspiration in Thompson's work generally, he is also inspired by contemporary fashion, film, and music. It is this playful mixing of genres and reference points that not only makes Thompson's approach distinctive, it also resonates historically with the blending of scientific and popular genres in the archival imagery with which he has engaged.”From the catalogue essay ‘Spiritual repatriation and the archive’ in Christian Thompson's We bury our own by Christopher Morton (Curator of Photograph and Manuscript Collections at the Pitt Rivers Museum) published to accompany the exhibition held at the Pitt Rivers Museum in 2012.Christian Thompson will be contributing to ‘The Future of Ethnographic Museums’ conference in Oxford in July 2013 with a performance piece inspired by the Australian Aboriginal collections at the Pitt Rivers Museum.Back coverGUN CONTROLMen browsing handguns on display at a gun show in the US.The recent mass shooting, in which six members of staff and 20 six‐year olds were killed at Sandy Hook Elementary School in Connecticut, has put gun control back on the US political agenda. However, the National Rifle Association (NRA) insists any restriction on gun ownership equates to a loss of liberties supposedly guaranteed by the second amendment to the US constitution at a time when only single‐shot guns were available. Debate surrounding this issue has now taken an ominous turn, with death threats against journalists who made the identities and addresses of gun owners already in the public domain more easily navigable.In a reading of history that resembles Hollywood, the NRA compares Obama to Hitler. However, it uses intimidation and propaganda to stifle rational debate on this issue, which is very much in the public interest. Furthermore, along with the gun industry, it benefits financially from increased gun sales which disproportionately affect the poor and the black.This issue's guest editorial asks what anthropology has to say about the issue of gun control. This is followed by a statement from the American Anthropological Association calling for research on the relationship between gun use and public health. Public funding for such research in the US has been blocked until now by powerful lobbyists.

The Scope of Regulatory Authority Under the Second Amendment

This paper will appear as a chapter in a forthcoming book to be published by the Johns Hopkins University Press that analyzes the efficacy of firearms regulation. In this paper, the authors analyze the emerging jurisprudential framework for assessing the validity of firearms regulation under the Second Amendment to the United States Constitution. This emerging framework, the authors contend, preserves substantial regulatory authority for federal, state, and local governments. The authors then assess the constitutionality of the leading proposals for regulatory reform that have emerged in the wake of the tragic events at Sandy Hook Elementary School in Newtown, Connecticut.

Volunteer Psychiatrists Help Newtown Cope With Tragedy

Back to table of contents Previous article Next article Professional NewsFull AccessVolunteer Psychiatrists Help Newtown Cope With TragedyAaron LevinAaron LevinSearch for more papers by this authorPublished Online:18 Jan 2013https://doi.org/10.1176/appi.pn.2013.1b15AbstractConnecticut psychiatrists recount their experiences aiding a community in shock after the shooting at Sandy Hook Elementary School last month.On Saturday, December 15, 2012, the day after the mass shooting at Sandy Hook Elementary School in Newtown, Conn., Shaukat Khan, M.D., the chair of the Connecticut Psychiatric Society (CPS) Disaster Psychiatry Committee, organized the district branch’s disaster team. Over the ensuing week, team members provided psychological first aid or counseling to a community suffering from the tragic event.Wooden angels are displayed as part of memorial to the shooting victims in Newtown, Conn., just days before Christmas.AP Photo/Seth WenigMental health professionals—social workers, nurses, licensed therapists, pastoral counselors, and school counselors, as well as the psychiatrists—all volunteered to help area residents at several locations in Newtown. Some of the psychiatrists recounted their experiences to Psychiatric News a few days later.“We met beautiful little children, hearing their stories, meeting the parents and teachers, supporting them as much as we could,” said Khan, a psychiatrist at the VA Connecticut Health System in West Haven and a clinical assistant professor at Yale. “We are possibly making some difference in their lives.”One little boy, who was in another classroom during the shooting, arrived with his father and younger sister. He told Khan that he had a dream in which something bad was happening and he put his sister into a closet to save her. Later, speaking to Khan alone, the father broke down in tears from his own stress.“It was a heartbreaking experience, with saddening encounters, but satisfying work,” he said.Samya Hawley, M.D., is a child and adult psychiatrist who works with children at the Village for Families and Children in Hartford. She responded to an e-mail request for volunteers from the Connecticut chapter of the American Academy of Child and Adolescent Psychiatry and worked a 10 a.m. to 1 p.m. shift at Newtown’s town hall, talking to whoever walked in the door.These were brief encounters, she said. They were “more supportive and reflective, just letting people know that they were not alone and that in the community, people were there for each other.”“In Newtown, everyone is two or three degrees removed from someone directly affected by the shooting,” said Sohrab Zahedi, M.D., another volunteer who worked a three-hour shift at the Reed Intermediate School on the Sunday after the attack.The psychiatrists, psychologists, social workers, and others there did more than counseling, said Zahedi, a forensic psychiatrist at the Hartford Correctional Center.“Often, we were offering guidance about what adults can do and how they could talk to their children about the event,” he explained. “These kids need to feel safe, and that means a return to a normal routine.”He advised people to acknowledge the extraordinary nature of the crime. They should expect to cry or feel weird or angry and would likely see children expressing their emotions with occasional outbursts.“Mainly, I listened,” said Zahedi. “Just having someone there to talk to was the most important thing for them.”On a Sunday shift the weekend after the shooting, child psychiatrists worked with both children and adults, said Carolyn Drazinic, M.D., Ph.D., president-elect of the CPS and an assistant professor of psychiatry at the University of Connecticut School of Medicine.“It was a whole community pouring in to get help and counseling,” she said. “People all knew somebody affected by the tragedy.”When people asked her how to talk to children, she suggested talking to them on their developmental level, speaking the truth, but not going into unneeded detail about the crime. Use of medications was generally discouraged, she said.A training course in disaster psychiatry led by Khan and others and held just a month before the school shooting proved helpful, she noted. “We coordinated with the Red Cross,” she said. “That was essential for having the response be organized and helpful.”The psychiatrists’ first week in Newtown was only the beginning, said Khan. “We’ll need to figure out how the CPS can help with follow-up and continuing care.”Based on this experience, Khan hopes that APA will support more psychiatric disaster training for its district branches and push for greater inclusion of the topic in medical school and residency training. ■ ISSUES NewArchived

Psychiatrists Provide Help, Advice Following Newtown School Murders

Back to table of contents Next article Community NewsFull AccessPsychiatrists Provide Help, Advice Following Newtown School MurdersAaron LevinAaron LevinSearch for more papers by this authorPublished Online:4 Jan 2013https://doi.org/10.1176/appi.pn.2013.1a23AbstractLocal psychiatrists volunteer to help Newtown, Conn., residents recover from last month’s shooting tragedy.The Connecticut Psychiatric Society (CPS) reacted swiftly to the tragic shooting at Sandy Hook Elementary School in Newtown, Conn., on Friday, December 14.Society President John Santopietro, M.D., and Disaster Committee Chair Shaukat Khan, M.D., consulted that afternoon with APA experts including members of APA’s Committee on the Psychiatric Dimensions of Disasters. Within hours, 100 society members responded to Santopietro’s e-mail requesting volunteers to help in the stricken town.A woman comforts a young girl during a vigil service for victims of the Sandy Hook Elementary School shooting in Newtown, Conn., on December 14. Connecticut Psychiatric Society members were among those who offered their services to the grieving community.AP Photo/Andrew Gombert, PoolMeanwhile, Khan contacted the Red Cross and the Connecticut State Medical Society to let them know about the CPS volunteers. Khan was already registered with the Red Cross as a mental health volunteer.By coincidence, the CPS had conducted a disaster-response training session for members just a month earlier. That course was led by Frederick Stoddard, M.D., a clinical professor of psychiatry at Harvard Medical School and a psychiatrist at Massachusetts General Hospital. Stoddard is coauthor with Anand Pandya, M.D., and Craig Katz, M.D., of Disaster Psychiatry Readiness, Evaluation, and Treatment (American Psychiatric Publishing).The class covered such points as the psychiatric impact of disasters, grief and resilience, psychological first aid, and the postacute stages of a disaster.“The training helped prepare us for the situation at Newtown, but, of course, not entirely,” said Khan, a psychiatrist at the VA Connecticut Health Systemin West Haven and a clinical assistant professor at Yale.“You can’t be completely prepared for something like this,” said Stoddard. “It is such an atrocity.”Psychiatrists gathered at Reed Intermediate School in Newtown, Conn., to assist community members after December’s shooting. From left: Frederick Stoddard, M.D., of Massachusetts General Hospital; Irvin Jennings, M.D., executive and medical director of nonprofit Family and Children’s Aid; and Shaukat Khan, M.D., disaster chair of the Connecticut Psychiatric Society.Shaukat Khan, M.D.Perhaps the most helpful aspect of the training in light of the later Newtown tragedy was the inclusion of a speaker from the American Red Cross, said CPS President-elect Carolyn Drazinic, M.D., Ph.D., an assistant professor of psychiatry at the University of Connecticut. The speaker explained how the Red Cross coordinates the overall response to disasters, an insight that was helpful in integrating the CPS volunteers into the general emergency response. By Saturday afternoon, Khan had completed a needs assessment. Working through the Red Cross and state and local health agencies, the society arranged for at least two psychiatrists to be on duty along with other mental health professionals for three-hour shifts from 7 a.m. to 7 p.m. at a crisis-response center in Newtown. On Sunday, Drazinic and colleagues met with more than 300 children and adults.“The handoffs between professionals is critically important and were done at Newtown in a collegial and careful ways,” said Stoddard, who drove from Boston to consult with the CPS. More such help will be needed in the future to contain the suffering and anxiety, said Santopietro, chief medical officer at Community Health Resources in Windsor, Conn.“I consider this to be the psychological equivalent of a nuclear blast,” said Santopietro. “The immediate damage is unthinkable, and there is some rate of decay, but the fallout will continue for weeks and months and years.”Robyn Hoffman, A.P.R.N., of Family and Children’s Aid coordinates mental health volunteers at the Reed Intermediate School after the Newtown shooting.Shaukat Khan, M.D.The CPS will continue working with health agencies in that long-term effort.“Concentric waves of psychological pain are rippling out from Newtown, and we want people to get excellent care,” said Santopietro. Pausing between meetings and phone calls in the days just after the shooting, he reflected on the task ahead for the society’s members.“This is the work we do,” he said. “We deal with human suffering and the complexity of the brain and human behavior. We deal with communities and human relationships. We help people through personal, psychological, family, and community crises. This is psychiatry.” ■ ISSUES NewArchived

December 2012 Connecticut School Shooting Position Statement

In response to the killing of 20 children and 6 adults at Sandy Hook Elementary School on December 17, 2012, this position statement argues that research supports a thoughtful approach to safer schools, guided by four key elements—balance, communication, connectedness, and support—along with strengthened attention to mental health needs in the community, structured threat assessment approaches, revised policies on youth exposure to violent media, and improved policies and practices related to common-sense gun safety. A list of endorsing organizations and individuals is provided.