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Murderers of Innocents: Common Sense Psychology and Mental Illness
The recent Newtown, Conn. massacre has elicited much commentary about psychological causes and medical treatments that might prevent such disasters. Some journalistic discussion is informed and pertinent, but much is mistaken and irrelevant. I want to correct some of this and offer a few further ideas about why and how an impaired, “sick” mind produces mayhem. I will focus on predisposition including brain factors and psychiatric diagnoses, cultural reinforcement and, finally, chemical or emotional precipitators, (“triggers”). First, two questions for the reader:
1. Why should you listen to me? I have treated patients who have murdered innocent persons despite my best efforts and I have published many articles in many journals in psychiatry
2. How large is the contribution of Neuroscience to our understanding of murderous rampages? The important matter of gun control and safety I leave to others, except to repeat the obvious mantra, “both people and guns kill people:" If I am enraged, crazy and out of control I can destroy more lives with a loaded Uzi weapon than with my Boy Scout pocket knife. Neuroscience (including neuroimaging) has added zero to our understanding of the psychology of person who kill strangers and innocents. This discipline has provided little help for psychiatric diagnosis and treatment, but its research may provide relevant understanding of violence after a few more decades.
I. The Brain as Predictor
The National Rifle Association blames serious mental illnesses for recent frequent violent sprees. Steinberg (NYTs, 12/2012) labeled Adam Lanza, the Connecticut shooter as a person with Schizophrenia. The author wants to include in the same category Seung-Hui Cho, the 2007 Virginia Tech killer and JL Loughner, who shot the congresswoman, G. Giffords, among others in Arizona in 2011. He implicates the pre-frontal cortex of the brain was vulnerable because of stress, often originating in adolescence. If he is right, than can we in the future identify and diagnose this disease? Can we predict the danger and treat a person like those named above thereby preventing a mass catastrophe? No, we cannot. Localization of a major psychiatric disorder in a specific brain region is hazardous. While excellent at detecting cancers, blood vessel abnormality or tissue loss, not even the most sophisticated brain imaging method has identified a psychiatric disorder of any kind. The common severe injury through auto trauma or fist blows to the front of the skull (where the pre-frontal lobe is found) does not produce schizophrenia, (I. Feinberg, 1999). Genetic aberrations do not predict violence. J. Buckholtz (10/18/12) examined the MAOA “Warrior” gene hypothesis, identified by DNA sequencing and found it to be a science fiction fantasy. Even the alleged association of brain cancer with violence by neuroscientists, (D. Eagleman, 8/11) is unproven. Charles Whitman, the notorious University of Texas Tower shooter, who killed 17 persons in 1966, was found at autopsy to have a small brain tumor pressing on an amygdala nucleus in his brain. While a few experts claimed that a glioblastoma was associated with his rampage, other scientists disagreed pointing out that destruction of the amygdala produces calming in laboratory animals.
II. Psychiatric Diagnosis as Predictor
I have argued often (Barglow 2011&2012) that here is little connection between American Psychiatric Association diagnostic entities such as PTSD with violent murderous incidents. The categories will be officially revised later this year, but their content offers no insight into human violence. I mention two recent examples of war atrocities many commentators attributed to PTSD. Captain Hasan Nidal’s murdered 13 innocent persons at a Texas military base in November 2009. But Nidal had not been in combat, and his behavior was more likely fueled both by a radical Muslim ideology and the threat of an assigned tour of overseas duty, than by PTSD and the aftermath of war trauma. Sergeant Robert Bales shot 16 Afghan civilians in 2012. However he was intoxicated at the time, most likely with alcoholic delirium, and had been brain damaged earlier. Forget about PTSD, schizophrenia and psychiatry are associated with violence except for some medication management.
III. Cultural Re-Enforcement
Certainly culture can amplify violent tendencies. The violence called “Going Berserk” has an ancient history. “Berserkers” were Norse warriors, “Baresaks,” who battled, often naked, in an uncontrollable, trance-like bestial fury, first mentioned in the late ninth century Scandinavian poem, Haraldskvaedi. (“Baresark” may refer to a medieval thin shirt made from a bear pelt.) Today, as many Americans consider them admirable they judge them insane. Rampage murderers are almost exclusively male. We reviewed several hundred American incidents resulting in the death of strangers and innocents during the past half a century and found only 7 were women perpetrators, (N, Kreisberg, 2012). In Israel and Switzerland, guns are as frequently owned as in the USA, but gun individual or mass murders are rare. So culture does foster or inhibit violence as shown also by comparisons of the U.S. with France and England. North America is only a few centuries old and is still dominated by a frontier mentality, offers a tentative explanation. But the psychological histories of America’s recent mass killers (prime example – the Columbine Colorado shooters) do show a pattern of social isolation, poverty of intimate connections, mental fragility and almost total absence of self-esteem usually associated with masculinity concerns. If a vulnerable young man believes, “I am nothing, no-one, a powerless despised victim” then a male-superman-omnipotent rage outlet through rape of an individual woman or mass murder constitutes an ideal tragic expression.
IV. Final Triggers for Mass Violence
If there are symptoms of a severe mental disorder (like hallucinations that command a person to kill, or persecutory delusions) rarely do they lead to behavior ending in death by suicide or homicide? But the inflammatory incitement by a hate group, the sudden loss of control created by drugs or alcohol or the abrupt cessation of restraining psychiatric medicine, may fuel explosive rage. Half of the homicides in Australia from 2000 to 2006 involved alcohol consumption (Australian Institute of Criminology, 2009), a statistic mirrored by data from the U.S. and Canada. Yes, a documented record of prior violence is a valid predictor. But the U.S. must maintain its high civil liberty standards and use preventative detention only with the highest standards of evidence. Our treatment systems, when adequately funded, can utilize benign legal methods to force persons with a clear history of violent deeds to accept life-saving medicine or at least frequent observation by family members and educated sensitive professionals. Unlike Russia in the 1960s who used mental illness as an excuse to prosecute dissidents or even benign Switzerland that keeps close track of all its citizens, America’s democracy limit our options in preventing all outbreaks of mass murder. Even after implementing optimal interventions for those persons identified at risk for dangerous loss of control and treatment of the seriously mentally ill there can be surprises that defy inspection and prevention.
I fear that the Sandy Hook killer, Adam Lanza encapsulates this thorny challenge. A healthy young child expands its innate compassion for close family members or intimate friends and is inhibited in its intermittent normal destructive tendencies through empathically sharing the distress and pain of most human beings. Profound psychiatric disease can impair such normal progression. An autistic adolescent can, with amazing rapidity, imitate some motoric actions of a parent (using so called “mirror neurons”), but be incapable of comprehending others’ more nuanced complex emotions and precipitating unbridled rage responses. Lanza’s mother was a survivalist who allegedly stockpiled food and semi-automatic weapons. The boy had not spoken to his divorced father (who might have restrained him in some manner) for 2 years. I guess that he was prescribed psychotropic medication that he used only intermittently. In summary, this catastrophe was the final outcome of a unique and infinitely complex amalgam of variables that created terror and pain beyond human prediction or comprehension.