The shooting tragedy at Sandy Hook Elementary School in Newtown, Conn., underscores the urgency for mental health practitioners to understand the TILT iceberg. The iceberg is a graphical depiction of the risks for people with Toxicant-induced Loss of Tolerance.

Practitioners need to take a proper history of their patients and think about the role of petrochemicals/drug exposures in violence. These hair-trigger anger reactions were not uncommon among chemically-exposed Gulf War veterans I saw as a consultant for the Veterans Administration. The veterans had become chemically intolerant and were so afraid they might harm their own families that they gave their guns to friends for safe-keeping.

Dietary intolerances are one of the main consequences of TILT, based upon our extensive studies of people who became ill following exposure to pesticides, solvents, substances used in remodeling, and Gulf War chemicals.

Prisons are controlled environments in which it’s been shown that reducing exposures, even to such benign chemical substances as sugar, can reduce violence.

Read an in-depth exploration in the book I co-authored,
Chemical Exposures: Low Levels and High Stakes.

The Sandy Hook shootings, like those earlier in Oregon, Colorado and elsewhere, appear random but individuals whose limbic systems have been sensitized by exposures and then are triggered by cleaning agents, foods or medications they no longer can tolerate are more likely to pick up a gun and use it.

Using the QEESI, or Quick Environmental Exposure and Sensitivity Inventory, with patients and reducing exposures (pesticides, solvents, etc.) could help. TILT may be responsible for a small subset or a large number of cases, but almost no mental health professionals are aware of this illness dynamic/new paradigm and they must not miss the diagnosis. Too many lives are at stake.

Scientists, healthcare professionals and especially people with chemical intolerance have achieved a victory that took years to win. In a nutshell: High-level U.S. policymakers now say chemical intolerance needs serious investigation.

The recently concluded “National Conversation on Public Health and Chemical Exposures,” sponsored by several government agencies, issued a detailed statement in October 2011 that summed up two years of deliberation among hundreds of experts. The statement, in brief, calls for intensified work to understand chemicals and their health effects.

I think the statement will influence health policy and promote new research and clinical inquiry. Progress in the science, diagnosis and treatment of chemically-induced illness has been painfully slow. I’m excited to see this new development.

The National Conversation, in its final statement, urged intensified study of:

• Health effects of chemicals, including low-dose, multiple and cumulative exposures
• Individual susceptibility, including the interplay between genes and environment
• Community vulnerability and disproportionate effects from past exposures
• Effectiveness of interventions to protect public health

To me, one of the most important recommendations called for human studies using environmentally controlled research units. It said: “Studies of variation in susceptibility as manifested by chemical sensitivity/intolerance, including clinical studies conducted in facilities adequate for this purpose, are needed.”

This recommendation for research facilities first appeared in a report commissioned by the State of New Jersey that I co-authored in 1989 with Nicholas A. Ashford, Ph.D., J.D., professor at Massachusetts Institute of Technology, as well as in subsequent editions of our book Chemical Exposures: Low Levels and High Stakes.

Here is an excerpt from recommendations in the National Conversation’s report “Chapter 3: Achieve a More Complete Scientific Understanding of Chemicals and Their Health Effects”:

“Recommendation 3.5: Improve understanding of individual susceptibility to chemical exposures.”

“Those seeking to protect the public from the adverse effects of chemical exposures need a better understanding of variations in individual susceptibility to help prioritize prevention and treatment efforts. Some individuals in certain groups (e.g., developing fetuses, children, pregnant women, the elderly, disabled persons, persons with chronic diseases, persons with previous heightened sensitivity to chemical exposures) exhibit unique susceptibility to chemical exposures. Some of this variability in susceptibility may be related to genetic variation, acquired epigenetic changes, health effects from previous exposures, or nonchemical stressors. To improve the understanding of these variations, funding agencies should continue to support research into mechanisms of variation in individual susceptibility and the role of such variations in the observed burden of environmentally related disease. Studies of variation in susceptibility as manifested by chemical sensitivity/intolerance, including clinical studies conducted in facilities adequate for this purpose, are needed. Population-based studies of exposed groups may yield additional insights.”

“Further, the federal government should support an existing working group or convene an interdisciplinary group of scientists and clinicians from federal agencies, NGOs/public interest groups, industry, academic institutions, and representatives of affected patient communities to develop a research agenda on chemical sensitivity/intolerance.”

The National Conversation was a two-year collaborative process that produced an action agenda in June 2011 on new ways to protect the public from harmful chemical exposures. In October 2011, the leadership issued its final recommendations at an implementation strategy session in Washington, D.C., hosted by the American Public Health Association (APHA).

I chaired the National Conversation’s subgroup on Individual Susceptibility, and served as a member of the larger Scientific Understanding Work Group, one of six working groups assigned to various aspects of chemical exposure. The work group issued a full-text action agenda.

As part of their mission to advance the public’s health, the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry supported the National Conversation. Dozens of government agency, nonprofit and industry experts and thousands of members of the public were involved in developing the recommendations.