Adam Lanza

Mass killings with weapons meant for combat have raised our level of awareness, once again, that not only do we need to consider gun control, but to pick out persons with the propensity to become mass murder and whether we can detect them before the killings. The myth that has survived to our "comfort" has been that, indeed, there are warning signs that can be detected by anyone attuned to looking more closely. But does this make us a nation on constant alert for behaviors we consider out of the norm and signaling potential murder? I question that we can detect them is a somewhat unsupported assumption.

What do we believe we know about persons who commit mass murder or mass murder with military-grade guns? The behaviors that we've been led to see as danger signals are no assurance at all. Of course, some of the murderers will fit the profile developed by the FBI or some other person familiar with these cases, but they are no iron-clad assurance that we can quickly detect potential for these acts and prevent them.

The horrific killings at the Sandy Hook school by Adam Lanza who was not only equipped with frightening weaponry, but smashed through security doors is chilling. In his case, the boy had obvious, serious mental health problems which were known to his mother (who he killed) and probably to the school authorities. His was an extreme case where he should not have had access to any weapons and should have been in a closely-monitored treatment facility well before the killing.

Any child who communicates with his mother via email, while they both share the same home, must be evaluated, especially when they refuse to come out of their room. These signs alone should have prevented him from having access to a gun and signaled the need for mental health care.

James Holmes

The so-called "Batman Killer," James Holmes, gunned down people in a movie theatre in Aurora, Colorado. He was known to the mental health staff at a college and had been in treatment, but who knew he would be a killer? What were the signs in his case that pointed to potential for danger and were they missed by professionals? Yes, professionals are not infallible in singling out cases of dangerousness.

What is the standard usually used here for dangerousness? If someone has been dangerous in the past, it is highly predictive of danger in the future. But was Holmes dangerous in the past? How much do we know? The psychiatrist who was treating him said he was "hostile" toward her but had no history of prior violence.

The mental health professional who referred Holmes for psychiatric evaluation and treatment indicated he had said he wanted to kill people but specified no one and had never done so. It was also indicated that he was the "most anxious" person the professional had ever seen. The notes of the professionals have been made available after a lawsuit by The Denver Post.

Andrea Yates

Not everyone who kills meets the profile of a loner, socially inept, killer of small animals and lover of guns. Consider the case of Andrea Yates, her high school valedictorian, captain of the swim team and member of The National Honor Society, former registered nurse and mother of five who drowned all of them. The family was living in a converted school bus, children were home schooled and Yates was under psychiatric treatment for increasingly severe postpartum depression that escalated with birth of each child.

Her medication was stopped when she was switched between psychiatrists and the hallucinations took over. The children were drowned one by one by a women who was legally unable to know what she was doing was wrong.

Calm, agreeable countenances may hide the most horrendous of thoughts and intents. We have no way of knowing. There is no real pattern, except in some cases, and it is impossible to pick out those who may go on to become killers.

Superior students in universities where competition is fierce, can, without warning, begin a killing spree. Doctoral students who fail their oral exams and are denied their degree can kill everyone in the room. Physicians who work emergency medicine can, under cover of their job, kill those they see as wishing for death and appoint themselves an "angel of mercy" by providing a deadly medication.

Killers come in all sizes, sexual orientations and ethnicities. The best we can do is try to help those in obvious need of help before their lives turn toward a horrific act. The obvious problem is that, while we are told to report suspicious behavior or verbalizations of violence, we can never know whether the person truly would commit the act. We might, in many cases, act too quickly and report the innocent. It isn't an easy task and not even professionals are free from error.

Everyone has a responsibility to use language carefully. Statements of intention to commit suicide must always be taken at face value and not dismissed. But statements of mass murder also cannot be see as passing moments of anger. Regret can be seen as either reporting erroneously or not reporting with resultant violence. How should we err?