There were 28 lives lost

Last Friday's mass-shooting at a Connecticut elementary school was a tragedy that has rocked the region, nation, and world. The brutal deaths of 20 first-graders, 6 and 7 years old, is unfathomable. It is a source of immense sorrow and grief, and enough to inspire dread in the hearts of parents everywhere.

There are so many questions for mental health to consider in such circumstances: how to intervene in times of crisis so that the risk of PTSD is minimized; how to talk with children about loss, danger and safety; how to help survivors (children, teachers, and first responders, as well as parents and families who lost loved-ones) be resilient in the face of their horrific experiences.

However, before tackling any of that, I feel the need to address something that has bothered me in media coverage of the event. Most of the news stories have talked about the 26 who lost their lives at Sandy Hook Elementary School. The fire department set up 26 Christmas trees between the school and the fire house. And while the school shooting is perhaps the most tragic part of Friday, and the most outside of our framework for "typical" homicides (if one can ever say such a thing is "typical"), it's important to remember that 28 people died that day - 28 untimely, preventable, and therefore tragic deaths.

In addition to the 20 students and 6 school personnel, the 20-year-old shooter and his mother also died. It may not be politically correct to speak about these deaths, since the young man was responsible for all the other deaths, and his mother owned the guns and almost seen as "guilty by association," but both still died unnecessarily. And both likely died in a significant amount of mental and emotional pain.

From what we have heard, the shooter, Adam Lanza had a history of mental illness. We do not yet know if he was receiving treatment, and what type. He was only 20 years old - barely an adult himself, and at an age when many new symptoms of mental illness can begin to emerge. For him to decide that the only way out of his pain was to massacre children and then kill himself, we have to conclude that he must have been in significant anguish.

His mother likely experienced years of anguish trying to help him cope with his symptoms, and receive needed services in a country where such services are not consistently available, and those who need them are stigmatized. If she was awake before she was killed, she also likely experienced a flood of emotions: horror, terror, anguish that her son would become a killer...we can only imagine.

Both of these people died tragically and deserve to be remembered in the death toll. As we think about what we will do differently to increase safety in the future, we need to think not just about school safety and gun control, but how we identify, respond to and provide for the needs of youth and families at risk for significant mental illness, or violent behavior (while not equating mental illness with risk of violence). We will have succeeded when no one experiences the kind of pain that would lead them to consider mass-shootings. After all, prevention is our best defense.