(Edel Rodriguez for The Washington Post)

When the doorbell rang one night in 2006, I opened my front door to find a diminutive figure standing before me, her face crestfallen.

“Mom, what happened?” I asked.

“I thought I was going to die,” she whispered, my father gently guiding her inside.

My brother, then 43, had suddenly spun into a rage, she said. She rushed to her bedroom and locked the door; my brother broke it from its hinges, chasing her. She curled into a fetal position on her bed as he pummeled her back and head before walking away as quickly as he had sprung on her.

“Why did you let this happen?” I asked. But I knew the answer.

My mother, like countless other mothers on the front lines of America’s mental health battle, is in a risky position. She cares for a mentally ill child.

We don’t know whether Nancy Lanza ever thought her son Adam might hurt her — news reports say he had Asperger’s syndrome and a personality disorder and wasn’t known to be violent. But she’s part of an alarming number of parents who’ve been killed by their children.

Parricides, or the killing of parents, were 13 percent of U.S. family homicides in 2008, up from 9.7 percent in 1980, according to the FBI. About half of parricides involve children killing their mothers. The typical offenders, according to researchers, are adult sons who are ill and unemployed. Nearly half of them are 24 or younger, an age when, scientists say, the cognitive mind is still maturing; Adam Lanza was 20.

But what goes largely undocumented is the many mothers who live in fear of their children.

Kathleen Heide, a professor of criminology at the University of South Florida and the author of “Understanding Parricide: When Sons and Daughters Kill Parents,” says that most often, when people kill their mothers, they are sick and untreated.

As mental health services are cut, mothers become the agents-in-charge, serving as constant reminders to these children that they’re not well. “The moms are trying to keep their children safe. In illness, the sons many times resent their mothers,” Heide says, and that becomes particularly acute without treatment.

Even in popular culture, matricide is a theme for troubled youth. Rap star Eminem wrote a song, “Kill You,” lashing out at his mother for the dysfunction in his life that he attributed to her.

Too often, mothers search desperately for beds for their sick children, fighting with insurance companies and treatment teams. According to the nonprofit Treatment Advocacy Center, by 2010 the number of public psychiatric beds in the United States had dropped to levels last seen in the 1850s — about 14 per 100,000 people. Since 1955, the peak of psychiatric hospitalization, 95 percent of the nation’s public hospital beds for people with acute and chronic severe mental illness have been eliminated.

From Tucson to Aurora, Colo., young men suffering from mental illness have taken the lives of others.

“Those who kill are untreated most of the time. It’s not about access to weapons. . . . It’s about treatment,” says Dominique Bourget, a forensic psychiatrist at the University of Ottawa who has studied parricide. With the killing of mothers, she says, those who are sick often strike out at “the people most loving to them.”

Our failure to provide sufficient mental health support was highlighted further when Liza Long’s blog post — “I Am Adam Lanza’s Mother,” about the difficulty in caring for a mentally ill son — went viral this past week. She struck a nerve with other mothers desperately struggling in their homes with ill, untreated children. Last year, a mother who chronicles her battle to find treatment for her son wrote on her Web site, “Saving Zach”: “Living in fear became the norm in my house.”

Sometimes mothers send SOS messages to each other by e-mail, too afraid that their sons might overhear a phone conversation seeking help. In my parents’ home, my mother hid her cooking knives when my brother was very ill.

In April 2006, just before my battered mother stood at my doorstep, Amy Bruce, of the small town of Caratunk, Maine, was struggling to get her son, Will, then 24, treatment for paranoid schizophrenia. He had been discharged from a facility despite his parents’ protests.

One day two months later, after getting the mail, he walked up behind his mother and killed her with a hatchet. He is now in a forensics unit at a local hospital.

“I heard the pope telling me to kill her because she was an al-Qaeda operative,” Will told me by phone this week. He seems lucid and clear-thinking now and is receiving treatment.

He says he misses his mother. “I try to do everything to honor her memory. We had our differences, but it was petty. I miss hugging her. She used to hug me all the time.” But, he admits, “she was a little afraid of me.”

Ironically, it was only after killing his mother that Will got the right treatment.

“Why do mothers die?” asks his father, Joe. “Because they love their kids enough to continue to care for them when nobody else will help. Amy never gave up on him.”

In a letter Joe found in his wife’s purse after her death, she had written to her son: “I love you more than life itself.”

It didn’t surprise me that Adam Lanza’s first victim was his mother. It is the news I have dreaded receiving for almost three decades. In 1982, my brother was 20 and started showing signs of serious mental illness, but my family didn’t know what they meant. Two years later, he went to our native India to try to play club soccer, his passion. Over that year, he got very sick, slipping into hallucinations and delusions, later diagnosed as schizoaffective disorder. My mother flew there and brought him home. Back in the United States, he attacked her for the first time, scratching the right side of her face with his nails, grown long.

“A part of me died that day,” my mother says.

Yet, she persevered, taking blows through the years, one time landing in the emergency room with cracked ribs. After I became a mother in 2002, nursing my child through the night with a simple fever, I finally understood why my mother allowed herself to be vulnerable: Her unconditional love for her child transcended her fears.

Over the three decades since my brother’s onset of illness, my parents, now in their 70s, have selflessly negotiated our gutted mental health system, trying to keep him stable. All the while, they have loved him and worked very hard to keep him well, going with him to doctor’s appointments, giving him $5 to get an iced tea and a snack at Hardee’s. But support is limited. Dozens of times, my father has taken my brother to the local jobs office for the disabled. He never finds work.

Along with the rest of the nation, my heart goes out to the families of the 20 children and six adults Lanza killed at Sandy Hook Elementary School. I know it is easy to judge Lanza; that is an understandable response to such a seemingly senseless tragedy. But I would argue that the tragedy makes sense if you look at it from a psychiatric perspective.

Psychiatrists, social workers, nurses and other health-care professionals have explained to my family why mental illness poses such challenges. When very sick, a person suffering from schizophrenia, bipolar and schizoaffective disorders, or other illnesses can have scrambled thinking, feelings of grandiosity, paranoia, delusions, irritation and rage. We don’t know whether Lanza had a mental problem, but other major symptoms of serious illnesses include a lack of self-awareness, a loss of empathy and the emergence of dissociation, or the cutting off of emotions — three characteristics that friends and neighbors have used to describe Lanza.

“Dissociation can cause someone to disconnect from their feelings and their connection to humanity,” says Marlene Steinberg, a psychiatrist and the author of “The Stranger in the Mirror.” When “that connection to someone close is broken,” she says, even assaulting a mother becomes plausible.

I know it is very difficult — perhaps impossible for some — to extend a kind thought to those who take the lives of others. But we must, for it is that lack of empathy that allows humans to kill.

This past week, after visiting me at my home in Northern Virginia, my mother took the bus home to Morgantown, W.Va. In the dark of night, as she descended from the bus, a man approached her quickly. It was my brother — he had driven himself to pick her up, for the first time. He has been stable now for several years.

Laughing and buoyant, he strode toward her. “Hi, Mom!” he said, beaming. He carried her suitcase to the car, then happily chatted with her all the way home.


Asra Q. Nomani, a former Wall Street Journal reporter, is the author of “Standing Alone: An American Woman’s Struggle for the Soul of Islam.”

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Asra Q. Nomani, a former Wall Street Journal reporter, is the author of “Standing Alone: An American Woman’s Struggle for the Soul of Islam.”