Dr. Barry Waterson
Once again we have had a horrific school shooting in our country. How is it that this keeps happening?
It’s time again to grapple with what to do to so that the Parkland students’ wish for #neveragain can someday be realized. In the aftermath and the public outcry we ask ourselves why highly specialized military weapons are so easily accessed by obviously disturbed individuals. Will we finally make changes to our gun laws that value human life and safe schools more than the insanity of the NRA and its second amendment fanatics? Is the answer in background checks and improved mental health services? We must do whatever we can to keep killing machines out of the hands of deranged individuals. If improved mental health services are the answer, what kind of improvements should be considered?
There are a few facts about this shooter that are beginning to emerge. For one thing, he’s still alive. He can be interviewed, tested and evaluated in hopes that we might better understand his personality and motivation. We know already that he was adopted, and that both of his adoptive parents are dead; his mother dying just this last Fall. He was expelled from Parkland High School for emotional and behavioral problems and floridly displayed signs of acute emotional disturbance observed during his behavior while in school and also in his online presence. It now appears that he was referred for mental health counseling and an alternative placement, but refused this recommendation and because he was 18 years of age, and as a legal adult, he could not be required to participate. According to the Broward County Sheriff’s office, there were 23 “911” calls associated with him over ten years, including 15 from his mother. Another report states that he was evaluated by a mental health crisis team after throwing his mother against the wall for taking away his video games.
The school and local community are likely thinking about what they should have done to prevent this tragedy. In retrospect there were certainly repeated clear indications of his violent tendencies and threatening behavior. I offer here some thoughts on what might be done to detect and prevent future acts of school violence and some thoughts on one action that was not taken in this case. This is not an indictment of Parkland High School or its staff and administration. It is something that takes place in what I suspect is the vast majority of school systems in the country.
Why do we expel students who are demonstrating mental illness and strong tendencies toward anti-social and violent behavior? I suspect that we have the idea that getting them out of school protects other students and the school community from their violent and disturbed behavior. Once again we have ample and horrific evidence that this is untrue.
Since 1974 US schools have been mandated to identify and treat students with severe emotional disturbance. There are clear guidelines and regulations for how to define and identify students with severe emotional disturbance. There are penalties and processes in place for the failure to do so. Nonetheless it’s not uncommon for such students to be expelled, especially in secondary school programs. Expelling such students not only violates existing law, it also removes them from what could and should be their best source of help and intervention. Educational staff, with the help of well-trained mental health consultants can identify students whose success in school is damaged by severe emotional disturbance. We don’t need to wait until violence is imminent to make this determination. There is good evidence that failure in critical developmental areas that are precursors to later violence can be determined early in a student’s school participation.
As someone who has spent a good deal of his career consulting in public schools and intervening therapeutically with psychotic children and children with severe emotional disturbance, I can tell you of children with psychosis whose mental development has been replayed in a strongly connected therapy relationship with a stable dependable and trustworthy therapist. When stable and helpful attachment relationships are offered to young children, prior to the onset of adolescence, their therapist essentially re-parents and repairs crucial patterns of emotional development that underlie psychosis and the impulse toward violent action.
I suspect that many schools offer much less intensive mental health services for emotionally disturbed students. Later they turn to expulsion rather than intensive intervention. Nikolas Cruz participated in some short term mental health counseling. He was evaluated by a local mental health crisis team, when he was still in school and declared to be not dangerous because he had an educational plan and a supportive mother. His supportive mother was apparently his first abuse victim. She was calling out for help with his violent tendencies directed at her. Reports that Cruz was woefully unprepared in daily living skills, things like not knowing how to operate a microwave, suggest that he was able to dominate his mother and was not helped to take responsibility for himself. We have to help parents when their children exhibit highly deviant behavior.
Skillful intervention is expensive. Budgets are strained. But there are thousands of teachers, educators and mental health professionals on the front lines of education who struggle to try to help severely emotionally disturbed children. Teachers usually know when children aren’t developing normally. They have lots of students with normal development to provide comparisons. Teachers will tell you that they are seeing many more children who need help and intervention with their emotional development. Schools sometimes feel like mental health emergency rooms for an epidemic of children suffering from parenting and attachment trauma. Isn’t it time to help them to do their job with better research, better training, better staffing and better financial support of early intervention programs that have the potential to use our schools to develop sane, productive and non-violent members of the school community? Those students will grow to become sane, productive and non-violent citizens.
To do this job will require resources. It may not happen until we have school-based health clinics supported by public single payer health care. We have made some steps toward this in Vermont, where public healthcare funds can be used for providing significant intervention to low income children with severe emotional disturbance. Isn’t it time to move toward offering effective child mental health services through our schools? There is considerable expertise that has been developed in the last 20 years which could now be marshalled toward addressing the problem of school violence in a long term and preventive way.
What would this look like? In addition to screening violent teenagers and insuring that they receive mental health care and are kept away from guns, an additional approach that provides early identification and developmental intervention will be needed. Mental health professionals are likely to agree that early intervention and prevention are more likely to be successful than waiting for acutely violent behavior to occur and then providing treatment.
Two decades ago I designed an intervention program for an elementary school and participated in the program as a school psychologist/consultant psychoanalyst. The consultation was school wide and with the help of a sympathetic administration, tried to create a whole school environment that thought about students in terms of their mental development and offered an atmosphere of warmth, nurturance and attachment. As the consultant therapist, I participated in meetings of teams organized under various legal structures (IEP, 504 etc.) to determine a program of instruction and services to meet the needs of the children. The therapy services provided included individual psychoanalytic therapy one hour per week for young children with significant delays in emotional development.
The individual therapy was also used as a door into these students’ classroom environments and home environments through classroom consultation and collaboration with parents. Teachers were helped to understand emotional development and to consider their relationship with the children as part of the child’s treatment team. Careful patient clinical work with parents sometimes resulted in developing enough trust that parents’ could disclose domestic abuse, alcoholism, substance abuse, mental health and other parenting problems. We worked with state child welfare social workers, but tried to keep the school as the community center of the treatment for both children and parents.
With the help of the BGSP faculty and the faculty of the Yale University/Anna Freud Center Research Training Program in Psychoanalysis, I wrote a dissertation at BGSP that described the intervention program, including how it was applied in the case of one psychotic child. The study documented shifts in mental development and how principles of Modern Psychoanalytic child therapy and Mentalization Based child therapy are provided and how they are linked to developmental progress. The areas addressed include those that allow for improvement in self-reflection, impulse control, personal boundaries, respect for others and the capacity to tolerate and endure high tension states of both sexual and aggressive arousal without resorting to violent and destructive action or violating the rights of other students.
Bringing an understanding of Modern Psychoanalysis and Mentalization theory to public education and providing educational and clinical services through schools as community health centers, would be my suggestion for addressing violence in this country in a broad and preventive way. Schools can promote healthy emotional development as well as academics and assist parents in providing for their children’s attachment and developmental needs.