http://www.nytimes.com/2012/12/18/opinion/what-drives-suicidal-mass-killers.html

This is an excellent analysis of the problem.

Did the article mention the effects of prescribed psychopharmaceuticals? If not, it is way off the mark.

The use of SSRI's in particular is associated with a known percentage of patients who develop a syndrome known as "akathisia", which causes suicidal and aggressive ideation and behaviors. A very large percentage of mass killers are taking SSRI's, or chantix, or fanapt, or some other "antipsychotic" drug that triggers psychotic behaviors in some patients. This fact is well-known from the science and lit., but the FDA chooses to ignore the data.



Edited 1 time(s). Last edit at 12/20/2012 04:13AM by hello.

What about Adderall?

"Addled" truck drivers, high school students studying for their SATs and grad students pulling all nighters studying for mid-terms and finals...

How many people who, when depressed, might be suicidal or homicidal ANYWAY, and the introduction of SSRI's may simply be coincidental to the outbursts of violence?

Truly, correlation does NOT mean causation, as you should know, having posted on this board for awhile. What if the anti-social behavior of depressives would be worse without SSRI's? You can't claim to know that it wouldn't...

Maybe you should read the original scientific studies of these drugs, and the diagnoses of akathisia. I didn't make this up, because of my personal agenda. It is not a mere correlation. This is the finding of teams of researchers. This evidence was presented decades ago, but newer versions of the FDA have passed these drugs.

Read the science, helamonster.

Sillysally, I don't know about adderal and akathisia, but try a search for it. I know some amphetamine-based drugs do cause aggressive, antisocial behaviors in some people. Drugs like Eskatrol have been linked to murder/suicide.



Edited 1 time(s). Last edit at 12/20/2012 04:12AM by hello.

maybe you should post the links to some peer reviewed studies published in well known academic journals.

At what point would you think the incidence, or causation, if any, would make it necessary to withhold a drug from market?

1%? 0.1%? 0.001%

At what point do we deny the use of meds that provide to relief to millions to prevent something that has not been definitively proven to be caused by the drug?

We make choices, set standards and try to produce the best outcomes.

I would love to see your peer reviewed studies linking the use of SSRIs and mass murder. I would, also, be interested to hear what you suggest should be our alternative therapy to use to treat people who are successfully using SSRIs, when SSRIs are not available...

Isn't your argument linking SSRIs and Lanza's actions kind of weak, since you don't even know whether he was taking a SSRI?



Edited 3 time(s). Last edit at 12/20/2012 01:25AM by John_Lyle.

John_Lyle Wrote:
-------------------------------------------------------
> At what point would you think the incidence, or
> causation, if any, would make it necessary to
> withhold a drug from market?
>
> 1%? 0.1%? 0.001%

I don't know.

>
> At what point do we deny the use of meds that
> provide to relief to millions to prevent something
> that has not been definitively proven to be caused
> by the drug?

I'm not sure that we do.


>
> We make choices, set standards and try to produce
> the best outcomes.
>
> I would love to see your peer reviewed studies
> linking the use of SSRIs and mass murder.

The studies I read link SSRI's to akathisia.

I would,
> also, be interested to hear what you suggest
> should be our alternative therapy to use to treat
> people who are successfully using SSRIs, when
> SSRIs are not available...

Not my topic, or concern...


>
> Isn't your argument linking SSRIs and Lanza's
> actions kind of weak, since you don't even know
> whether he was taking a SSRI?

True. It is likely, but not yet known, that Lanza, who was reportedly autistic, had been prescribed SSRI's at some point, as SSRI's are often prescribed to autistic patients. They are prescribed very frequently for people with affective disorders. Unless his records are released, we may never know all his meds. Medical records of mass shooters are often closed.

I personally do feel that this psychopharmaceutical-suicide-murder association bears further study.

Here's a link to one study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564177/

Interested parties should be able to search from there.

Fanapt was denied release by the FDA in its original application due to hostility and aggression in user's trials. But it was later approved anyway. And there have been murders and suicides involving Fanapt users. But we have no confirmation that Lanza was on Fanapt.

I fault the original article linked, and the media in general, for ignoring the connection between psychotropics and murder/suicide, which has become an epidemic among this decade's returning military servicemen. I think this topic should be part of the general debate.



Edited 2 time(s). Last edit at 12/20/2012 04:11AM by hello.

That's a bit like finding a correlation between people who die of asthma attacks and ventalin usage.

50% of any demographic suffering from something will likely be taking something to treat it.

Edited 1 time(s). Last edit at 12/20/2012 04:07AM by hello.

article about drug maker Lilly's hide and coverup about the prozac/suicide connection:

http://usatoday30.usatoday.com/news/health/2005-01-05-prozac-usat_x.htm

from BBC:

http://news.bbc.co.uk/2/hi/health/758763.stm



Edited 1 time(s). Last edit at 12/20/2012 03:57AM by hello.

The USA TODAY article doesn't discuss trials, etc. Just the opinion that the 'expert' consulted said, (without any supporting facts, just his opinion):

""American people were guinea pigs for a few years. If we had known the truth, we would have used it more wisely from the start," Teicher said."

Like with anything else, hind sight is 20/20. He alleges no benefit or detriment had it been used different.

The BBC study deals with Lustral®, (i.e.; seratraline AKA Zoloft® in the states). Not Prozac.

In reviewing your source, I notice it is six years old. Further many, if not all, the citations are dead links; which means I must rely on the unsupported statements of the authors (which is not to insinuate they are less than truthful or accurate.)

The primary purpose of the article was to determine how to 'present' accurate evidence in court about whether use of these meds causes/caused violence behavior. Jury findings have no scientific validity, nor do statements from the bench or jurors after the trial. Cases are won and lost on who presents the best 'dog and pony' show to the court and to the jury.

In test subjects in the risk of developing 'aggressive behaviors' was less than 0.5% and 0.66% for non-lethal events. I order to be listed as an adverse reaction to a drug, it must occur, at a minimum, in 1% of the users who take it during trials.

The authors' conclusions were:

"In practice, clinicians need to be aware of the issues, but serious violence on antidepressants is likely to be very rare. When violence is a suspected outcome, every case has to be considered carefully, on the principle that individuals are responsible for their conduct, unless there is clear evidence of compromised function that cannot be otherwise explained."

I worked as a medico-legal consultant, in between my other enterprises, for over ten years. In my assessment, in all the clinical/legal cases cited all doctors and, particularly, the nurse practitioner, failed to provide care within the standard. Mainly because they failed to provide good continuity of care, (they made decisions without adequate information of the pt's history); they ignored pt. reporting; they failed to insist on adequate patient follow-up; they failed in their duty to refer to psychiatrists; etc.

The grandparent's exceedingly poor judgment in removing their grandson from an inpt. facility against medical advice and their primary care physician's failing to insure continuity of care and adequate monitoring after prescribing meds that were clearly contraindicated, in my opinion, almost arises to the point of criminal negligence.

Sorry, I just do seen anything close to a statement in your source that definitively causally connects use of SSRIs to murder.



Edited 1 time(s). Last edit at 12/20/2012 01:22PM by John_Lyle.

I didn't mean the article linked to be "definitive". Readers could do some search of their own, if they actually cared about the topic...

Maybe search, I don't know, "SSRI's and suicide"? :)

Are you denying that there is a link between SSRI's and suicidal ideation? Are you denying that Lilly tried to obfuscate and hide this data?

Now that Lilly's Prozac patent is expiring, they are rolling out a second, re-tooled, re-named version, which they claim they have successfully tweaked so that the new drug causes less suicidal ideation than Prozac. Their words, not mine.

Hello –

You are painting a moving target. You make a reference, I discuss it, then you say it wasn't definitive and I should have done more research.

If you wish to make a point, please make it. If there are sixteen references, then include sixteen references. It seems disingenuous to refer to an article and then say, "No, I didn't really mean it." In debate, it is generally accepted that the person making the assertions provide support for their assertions.

I have no idea what Lilly's intention was in doing whatever it did. Yes, I have heard allegations of a link between SSRIs and suicide.

The evolution of the SSRIs has continued from the more general - prozac - towards the more refined. SSRIs started being like hitting depression with a tennis racket. Very non-specific. Like most classes/types of drugs - think benzos starting with diazepam and progressing through fast acting benzos like alprazolam that have a specific use - SSRIs are being constantly refined. It wouldn't make sense for a manufacturer to not make a safer drug if they could. Making a drug that is safer doesn't mean they have ulterior motives. Drug companies are profit driven.

From my position, it appears you believe SSRIs aren't safe and that their manufacturers are intentionally obfuscating in order to sell unsafe medications. I don't agree.

Thanks for the discussion...

I meant to post the article, but it was a pop article. It wasn't a definitive scientific work, altho one of the articles I posted referred to a study that established a link between SSRI's and suicide. Another I posted showed that doctors were taking note of the poor science supporting the safety of Prozac. I suppose you missed those. The articles were meant to be informative, and to stimulate others to do some research.

Sorry I don't want to debate you, not that interested or energetic. I just wanted to make the point that there is a problem, and it should be considered in the general debate about mass murderers.

Disagree all you want.

Exactly what I was thinking!

Testimonials are said to be worthless, except for when they're our own.

Aside from the reading and thinking I've done on the subject of drugs that affect neurotransmitter functioning, I was my own guinea pig a few months ago.

Neurontin is the brand name for gabapentin, which acts upon the GABA neurotransmitters. It can be used for epilepsy, but in my case I was hoping to get some relief from nerve pain associated with MS.

I had to wean myself off gabapentin over a period of weeks after the side effects became intolerable:

- increased agitation and anxiety
- physical jitteriness
- morbid fascination with various methods of death

I'm like the next person and I worry about things, generally have a few neuroses.

I have never in my life felt as weird and "not me" as I did on gabapentin. I am in a pretty good place in my life, feel very fortunate for lots of reasons. Yet while on this drug I was very easily irritated, on edge, and the worst part was what I can only describe as random thoughts of different ways I could take my own life, which were extremely unwelcome and traumatizing

The most spectacular was feeling upset in knowing I was going to have to wean off the gabapentin: it was working for the nerve pain but by that time (about 10 days in) I was in such mental hell I knew it had to be the drug.

I passed underneath my 2nd floor balcony as I was feeling exceptionally upset in anticipating a return of the nerve pain upon cessation of the drug, that I briefly had a thought: that balcony was plenty high enough and strong enough for me to hang myself, but I'd want to do it after putting the dogs out in the yard, so they wouldn't be traumatized by my body.

I started crying - this thought was Not. Me. At. All - and just knowing that it was so foreign was extremely distressing. I really can't describe it. I'd had thoughts a few days prior wondering how long I'd suffer if I stepped in front of the train when I heard the horn of its passing a few blocks away.

I was able to safely wean off the gabapentin. The nerve pain returned, but I've been working more on meditation and will be joining an organization in my state fighting to get medical greenherb legalized.

Point of my story: gabapentin is a drug that is used to treat seizures. Many drugs used to treat states of mind in psychiatry are crossovers from the same class of drugs.

Makes utter and total sense to me that an undefined percentage of people (possibly large) might have a similar - or worse - effect, depending on their situation, what traumas they've been through, their levels of depressive feelings.

Clinical trials mean very little any more. Drug companies maintain total control over their raw data, commonly use ghostwriters, and are not required to publish all the studies they run - they can publish the favorable stuff and if there's not-so-favorable or outright negative stuff, it will never see the light of day. Totally legal.

Every time I see the cartoon Abilify ad I feel sick to my stomach. Instead of being a big, fat red flag that perhaps we should re-visit the true efficacy (and risks) of SSRIs, let's just assume that progress has been made because we now have yet another "add on" drug we can buy to supplement what should have been helping us in the first place.

Abilify® is an atypical anti-psychotic, NOT an SSRI...

I have had serious side effects when using Neurotin®. Athough, none of the ones you had.

When the side effects became significant enough, I immediately called my doctor. Who immediately told me to stop taking the Neurotin®–which I had already done. The adverse effects stopped.

Since I have never, personally, (and not speaking for anyone else or insinuating Neurotin® isn't effective), gotten relief from my chronic paid with a neuroleptic.

We moved on to another drug for my chronic pain.

As a paramedic working in a level III trauma center emergency department I have seen a variety of reactions to a variety of drugs. I have seen people taking Tagamet® (the first histamine blocker for gastric hyperacidity and, at one time, the number one selling drug in America) suffer from confusion and paranoia. Etc. I've, also, seen thousands who took Tagamet® with not significant side effects. Anecdotal reports on what might happen stir concern, but they do not equal 'data'. We need to pay attention to the scientists...



Edited 1 time(s). Last edit at 12/20/2012 12:41PM by John_Lyle.

John_Lyle Wrote:
-------------------------------------------------------
> Abilify® is an atypical anti-psychotic, NOT an
> SSRI...

Like many SSRIs its mechanism of action is upon various parts of the dopamine and serotonin neurotransmitter pathways.

As a result, it's very difficult for me to not see it in a "Tomato / Tomahto" light.

And while we're on the subject, isn't it interesting that we've reached the point of using psychiatry's equivalent of a sledgehammer (a drug normally reserved for treating psychotic symptoms) for depression?

John_Lyle Wrote:
-------------------------------------------------------
> As a paramedic working in a level III trauma
> center emergency department I have seen a variety
> of reactions to a variety of drugs. I have seen
> people taking Tagamet® (the first histamine
> blocker for gastric hyperacidity and, at one time,
> the number one selling drug in America) suffer
> from confusion and paranoia. Etc. I've, also, seen
> thousands who took Tagamet® with not significant
> side effects. Anecdotal reports on what might
> happen stir concern, but they do not equal 'data'.
> We need to pay attention to the scientists...

Oops, I responded to your post before I saw your edits/additions.

I respect your experiences and agree that a wide variety of people can have a wide range of side effects to the same drug. I also wanted to thank you for doing a tough job.

My only reservation about paying attention to scientists is when their endeavors are funded by corporate interests.

By the by, do you mind sharing what's helping your pain right now? Many thanks!

Frog:

In my research, hitting many people who it was thought might benefit from taking anti-psychotics with haloperidol was hitting them with a bus. Once I saw a pt. suffering from tardive dyskinesia from haloperidol, I knew there had to be something better than that. In my experience atypical anti-psychotics are better, because they work and have less side effects.

As for what I am taking for chronic pain, now. Very infrequent hydrocodone and muscle relaxants. However, right now, I am recovering from being broadsided by a truck at 50MPH, my ribs were bruised, I broke 4 spinous processes of my lumber vertebrae, I fractured my right wrist, etc. I am not so sure right now is indicative of the rest of my life and how I will deal with what will, almost certainly, be increased chronic pain...

I get out, I hike, I walk my dogs, etc I do whatever I can to deal with it on a non-pharmacological basis. I, often, go to my incredibly hot physical therapist to get more advice and sometimes just to stare at her (LOL). Often I end up taking a benzo and going to sleep when it gets unbearable; means I sleep a lot of days away.

I am 55, I plan on being as active as I can until they dress me up in my temple garments and send me off to the outer darkness. Where can all party together.



Edited 2 time(s). Last edit at 12/20/2012 01:26PM by John_Lyle.

John_Lyle -

Egad, you’ve really been through the wringer and then back again. I am so sorry to hear about the considerable horrors you’ve gone through, and wish you the best in future healing and health.

I’ve been down the opiod/narcotic and benzo paths before but they don’t do much for nerve pain. Plus I hate being constipated (sorry, it had to be said…) I don’t mind feeling all relaxed and dopey, I suppose, which can help take one’s mind off the discomfort even if it’s not doing much to alleviate it. I’m serious about the medical mj – several friends with neuropathic MS pain have used it for the better part of 5 years and it does wonders. But they live in Washington state.

Dogs and hot PTs are a great way to address pain sans medications, for sure. I used to have a PT who reminded me of a young Rutger Hauer. In some ways, I’m kind of glad we moved last year because my unrequited crush was invading my dreams in an embarrassing kind of way…

You’re on your own with the temple garments. I was able to dodge that particular bullet by getting the hell out right after high school.

But I’ll meet y’all for the Outer Darkness Party – there’ll be so many of us there that they’ll be lonely in the CK…rofl

Actually, I should have said, 'try to dress me in my temple garments.'

My sister and I have a deal - whoever dies first, the other one fights off the morg....

Narcotic analgesics are really interesting in how they work. 'Analgesia' means without feeling. They really aren't 'pain killers' in that they don't make the pain go away. They just make you not care about it.

If you give a person an adequate dose of a narcotic analgesic and asks them if they still have pain, they often will say, 'yes'. If you ask them how they feel, they will tell you great - the pain is still there, they just no longer care about it.



Edited 1 time(s). Last edit at 12/20/2012 11:53PM by John_Lyle.

I think it is superficial, lacking acknowledgment of the new variables in our society, such as early prescribing of Ritalin and Adderol for normal fidgety boys to "help" them concentrate (read: to help me manage my overcrowded class).

Genetic factors are not included and there has been much progress there, including the isolation of a "spiritual" gene and the disappearance of the Jewish Indian.

Another marked difference is a society which admits material into the psyche of boys to alter their ideas of what masculinity is. And at an earlier age: sex, violence, abuse, nihilism, religious fundamentalism.

And what about the violent video games and television entertainment that offers nightly entertainment torture, violence plus sex, and "re-enactments" of sadistic crimes. This is what passes as entertainment in America. Well, don't we all want to get attention? Let's be entertainers, but we're not going to be a vaudeville act, so how will we become famous?

It is known that the military is quite fond of video games because they do the recruiting for them. By the time boys are teenagers they have vicariously slaughtered thousands and there is no desensitizing necessary.

It's not simple.


Anagrammy

Anagrammy –

I would like to know more about the 'spiritual gene.'

I have a friend who is a lay church leader who insists we all have an 'innate god consciousness.' I wonder if they have anything to do with each other?

Hi John,

The theory of a spiritual gene came out of the classic twin studies. It was serendipitous that they discovered the twin daughters of preachers who were given up for adoption, even though raised in a secular/atheist home, tended to be VERY religious.

As you no doubt know, religious ritual has many elements which appeal to obsessive compulsives. I remember an aunt being very upset when the priest turned to the wrong direction when going to get a chalice from an altar boy. She was a bit of a meditative head-nodder, the same rocking motion which the disturbed and anxious find soothing.

So there's that. I didn't dig into it research-wise, so have fun and let us know what you find.

I always enjoy your posts!

Anagrammy



Edited 1 time(s). Last edit at 12/20/2012 03:26PM by anagrammy.

His conclusion is that the actors in these cases are mentally ill. He doesn't explain why, he just looks at results and draws a conclusion. Which really isn't that helpful, other than it gave the NYT an opportunity to use a stupid graphic...

He doesn't even suggest any possible solutions, he just says: If the perpetrators lived in the middle east they would, probably, be suicide bombers. Perhaps, marginally interesting, but hardly profound. And I am not sure how it adds anything to the discussion.

Perhaps it could serve as an illustration as to why 'gun control' isn't the best solution to stop these occurrences. Rather that we ought to be able to provide adequate mental health care to everyone. Not just the rich.



Edited 1 time(s). Last edit at 12/20/2012 12:45AM by John_Lyle.

It was only a 3 year study and, as far as I know, the 1st of it kind. So I woundn't expect too much in the way of conclusions. More, is this issue worth studying?

What I took away was that Islamic extremist suicide bombers are suicidal mass murderers that have a "culturally appropriate" manner to kill themselves (there being less suicide in Islam) and whole bunch of others. That cross culturally, there are parallels. And that in America's culture, deeply saturated with guns (not explosive vests) and not particularly at war with anyone on their own soil, Lanza's crazed actions, in part, grew out of his culture. Both were crazy and wanted to kill themselves after or while killing a lot of other people. I'd say there's a parallel worth thinking about there.

I didn't spend that much time with the article. But I was skeptcal about how firm a conclusion one could draw from the sources the author used. Its the old diagnosing the dead. And the diagnoses has to be some form of mental illness, hard enough to classify after multiple face to face sessions.



Edited 2 time(s). Last edit at 12/20/2012 08:51AM by lulu.

At the risk of opening a can of worms, which directly challenges a very deeply entrenched cultural "Religion", I'd invite anyone interested in the subject of psychiatry, psychiatric drugs, and the effects on our society to check out this website:

http://www.madinamerica.com/

No, I am not a conspiracy theorist! Due to long personal experience, a lot of reading and thinking, and the knowledge of who benefits the most from the sale of a commodity, I've slowly come to the conclusion that the way we think about "mental illness" is, quite frankly, insane.

I used to worship the term "double blind clinical trial in a peer reviewed journal" until I began to learn more about the control that drug companies hold over raw data, ghostwriting, the number of studies that can be run without ever being published (selective publishing), etc.

Again - this isn't a conspiracy with someone pulling the strings. But we'd all do well to seriously question the way we worship "clinical studies" and look a little deeper down the rabbit hole.

Foucault's History of Madness

http://www.amazon.com/History-Madness-Michel-Foucault/dp/0415477263

Holiday reading.

I'm familiar with the meta research that shows the effective rate of many antidepresents is at or near that of the placebo.

I'm also aware that in double-blind studies, the subject will usually not get any negative side affects with the placebo but will with the active pill. This makes it hard for the study to be truly double-blind.

But its a big leap from there to Prosac creates mass murderers.



Edited 2 time(s). Last edit at 12/20/2012 12:32PM by lulu.

lulu Wrote:
-------------------------------------------------------
> But its a big leap from there to Prosac creates
> mass murderers.

Thanks for the link, lulu - I just put it on my amazon wish list and will check it out after I finish reading Szasz
http://www.amazon.com/The-Myth-Mental-Illness-Foundations/dp/0061771228/ref=sr_1_sc_1?s=books&ie=UTF8&qid=1356026370&sr=1-1-spell&keywords=Thomas+Szatz

I'm not sure if that's what's being said. There are plenty of mass murderers who were never on prozac.

Plenty of people take prozac without becoming mass murderers.

Might there be a certain class of individuals that - due to their particular circumstances and brain chemistry - in which prozac is contraindicated because it might increase risk of violence and suicide?

Makes sense to me.

frogdogs Wrote:
-------------------------------------------------------
> Might there be a certain class of individuals that
> - due to their particular circumstances and brain
> chemistry - in which prozac is contraindicated
> because it might increase risk of violence and
> suicide?

There might. Emphasis on might.

You also might be interested in

http://www.amazon.com/Fits-Trances-Visions-experiencing-explaining/dp/0691010242

which covers JS's period (but she doesn't talk about JS which has always puzzled me).



Edited 1 time(s). Last edit at 12/21/2012 03:07AM by lulu.

I've been thinking about this a lot today. The vast majority of people, including the mentally ill, simply do not do things, like a mass shooting. What follows is simply my theory. I have no idea what goes on in these guy's heads.

I would have to say that the very small minority of mentally ill people who go on killing sprees, the two things that separate them from the rest of society is a combination of selfishness and frustration.

To have an untreated mental condition, is to suffer. They have a complete inability in dealing with, or even understanding the world around them, and this causes suffering. It also causes a lot of frustration. They feel powerless, weak, and angry that they are suffering, and blame others, no matter how innocent or misdirected.

The Sandyhook shooter wanted his town to suffer. He knew enough to know that killing their kids would cause a lot of suffering. He wanted them to suffer, because of the anger that grew out of his mental condition. The kid played violent video games almost non-stop in his dark basement, but this wasn't the cause of his aggression, it was self medication. He was dealing with his frustrations by killing and inflicting suffering on imaginary beings, and after a time, it wasn't doing enough for him. He wanted to live out the real thing.

Killing his mother, was probably a way of dealing with his anger and frustration of having to deal with another mentally unbalanced person. The mentally ill often have a hard time taking care of themselves, taking care of another, especially another special needs person is probably beyond a lot of them. This would have made the son very frustrated. Killing her probably, in his sick mind, provided some kind of relief, and he wanted more. For the first time in his life he had felt empowered. He could do something that mattered, no matter how dark or evil. Frustration with the world and his inability to interact with it had probably made him feel powerless and inadequate. Seeing adults and children powerless in front of him probably made him feel differently.

Then when he was finally confronted by adults who were not powerless in front of him, the police, all his feelings of inadequacy returned. He was out of his league, the guy who gets picked last for the dodge ball team, and gets murdered on the field, only this time, it was a little more serious then wounded pride. As the cops entered the building, as he heard their sirens, and the noise of them breaking down doors, he would have felt a crash. It was all ending, and that was why he finally turned the gun on himself, and blew his brains out, just as nearly every one of these guys does.

Again we don't know. This is just all speculation. I do think if we developed programs for the mentally ill, that helped them find a kind of adequacy, that helped them feel like they mattered in a positive way, we might see a lot fewer of these incidents.

I have always wondered if killers Lanza picked a school because he knew there would be a large number of targets there.

With the exception of 'school revenge' shootings (Columbine); I have to wonder if mass murderers of this ilk are drawn to places where there a large number of people to shoot: malls, schools, public gatherings, churches, etc.

As far as I can recall I don't think Lougher had any particular animosity towards Rep. Giffords. (I may be wrong, if so, tell me.)

Focusing on more 'gun control' is all well and good, but it's kind of myopic. We need to approach the problem holistically.

And I think providing adequate mental health care to everyone, regardless of ability to pay, is a place to start.

As a civilized society, don't we owe it to our most vulnerable citizens to have the opportunity to live full lives without pain?