Hearts of Darkness

Chapter 8

Psychiatric, Sociopsychological, and Genetic Backgrounds of Violence and Aggression

Against the background of the epidemic of violence perpetrated by suicidal mass murderers, some common denominators define the underpinnings of their crimes. First, we know from records that almost all suicidal mass murderers are mentally ill and that their illnesses were detected years before their crimes. Second, we know that many suicidal mass murderers had gone through some types of medical screening, even forms of psychotherapy, and were diagnosed with various psychological or behavioral issues. Third, we also know that many suicidal mass murderers actually studied the crimes of other suicidal mass murders, for example, Adam Lanza’s research into the crimes of Anders Brevik and Cho Seung-Hui’s expressed admiration for Dylan Klebold and Eric Harris at Columbine High School and Cho’s wish to copycat their crime. These three common denominators cause us to wonder whether Boston’s Brothers Tsarnaev were also suicidal and whether they abandoned their plan to escape from Cambridge to confront the police to commit suicide-by-cop in a firefight rather than allow themselves to be caught. We know now that Dzhokhar, the younger brother, was caught on a police helicopter—mounted FLIR camera while hiding and bleeding out under a tarp in a boat in a private citizen’s backyard, taken into custody, and charged with using weapons of mass destruction. He was hospitalized and is recovering from gunshot wounds after the confrontation with the police. He told interrogators that he and his older brother had planned to escape from Boston with improvised explosive devices they were going to plant in New York City in coordinated terrorist attacks. This is scary.

The commonalities that link suicidal mass murderers include, first and foremost, mental illness, an illness so profound that the perpetrator, although he might appear logical and methodical in his behavior, is living in a world of his own fear and fantasy that shuts him off from reality. Each of the subjects covered in this book share this form of mental illness, usually schizophrenia, a splitting off between the subject’s delusional world of reality and the actual world of reality. It is no surprise that almost every one of the mass murder perpetrators we hear of has at one time or another either been deemed mentally ill by a psychiatrist or psychologist or has displayed the behavioral symptoms of someone going through a crisis of mental illness, even if that behavior is only vaguely apparent to the outside world. In fact, one of the most frustrating things about someone who acts strangely in a friend’s or neighbor’s description is post mortem—because most of these individuals wind up committing suicide—a line connecting the dots of the person’s behavior and actions comes up as if it is a treasure map written in invisible ink held over a flame or hot light bulb. A pattern suddenly appears and makes sense, yet at the time of the perpetrator’s crimes, the dots were simply dots: points on a timeline that bore little relationship to each other. We can see this in Tamerlan Tsarnaev’s timeline because of his personality shift after he was told he could not compete for the US team in amateur boxing and became aware that his American citizenship application was held up for further investigation. Absent official American citizenship, the only sense of acceptance he could find was in radical Islamic jihad, much to the consternation and concern of his parents.

Serious mental illness may come in a variety of forms, but it is almost always progressive, ending up with the person feeling hopeless, in pain, and aggressive toward a world that seems neither to understand nor care. If and when the mentally ill person becomes suicidal, that is when violence itself is most likely, as we have seen over the course of mass murders since Charles Whitman in the Texas University bell tower almost forty years ago. Suicidality and mental illness go hand in hand.

The myth about mental illness is that it is static. If a person has schizophrenia, the person is mentally ill and may only get better through treatment. But what most people do not realize is that if left untreated, a mental illness progressively gets worse until, like Adam Lanza, what was just a person’s fear that something may be wrong with his mind becomes a creeping paranoia walling off the person from the rest of reality. Thus made vulnerable by his mental illness, the perpetrator-to-be is prone to react to and from any stimuli that would not normally be a call to deadly aggression for the rest of us. The perpetrator falls victim to his own neurobiology as well as the external stimulus such as violent video games, television shows, or motion pictures portraying scenes of extreme and graphic violence.

The Neurobiology of Aggression

Question: Are Patients diagnosed with schizophrenia more likely than the general population to commit homicide? If so, what is the evidence?

A robust body of evidence demonstrates an association between psychoses and violence, most significantly between psychosis and murder. Substance abuse comorbidity increases this correlation between serious mental illness, violence, and suicide. Comorbidity is the presence of disorders in addition to the underlying illness, such as frequent attacks with bipolar affective disorder. Thus, people with mental illness are sometimes substance abusers or display symptoms of other diseases. Thus, the increased risk associated with this comorbidity is of a similar magnitude to that in individuals who have only substance abuse problems. This finding would suggest that violence reduction strategies could consider focusing on the primary and secondary prevention of substance abuse rather than solely targeting individuals with severe mental illness. This strategy would be like working from the outside in to remedy as many of the antisocial behaviors (often, outward manifestations of aggression) as possible to get to the core problem. Aggression is defined by hostile, injurious, and destructive behavior often caused by frustration. It can be categorized as impulsive or premeditated. Impulsive aggression is accompanied by over-reactivity to a stressful trigger, such as being insulted, and is accompanied by negative emotion and autonomic arousal, such as palpitations, sweating, and fast breathing. The autonomic responses to a stressful trigger bypass the brain’s cognitive or rational assessment and involve reactions not immediately under the person’s control. This is similar to a fright reaction when something startles a person, who then screams even as he recognizes that whatever startled him is not a threat. In people who gain control of their emotional response, autonomic reactions are quickly rationalized and the person returns to a state of emotional balance. Premeditated murder, however, is cold-blooded because it is planned with motive and not accompanied by autonomic arousal or caused by triggering stress. Contributors include political, cultural, socioeconomic, and neurobiological factors, the last of which we know more about.

Impulsive aggression occurs when the imbalance is top-down among insula and amygdala and anterior cingulate and orbitofrontal cortex—structures in the brain that control body reactions. The insula, for example, controls the hunger reflex and cravings. The amygdala area is part of what neurologists used to call the “old brain,” where emotions are processed, an area that governs both fear and pleasure responses. These are also called “visceral” responses because the body responds autonomically, beyond rational mediated control to perceived threats such as frightening or threatening experiences. The amygdala and insula assess threat in context of an experience stored in the amygdala, which is similar to a repository of prior stimuli that have triggered both fear and pleasure. The body’s responses to these feelings are also stored in the amygdala. Think of a stored set of deep threats, such as buried memories of childhood abuse or sexual abuse. Those memories can be stimulated by an event that falls into the same threat category of the prior abuse, hence a potential basis for post-traumatic stress disorder. The orbitofrontal and cingulate areas assess situations in terms of reward or punishment consequences for action on impulse. Thus you have a signal, cognitive processing of it, and regulatory response to processing. This neurological subsystem acts as a primary switchboard to connect perceived external events to a type of yes/no or good/bad response. It assesses the likelihood of a reward or a punishment for a specific action so that the person can judge how to respond. If this system is broken, and there are a variety of ways it can become dysfunctional, the person’s response to external stimuli may seem awkward, inappropriate, or simply strange. For example, a combat veteran from the Vietnam War may have an abnormal fear-based response to a simple walk in the woods because, in his experience, walks among jungle-like foliage may evoke memories stored in his amygdala of bloody ambushes that killed members of his unit. Thus, he has a heightened sense of fear even decades after the event itself.

Neuromodulators are just what their name implies: chemicals that work on neurocircuits, the networks of nerve cells in the brain, whose uptake affects moods and information processing. These chemicals include glutamate (an amino acid that acts as a messenger chemical in transmitting information to neurons, too much of which is toxic to the neurons), GABA (a member of the amino acid family that regulates the excitation of nerve cells in the central nervous system), NE (or norepinephrine, a neurotransmitter that regulates the body’s arousal mechanism from hunger and mood control and operates in the central nervous system), DA (or dopamine, one of the primary transmitters for mood reactions, particularly within the limbic system), serotonin (another neurochemical controlling mood and sleep functions), neuropeptides (chemical signals within the neurocircuitry of the brain controlling physiological reactions), and acetylcholine (a neurochemical that helps mediate memory and learning and is an important brain signaling chemical). Serotonin appears to be the major mediating neurochemical that affects much processing in the brain.

And here’s how these chemicals work together. Glutamate is a generalized neurotransmitter operating throughout the brain and is mainly responsible for stimulating neurons. For example, the limbic brain cells might fire up to the cerebral cortical frontal lobe cells and activate them. Therefore, you should become more alert and think faster. But its counterpart, GABA, inhibits this activity. Thus, the balance between GABA and glutamate is increasingly important today for potential therapeutic targets of drugs to both activate certain regions of the brain or inhibit them, but mainly to balance them. Acetylcholine is necessary for memory. Hence, by blocking it with anticholinergic drugs and then experiencing something, you won’t remember the experience.

Acetylcholine does many other things throughout the brain and the body, including stimulating the gut and regulating pupil size. Norepinephrine (NE), dopamine (DA), and serotonin are, like glutamate and GABA, widely dispersed throughout the brain and regulate much brain activity, but in a more specific way than simply increasing or decreasing activity of a cell. NE is necessary for interest and attention, but its dysfunctional transmission is also responsible in part for depression. DA is necessary for pleasure and energy, but its dysfunctional transmission is also responsible for depression and attention deficit disorder when deficient. But amphetamine psychosis and psychosis from bipolar to schizophrenic illness are found to have excessive dopaminergic neurotransmission in the limbic system. Neuropeptides are small molecules that operate inside and outside the cells, but they are the building blocks of proteins necessary for structure and function of the brain. DNA, for example, is a series of neuropeptides.

Serotonin, dopamine, and norepinephrine do not activate cells directly, as apparently does GABA, but, rather, they work through a second messenger system inside the brain cell, informing the DNA to produce different proteins, both for structure of brain tissue and neurotransmission. These chemicals affect protein production within the brain. Thus, a protein’s improved production because of these neurochemicals via neuropeptide manipulation actually works like a fertilizer for brain cells, making them grow, sprout branches, and direct these branches and growth in the right direction. In schizophrenia, they are all tangled up; thus, signaling is chaotic.

When there is a dysfunction in the generation and uptake of chemical neuromodulators, the factors include cognitive impairment, psychosocial impairment, sensory impairment, and distortions of sensory perception by drugs and alcohol. You can see how, even though the human neurological system is resilient and has its own defense mechanisms, events that disturb the balance of chemicals and functions of various parts of the brain can have a huge effect on behavior. For our purposes, we focus on impulsive aggressive behavior.

Impulsive aggression can occur as the result of bottom hyperactivity in insula and amygdala, encoded for experience, and hypoactivity in the orbitofrontal cortex and anterior cingulate cortex—limbic music of hyperactivity or cortical hypoactivity, respectively. Cortical hypoactivity due to lesion, reduced brain volume, or aberrant information processing is dependent on serotonin for regulation and can be dysregulated by DA and NE. This means that if there is a dysfunction in the uptake of serotonin, a brain modulator, caused by any number of events, such as brain injury, lesions resulting from seizures, or reduced brain volume resulting from, for example, long-term alcohol abuse, the brain reacts aberrantly. If an at-risk individual, primarily a patient suffering from schizophrenia, is left untreated because of a misdiagnosis, lack of access to health care, or simply because parents or teachers do not understand that a child may be mentally ill, the long-term effects of brain dysfunction are progressive and the individual retreats into his or her own world devoid of external reality.

The amygdala, located deep inside the brain, provides emotional responses to stimuli involving basic emotions such as fear and flight. Generally, within a healthy neurological system, the amygdala stores long-term memories of emotional experiences and compares external stimuli to stored memories to generate a response. In a healthy amygdala, there is ample room for memory storage. However, there are instances of reduced amygdala volume resulting from emotional hypersensitivity or because of repeated stimulation—usually negative stimulation—a form of amygdala overload resulting in something akin to a dumping of long-term emotional memories into the conscious mind. Constant emotional pounding on the amygdala, caused by repeated threatening experiences, can actually reduce the volume of the amygdala to store memories. When that happens and a memory dump results, even a slow-drip leak into the conscious mind, the person’s mind is flooded with something we call “limbic music,” something akin to a waking dream state in which the person cannot differentiate between dreams and external reality.

Think of Adam Lanza, deeply psychotic, immersed in violent, single-shooter video games, sliding deeper and deeper into a waking dream state, albeit within the digital world of his computer while safely ensconced in his room. However, if his comfort zone is disturbed by even the slightest jarring, or if he feels threatened to the point of his perceived destruction, what might his response be? For a long-term schizophrenic, who has little or no grip on external reality, that response might take the form of a waking dream. Awash in limbic music, Adam Lanza, who may have once been able to differentiate right from wrong and might be aware of his immediate surroundings, acts as if he is in a dream in which he is the single shooter in Call of Duty who methodically eliminates all the threats to his avatar in the video game session. Only it is not a video game session and Lanza is not the avatar. This is real life. He is the real shooter, and he shoots real bullets. He eliminates his targets in his internal dream state. First, his mother, whom he sees as the cause of the disruption of his comfort zone because she is moving the family out of Newtown. Then it is the school he attended, the grade he attended, and the children, whom Lanza perceived to have threatened him with touching or other forms of social contact and who have now become his alias targets, standing in for those children who had bullied him over a decade earlier. And, finally, after less than five minutes of shooting, during which he expends more than 150 of the .223 rounds from his Bushmaster AR-15, he turns the weapon on himself. Game over. But it was never a game for all of us in the real world.

What we are seeing from Adam Lanza or James Holmes, and particularly from Jared Loughner, is pathological aggression, all too common in some psychiatric and personality disorders that may share risk factors with psychiatric disorders. Psychopathology may be a risk factor where there is an incorrect dosage and inadequate follow-up of antipsychotic medications or even cross-reactions between different medications. Manifestations of pathological aggression may also depend on genetic vulnerability, with cognitive impairment leading to deviant behaviors such as serial killings and murder.

For example, imagine someone like notorious serial killer Ted Bundy: intelligent, a volunteer at the University of Washington rape crisis center, and a first-year law student with important political connections. Yet, deep within his psyche, Bundy had no ability to relate to other people in a healthy way. He was a sociopath, brooding and angry, completely unable to respect physical, emotional, and social boundaries because his mental illness, his paraphilic compulsion for sexual homicide, also called “lust killing,” and his psychopathic personality had made him blind to them. Everyone and everything belonged to him because everyone and everything was simply an object over which he must exercise control. He was a sex offender, a thief, and a cat burglar. Within his victim target group, he may have seemed harmless at first, sympathetic, friendly, and in need of assistance from his prospective victim. Then he struck, knocking his victim unconscious and strangling her to death. Then, after secreting away his dead victim, he exercised complete sexual control over the dead body—no need for social niceties or relationship management. His victim belonged to him even as she decomposed in some remote location in a northwestern primeval forest. The body disposal site itself, Bundy once told the police, was sacred to him.97 Bundy, of course, was found guilty of murder in Florida and executed. But what his real pathological motivations were, we can only guess. His secrets died with him. All of this having been said, offenders like Ted Bundy, Gary Ridgway, Jeffrey Dahmer, or Arthur Shawcross are not suicidal mass murderers. However, they may share the same limbic dream state as offenders like Adam Lanza during the commission of their crimes.

Among at-risk, suicide-prone individuals, susceptibility to aggression might be caused by co-occurring psychopathology, such as cognitive impairment, a form of deviant violence that can result from the neurological inability of the at-risk individual to respond to any perceived threats with even a marginally rational response. Think of James Holmes as he realized that he was sinking deeper and deeper into a world of fear and aggression. While under therapy at the University of Colorado, he was unable to participate in that therapy because he could not converse with the therapist for numerous possible reasons, including being locked off campus after he had flunked out. He could only descend deeper and deeper into his psychotic dream state until he, like Adam Lanza, inhabited the role of his avatar, only in real life. He became the Joker, even though there is no Joker, except on the screen or in comic books. But it is a role that allowed him to manifest his psychotic aggression in the comfort zone of a character and not the real James Holmes.

In this case, we have actually witnessed the terror of a fragmented mind coming together, glued like pieces of a jigsaw puzzle into a mosaic of horror. The biology of dysregulation, hypersensitivity, and hyperreactivity may result in impulsive aggression in borderline personality disorder (BPD).

BPD, though not considered to be a mental illness, is a very broad spectrum of enduring lifelong personality traits, frequently and mistakenly diagnosed because of a cross-sectional view of a patient without a longitudinal, or long-term, history of the necessary signs and symptoms. The underlying psychopathology is usually overlooked as well; it can include polymorphous perverse sexuality, specifically, gender identification instability and long-standing paraphilias, otherwise known as sexual perversions. There may be a history of what is called “splitting,” wherein there always have to be good nurturing and bad nurturing figures, such as a good parent and a bad parent. The third element is called polyneurotic symptomatology. This element entails the presentation of multiple neurotic complaints, such as undiagnosable pain sensations, pseudoseizures, vague illusions mistaken for hallucinations, and other complaints that almost always have no physiological component. In other words, someone constantly complains about pains in his or her joints, but ultrasounds, MRIs, and X-rays indicate that there are no injuries and nothing to cause the pain. Thus, the pain may be deemed psychosomatic in origin. Although this triad of psychopathological elements is not Axis II criteria, which means it should establish a diagnosable basis for a mental illness, the triad should be sufficient to make BPD a diagnosis that has the reliability, specificity, and validity it needs for studies as serious as attributions of violence. Of course, there are severe narcissists and psychopaths—particularly sexual psychopaths—who do fulfill the criteria for BPD. Many patients with PTSD unfortunately fulfill the criteria as well. Therefore, BPD is often associated with PTSD, making things even more complicated when it comes to establishing a diagnosis.

Individuals with the Axis II personality disorder known as BPD have an extreme sensitivity to disappointments, perceived challenges, insults, and frustration. They have very low resiliency, a low tolerance for negative external stimuli, and an inability to cope with life’s setbacks. At the more extreme edge of BPD, individuals display an impulsive aggressive reaction to challenges and disappointments and aim that aggression at target groups, but this aggression is not limited to just those groups. BPD sufferers can also become suicidal at the extreme range, and this form of suicidality is also aggressive. Thus, mass shooters such as Christopher Dorner, who commentators have said was an “injustice collector,” drew disappointments into himself.98 That inward struggle ultimately resulted in his violent aggressive homicidal and suicidal acts and displayed some of the classic symptoms of impulsive aggression of BPD, although his manifesto is a classic flight of ideas from a manic depressive patient, too. Inasmuch as we don’t know his history of military service in the Middle East, his apparent BPD could have also been untreated PTSD. Perhaps some of the motivations underlying aggression in BPD sufferers are a need to restore a sense of balance to their lives and to reestablish equilibrium in their neurocircuitry by enacting what they see as justice to remedy their perceived injustices. This is what is known as projective identification, wherein the sufferer justifies his or her murderous rage based on a perception of the antagonist’s aggression. Such projective identification defensive operations are necessary in warfare so as to justify killing a faceless enemy who, you are told, seeks your death. Projective identification is the foundation stone for paranoia. This explains such things as the Unabomber’s manifesto, Breivik’s manifesto, and Dorner’s online manifesto about the injustices he claims were heaped upon him. Dorner drew some of his language both from the Unabomber Ted Kaczynski and from Breivik, whose manifesto echoes statements made by Kaczynski.

We don’t know if Adam Lanza was diagnosed with BPD on Axis II, but serious mental illness in children, such as bipolar affective disorder and schizophrenia, can be mistaken for borderline personality disorder, for which there are no effective psychopharmological solutions. Treatment for such misdiagnoses can lead to dangerous extensions of duration of untreated psychosis until it is too late, as we have possibly seen in Lanza’s case and certainly with Cho Seung-Hui. The child’s or young adult’s life comes to an end with suicide, intractable addiction, or incarceration after conviction for the commission of a felony.

Because those who have BPD are almost always emotionally disruptive—the least little thing will set them off if it is a perceived slight—family members of those with BPD are also at a loss to find a remedy to the person’s behavior. Thus, imagine that you are a parent of an adolescent with BPD, who is awash in self-hatred and experiences remorse over his life, but who also has bipolar tendencies that make him or her swing from mania to an almost inconsolable depression. The manic highs can be marked by extreme aggression, while the lows are marked by self-mutilation or even suicidal ideations. For this reason, psychiatrists sometimes report that family members of those suffering from BPD describe the person as “mercurial” because of his or mood swings. These mood swings would be almost charming if the extremes of that bipolar behavior were not destructive or self-destructive. Furthermore, what can be so perplexing to family members is that a loved one who has BPD may be able to camouflage his behavior so that, to the outside world, the person may seem to act a little strange but is not perceived as a threat. This is how many potentially dangerous BPD sufferers can fly below the radar, especially because those few people close to the patient may not understand the disorder or its symptoms. Moreover, many parents of children with BPD may interpret the hyper and morose periods of behavior as a form of emotional growing pains. This is especially true among adolescents struggling with puberty, the flow of neurochemicals and hormones, and the stresses of either conforming to the outside world or being an outcast. Think of Adam Lanza trying to cope with his fears as the demands of the outside world threatened to disrupt his private comfort zone and closed in on him from every angle.

The neurobiology of BPD seems straightforward even if there has not been enough research to pinpoint the exact cause of the disease. There seems to be reduced activity in the frontal cortex of BPD sufferers, implying that the mediating function of the higher-level brain may be impaired, while the limbic region of the brain seems more active. That means that many BPD sufferers may be partially in a waking dream state with their conscious brain flooded with memories and emotions that may influence their wildly swinging moods. Also, the lack of uptake of the neurochemical serotonin probably plays an important role in BPD, because serotonin is the chemical that mediates mood swings. Some people with aggressive impulsivity have been found to have reduced levels of serotonin in their spinal fluid, thus possibly reducing the capacity of the frontal cortex to function properly. Medications that increase the flow of serotonin and that can promote greater activity in the frontal cortex generally improve the behavior of those with BPD, particularly among adolescents and young adults, who are most prone to violent mood swings.

Lack of empathy in psychopathy and Asperger’s syndrome—called a behavioral disorder and not a mental illness by groups advocating a greater understanding of the syndrome—has been labeled a factor in the aggressive behavior of those afflicted with the disorder. Others have said that high-functioning victims of Asperger’s are incapable of emotional empathy and therefore, under the influence of violent stimuli, are more prone to committing crimes of violence than those who do not suffer from the disorder. As reported by USA Today on December 10, 2012, Geraldine Dawson, the chief science officer at Autism Speaks and a professor of psychiatry at University of North Carolina at Chapel Hill, wrote that studies have challenged this view, saying that individuals with Asperger’s or high-functioning autism do not perpetrate violence at levels greater than those who do not have the disorder. This was also reported by CNN.99 However, if what is identified as Asperger’s is actually childhood schizophrenia or a premorbid schizophrenia, the emotional withdrawal typical of an Asperger’s sufferer can easily be confused by clinicians not well-versed in diagnosing psychotic behavior. BPD is not a psychotic disorder, although BPD patients can become transiently psychotic. It is likely that the lack of social empathy typified in Asperger’s sufferers lends credence to the popular belief, whether true or not, that Asperger’s sufferers are more prone to commit crimes.

It also seems evident that there is a genetic component to the current suicidal/mass murder epidemic. The genetic component does not mean that people can be born violent. It means that there might be a genetic predisposition to forms of brain dysfunction or neurological dysrhythmia that may make the person susceptible to certain types of environmental stimuli that contribute to psychiatric disorders. If an individual has a genetic predisposition to reduced function of the frontal cortex or a dysfunctional amygdala, thus leaving the individual prone to limbic music, which is the flooding of the person’s consciousness with unmediated emotions from the amygdala, the person could be more prone to impulsive responses to those stimuli he or she perceives as threatening, even when they would not be threatening to an emotionally resilient individual.

Part of the biological basis for different types of aberrant behavior, particularly among psychotics, lies in the way the brain processes “reward” stimuli. The reward sensation is processed in the striatum, an area of the brain located inside the cortex, where abnormal activity can produce abnormal behavior. For example, if there is hyperactivity in the striatum and the activity in the mediation function of the frontal cortex, the subject may not be able to control his ability to process a reward reaction. The reward reaction resulting from the action of the neurochemical dopamine on the striatum may also result in aberrant behavior with a loss of impulse control, so violent responses are not impeded by the logical functioning of the brain.

Before parents with ASD-diagnosed children express their unhappiness at our grouping their children with possible mass murderers, or at our including the autism spectrum, it is important to insert this caveat: autistic children are not automatically violent, nor will they ultimately become Adam Lanzas. In fact, they may be more likely to become victims of violence or, at the least, bullying. We describe ASD as a behavioral disorder because we are describing an equilibrium problem among the different processing centers in the brain whose relationship to each other is a major factor in mediating primal reactions to external stimuli. For example, to get a child to accept a family’s moving to a new location where he or she will have to make new friends, adjust to a new school environment, and acclimate himself to completely new surroundings can be upsetting. But for children with behavioral and developmental disorders, such a move can be absolutely traumatizing.

Attention deficit hyperactivity disorder (ADHD) is a real disorder in which the child or adult not only has an inability to focus and maintain that focus, but the resulting lack of focus generates an increased level of activity often inappropriate to the situation. Because the brain uses various chemicals to help send messages across the nervous system, an imbalance of these chemical messengers may result in the inattentive and hyperactive or impulsive symptoms of ADHD, a condition that may also have reduced frontal lobe inhibition. This condition also results in increased impulsivity and a loss of impulse control. Another caveat: neither children nor adults with ADHD automatically turn out to be suicidal mass murderers, but ADHD contributes to other disorders that may result from the person’s inability to adjust to what he may perceive to be hostile or threatening external situations. ADHD is also a problem in classroom situations because a student (especially a child) suffering from it may be inattentive and disruptive in class, resulting in poor grades, a sense of failure, frustration, and even behavioral issues as the child acts out to express frustration and anger. But ADHD can be treated symptomatically in a variety of ways, particularly with psychopharmaceutical medications.

Treatment for ADHD also focuses on improving cortical inhibition by increasing the flow of serotonin and reducing limbic hyperactivity with anticonvulsants. Stimulants can improve cortical inhibition, while clozapine and other atypical high-dosage medications increase serotonin at 2a receptor in cortical areas for inhibition and reduce dopamine in limbic dysfunction.

In treating ADHD, we are balancing drive with inhibition to increase focus. Genes do not cause ADHD, but they determine processes within brain systems that produce behavior, such as violence, as a manifestation of PTSD. Like many of our subject suicidal mass murder offenders, such as Loughner, Routh, Holmes, and Lanza, it was not genetics per se that turned them into the people they were. However, it easily might have been that somewhere in the genetic mix that makes each of us an individual, composed of the many variants we inherit from our parents and their parents and those in our bloodline who came many generations before us, are chromosomal combinations that might impair or impede one or more types of neurological connections resulting in aberrant forms of behavior. How these forms of aberrant behavior are addressed, either by parental guidance, social institutions such as school, or medical intervention, can prevent an at-risk individual from falling through the biological safety net that keeps the individual from catastrophic harm.

Nature interacts with nurture, and it is that form of positive nurture that we believe may be on the wane.

97 Keppel, Robert D., and William J. Birnes. The Riverman. New York: Pocket Books, 1995, Reprint, 2005. See also Liebert, J., MD. “Contributions of Psychiatric Consultation in the Investigation of Serial Murder.” International Journal of Offender Therapy & Comparative Criminology, 1985.

98 Griffith, David. “Chris Dorner: The Injustice Collector.” Police Magazine, March 5, 2013. http://www.policemag.com/channel/patrol/articles/2013/03/chris-dorner-the-injustice-collector.aspx.

99 Robison, John Elder. “Autism Link to Violence Is a Myth.” CNN.com, April 7, 2013. http://www.cnn.com/2013/04/06/opinion/robison-autism-violence (accessed December 12, 2013).