|By Dr. Bill Knaus|
Since Cho Seung-Hui massacred 32 people at the University of Virginia, the greater US college community has responded by efforts to support its fallen fellow students, and the friends and the families of the students. Many parents of college students from Maine to Hawaii have especially felt unsettled by this event. Those who mourn continue to mourn because the lives of those who were lost in this massacre were meaningful. For them, there is no future.
This paper is intended to explore psychological factors that contributed to Cho's murderous rampage and to explore what can be done for the future to prevent more of the same. Let's start with putting the April 16 shootings that took place on the Virginia Tech campus into context. The mass murderer, Cho Seung-Hui, was a highly disturbed, destructive, individual who acted in an evil way by deliberately ending the lives of 32 others. Cho chose suicide following his rampage. His endgame was destruction. When he destroyed all that he was able, he took his own life.
The vast majority of people who suffer from mental disturbances are substantially more of a problem to themselves and to those closest to them who may feel stressed by their disability. It is statistically rare for any mentally distressed individual to go on a killing spree. This is important to keep in mind.
Cho's mass destructive conduct is very rare. How is this to be explained?
Cho Seung-Hui may have suffered from a rare mental disorder called paranoid schizophrenia which is characterized by distrust, suspiciousness, and delusions of persecution. Cho thought that others thought they were better than he. He may even have seen that others intended to harm him.
Many people who suffer from this form of mental disability suffer from delusions of grandeur that often cloak a morbidly sick self-concept. Paranoids of this kind may have a hard time separating delusions from reality. They tend, as a group, to lack a sense of identity. Their boundaries between reality and fantasy are typically blurred. Some feel an inner terror of not knowing who or what they represent. Cho's representation of himself as a "?" mark, suggests this lack of identity
Cho said that he saw himself as Christ-like martyr. He asserted that he was a few semesters away from a Ph.D. Cho's heroes were the Columbine killers. Cho's actions suggest that his intent was to one-up them. In that way he'd go from a "zero" to a national figure. These are possible reflections of grandiosity thinking that often cloaks and compensates for a sick self-concept.
Cho probably depersonalized and dehumanized his "victims." They were a means to an end, and objective evidence of his power to assure that he had a legacy. It was grandiose for him to think that his legacy was worth the lives of 32 others, if that is what he thought.
Paranoid schizophrenia typically involves a pattern of guardedness, anxiety, hostile fantasies, and sometimes violence. Cho appeared guarded in his responses when he was interviewed about his mental health state. He had a long history of anxiety and hostile destructive thoughts. Cho's destructive irrational thoughts were as murderously violent as was his behavior.
A mental health observer described Cho's affect as "flat." Flat affect is characteristic of schizophrenia. Cho is presented as having a history of "weirdness," social isolation, shyness, manifest disturbances, and irrational thinking patterns which, from other psychological information, support a schizophrenic hypothesis.
Most paranoid schizophrenics don't act out their delusions in the way that Cho acted out his. Compared to other forms of schizophrenia, most people in this paranoid group function adequately in educational and occupational settings.
People with paranoid schizophrenia may share a common diagnosis, but they are all different. Cho was a rare wild card in this group.
Whether one agrees with this paranoid schizophrenic assessment or not, thinks Cho was depressed, or view him as a psychopath, Cho's massacre of innocent others was the act of a person with a deranged irrational mind. Because of his planned actions and knowledge of what he was doing, had he survived, it is doubtful that he would have been declared innocent due to insanity. Still, he acted abnormally with deadly intent.
Some of his Virginia Tech classmates saw him as mentally ill, and complained to authority. He was detained, evaluated, found dangerous, and released. Why wasn't Cho's destructive tendency, once it was known, taken seriously enough to protect him and society from harm?
In fairness, one would need a crystal ball to foretell the full extent of this tragedy. In hindsight, some telltale signs were there. Some stories he wrote and presented to his English professors, were frothing with bizarre tales of destruction. He had a history of mental disturbance.
This opinion statement further breaks out into two parts: 1. A proposed psychological profile that expands upon the issues presented above; 2. Recommendations to help protect the public and mentally or emotionally disabled individuals. They follow.
A POSSIBLE PSYCHOLOGICAL PROFILE OF A MASS MURDERER
The following assessment of psychological factors about Cho, is based upon fragments of information from media-reported sources, and is subject to such limitations. It represents opinions and hypotheses. The following provides an assessment of a meaning of the reported history and actions of Cho.
1. Cho's published history is that of an extremely troubled human being. He reportedly appeared as a timid, withdrawn, shy, oddly "pushy," socially phobic person with a fear of public speaking who seemed "weird" to some who knew him. He showed inappropriate social judgments. He engaged in socially inappropriate Internet stalking of a least two women. He seemed to live in seclusion, secrecy, and isolation. He had a burning hatred and rage for others whom he saw as thinking they were better then he.
2. Cho predictably suffered from an extreme evaluation anxiety where he saw people judging him and resented, with rage, what he created in his head. This presumed self-referencing attitude probably spun into a self-fulfilling prophesy where his attitude and behavior probably evoked some responses he hated.
3. Cho was described as a bullied and teased child. He was teased because of his accent. But this may not be a frequent pattern, and his high school years reportedly seem unremarkable regarding people picking on him. People who are intensively into their own troubled worlds, who have trouble communicating with others, as with Cho, are uncomfortable to be around. Thus, they are more likely to be shunned or badgered. This process can then feed into the belief that something is wrong that they cannot correct. It's a vicious cycle. Whether or not Cho was bullied or teased as a child doesn't justify his actions. Many people are bullied and teased and few go on killing sprees. This is, however, a higher incidence of mass murderers among bullied people.
4. If the paranoid schizophrenic description is reasonable, then Cho's hatred of "others" might be viewed as a "restitution symptom." Such symptoms represent the individual's explanation for the inner mental and emotional turmoil he or she experiences. The person then bonds to the explanation. According to this theory, Cho acted like he believed that other people's pretentious projection of superiority was the cause of his distress, and they have to be punished. This belief makes his inner disturbance "feel" reasonable. But this distorted explanation doesn't make life any better. Unfortunately, such a fixed belief can justify hostile and deadly acts. In contrast, most males, and a significant subgroup of females, act like "externalizers" who are inclined to blame external conditions when things go wrong. That orientation can deviate from fact and reality and can be dysfunctional without rising to the level of Cho's destructive disturbance. Cho presents an extreme set of beliefs that appear marked by a violent, blaming, delusional state of mind. The difference between Cho's externalizing and that of most "normal" people who tend to project blame, is the difference between a firecracker going off and 100 pounds of dynamite exploding.
5. Some paranoids weave together fragments of observance to build a case of a conspiracy against them. It is the rigidity and unyielding nature of these beliefs that make them pathological. If someone effectively questions aspects of a person's paranoid system, a paranoid thinking person is likely to later return with a counter argument to restore the subjective validity of the restitution symptom or belief. In comparison, practically all "normal" individuals have self-defeating beliefs, but are better able to alter them when presented with disconfirming facts and information, or to see the lack of evidence under conditions of self-examination.
6. A paranoid thinking person twists and contorts reality to fit the restorative belief system. In some conditions, this twisted process can lead to harming those whom they mistakenly believe intend to harm them. This includes even innocent strangers.
7. When a person is in a floridly rigid paranoid state, cognitive interventions or arguments against the paranoid thoughts, take a long time to have an effect, that is, if they have any effect at all. Being heavily treated with a sedative medication is probably the better alternative. This takes away the energy to act with destructive intent.
8. Asserting a life and death power over others (power pathology) may have been part of Cho's resolution to a chaotic inner mental life that churned with suspicion and violent content. This drive for power was directed to control the life and death on some of his fellow students. He obtained the guns. He asserted power by pulling the triggers.
9. Cho looks in his video "manifesto" like a person with an extremely intense, rigid, self-referenced focus. His thoughts are filled with distortions. In his video, Cho made a statement filled with examples of emotional reasoning that included inflammatory overgeneralizations about others. He constructed his rant in such a way as to justify his raged murderous motivations. His statement is similar to that of an agitator, full of fury and overly general accusations. It reduces to cinders once the exaggerations, irrationalities, vague references, and emotionalized statements are removed from the document. When these destructive justifications are removed from the manifesto, what is left is a series of "articles" and verbs. Both the intensity and apparent loss of reality boundaries that describes Cho's disturbance.
10. Cho's destructive planfulness and organization are evident. He got two handguns a month apart. He ordered extra clips for the handguns from "ebay." He obtained chains to lock the door so people would have trouble escaping his wrath. He made a videotape and statement and he mailed it as an "overnight" delivery. Once he mailed out the tapes and document, in his mind, the choice to kill again was set. He knew he wasn't going to walk away from this act. He had already taken lives. Part of the plan was to destroy himself after he could no longer destroy others. He executed the plan.
11. Cho was prescribed antidepressants, but we don't know if Cho was depressed or not. He did seem organized enough to obtaining firearms, extra ammunition clips, and a chain to lock students into a class room building. He did make a tape and he mailed it. Thus, an argument can be made that he was organized for a long-enough time to prepare for and to follow through on his methodical killing spree. That information would suggest that depression was not a prominent feature.
12. Cho was allegedly treated with antidepressants. If depression were a valid diagnosis, it may have been a coexisting condition. In about 50 percent of the cases of those suffering from depression, we find anger. A small percentage experience persistent rage. Those few with an extreme rage related to the depression, are most dangerous when coming out of a depression because they fear that they will slip back. In such instances, suicidal and homicidal impulses are commonly present. Nevertheless, an assessment of paranoid schizophrenia seems to explain better Cho's condition.
13. We don't know for sure if Cho was taking antidepressants at the time he murdered the Virginia Tech students and professors, or if he was taking them routinely, then stopped taking them. Stopping antidepressants abruptly, without tapering them, can add to an agitated state. Teens and young adults are at higher risk for suicide when on antidepressants, thus, the FDA black box warning on the pill containers.
TAKING CHARGE OF THE FUTURE
We can't rectify what has happened at Virginia Tech. Although memories live on, the past is gone. We can learn. We can look to the future and think differently about what is important to do to reduce risks of a similar happening.
Facing Threatening Individuals
I can only imagine the raw terror the students and professors who looked down the barrel of Cho's guns experienced, who smelled the scent of burnt gunpowder, who saw their friends and classmates falling after being shot.
In an unexpected, immediate, and overwhelming danger, humans tend to behave in extreme ways. They freeze, frenzy, or fight. Few reflect quickly, then act.
In initial moments of ambiguity and uncertainty, few assess the situation and decide a course of action that is appropriate to the demands of the situation. Experience or training for comparable situations, can help tip the balance in favor of a response that puts the recognized danger factors into perspective. Common sense can serve the same purpose. So, once it was clear that Cho represented a deadly danger, some jumped out of windows or hid behind barricades. Others in different classrooms, sought shelter.
In dangerous circumstances, it's in the initial moments of confusion and uncertainty where people are most vulnerable. In the Virginia Tech shootings, Cho, knew he intended to kill. Others had to figure it out before the shooting began.
When faced with an immediate overwhelming danger, as a species, we are programmed for flight or fight. The primitive parts of our brains first perceive the danger. Millions of years in the evolution of our survival mechanisms kick into gear. This reaction prioritizes "freezing" when an overwhelming but deadly predator is near. Predators are alerted by movement. Freezing has a survival value.
A primitive freeze survival reaction is dangerous when a predatory human is in our midst. Dangerous humans don't act in the same predictable way as, say, a hungry bear. A lack of movement makes it easy to shoot people while they stand in place. However, sometimes the best survival strategy for a group of people is to attack the assailant using superior numbers. Some will likely die in the process. But the idea is to avoid getting shot. This commonsense idea is not so easily accomplished in chaotic situations.
Following the 9/11 crashing of terrorists hijacked planes into the Twin Towers, United Airlines Flight 93 passengers, who figured out what was happening, probably attacked their assailants. When faced with nearly certain destruction, it is probably best to act in a way that gives you the best chance. This time the group didn't survive. Attacking the assailants still gave them their best chance.
The situation is important to put into perspective. It is normally ill-advised to confront armed "robbers" in a bank. They are typically after money. In a classroom setting, religious setting, restaurant setting, and in public transportation settings, someone blandishing a gun or knife or bomb, who appears agitated and unstable, may be viewed differently. It is here where judgment comes into play.
Having leadership available to help people mobilize to defend themselves and to act swiftly, is often lacking in crises that occur at unexpected times and places. Judgments will be imperfect. Perceptions of the situation can be based more on fear than on reason.
A Possible Change of Menu
Perhaps the time has come to look at the current menu of services and processes to help those who are afflicted by mental disabilities that they did not choose to develop. How can a society protect individuals and itself by reducing the risk of individuals repeating disasters such as the Texas Tower killings, the Columbine student killings, the Marshall Applewhite Heavens Gate mass murder, the Jim Jones "Peoples Temple" Jonesville killings (700+ deaths)? The most recent tragedy at Virginia Tech, can be a catalyst for looking more deeply into what can be done.
It is unlikely that mass killings are only inflicted by people with paranoid schizophrenic rage disorders. Jim Jones sounded paranoid and driven to control, but he was probably not a person with paranoid schizophrenia. In Jones' case, hostility may have been his cover for fear, and he compulsively carried out his mission with deadly intent fueled by that fear. Marshall Applewhite appears to have been a person with a power pathology. People with power pathologies orient their lives around gaining a sense of absolute power and control over the lives of others. They commonly intend to instill fear. In Applewhite's case, he gained a sense of personal power through controlling the thoughts of his followers and ultimately causing their mass suicide.
People like Applewhite, Jones, and Cho are unlikely to voluntarily seek psychotherapeutic treatment, or to cooperate in such a process. They may not recognize they have the sort of mental disability that can extend to socially destructive death dealing actions, or that their planned acts represent deranged thinking. So what are some basic options?
Let's start this exploration with a question. Do members of the US society have an ethical responsibility to safeguard its mentally ill fellow citizens? If not, why not? If so, why? The answers to these serious philosophical questions can shape future direction in this area.
Supporting the health and welfare of vulnerable mentally ill citizens can be seen by some to be slipping on the social priority scale. For example, in Massachusetts, about 800 people who were in the State's facilities for the mentally ill, died following the closing of some major state hospital facilities. Community living was seen as a choice. But many were not prepared to live on their own without endangering themselves. Promised resources were too frequently inadequately delivered.
Following the closing of many of Massachusetts' owned hospital facilities for the mentally ill, some received care in group homes, by their families, and in alternative state facilities. However, many found their way to homeless shelters, fell prey to drug dealers, landed in prison, or died in some isolated place. Thus, the idea of choices in the community living model was partially an illusion.
Continuity of Care
In 1962, President John F. Kennedy presented a partial answer to the challenges we face today. He noted that what this nation needed was a "continuity of care" program for those with mental illnesses and mental retardation. This included facilities for people who were temporarily or permanently incapacitated with a mental illness or permanently lacked functional skills because of profound or severe mental retardation. He saw that many could life productive lives in the community, and were misplaced in mental health facilities. He recognized that needs of people with disabilities change as people age, and that it was important to prepare through a continuity of care vision.
Can we profit from a "state" or a national plan based upon John F. Kennedy's "continuity of care insights" and direction? I don't see anyone meaningfully stepping up to the plate on this issue. I don't see managed-care companies making that kind of investment possible to prevent mental illnesses for worsening.
State governments are not know for compassion for those with mental disabilities. For example, the Commonwealth of Massachusetts sometimes needs prodding by the Courts to do its duty to support the health and welfare of its most vulnerable citizens. In a recent Federal Court ruling, Judge Michael Ponsor ruled in favor of plaintiffs who complained of inadequate mental health care for low income children. He found that the Commonwealth violated Medicaid law by doing a woefully inadequate job in monitoring the affected children's mental health needs.
Is it the responsibility of good government to provide for those who cannot ably care for themselves? And who decides what constitutes quality care?
There is a certain benefit for creating opportunities for people to effectively manage their stresses and distresses. People who experience less stress are, on average, likely to have fewer physical healthcare problems compared to their more stressed peers. With skyrocketing health care costs, pragmatic government might consider ways to start early mental health skill development programs to help the children who will later become the adult consumers of medical services, reduce their reliance on such services because they are less necessary. This can be a major part of a long-term solution.
Inexpensive evidence-based positive preventive school mental health programs delivered to all students, could prove beneficial to help promote a psychologically healthier population. This longer term solution merits careful review.
Some scientifically supported school mental health programs can be implemented by presenting them in a cookbook fashion. Teaching mental health skills seem to correlate with improved school grades. That shouldn't be a surprise. Children with stresses that they believe they can cope with, are likely to better focus on their studies. That potential is another potential positive situation.
Children taught how to develop and apply critical thinking and methods of scientific inquiry to meet personal challenges and to cope with personal adversity, can use those skills over a lifetime. Less stress can come about from believing that one can organize and regulate one's thoughts and behavior to cause constructive results. In other instances, learning not to worry about what can't be controlled, can make a difference. A positive prevention program can be part of a general "continuity of care" plan that augments, rather than replaces, current mental health intervention systems. (I'd be happy to update and donate the mental health program I developed, that has a science to back it.)
Sadly, even if all reasonable preventive measures are in place, unexpected and unprepared for events such as the Heavens Gate mass suicide and Virginia Tech killings are still likely to happen. But perhaps this would occur with a lesser frequency.
We don't know for sure how many disasters are avoided through positive mental health programs and interventions. I'm confident that many therapeutic interventions have gone unheralded, and did serve to prevent similar occurrences such as the Cho killings. But we can still do better.
It is the mark of an enlightened society that those with disabilities are provided opportunities to develop their capabilities to lead independent and meaningful lives, and for those who cannot do so, to be in a safe and secure environment wherein they can still stretch to whatever limits of their human capabilities that they are able.
We've made considerable progress over the last Century in creating conditions for people with mental disabilities to lead productive and independent lives. We still have a long way to go in putting into place evidence-based programs that people can profit from so that they can develop their capabilities and contribute to their communities.
Is prevention worth the time and money to consider? You decide.