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Please begin with an informative title:

Note: I realize this is speculation and that it is highly inappropriate to diagnose a mental illness based on media reports. But since many are doing this already and they are causing harm with poor speculation (for example, to children with Asperger's), I feel compelled to speak up based on my understanding of mental health issues.  

The shooting of 20 children is incomprehensible. Why would anyone do this?

I am not an expert on mental health, but I have some familiarity and training and there is only one answer that makes any sense (if you can call it sense): the shooter did not believe he was shooting children - instead he was shooting "bad" guys in some parallel universe he has been constructing in his mind the past few years.

We don't talk about mental health much in this country and, when we do, it is a confusing mess of a discussion that tends to get things very wrong. For example, there is nothing in Asperger's that could lead to this result. Children and adults with asperger's struggle to interpret the emotions and motivations of others - but this is the only thing different about them. They would be horrified by the concept of shooting a child.

Only a mental health issue that involves an alternate reality and psychotic break could explain this result. Add to this the fact that it is a bright young man of 20 who has struggled to transition to the "real world" after school (is not working, lives at home, is a loner) and the highly probable diagnosis is schizophrenia.

Unfortunately, schizophrenia takes some of our brightest into a mental abyss and most do not come back. I am not sure that this is what happened with Adam Lanza but it fits. Follow me below for more.

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If you have seen the movie A Beautiful Mind, you have seen a good depiction of schizophrenia as John Nash, a brilliant economist, struggles with an alternate reality where his longtime college friend was completely imaginary. Nash couldn't tell what was real and what was an invention of his mind. Eventually, he learned to deal with the condition and had a successful career as a professor, so the movie had a happy ending. The reality of schizophrenia, however, is that John Nash is one of the few who was able to rejoin reality. Most stay in their alternate worlds and are unable to rejoin society as "normal" people.

The heartbreaking thing about schizophrenia is that it usually strikes young adults as they are graduating from high school and going to college. I mention college because most children with schizophrenia are intelligent and have done well in school. But then something goes wrong in the period from 17-22 and they are unable to cope with reality. They start hearing and seeing things that are not real and they invent alternate worlds in their minds to live in. The result is that they are unable to hold real jobs, appear strange to friends and family, and end up alone with their thoughts in their alternate reality.

For most people with schizophrenia, there is no danger to society. They do not take up guns and shoot people. Instead, after drifting in and out of jobs and relationships, they quietly become homeless. In other words, the chronic homeless have many who suffer from schizophrenia. In popular culture, it is common to hear jokes about people yelling at inanimate objects. But this is not really a joke because this person believes they are having a conversation with someone.

This illness raises many questions: don't they know it is not real? why don't they stop listening to the voices like John Nash did? I don't know the answers to this as I do not work with schizophrenics regularly. But I suspect most do know something is off but struggle to do anything about it as their mind is clouded on the issue of what is real. Also, if you are paranoid about the world being run by robots or aliens and then everyone starts telling you to ignore this - you might just believe it was the robots trying to convince you they are not real.

For me, this issue has a personal connection because just this week one of my students appears to just have gone into the abyss. He is a bright young kid who had been sharing his ideas for a business he wants to start. At first, he was rational but a bit dreamy. But as time went on, the ideas were grander and hard to believe were real. Then he showed me his secret document that pulls it all together. What I can only call a "manifesto" was a document full of magical thinking that pulled together ideas from many sources into a jumbled mess that he clearly thinks outlines the solution to the universe. When I did not "get it", he was a bit disappointed, but refused to engage in dialogue as to the meaning of any of the parts or how the logic did not make sense. Instead, in his mind it was apparently perfect how it all fit and he did not recognize the concept of questioning something so brilliant. So he just looked at me like I was crazy when I didn't understand. This may not be schizophrenia but it fits the typical picture - bright young adult who devolves into an alternate universe instead of going out into the real world in the usual way (get an entry level job, work your way up, etc.)

Bringing it back to Adam Lanza, we know very little at this point. But I have noted the following from media reports:

20 years old

Living at home with no discernable employment

Strange behavior (a bit different, troubled, loner, etc.)

Brother has not spoken with him since 2010 (estranged)

Bright student in high school

Unfortunately, this all fits the typical pattern of schizophrenia as this appears to be a young man who struggled making the transition from high school to the real world as a young adult.

Considering now the shooting of 20 children. Such a horrifying act is beyond what any other criminals have done. Most multiple shootings are to get back at someone - they have a motive however twisted it might be. But there is no motive for shooting innocent young children. This does not fit with our common conception of what "evil" people do and this makes it impossible to understand.

To me, this only makes sense as a tragic case of schizophrenia - where a young adult devolves into an alternate reality. Unfortunately, mental health issues are heavily stigmatized and it is difficult for a young adult to admit they have a problem in their lucid moments. I imagine Adam struggled with this illness for years as he was sliding away from reality. After the fact, it seems clear what happened, but this is a slow ride down and maybe the family did not realize the severity. Adam likely hid his delusions and creeping alternate reality from everyone. But it must have come out eventually as his first victim was his mother which suggests a confrontation gone wrong. And something as traumatic as shooting your own mother can easily set off a psychotic break where you are "all in" on your alternate reality. If the school and everyone in the school were (for some unknowable reason) the evil ones in Adam's reality, then there is logic to trying to take out as many as he could in a final stand. He likely did not see them as children - maybe they were killer robots or some other type of creature. In essence, once he committed an act as horrible as killing his mother, this triggered a psychotic break where he was "all in" on his fantasy world with him against them in a battle Adam did not expect to survive.

I apologize if the speculation has offended anyone. I just don't like to see all the "evil" talk like this was the devil at work. There is unfortunately a simple explanation for what happened - there are people with serious mental illnesses among us and they should be given help (and not given access to guns). Hopefully this diary will help to dispel some of the confusion about the different types of mental illness. Depression or mania or Asperger's can't explain purposely shooting small children; the only mental illness that can is a psychotic break with reality which means schizophrenia.

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