I have been viewing the horrific Newtown mass murder through my lens as a psychotherapist specializing in grief, loss, trauma and caregiver support. My professional lens was sharpened by my experiences providing critical incident stress debriefing and traumatic grief counseling in the wake of the mass shooting in Aurora.

Former Pennsylvania Governor Ed Rendell observed on MSNBC (12/16/12) that the issue is how to keeps guns out of the hands of the mentally ill. I would reframe the question as how to best treat and serve the mentally ill/developmentally delayed and their primary caregivers to prevent this type of tragedy. Despite some progress, there is still much shame and stigma connected to mental illness and to reaching out for support. The lack of ready and affordable care for the mentally ill and their loved ones compounds the problem. I can’t help but think that these obstacles to mental health care played a major role, preventing both the alleged shooter Adam Lanza and his mother slain at his hand from getting the care they desperately needed and deserved.

I was struck by the description of Nancy Lanza, Adam’s mother, presented in the front page Sunday New York Times article “A Mother, a Gun Enthusiast and the First Victim” (12/16/12) by Matt Flegenheimer and Ravi Somaiya. As we have all now learned, Ms. Lanza was divorced in 2008. Her son Adam lived with Ms. Lanza full-time. He was still living with his mother at age 20, at the time of the shooting. No one else lived at the home. Ms. Lanza was described by several people who knew her as “nervous” and “high strung.” In addition to living full-time with her troubled son, she home schooled him after she became dissatisfied with the education and care her son was receiving in the local schools.

The image that came to me as I read this description was of a woman at the end of her rope, burning out from the stress and despair of caregiving for her disturbed son. Based on statistical evidence, it is likely that the difficulties in caring for Adam contributed to the breakup of Ms. Lanza’s marriage.

When I try to put myself in their situation, I imagine an atmosphere of volatility and stress, helplessness and hopelessness. I can imagine that Adam knew he “should” be living on his own, with a full time job, or away at college. I can imagine his shame and rage at his situation. I can also imagine that he projected his rage onto his mother, not only because she was there as an easy target, but also because she was a constant reminder of Adam’s perceived failings as a young man. I can also imagine that Ms. Lanza was overwhelmed by the responsibilities of caregiving for her son, and trying to maintain some semblance of a nurturing relationship with him.

I also wonder what precipitated Ms. Lanza’s enthusiasm for guns and target shooting. Many have asked why the mother of a mentally ill son would have guns in the house. Clearly, this is a sign that all was not well in Ms. Lanza’s world, and the stress of caregiving may have clouded her judgment. Without yet knowing more about that, I can also imagine that she turned to the sport of guns and shooting as an outlet in the wake of her divorce in 2008 and being Adam’s sole primary caregiver. Did Ms. Lanza reach out for support, or was she too ashamed to do so, or did she just not know where to turn for the help she desperately needed?

As a therapist providing support to family caregivers, individually and in support groups, I am acutely aware of their needs. I hear about the sense of isolation, shame, helplessness, hopelessness and despair family caregivers experience. I also hear of the verbal and emotional abuse they sometimes have to endure. It is well documented that family caregivers suffer more physical illness, as well as depression, than others in their age group, and also suffer more divorces and schisms in relationships with other family members

We need to do more as a society to remove the stigma of mental illness, open more doors to support for family caregivers and make care for all touched by mental illness more available and affordable.