The mass murder of 20 children and six adults Friday in Newtown, Conn., has provoked yet another round of recrimination, finger pointing and breast-beating. Was the shooter mentally deranged? If there was more gun control, would this have happened? Did violent video games play any role? What we fervently want as we continue to reel from a story whose misery seems to know no bounds is to find a clear cause - a reason why this happened - so that we can fix it.

We hope to see something in all the stories, analyses, commentaries, Facebook postings and Twitter speculation that gives us the reason behind what happened and thus a guarantee that if we understand and act on it then no 6 year old or her parent need to worry ever again what might happen at their school. We hope that no college, hospital or mall will ever again have a reason to practice drills for "shooters" and no play or movie-goer grow anxious over who has snuck into the theater with evil intent.

But, there is no simple answer. We have ourselves to blame for where we find ourselves in terms of mass shootings. Our culture is too far down the road of tolerating and even extolling violence. We do so in our popular entertainment, we permit the mass marketing of violence to young kids, and we thrill to it in too many of our sports. A lot of people make a lot of money selling violence. I doubt that will change.

Nor will the easy availability of guns. We have been well aware of the cost of easily obtained high-powered guns for a long time.  Even if we move toward tighter gun control laws and seek to reduce access to automatic weapons and ammo, which I favor, we have so many guns in circulation that these efforts are too little, too late. Will deaths fall if killers are not armed as if for combat with automatic weapons and full body armor? Yes. But, will ready access to automated weapons, guns and this kind of equipment disappear any time soon in America? I am afraid not.

So what are we left with as a way to construct a response to Newtown and all the Newtowns before it? I think we need to rethink how we think about violence in the situation in which we find ourselves — armed to the teeth in a very violent society that is nervous and full of fear. The only way to reduce risk in such a tinderbox is to give up a bit of liberty.

First, make the discussion of violence a public health priority. Ask health care workers to talk about the threat of violence in all its forms as a huge public health problem — from suicide to domestic abuse to mass murder. Insist that doctors and nurses talk about guns and weapons with their patients noting their risks and the need for safety handling and storage when they are present.

Ditch efforts, such as Florida’s, to prohibit these discussions. Take the stigma out of talking about the possibility that someone you know will may be prone to violence and offer clear directions about what to do about that.  Let prying in the name of health into what is now deemed private be the accepted norm.

Second, fix the broken mental health system. Not all who are violent are mentally ill.  And mental illness is not always a reason not to hold someone responsible for their actions. Still, no one with a kid who has a mental health problem, and I mean no one, has ready access to competent mental health assistance.  Ask parents who have a kid with anorexia, compulsions, a personality disorder or schizophrenia how easy it is to get services and you will quickly get an unhappy earful.  

If you have a heart attack in any American town or city you can expect an ambulance within minutes. If you or someone you knows has a mental breakdown or ongoing drug abuse why cant we expect the same rapid response and treatment capability? We also need more incentives for doctors, nurses and social workers to specialize in mental health. The nation needs fewer dermatologists and allergists and a lot more psychiatrists and psychologists.

Third, start to screen kids in school — all schools --  for signs of problems involving violence be it bullying, domestic abuse or social isolation. We screen kids for hearing and vision problems but looking for early signs of mental illness is somehow off-limits. A kid can be labeled as at risk of diabetes but not suicide or violence. A bit of screening and some early counseling for those found to be at risk of violence is not going to lead to the thought police controlling the next generation of Americans.

As much as we want it there is no quick fix for Aurora, Columbine, Newtown, Virginia Tech, West Nickel Mines and the scores of other school, mall and public building massacres America has seen over the past two decades. Given where we find ourselves, the fix means giving up a smidgeon of liberty to better protect safety. It means seeing violence as a public health problem that is just as real as swine flu or obesity. It means committing to a hard societal slog from a very bad place to something a bit better.

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Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

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Community members will have to decide whether eventually to reopen Sandy Hook Elementary School after a gunman killed 20 children and six adults on Dec. 14.

Classes are set to resume Tuesday in Newtown, Conn. -- everywhere but at Sandy Hook Elementary School, where a gunman shot and killed 20 children and six adults on Friday.

The school has been closed indefinitely, authorities said Monday, while law enforcement officials process the crime scene, a grim task that could take months. 

But what happens after the investigation to the site at 12 Dickinson Drive remains in unclear. Whether it can -- or should -- reopen to serve 525 kindergarten through fourth-graders depends on how the community and the children respond, experts say.

For now, some local parents say it’s too soon to tell.

“I haven’t even given it any thought,” said Andrew Paley, 40, of Sandy Hook, father of 9-year-old twins Ben and Ethan, both Sandy Hook students who were at the school during Friday’s rampage. 

Students from Sandy Hook are set to begin classes soon at Chalk Hill School in nearby Monroe, district officials said. The building has not been used as a school for 18 months, according to local press reports, and is being renovated quickly to accommodate the Sandy Hook classes. Though there is no firm date for them to start in the new site, being together in class should help students begin to heal, experts said.

It’s important for young children to resume normal routines as quickly as possible, said Amy Smith, president of the National Association of School Psychologists.

“For kids to recover from an event like this, they need to be safe and they need to believe they are safe,” Smith said. 

But whether the student Sandy Hook students at those kids -- or any children -- can return to the Sandy Hook site, a building where youngsters and adults were shot, most multiple times, is doubtful, said Dr. Liza Gold, a clinical professor of psychiatry at Georgetown Medical School.

“You have to think about what’s going to help these kids most in terms of regaining a sense of safety and minimizing the effects of trauma,” Gold said. “You can’t bring them back to that school. You have to think of it as a place that has been contaminated.”

Across the U.S., schools and other venues that have been the site of mass shootings have had to grapple with the question of what to do with the buildings.

For some, it’s been a matter of removing all signs of carnage and getting students back to class as quickly as possible. At Thurston High School in Springfield, Ore., the cafeteria that was the site of a 1998 shooting opened less than a week after freshman Kip Kinkel opened fire, killing two students and wounding 24.

But at Columbine High School near Littleton, Colo., the school was closed for four months after an April 1999 shooting that killed 12 students and a teacher, plus the two gunmen, Eric Harris and Dylan Klebold. The school’s library, where much of the attack occurred, was replaced with an airy atrium and a new library was built elsewhere on campus.

Virginia Tech’s Norris Hall, the primary site of a 2007 shooting that left 32 victims and the gunman, Seung-Hui Cho, dead, eventually was reconfigured and renovated. The second floor space was turned into the school’s center for Peace Studies & Violence Prevention, said spokesman Mark Owczarski.

“In essence, the building continues,” he said. “It has a new life, a new look.”

In Aurora, Colo., the movie theater where gunman James Holmes killed 12 people and injured 58 in July will reopen next month, according a letter from Tim Warner, president and chief executive of Cinemark. The company made the decision to refurbish the Aurora Century Theater after surveying the community. Victims and their families will be invited to the site to visit before the opening on Jan. 17. 

But some spaces have not been reclaimed. The one-room Amish schoolhouse that was the site of a 2006 shooting was razed after Charles Roberts opened fire on a dozen girls barricaded inside, eventually killing five. A new schoolhouse was built on a different site in Nickel Mines, in Lancaster County, Pa., according to press accounts.

“I thought there was a widespread feeling in the community that it was important to remove the building,” community spokesman Herman Bontrager told USA Today at the time. “Especially for the children, but not only for the children.”

Only time will tell if the Sandy Hook Elementary School site can be resurrected enough to feel safe for kids, said Gold.

“If you think about a workplace setting, adults could work through that trauma,” she said. “A little kid might not even understand what is disturbing to them.”

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