The Mass Murder/Suicide Epidemic: A Growing Menace
From a medical perspective, we know that in epidemics, pathogens do not simply stop killing. They spread and look for new hosts in which they can survive in a symbiotic relationship. But when the host dies, they move on. These “pathogens” are moving on—not only right through our culture, but into societies from modern Western Europe and Scandinavia to the Middle East and North Africa. Governments and individuals only respond with more violence. We are consuming ourselves, and leaders of even the most civilized societies have no idea how to prevent the violence. We can only react to the violence in all-too-familiar ways, such as the literal army of police and military vehicles in Boston. Where did this army zooming past classic Copley Plaza come from? Then, from McHale Pavilion to Sandy Hook and Boston, we lament loss of life while politicians and anchormen engage in a collective head-banging about the causes and what preventive measures they can devise. But, unfortunately, the pattern of mass murder and suicide has become routine, as have the innocuous comments of the “punditistas.”
We have heard this and similar stories countless times before on the news or online: A strange-looking person walks into a building filled with people. The building could be a school, a workplace, a house of worship, a shopping mall, or even a street-corner gathering. The person may be wearing a baseball cap pulled down over his eyes or turned around backwards. Maybe he wears sunglasses, a black outfit, a hoodie, a flak jacket, or even makeshift camouflage. Few notice the person at first, perhaps because he blends in with the crowd, or perhaps because he’s hanging at the edge of the shadows. But suddenly, without any warning, the person brandishes a firearm—usually a semiautomatic rifle or pistol—and opens fire on people in the crowd, targeting some directly or sweeping the weapon from side to side to cut a wide swath of destruction. People cry for help and dial 911. Scores of cell phone messages light up the local first-responder dispatch boards. People begin screaming as they hit the ground. Some flee for the exits and make it out alive. Others do not. Within minutes, sirens wail. Law enforcement personnel in black uniforms and military helmets enter the building to search for the shooter. However, when they find him, more likely than not, he is already dead from a self-inflicted gunshot wound or merely standing outside in dazed silence, as if another act of murder and mayhem was happening nearby. Another act was almost part of the script in Aurora, Colorado, where a mad chase could have spread murder and mayhem through the streets of Denver but for James Holmes’s quiet, almost catatonic, surrender. More lives, however, were lost in Cambridge and Watertown because the script was acted out, complete with suicide vests. In Massachusetts, an emergency room doctor, interrupted between cases, answered questions about the causes of death in the case of the older brother, Tamerlan Tsarnaev. This doctor dispassionately told reporters that the elder Tsarnaev’s body was too full of bullets and shrapnel from his suicide vest to really tell anything other than that he was fatally shot by police. All in a night’s shift in a US emergency room these days?
Where are we? Beirut? Damascus? Kandahar? How many times has this happened over the past five, ten, or fifteen years? Trace it back to Richard Speck’s horrible mass murder of nurses in Chicago followed by the University of Texas Tower suicidal mass murder by former US Marine Charles Whitman. Those were rarities in their day, even though some will say nothing has changed. Nothing since 1966? From Virginia Tech in 2007 to Boston in 2013? A great deal has changed. Especially if you are a police chief and not a researcher in an ivory tower manipulating statistics to prove nothing has changed. The researcher may not be asking the question, but the police chief and those he protects are. How many more times will it happen? Who will be the next victims? And where? At a shopping center? In class? At church? At a sporting event?
Whether the shooter’s name is Dylan Klebold, Cho Seung-Hui, James Holmes, Wade Page, William Spengler, Adam Lanza, Christopher Dorner, or the Brothers Tsarnaev, the commonalities are there and very apparent. In the aftermath of the tragedy, experts and pundits alike make the same kinds of pronouncements about loners, the unpredictability of these events, the impossibility of preventing them, and the need to have more guns and armed guards present. However, when Jeffrey Johnson shot a coworker right by the Empire State Building in midtown Manhattan in August 2012, the police officers who apprehended and shot Johnson also shot more than ten bystanders in a hail of fire, as reported by newspapers at the time and in the Huffington Post.3 No matter what the various talking heads, bloggers, and self-anointed commentators say to palliate the public angst and growing fury, they seldom get us any closer to a solution.
What we now believe is that skilled clinicians can identify the behaviors of potential suicidal mass shooters and possibly prevent their crimes if they read the warning signs when legal opportunities (e.g., recurrent domestic violence, grossly psychotic communications, behavior in family or public settings) present themselves to do so. We can prevent many more of these types of crimes from happening than we currently are led to believe we can, without resorting to violation of anyone’s rights under the Constitution’s privacy, search and seizure, and due process clauses or the First and Second Amendments. While we cannot prevent the crimes completely, we can at least limit the number of casualties. The problem is that even the experts will not admit that the answers are already there. The many cases we examine in this book demonstrate how the behaviors of these offenders, whether in private or in front of friends and families, manifested a potential danger. The behaviors of suicidal and homicidal offenders indicated that the perpetrators were themselves victims of helplessness in their own situations and feared what would happen to them.
These psychological states of fear and helplessness that generate psychotic fury are the basis of the commonalities that stretch across all of the mass murders and suicides over the past two decades and probably well before. The fear and helplessness, when triggered by psychological traumas, tend to lead offenders to mental disorganization and threats to self and others in a person’s already brittle adjustment. Some offenders, like Tamerlan Tsarnaev, may have concealed their boiling wrath at society for their perceived failure to settle into society before pulling the trigger or lighting the fuse of a pressure-cooker bomb as a final vendetta against society. The mentality of most others, however, was obviously deteriorating into fatal, psychotic, suicidal mass murder before they pulled the trigger.
When self-proclaimed experts argue that mass murder/suicide events, such as those that occurred at Sandy Hook Elementary, Tucson, or Webster, New York (the William Spengler case), are unpredictable, they are off the mark because of the clear commonalities that stretch across the landscape of suicidal offenders, and even offenders who do not commit suicide. Was James Holmes in Aurora planning to survive his shooting spree? Was his aim to spend the rest of his life behind bars while his death-penalty appeals worked their way through the courts for the ensuing decade, or did he plan to die by a police officer’s bullet, thereby ending his pain in an apocalyptic moment of public self-destruction? Or was Holmes planning an escape as police and other first responders dealt with the explosive booby traps in his apartment, as they would later deal with the Tsarnaev bombs planted at MIT? In Holmes’s delusion, was he the arch-villain of the world of Batman, ready to strike again?
We believe that by examining the commonalities of the mass murder events of the past decade, or by starting earlier with Dylan Klebold and Eric Harris at Columbine or with Charles Whitman, who mowed down his victims from the University of Texas’s bell tower, we can understand the psychology behind these crimes, identify behavioral warning signs, and recommend preventive measures. In addition to being able to isolate the issues pertinent to suicidal mass murders and find the ways to address the common issues as warning signs, we look at ways to implement suggested preventive responses in the fields of public policy and public health policy and give advice to parents, teachers, and employers. As difficult as these tragedies are to comprehend because of their cruelty and magnitude, they are ultimately understandable as a class of crimes, even if a case such as that of Wade Page at the Sikh temple in Milwaukee differs from a case such as that of William Spengler in Webster, New York; Anders Breivik in Norway; Adam Lanza in Newtown, Connecticut; or the Brothers Tsarnaev in Boston. We also believe that the sheer number of mass murders and suicides and, more important, their frequency indicate that we are facing a growing epidemic of mass murder, with crimes feeding upon crimes as more horrendous crimes make headlines.
Is there a general wave of violent psychotic behavior spreading across the landscape? Are we looking at a new form of what traditional psychiatrists refer to as folie à deux, or shared psychosis, which we suspect is what Ross Ashley suffered from? In the wake of the Virginia Tech massacre, not many recall Ross Ashley, a student at Radford University, whom residents of his apartment complex long observed to be grossly psychotic; he stole a car, shot a police officer to death at nearby Virginia Tech, and then killed himself. What else was he planning? Or are we simply so inured to such seemingly senseless violence that motivations for murder and suicide do not matter anymore? If these motivations are a form of shared psychotic behavior, then the behavior might well be spread by the mass media unintentionally feeding, without malice of intent, the psychotic delusions of an offender. Thus, Cho Seung-Hui, while still a child, might have seen the news coverage of the Columbine shootings and amalgamated that into his own self-destructive, apocalyptic delusions. Therefore, it is appropriate to ask whether the news reports of horrendous crimes are reaching an at-risk population of potentially dangerous offenders, so that each crime indirectly inspires the next. If that is the case, then we may be in an area of public health where the prevention of psychotic behavior runs right up against the First, Second, Fourth, and Fifth Amendments of the US Constitution. What can be done about that, except to tell people to stay away from crowds and public places, and far away from anyone who looks just a bit out of the ordinary? Is that a solution?
Worse yet, we seek to purify society of “strange” people by criminalizing them. If someone acts out on the street by ranting about his paranoid delusions, police haul him away to jail if he is not responsive. Thus, our jails are full of the mentally ill, who cannot fend for themselves. We consider them dangerous and stigmatize them. Suicidal mass murders have broken into the public consciousness. But the mentally ill—some dangerously ill—are still out there in growing numbers while our first responders have no protocols for dealing with them humanely. The situation is worse for mentally ill combat veterans, who may have no place to go. We find crowd or people-avoidance reactions bordering on agoraphobia among combat veterans returning from war zones.
In post-deployment workups, clinicians found that veterans from both Vietnam and the Middle East had similar avoidant reactions to environments in which they might have suffered traumatic experiences. Soldiers returning from Vietnam, for example, who had suffered from invisible war wounds tended to avoid dense foliage that reminded them of the jungles where they had fought an insurgent enemy. Trees and heavy brush provided cover for that enemy; therefore, trees and dense brush were threatening to returning soldiers suffering from post-traumatic stress disorder. Similarly, veterans from Afghanistan and Iraq were reluctant to enter into ordinary civilian gatherings because an insurgent with a cell phone and improvised explosive device could wreak carnage similar to what spectators on Boylston Street witnessed in Boston. If we apply some of this residual avoidance of threatening situations to at-risk individuals whose behavior borders on dangerous, we can see how these individuals may actually be triggered into violence simply by a situational event, such as the upending of a comfort zone, as happened in the Adam Lanza case, or a perceived threat from an enemy, even if the threat is not real. A biker who just returned from Kabul may cut in front of you on the interstate at high speed and crash into the roadside because he saw a pile of dirt on the side of the road hundreds of feet ahead. Just the perception of fresh dirt is an adequate threat of an improvised explosive device, and it might be enough to trigger dangerous behavior because of loss of the sense of present time. This loss of present time takes a combat veteran back to survival instincts learned months or even years ago.
What are the lowest commonalities we can discern from the spate of mass murders and suicides over the past ten to fifteen years or even all the way back to Charles Whitman in Texas, whose mass shooting helped define the paradigm of mass murder/suicide? Knowing what we now know about James Charles Whitman’s autopsy, for example, which he, himself, ordered in his own journal when he wrote that his mind was “going,” it is clear that actual tumors on the brain can drastically affect behavior. Whitman had brain cancer, which can lurk in a silent area of the brain where it might be undetectable until either pain or extreme behavioral dysfunction requires a neurological intervention. We now believe that it was the cancer that initially set Whitman off. Whitman knew there was something wrong with him, and he was right. Thus, we now have the need to scan the brain of every first-episode psychosis sufferer, like Cho and Holmes and, likely, Lanza, too. That is actually a standard of practice over which insurance companies will usually not fight too hard and will fork over the thousand-dollar medical expense to perform, following first episode of psychosis—estimated at one hundred thousand cases per year in this country. Psychosis usually occurs in late adolescence and early adulthood—the very population concentrated on college campuses and military bases.
Undiagnosed history of mental illness, as with Jared Loughner, or underdiagnosed mental illness, as with Cho, are perhaps two of the most basic attributes we can assign to suicidal mass murderers. In any biographical sketch of the offender, we find a history of mental disturbances. These disturbances range from complete schizophrenic delusions with likely accompanying auditory hallucinations that could make a patient look selectively mute (as Cho Seung-Hui was initially diagnosed by a child psychiatrist intern)4 to a loquatious Holmes making a classroom presentation on neurobiology. Loughner, and James Holmes, suffered from first-episode paranoid schizophrenia, with ominous prognostic outcomes accompanying extended duration of untreated psychosis (DUP).
In the most serious of these psychosis cases, the offender is completely cut off from reality, perhaps like Jared Loughner of Tucson, Arizona, who shot Representative Gabrielle Giffords and killed others during a “street-corner town-hall” type of event. Tragically, the offender became aware that his behavior was aberrant after he took the antipsychotic medication Risperdal for first time in prison. Loughner’s psychologist testified in federal court that Loughner told her he would not have committed the Tucson shooting had he been taking this medication years before going berserk at Safeway Plaza. No one had ever offered Loughner the medication, despite his school career pattern of disruptive behavior at Pima Community College in Tucson—similar to that of Virginia Tech student Cho Seung-Hui. Why was there no official inquiry of dangerousness after these red flags? In fact, the Cho case appears to have informed Pima Community College’s response. Unfortunately, the inquiry was prompted simply to get Loughner off campus and keep him off. The professionals simply dumped an emergency medical problem on his helpless parents. Is that the way they would have treated a student stumbling around with blood all over his face? Of course not. But psychiatric emergencies are different, which might be what professionals at Pima Community College and Virginia Tech obviously believed. Psychiatric emergencies are not real illnesses for which they are responsible as both clinical professionals and concerned college staff. Both colleges clearly marketed their student health and psychiatric services in promotional materials and student handbooks, leading students and parents to believe that they had the know-how and resources to take care of any student, whether on or off campus. But in the end, Pima Community College security personnel visited Loughner’s home to make sure he stayed off campus.
For his part, Colorado’s James Holmes, now facing the death penalty, is likely to raise the issue of insanity in his defense during his upcoming trial for the massacre he perpetrated at a movie theater in Aurora, Colorado, now referred to as the “Dark Knight Murders.” What did his purchase of ammunition, explosives, and detonating material indicate even as he sought psychiatric help from university health services? And, as the authors have documented in detail in Suicidal Mass Murderers: A Criminological Study of Why They Kill (CRC Press, 2011), Virginia Tech shooter Cho Seung-Hui was clearly suffering from paranoid schizophrenia while on campus, although he, like Loughner, was not diagnosed with this devastating disorder while he lived on campus. Despite repeated episodes of irrational, disruptive behaviors on campus that resulted in involuntary commitment for Cho and a suspension from college for Loughner, no other official actions were taken that could have been seen as preventive for the community in general. The two psychotically behaving individuals were simply taken out of their respective communities—Cho, temporarily—even as they acquired weapons and ammunition.
Hopelessness
Psychiatrists universally agree that people who are suicidal believe they have nothing to lose. Either they are in tremendous physical or emotional pain, or they believe, realistically or not, that their lives are devoid of hope. For example, when hearing a young person tell of his devastating loss of feeling and struggle with discrimination of reality from delusions and auditory hallucinations, psychiatrists working with this seriously mentally ill population understand why the risk of suicide following discharge for first-episode psychosis in young adults is among the highest for any population, other than Huntington’s chorea, which approaches 100 percent. Imagine that a young person becomes aware that she is losing her mind or that a young man is plagued by ideations of suicidal violence, but there is nothing either of them can do about it other than talk to a psychiatrist. Think of the panic, the hopelessness, then the frustration and anger. We can see these feelings in the rantings of James Holmes, the plays and writings of Cho Seung-Hui, and the ravings of manifestos written by Anders Breivik and “the Unabomber” Ted Kaczynski.
Dr. Emil Kraepelin, a German psychiatrist, gave the name dementia praecox, also called premature dementia, to the disease we now call schizophrenia. Schizophrenia is a condition that begins with a sufferer’s awareness that something is very wrong with his or her ability to cope with reality. The person is aware of losing his or her grip on everyday comings and goings, and the person has strange or perhaps troubling ideations. Imagine knowing for a short while early in life that you are losing your mind. It is more than unnerving. That insight eventually goes away in form of anosognosia, or loss of awareness of sickness. Before the insight goes away, this patient, like a neurologist diagnosed with Alzheimer’s disease, is one of the highest risks for suicide because for a short time he or she will know about nine years of merciless progressive dementia lie ahead. Some victims will likely take the opportunity of earliest memory loss to destroy themselves while they can.
Hopeless people rarely plan for the future. They have what is known as “foreshortened future.” Therefore, in examining patients at high risk for suicide, one must patiently listen for their plans. Those planning to kill themselves really have no plans because they intend to be dead. They are not worried about Christmas shopping because they are not intending to be alive for Christmas, probably just like Adam Lanza, who possibly intended from the outset to destroy himself after the shooting at Sandy Hook. William Spengler, in his Christmas Eve ambush of first responders in Webster, New York, might have had similar intent. Perhaps James Holmes, too, had plans to destroy himself if he knew of the “success” of his booby-trapped apartment that miraculously did not level a city block.
A significant percentage of hopeless people bent on suicide are capable of violence toward others; we see this suicidal bent increasingly often in combat veterans. They will take their loved ones with them, and rarely, but increasingly, they take strangers on campus and public places, too. The courts drafted the medicolegal construct for “danger to self or danger to others” so that it met a legal rather than a purely medical standard. However, a legal standard must conform to the US Constitution—a medical standard, when not applied within a legal context, need not. Mother Nature also tends not to regard the US Constitution and usually does not discriminate between what is legal and what is not. In fact, research has shown that only a small fraction of patients who were involuntarily committed were dangerous only to others.
The cases we cite involve individuals who were dangerous to self and others. Accordingly, we believe there is rarely a more dangerous situation than intervening in, or trying to stop, an active suicide attempt by a person with a gun. We saw that public safety warning on television for days after the Boston Marathon bombing, even though the warning may have not been for suicidal mass murder, as it turned out to be. Suicide must be conceptualized within a spectrum of unremitting mental states of human destructiveness, all the way from the small percentage of suicidal mass murderers on one end of a bell-shaped curve to an elderly man who injects himself with too much insulin and is found dead in his apartment. Thinking of a suicidal person as purely dangerous only to himself is highly risky.
Ideations of Suicidal Behavior
Individuals often give off warning signs of their hopelessness, indicating by their words and actions that they have no other recourse than to destroy themselves, many times within the context of destroying others. It is an old adage that when someone tells you what he or she plans to do, especially what that person plans to do to you, you should take it seriously because it is likely that those plans will be carried out. Thus, when Dylan Klebold and Eric Harris announced their plans on the Internet to attack fellow students at Columbine High School or when Cho Seung-Hui announced in his middle school or in his short stories and plays that he planned to “do a Columbine,” they should have been taken seriously. James Holmes also talked about ideations of violence and was reported to have been in touch with his psychiatrist even days before the shootings in Aurora. William Spengler wrote that he actually had a plan to trap first responders in a hail of gunfire, which he did before he died.5 In fact, even though people who knew the shooters may indicate that the crimes simply came out of nowhere, closer examination reveals that the perpetrators of mass murder and suicides gave off clear warnings of an impending crisis as their personalities decompensated into hopelessness.
Access to Weapons
You don’t need a permit in most of the United States to purchase firearms, and in many locations, background checks are rarely carried out. Criminal databases and terrorist watch lists meant to prevent felons from obtaining guns are often not checked. In almost all states—New York and Colorado might be the first exceptions—those individuals under a psychiatrist’s care are guaranteed some sort of privacy, which is what Fourth Amendment advocates strongly support. You can go to a gun show in some states and purchase a firearm on the spot. The loopholes regarding gun registrations and background checks for firearms purchases allow those who are deranged, such as Spengler, to get their hands on firearms simply by “straw purchases”—acquiring by proxy. Adam Lanza used his mother’s guns, legally purchased and legally owned, but not legally carried by twenty-year-old Adam, to wreak violence upon the students at Sandy Hook Elementary School after he killed his mother with her own gun. James Holmes simply acquired his weapons on the Internet.
Killers Make Their Personal Statements
Mass murderers do not kill in a vacuum. As they drift closer and closer to their own violent climaxes, they project a pretext for their behavior, as irrational as that pretext might be. When Wade Page decomposed and violently struck out at worshippers at a Sikh temple in Oak Creek, Wisconsin, he had indicated his racist ideations years earlier in the military by illegally goose-stepping down the streets of Berlin and was on the watch list of the Southern Poverty Law Center.6 He continued to express his racist ideations, also as a rock singer, even after he was chaptered out of the Army, presumably for alcohol abuse. For a suicidal mass murderer, the crime is the statement, whether it is Lanza, Cho, Klebold, or Harris seeking revenge against those they had possibly perceived to bully or ostracize them or Christopher Dorner seeking his revenge against the LAPD, which fired him, he said in his manifesto, because of racism. Because in almost all the cases, police investigators cannot fathom the rational causality of irrational behavior, the statements made by the killers are almost always relegated to a closed-case file, a kind of dustbin of history. Thus, important clues to preventing these crimes are often overlooked. Words like “sick,” “demented,” and “crazed,” although probably valid, lay descriptors of suicidal or homicidal behavior, are too often used to dismiss the behavior of homicidal offenders and are unlikely to be deconstructed via suicide autopsy—a technique as necessary as the autopsy performed on Texas suicidal mass murderer Charles Whitman.
We need to know what leads up to murder and mayhem. Unfortunately, these apparently dehumanized people share most of our genome, although we cannot accept that fact and get rid of that evidence as soon as possible. We seek to execute James Holmes because he acted in what we would like to think is a social vacuum and has nothing to tell us. But despite calls for his execution, we may keep Dzhokhar Tsarnaev alive so that we can find out what he knows about a possible international conspiracy and sleeper cell at the University of Massachusetts and Dartmouth. Then we execute him, as if that execution would somehow expiate our collective sin of not discovering his plots sooner.
If we follow the breadcrumb trail of deconstructing the behavior of psychotic mass shooters and reach the end point of a brain autopsy, we will find valuable clues to explain this type of violent behavior. For example, Dr. Rey, a pathologist, was one of the few doctors who subscribed to the practice of suicide autopsy, which is a direction of investigation that medical examiners in suicidal mass murders need to push for.7
In cases like those of Adam Lanza, Wade Page, and Tamarlan Tsarnaev, we have great need to know what psychosocial or neurological abnormalities predated their loss of control. But among shooters who survive, like Norway’s Anders Breivik and Jared Loughner, they will be sent to prison for life, probably with minimal, if any, psychiatric or psychological assessments.
Of course, one might ask what good such assessments would do for someone incarcerated for life. The research stemming from psychiatric interviews with mass murderers confined and regulated within the prison system might go a long way toward figuring out how to identify the suicide- or homicide-inclined individuals in society and find ways to treat them to prevent violence. Pincus and Tucker did just that in prison populations and found a high incidence of head trauma, seizure disorders, and brutality within families. Their stark findings in this population of violent offenders should inform public health upstream at the mouth of the river, not downriver or at the last bridge just before bodies float out into the ocean and are lost forever to clinical research.
Maybe we are not completely certain about what James Holmes wanted to do, whether to escape or die in an explosion and take the lives of first responders along with him, but we do know that Loughner and Breivik stated flat out that they were on suicidal missions. It seems that mass shooters Major Nidal Hasan and Staff Sergeant Robert Bales, who both face Army courts-martial for their crimes, were on suicide missions as well. What if we had a legal requirement that every mass shooter who commits suicide or is shot by police must be turned over to the local medical examiner for a brain autopsy? What information would we glean from that? Similarly, what if every living mass shooter were forced to submit to a medical examination, including a battery of brain scans, psychiatric examinations, and thorough clinical psychological testing to determine their physical and mental states? We would get important information about these offenders’ abilities to comport their behaviors to the requirements of the law and the social system. Pincus and Tucker have already proven that.
In the case of James Holmes, for example, what was his evasion and escape plan? If he was so well organized with intent to create disaster in Aurora, where was he going to hide for the rest of his life? Did he have a valid passport and change of clothes? How about cash in his wallet or a reserve on his credit cards? How long could he keep on driving if he had no gas money? Ross Ashley, who killed a police officer at Virginia Tech before killing himself, had a change of clothes. Why? Now, if Holmes had a passport and way to the airport with a change of clothes, one might say he was obviously not suicidal. But he stood outside the theater, just like Anders Breivik at the mass shooting scene in Norway, apparently waiting for arrest. At first, the police thought Holmes was a first responder because of his black combat outfit. In other words, had he not been detained right away, he could have slipped away to wait for the reports of the explosion in his apartment. Does that sound illogical or carefully planned? If someone is crazed or demented, logic cannot be applied to his or her behavior. Simply dismissing such behavior is a big mistake because of the clues inherent in the behavior and statements made before the acts of homicide. These clues throw light on the offender’s state of mind.
Research has shown that many of the prehomicidal or presuicidal statements made by self-destructive mass murderers are very similar. The act of suicide itself, offering up the shooter as his own persecuted victim, is such a common feature that in especially severe cases, it can be seen as an offender’s pretext for the crime. Klebold and Harris claimed to have been persecuted and bullied. Cho Seung-Hui claimed that the “normal” students around him victimized him. James Holmes booby-trapped his own apartment perhaps because he believed he would be able to enjoy the prospect of a second mass murder, this time of first responders, before he committed suicide, thinking he was the Joker escaping in the Batmobile through Denver streets. Perhaps once incarcerated or confined to a mental institution, Holmes will become more lucid about his motivations and demons, and he might reveal whether he had any escape plans. If he did, he had about as much intent of living to fight another day as did Dzhokhar Tsarnaev, who imagined hiding and bleeding to death in that boat, firing off his last rounds at police, most likely expecting that they would fire back and kill him. But they did not. Self-styled jihadist Dzhokhar Tsarnaev failed in his mission, and like the Fort Hood shooter Dr. Nidal Hasan, may have to exist for decades or years in a cell, unless they were killed in same fashion they doled out to others. Wisconsin has no death penalty, but Jeffrey Dahmer, while cleaning the prison shower unsupervised, was attacked by acquaintances and relatives of his victims.
Paranoid Delusions Are Commonplace among Suicidal Mass Murderers
Jared Loughner was thrown out of Pima Community College and complained in an email to his shooting victim, Representative Gabrielle Giffords, that life around him was a sham and that nobody was doing anything about it. He voiced over a loudspeaker on campus, “It’s all a scam. Words have no meaning.” These are obvious clinical signs that he had lost his ability to discern reality and separate it from the voices ringing inside his head. When he was arrested, he told police that life was a scam. In his delusional mind, Loughner saw himself as a victim of that scam, persecuted and shunned. However, the perceived scam was his delusion, and language was losing its meaning within his psychotic decompensation. It would not be surprising if he did project responsibility for that onto the highest authority, who, it seems, was Representative Gabby Giffords, for whom, we believe, he probably fostered erotic feelings. Psychiatrists call these delusional erotic feelings “erotomania,” a delusion of passion, whose manifestations are referred to as “erotomanic delusion,” “paranoia erotica,” or “psychose passionelle,” a form of paranoid delusion with an amorous quality. We actually saw this delusion manifested in Cho Seung-Hui when he chose fellow student Emily Hilscher as his love object. She became his first shooting victim.8
In psychose passionelle, the patient, often a single woman, but many times a delusional person like Cho, believes that an exalted person is in love with him or her. This condition, called “de Clérambault’s syndrome” was originally described by Gaëtan Gatian de Clérambault as having a “phase of hope followed by a phase of resentment.” John Hinckley, Jr., had a similar delusion about President Reagan being in a love triangle with him and Jody Foster.
A delusional Adam Lanza might have believed his own mother was threatening to institutionalize him, destroying the comfort zone he had built for himself inside his room, along with acute rupture of their apparent symbiotic relationship, which she probably saw no way out of by then except for confining her son to residential placement at a Washington State facility like Secret Harbor, a tiny San Juan island, which would have seemed like a prison for Adam. Nancy Lanza had visited Washington State, leaving Adam alone in the house, and she possibly investigated placing him in an institution. She even might have confronted him with that alternative if he did not voluntarily leave the house to fend for himself. Secret Harbor is a residential facility for incorrigible children on a remote, otherwise uninhabited island in the San Juan chain, not accessible by any public transport. One can reach it only by private boat. Unfortunately, Nancy Lanza might have unknowingly ruptured the symbiotic bond by going off to Mount Washington, or perhaps she was intuitive enough to know it would be her last retreat to a favorite place for New Hampshirites, as she reportedly told her friends before her death. Secret Harbor is like a humane, private Alcatraz for kids, so isolated that no one lives on the island except for the institutional staff.
Qualifying Dangerousness in the Suicidal and Homicidal Insane
Although suicidal individuals can be dangerous, none of what we suggest is to argue that anyone who believes he or she is being victimized is an imminent danger to others. Nor do we suggest that the seriously mentally ill we see talking to themselves on the streets are dangerous. Only a small percentage of those who are seriously mentally ill are dangerous, and they are mainly dangerous to others who live in subpar support systems and who are often homeless. Treatment Advocacy Center says that 10 percent of reported homicides are caused by the seriously mentally ill, but only 6 percent of this cohort of the seriously mentally ill actually carry out homicides.9 Perhaps the fact that their victims are also seriously mentally ill and essentially abandoned by our institutions and society is the reason politicians, the press, and citizens alike ignore this astonishing homicide statistic. However, we know that people who do act aggressively in the face of a belief that they are being unfairly victimized need professional help. If these people are grossly delusional and hearing voices, particularly hallucinatory commands to harm others, they need psychiatric treatment with antipsychotic medications and close monitoring to make certain they take those medications.
Contrary to what some right-wing thinkers assert, nonadherence to antipsychotic medications—rather than taking them—is the most common cause of violence among the seriously mentally ill, especially when they complicate nonadherence to treatment with drugs and alcohol. That is why case management, all but a memory these days, along with case managers’ often preferred medication, long-acting Risperdal Consta, which can be given once every two weeks and which patients generally tolerate well, is absolutely critical. Older medications had uncomfortable side effects that aggravated the problem of nonadherence. Remember, because of anosognosia, or denial of illness, the seriously mentally ill patient often does not think he needs treatment—particularly a shot every two weeks. During a grandiose delusion, whether happy (“I’m a billionaire”) or dangerous, like Spengler (“kill everybody”), the delusional patient is unlikely to wish to part with the delusion for the harsh reality of economic destitution and pain of social alienation with a cacophony of voices saying awful things.
In many cases, even the seriously mentally ill might correct their perceptions about being victimized, as did Loughner after taking medication, although, sadly, it was too late to prevent the Tucson shooting. But within the seriously mentally ill population, an extended duration of untreated psychosis, or DUP, caused both the Tucson shooting and Cho Seung-Hui’s Virginia Tech massacre. Extended durations of untreated psychoses in the 1 percent of our population, the seriously mentally ill patients who will have a psychotic episode break in early adulthood, will create more victims of senseless violence and disasters from suicidal mass murders. This is the accelerating trend today in the wake of the gradual destruction of our public mental health system. Society does not have the resources to deal with a growing cohort of psychologically disturbed young people, whose mental illnesses may evolve into violent behavior toward themselves and possibly complete strangers who are misperceived as necessary targets of their delusions or the hallucinations that command them to harm others. If this seems like an implausible doomsday scenario, look at the growing numbers of suicidal individuals who launch attacks upon innocent victims, including the public safety officers who try to disarm them. On August 21, 2013, the Brothers Tsarnaev shot two Boston area police officers, one fatally, in their attempt to escape to New York. Three Arizona police officers in the Phoenix area have been shot by men who could not possibly have expected to escape alive. These suicidal offenders took their own lives in proxy events called “suicide by cop.”
Incidents of “suicide by cop” are soaring in this country, and police chiefs have acknowledged the problem. “We live in a very violent society. All I can do is train my officers best I can,” Sheriff Joe Arpaio, Maricopa County, told Fox News on August 8, 2013.
As of December 31, 2013, there have been at least eleven major mass homicides accompanied by suicides or attempted suicides since the 2011 Tucson shooting. There have been at least three times more that were aborted and thus muted in the news. Nevertheless, they were potential mass murders by offenders with a suicidal intent. For example, a young man entered a college classroom in Casper, Wyoming, after killing his father’s girlfriend.10 He fired an arrow into the head of his father, a college instructor, who still managed to wrestle his son to the ground so that students in the classroom would have time to flee and save their own lives. Police arrested the offender while praising the father, who died to save his students’ lives from his own son.
In another incident, police shot a man to death on the fifth floor of an Alabama hospital after he started firing an automatic weapon.11 This was not officially a mass murder, because only the shooter died. He allegedly had an issue with staff members who tended to his wife in the coronary care unit, which was where he was headed before the police shot him. Hospital staff immediately announced that the gunshots heard from the coronary care unit did not affect patient recovery, which was very hard to believe, particularly in his wife’s case. Tragically, in the wake of the Sandy Hook Elementary School shooting, we need to ask the question, “what happens next time?” because there appears no end to a small percentage of deranged Americans’ descent into evil.
What will happen the next time a lone shooter enters a school, workplace, hospital, or shopping center? What we know is that the lone suicidal murderers learn from one another, learn from one others’ actions and tactics, and understand, as did James Holmes in Aurora, just how to set the stage for their crimes. Even the most delusional of them are aware of headline-breaking mass murder stories. Like Cho, they may regard previous shooters as heroes and seek to emulate them. Unless we understand the nature of the epidemic, the mental health issues of those at risk, the emotional triggers that propel them into action, and the frustrations that wear down their resiliency until they resort to violence, years from now, we will still be stumbling in the dark and scratching our heads when another person perpetrates the next heinous mass murder/suicide.
The president wisely ordered the CDC to investigate the nature of the violence epidemic in America and look for causality across the entire spectrum of violent stimuli, including mental health issues. This will not be the first time such a set of recommendations was floated by the American people. We already had a governor’s report on the Virginia Tech massacre.12 Unfortunately, that Virginia report, made in the aftermath of the shootings, was written under the shadow of massive lawsuits being filed by the Virginias Tech victims’ parents. Accordingly, the report had to position the state in such a way that the state had to seem blameless in its actions with respect to the security procedures on the Virginia Tech campus on the day of the shootings. The Virginia Tech panel, comprised of individuals from the academic, medical, public safety, legal, and official government communities, focused on establishing the legal difference between “imminent” and “foreseeable future” in predicting dangerous behavior, using the legal standard to determine liability. In reality, what difference will this distinction between “imminent” and “foreseeable future” make in stopping the next Adam Lanza or James Holmes? The issues go far deeper than simply demarking a timeline in which predictability becomes more accurate.
The case of the seriously mentally ill Radford University student, Ross Ashley, who arrived on the neighboring Virginia Tech campus and killed a campus police officer and then himself, tells us that little will be accomplished unless we understand that the concept of “foreseeable future” means that a dangerous person can be triggered by any stimulus, almost all of them below the radar of those of us not at risk. To this day we cannot find out how much ammunition Ross Ashley was carrying. That would tell us what his intent was before he shot himself when he allegedly saw another police officer, who apparently was unaware that his comrade had just been murdered on campus. Worse, we cannot access investigative information on Cho Seung-Hui because his case is still under investigation. Is this investigation the premise of another commission report with promises that this investigation will be different?
Even though emissaries from the White House, including the president, the first lady, and the vice president, have been dispatched to sites of four suicidal mass murders, including Tucson, the Sikh temple in Oak Creek, Newtown, and Boston, only now has the president stepped up to order CDC research on the problem of growing dangerousness as a result of mental illness in American society. We contend, however, that unless we focus on some of the suicidal shooters individually, their backgrounds, the nature of their illnesses, and their external motivations, we will learn precious little to help us stem this epidemic. James Holmes from Aurora will probably be swept away into prison, as was Loughner. Are these individuals being swept under the rug because what they might have to say is too uncomfortable for Americans to hear? That does not seem to help. Meanwhile, politicians, especially those in Congress, kick the can down the road and hope somebody else will take the political responsibility for action on the epidemic of suicidal mass murders and inner-city gang violence. Maybe, in the course of our daily lives, we care little about the seriously mentally ill locked up in prisons, the homeless on the streets, or drive-bys in bad neighborhoods because if we have the means to move out, we know where not to go. Now everything is different; that was the message from Adam Lanza at Sandy Hook Elementary.
In cities like Chicago, multiple shootings are an almost daily occurrence. In 2012, five hundred homicides were unsurprisingly concentrated in neighborhoods where gangs rule the streets in a reign of terror and outgun the average police officer on patrol.13 What the official police reports of homicide numbers show, as reported by police superintendent Garry McCarthy and cited by the Chicago Tribune on December 28, 2012,14 even as crime statistics themselves indicate a decline, is that mass murder suicides and gang violence are trending upward. An upward trend in homicides that happen, which translates to a rate of 5.3 per 100,000 persons, as reported by the CDC, as often as once or twice per week nationally “with no apparent motivation,” indicates that we are in the midst of an epidemic. Although gang violence is different from suicidal mass murder because the motives are more obvious—usually involving monetary issues—inner-city young adults who have joined the military rightly feel at less risk in the “sandbox” of Iraq or Afghanistan than in their own urban neighborhoods.15 That is sad commentary on our society.
Many commentators in response to this epidemic of what we call suicidal/homicidal violence seek one-size-fits-all solutions, as if simply putting armed security personnel in schools will eliminate the problem. That solution may be part of a deterrent, but it is not a solution to the entire problem because armed security simply would not stop a delusional, psychotic gunman. NRA executive vice president Wayne LaPierre’s recent statement after the Sandy Hook shooting that “one sure way to stop a bad guy with a gun is to have a good guy with a gun” is false on its face.16 For example, James Holmes outgunned police entering the Aurora theater. The Jefferson County sheriff’s deputies dispatched to Columbine High School had to wait outside the building until a SWAT team with heavier weapons arrived. Meanwhile, students inside the building were dying. These “good guys with guns” were outgunned by the “bad guys with guns,” even in a situation involving a gun-wielding loner, who most often had a criminal record with multiple trips through the revolving doors of our judicial system or gross psychiatric impairment that had been ignored (Jared Loughner, William Spengler, and Wade Page) or undertreated (Cho Seung-Hui, Adam Lanza, and James Holmes). Even in schools with armed security on the premises, the problem is getting worse and worse each day.
An epidemic, this epidemic, at least in medical terms of a medical approach, means that there is a medical diagnostic model to ascertain the nature of the disease and the symptoms and the progression of that disease. The diligent search for causes of the disease and ways to mitigate it, as with schizophrenia, get remission, as with manic depressive disorder, or cure it if possible, as is sometimes the case with acute post-traumatic stress disorder or severe grief reactions is the core of the medical model. Looking at the epidemic of mass murder/suicide in America, we should be able to use a medical model to see whether there are scientific approaches to effect an end to the epidemic itself even if some cases of mass murder/suicide still occur. We have to reverse the trend and keep more people alive.
We have to look at causality, the nature of the offenders, the nature of the transmission of the disease, and ways to intercept the disease to control, if not to halt, its spread. In other words, we have to ask what we are dealing with and look for analytical rather than emotional solutions, although we (and even our nation’s leaders) are often overwhelmed by the tragedy when we consider the innocent victims, especially at Sandy Hook.
It is not just guns and it is not just mental illness, although both are significant parts of the mix. We believe that there are larger forces at work propelling too much of society to embrace violent reactions to all forms of life’s vicissitudes. Entire industries, particularly the film, television, gaming software, and music industries, make billions annually by catering to the most depraved instincts of man. Although these industries may not intentionally incite violence, many companies in these entertainment industries gratuitously promote violence to attract buyers and viewers to purchase or rent their products. Among the cohort of consumers of video and digital violence are at-risk individuals who, because of mental illness, may not have the resiliency or the emotional capacity to relegate violence to the world of guilty-pleasure entertainment. They may consider violence to be a first response, not something to be abhorred.
Dangerousness and the potential for violence can be insidiously infecting. Some people like Ted Kaczinski, the Unabomber, wait for years, fomenting waves of irrational anger deep inside their psyches and waiting to strike back at those they deem to have done them wrong. Others, victims of violence or sufferers of physical brain traumas or post-traumatic stress disorder, simply do not have the emotional resiliency to withstand difficulties that more resilient people can handle. The job of the analyst is to ask why, look at the backgrounds of the least resilient, and figure out what might have been done to turn that person off the path of violence. Doing anything less means that we are putting bags over our heads, making believe that the problem will go away if we do not look at it. That is not the way to solve the epidemic of mass murder/suicide that plagues American society today. The answer is to analyze it, determine the causes, enact remedies (both legal and political), and provide as much protection to easy targets such as schools and public facilities as we can without becoming demoralized if small steps do not solve everything. But we have to begin to understand, and analysis is the best place to start. If we look at a brief history of when mass murder/suicide broke into our collective consciousness, from Charles Whitman in the University of Texas Tower in 1966 to Christopher Dorner’s final battle with law enforcement as he huddled into a wilderness-cabin-turned-arsenal in California’s Big Bear Lake area, we can see the surface-level similarities between Dorner and Whitman: individuals who not only were clearly mentally ill but might have had neurological problems as well, who were decomposing and getting increasingly violent. These similarities stretch across all of the mass murder/suicides in between the two, including suicide by proxy and attempted suicides. Dorner and Whitman were both combat trained and had successful naval careers, Whitman as a Marine and Dorner as a naval reserve lieutenant. Both made their last stands as they held off police units surrounding them. So did the Brothers Tsarnaev until nineteen-year-old Dzhokhar, hiding under the deck of a tarped and shrink-wrapped boat while police surrounded him and weakened by blood loss from having been shot by police, let himself be taken into custody. Both Whitman and Dorner realized that something was mentally wrong with them, but they could not figure out what it was or how to get help. They reached out for help, especially Dorner, who broke down in tears in his patrol car while begging his LAPD training officer for help in getting into a reintegration program after return from combat deployment in Iraq. Dorner’s mental state in the LAPD, like Adam Lanza’s in Sandy Hook, James Holmes’s in the University of Colorado’s neuroscience department, and Wade Page’s in Milwaukee, deteriorated until they became self-destructive and killed innocent people.
With talking heads in cable television’s “punditorium” pushing grand solutions across the desks of news anchors—ban extended ammunition clips, ban assault weapons, mandate universal background checks for firearms purchases, close gun show and private sale loopholes, and create programs to help the mentally ill—we have yet to hear the most obvious approach we can take without having to negotiate with the NRA over gun control: identify the violently dangerous people so that we can head off as much homicidal and suicidal violence as possible. How do we that? First, we get our collective brains around the problem and then look at ways we can identify potentially dangerous individuals and figure out how to intervene in their lives to prevent violence. Is this asking too much? Not if we start by evaluating major mass murder/suicide perpetrators and determining how and where caregivers, loved ones, friends, or even the medical or judicial establishments could have intervened in their lives to prevent them from going over the edge.
The massacre of twenty small children at Sandy Hook Elementary School finally breached the public’s consciousness to the point where President Obama publicly declared enough was enough, a commission would be established to study the epidemic of spree shootings in this country, and this commission would not merely be a political diversion to assuage public anger but a real problem-solving commission to make policy recommendations. It was not a meeting to kick the can down the road until another, even worse incident occurred. The president had already addressed the survivors and their families at McKale Center at the University of Arizona after recently suspended Pima Community College student Jared Loughner had opened fire at a Safeway parking lot in Tucson. Then, the first lady personally met with surviving victims and their families of the Sikh temple massacre in Oak Ridge, Wisconsin. The memorial for families of the deceased in Newtown, Connecticut, affected the president as personally as it would any parent of school-aged children. The memorial also provided a window of opportunity to defy the bureaucratic constituencies and Washington, DC, lobbyists resisting change to any of the putative causes of our epidemic of spree shootings and senseless mass murders, for which the Sandy Hook massacre was the nadir in a seeming plunge of America’s social descent into evil. President Obama had not recovered from the shock of Sandy Hook before he had to memorialize the dead and injured in Boston.
Was all this the result of lax gun control and easy access to assault rifles and homemade improvised explosive devices? Was it constant exposure of children and young adults to violent media from Hollywood, the television industry, or, now, the flourishing gaming industry? And even as the smoke settled after the shooting, debunkers, deniers, and right-wing fanatics were busily trying to argue that the entire Sandy Hook incident was merely staged, a false-flag operation to enable the president to confiscate weapons from gun owners so as to subvert the Second Amendment and impose a European-style socialism upon America, which Alex Jones on InfoWars has consistently argued.17 And we wonder about the collective sanity of our population? Now Congress must ask cabinet officials and their captains and lieutenants what Tamerlan Tsarnaev was doing in this country. How did he obtain a green card, and what was learned about his past criminal record when his younger brother received a green card in 2012? Tamerlan’s application for citizenship was in process, but he was denied admission to UMass/Dartmouth, where his younger brother was matriculating. Procedures for obtaining a green card on visa from Kyrgyzstan take many years. Some official must have bent the rules for the elder Tsarnaev, despite the danger he posed within immigration channels. Were the Boston police ever informed of this clear and present danger? More significantly, are we going to find another breakdown of bureaucratic and interagency communications in the event that Boston’s FBI special agent was never informed of the Tsarnaev family and the agency’s interview of Tamerlan Tsarnaev based on Russian intelligence tips? Questions arose after the 9/11 investigation: How did the restructuring of our national security services help agents in the field connect the dots? Be assured: officials involved in the investigation of the Brothers Tsarnaev are preparing their answers for what promises to be an inquisitive and angry US Congress.
What path can we take to find a solution, even if that solution saves only a few lives? We begin by explaining why mental illness is a disease with a biological basis, just like any other illness, and how genetics interact with environment and upbringing in a society that not only misunderstands mental illness but stigmatizes it, as if the sick people are morally at fault. We must remove this stigma if we want to save lives.
3 Eltman, Frank. “Empire State Building Shooting Lawsuit: Wounded Bystander Chenin Duclos Sues NYPD.” Huffington Post, January 22, 2013. http://www.huffingtonpost.com/2013/01/22/empire-state-building-shooting-chenin-duclos-sues-nypd_n_2526361.html (accessed December 11, 2013).
4 Liebert, John, and William J. Birnes. Suicidal Mass Murderers: A Criminological Study of Why They Kill. Boca Raton: CRC Press, 2011.
5 Russell, Goldman. “Gunman, William Spengler, Shoots 4 Firefighters, Kills 2, in ‘Trap’ at Webster, NY, Blaze.” ABC News, December 24, 2012. http://abcnews.go.com/US/gunman-shoots-firefighters-kills-trap-webster-ny-blaze/story?id=18055594.
6 Goode, Erica, and Serge F. Kovaleski. “Wisconsin Killer Fed and Was Fueled by Hate-Driven Music.” New York Times, August 6, 2012. http://www.nytimes.com/2012/08/07/us/army-veteran-identified-as-suspect-in-wisconsin-shooting.html (accessed December 11, 2013).
7 “Death Investigation Conference,” sponsored by National Association of Medical Examiners, The Murdering Mind: What We’ve Learned from Ted Bundy, Seattle, WA, 1990.
8 Liebert, John, and William J. Birnes. Suicidal Mass Murderers: A Criminological Study of Why They Kill. Boca Raton: CRC Press, 2011.
9 MMWR. “Mental Health Surveillance Among Children—United States, 2005–2011.” Morbidity and Mortality Weekly Report No. 2 (2013). http://www.modernhealthcare.com/assets/pdf/CH88661516.PDF (accessed December 11, 2013).
10 Johnson, M. Alex. “‘Bow and Arrow-Type’ Attack Leaves 3 Dead in Casper, Wyo., Including 2 in College Classroom, Officials Say.” NBC News, November 30, 2012. http://usnews.nbcnews.com/_news/2012/11/30/15574250-bow-and-arrow-type-attack-leaves-3-dead-in-casper-wyo-including-2-in-college-classroom-officials-say?lite (accessed December 11, 2013).
11 Associated Press. “Alabama Hospital Shooting: St. Vincent’s Gunman Wounds 3 Before Being Killed by Police.” Huffington Post, December 15, 2012. http://www.huffingtonpost.com/2012/12/15/alabama-hospital-shooting-wounded-gunman-killed_n_2307505.html (accessed December 11, 2013).
12 Virginia Tech Review Panel. “Mass Shootings at Virginia Tech.” August 2007. Report of the Virginia Tech Review Panel Presented to Governor Kaine. http://www.governor.virginia.gov/tempcontent/techpanelreport.cfm.
13 Gorner, Jeremy, and Robert McCoppin. Chicago Tribune, January 1, 2013. http://articles.chicagotribune.com/2013-01-01/news/chi-cops-city-ends-2012-with-506-homicides-a-16-percent-increase-over-2011-20130101_1_homicide-surge-homicide-toll-chicago-homicide-victims.
14 Gorner, Jeremy, and Peter Nickeas. Chicago Tribute, December 28, 2012. http://articles.chicagotribune.com/2012-12-28/news/chi-chicago-2012-homicide-toll-20121228_1_latest-homicide-500th-homicide-tragic-number
15 Liebert, John, and William J. Birnes. Wounded Minds: Understanding and Solving the Growing Menace of Post-Traumatic Stress Disorder. New York: Skyhorse Publishing, 2013.
16 Ed Pilkington “NRA Chief Breaks Post-Newtown Silence to Call for Armed Guards at Schools.” The Guardian, December 21, 2012. http://www.theguardian.com/world/2012/dec/21/nra-newtown-armed-guards-schools.
17 “Sandy Hook Was a Total False Flag.” Before It’s News, March 28 2013. http://beforeitsnews.com/conspiracy-theories/2013/03/sandy-hook-was-a-total-false-flag-2449694.html.