A team of Yale researchers was among the first to diagnose the mental illnesses that plagued Sandy Hook shooter Adam Lanza, according to police documents. Their proposed treatment plan was ultimately resisted by the shooter and his mother.

On Dec. 27, the Connecticut State Police released its final report on the investigation into the Dec. 14, 2012 shootings at Sandy Hook Elementary School that left 26 students and school staff dead. The report contained the names of Kathleen Koenig YSN ’88 and Robert King, both staff at the Child Study Center, who began to treat Lanza in 2006. Together, King and Koenig sought to devise a course of treatment that combined behavioral-based therapy and a prescription for Celexa, a common anti-depressant.

However, Lanza’s mother, Nancy Lanza, objected to the program — particularly the use of medication to treat her son — and discontinued her son’s treatment after only four visits to the center.

“Koenig received a phone call from Nancy Lanza which reported her son was ‘unable to raise his arm,’” a document in the State Police report reads. “Nancy Lanza was reporting her son was attributing this symptom to the medication … due to her son’s symptoms, he would be discontinuing use of the medication. Koenig attempted to convince Nancy Lanza that the medication was not causing any purported symptoms which Adam Lanza might be experiencing. However, Nancy Lanza was not receptive to Koenig’s reasoning.”

Koenig, King and other Child Study Center representatives declined requests for comment.

Documents show that Lanza was first seen at the Child Study Center on Oct. 24, 2006 for a three-hour psychiatric evaluation conducted with King. The family was subsequently referred to Koenig, a psychiatric nurse, for regular therapy appointments.

The initial visit was arranged by Lanza’s father, Peter, who told police that Adam “loved being a kid.” But by age 11, Peter reportedly noticed a shift in his son’s disposition, prompting him to approach King.

During the initial examination, King found Lanza to have a “profound” case of autism and concerning isolationist and antisocial tendencies. Still, King insisted to police that he saw nothing to indicate extreme potential for violence.

“During my brief meeting with [Adam Lanza], while I was concerned clinically with his rigidity and social constriction, I noted nothing … which would have made this unfortunate outcome foreseeable,” King told state police.

Koenig’s meetings with Lanza resulted in similar conclusions, resulting in her advice that he take medication. In particular, Koenig was hoping to treat Lanza’s case of OCD, which she believed “severely limited his ability to lead a normal, well-adjusted life,” according to the reports.

The disorder resulted in a number of odd behaviors, including washing his hands repeatedly, changing outfits numerous times throughout the day and wiping down surfaces with his sleeves before handling them. He also grew exceptionally sensitive to light, doctors noted.

Additionally, Koenig revealed to investigators that Lanza asked several questions about mental disorders during therapy without any apparent relevance to himself — he often framed his curiosity as general interest in schizophrenia, psychotic depression and OCD.

Koenig’s attempts and Nancy Lanza’s subsequent refusals bring to the forefront the difficulty mental health officials often face when working with uncooperative patients. Unless patients demonstrate that they pose a clear danger to themselves or others, professionals cannot compel treatment.

However, parents often resist prescribed courses of treatment, according to Howard Zonana, the director of the Psychiatry and Law Division at the Yale Medical School. Zonana said several factors could influence such a reaction, including denial or a belief that one’s case is simply not extreme enough to be treated by medicine.

Bandy Lee MED ’94 DIV ’95, a researcher at the School of Medicine who specializes in psychiatric violence studies, said that treatment is a critical step in keeping patients stable.

“When mental illness is well-treated in society, patients are not necessarily more violent,” Lee said. “But when they go untreated and they are allowed to become severely ill, then we’re seeing a larger share of violence being committed by mentally-ill individuals. That violence is different in nature, because it’s often unpredictable — it’s often based on delusions.”

In the case of Adam Lanza, who was living with his family and for whom there was no obvious cause to be brought to the hospital emergency room for psychiatric illness, no mechanism in place in Connecticut would have forced him to undergo treatment, according to Harold Schwartz, psychiatrist-in-chief at Hartford Hospital and a member of Gov. Dannel Malloy’s Sandy Hook Commission.

Because Connecticut is one of only eight states in the nation that does not allow involuntary outpatient treatment commitments, patients must first be involuntarily admitted to inpatient treatment, Schwartz said. A patient like Lanza would not have met that threshold for admittance, he added.

While Lanza was undoubtedly mentally ill, individuals with severe mental illness are more frequently victims of violence than its perpetrators, Schwartz said.

“The research is pretty clear that mentally ill individuals as a class are not significantly more violent than individuals without mental illness,” he said. “Regarding extremely serious acts of violence, only a small proportion is committed by people with severe mental illnesses.”

Between 1974 and 2000, 34 percent of all school shooters were at some point evaluated for mental illness, according to a report by the U.S. Secret Service.

  • Trowbridge H. Ford

    Don’t understand Harold Schwartz’s conclusion.

    Is one-third of the American school population suffering from mental illness?

    I thought it wasn’t this bad, and wonder about the validity of his claim.

    • anonymous

      No, he is saying one third of the “school-shooters”.

      • Robert Riversong

        Actually the SS report described only “targeted school-based attacks”, not simply random school violence, and examined only 37 incidents over a 25-year period.

    • Robert Riversong

      That was a finding of a Secret Service study of school rampage shooters, not Schwartz’s statement.

      But studies have shown that 20% of all Americans suffer some form of mental illness each year.

  • Trowbridge H. Ford

    34% is not “a small proportion.” Seems that Schwartz is understating the scope of the problem, and how it can be reduced.

    • Robert Riversong

      There is an important distinction between being evaluated for mental illness and being diagnosed with mental illness.

      A recent study indicates that 20% of all Americans suffer some form of mental illness each year.

  • Rich Stenberg

    Kind of unsure whether to respond, since those comments might just be trolling… I think the point wasn’t whether being mentally ill might make you more likely to be a school shooter (apparently yes?), but generally whether it makes someone more likely to be violent. School shooters who were never evaluated for mental illness make up less than .01 percent of the population of people never evaluated, and school shooters who were evaluated make up less than .01 percent of the population who have been evaluated. That’s assuming that only like 1 percent of the American population has been evaluated for mental illness ever, which I’m certain is an under-estimate. We live in a very populous country, with only a handful of mass shooters every year. The quotes about mentally ill people being no more violent in this article had nothing do to with school shootings but with the more run-of-the mill violence that results in the vast majority of assaults, murders, etc, but which get less press attention.

    • Robert Riversong

      Trolling aside, your comment was an irrelevant diversion from the topic of the article.

  • Johnny Thorne

    Ma Lanza was a Ma Barker.

  • guest

    The Lanza family arranged for a three-hour psychiatric evaluation at the Yale Child Study Center and the psychiatrist involved met with their son only for a “brief meeting?” The majority of his treatment was conducted by a psychiatric nurse? Hmmm.

    Also, although psychiatrists feel constrained by fear of stigmatizing their patients from speaking candidly about the risks of violence among the mentally ill, the fact is that studies show that patients with schizophrenia are 20% more likely to commit violent acts than unaffected individuals. Aggression among patients with Asperger’s and autism is also known to be a problem. We do our patients no favors by attempting to sugar-coat things for the public, who can see for themselves that there can be an association between mental illness and aggression.

  • Kay

    Psychiatric drugs did NOT prevent the COLUMBINE shooting. An autopsy report revealed that the lead COLUMBINE high school shooter Eric Harris DID HAVE an antidepressant drug in his body at the time of the murders.

  • Kay

    Guest, According ti documentation, antidepressant drugs itself can cause aggression, hostility, mania, etc.

  • Kay

    According to documentation, antidepressant drugs itself can cause aggression, hostility, mania, and other bad effects.

  • Kay

    Several years ago, I was prescribed antidepressant drugs. Those drugs caused my heart rate to go up. Also, these drugs caused me to be LESS calm. I never was a threat to myself or others UNTIL AFTER I took these meds. Antidepresssant drugs don’t have the same effects on everyone. It helps some people, and it hurts about 5% to 10% of the people who take them.

  • Kay

    Folks, NO brain scans or exams of the brain are ever performed when diagnosing or treating mental illnesses or disorders. Only subjective instead of objective tests are performed. So mistakes can easily be made, and a lot of trial and error is going on.

    However, currently neuroscientists in both America and in Europe and trying to develop technologies that aim to be able to biologically detect mental illnesses and to monitor how the meds affects the brain. Things should improve then.

  • Zephyr

    According to the CSP’s own analyst, Paul Ginsberg, a gunshot was fired inside Sandy Hook School at 9:46:54 – almost seven minutes after the “final suicide shot” alleged by lead investigator Stephen Sedensky.

    • trollalert

      What does this mean?

      • Zephyr

        Just that if we are to have any hope whatsoever of improving society based on what we learn from Sandy Hook, to include accurate analysis of the shooter’s mental state, we need a thorough and accurate accounting of what really happened. The official story is that Adam Lanza took his own life at 9:40:03 a.m.; however, the CT State Police’s own analyst said someone was still firing a weapon at 9:46 a.m. (and in fact NPD officer Penna stated he heard the final shot at 9:51:31 as cops stormed the room Adam was in). If we don’t have accurate reporting as to his actions that day, I question how accurate our information on his mental state is. I know that journalists are continuing to submit FOIAs for additional info, and I’m hoping they are successful.

        • Myers

          Can’t have accurate reporting on an event and person who never existed

  • Trowbridge H. Ford

    The situation was made just more tragic when Bobby Rankin of Middletown, suffering from schizophrenia and off his medication, murdered his mother, Margaret Rohmer, by disemboweling her while visiting during the Christmas holidays – what helped induce Governor Malloy to increase state funding of mental health facilities to prevent such crimes in the future.

    Have neither seen nor heard any accounts of the dreadful tragedy in the local media. Perhaps, there were some, but only found it on Britain’s Daily Mail.