By Donald W. Black
For many years I have pondered the mental state and motivations of mass shooters. The tragic events in Newtown, CT this past week have brought this to the fore. Mass shootings have become everyday occurrences in the United States, and for that reason tend not to attract much attention unless the circumstances are especially heinous, such as this instance in which the victims were young children. We are all left wondering what can be done. While the attention span of the general public and the media is usually a matter of nanoseconds, this mass shooting seems different, and I hope will lead to positive policy changes. This tragedy presents an opportunity for our leaders to step up to the plate and lead and, one hopes, implement rational gun control legislation most of us agree is necessary.
But back to the shooters. As a psychiatrist with an intense interest in bad behavior, I expect that discussions will center on mental health issues which many believe motivate the shooters. I am intensely interested in these “issues” because, to me, the main issue that keeps coming up is that of psychiatric diagnosis. Everyone seems interested in the possibility of a psychiatric diagnosis, because it suggests that we might “understand” the shooter, and this may lead to better identification of future shooters, and both improved treatment and prevention.
But will the presence of a psychiatric diagnosis improve our understanding? Probably not, because — at least in the cases we know about — the apparent psychiatric diagnosis runs the gamut. Some shooters appear to have schizophrenia, others a depressive disorder, and still others a personality disorder, as has been alleged in the case of Adam Lanza. While we seem able to understand that a “crazy” person out of touch with reality might carry out an otherwise senseless act, the thought that someone who is not psychotic carrying out such an act is very unsettling. How could a person who is not psychotic behave this way? For example, depressed persons are by and large not psychotic, yet some will — in the context of being hopeless and suicidal — want to take others with them: spouses, children, etc. More typically, while planning to harm themselves, most depressed persons have no desire to hurt anyone else.
What about the non-psychotic people with a personality disorder? The Diagnostic and Statistical Manual of Mental Disorders — a compendium of psychiatry’s officially recognized disorders (about to come out in its 5th edition) — lists ten personality disorders; the most relevant to our discussion is antisocial personality disorder. This disorder is quite common (up to 4.5% of the population) and causes all manner of problems because the antisocial person always seems to be in trouble with the law, their spouses and families, or their employers.
The term antisocial is almost always misunderstood and is often construed to mean ”shy” or “inhibited,” yet in a psychiatric sense the term suggests rebellion against society. My profession has done a poor job in educating the general public about the disorder and for that reason it remains under the radar screen. (An older term that seems more entrenched is sociopathy.) In the DSM, the diagnosis rests on the person having three or more of seven symptoms (such as deceitfulness, impulsivity, irritability and aggressiveness, etc). Perhaps the most important is “lack of remorse,” which occurs in about half of those diagnosed antisocial. This is what allows the antisocial person to hurt, to mistreat, or even to kill others. These are the “psychopaths” we read about and fear. (Psychopathy is at the extreme end of the antisocial spectrum of behavior.) Few antisocials are killers, but many of today’s mass shooters would fit the description of antisocial personality disorder. I don’t know if Adam Lanza would, but as we peel back the layers of his personal history, we might find that he does.
We don’t know what causes antisocial personality disorder, but like many disorders it probably results from a combination of genetic and environmental factors. I have argued for many years that the federal government needs to direct more funds to investigating its causes and developing effective treatments. Despite its high prevalence and the fact that it contributes to so much of society’s ills, the government has shown little interest in funding research on the disorder. The National Institutes of Health RePORTER website lists only two projects in which the term “antisocial” appears in the title and only five in which the terms “psychopathy” or “psychopathy” are used. Considering that NIH funds literally thousands of projects, this can only be considered hopelessly inadequate. Overcoming this resistance to research on antisocial personality disorder and related conditions must be a priority.
We need wide-ranging projects to explore the origins of antisocial behavior and search for methods to change its course. Geneticists should investigate the mechanisms underlying antisocial behavior, locating genes that might predispose individuals to antisocial behavior and determining how these genes function. Neuroscientists should pinpoint brain regions or networks linked to antisocial behavior and identify biochemical and physiological pathways that influence its expression. A range of treatments — both drugs and therapy — need to be developed, tested, and refined.
Will these steps help us understand the conundrum of the mass shooter? Will they allow us to treat antisocial persons and prevent youth with antisocial tendencies from developing a full-blown disorder? We can certainly hope.
Donald W. Black, MD is a professor of psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine in Iowa City. He is the author of Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy), Revised and Updated (Oxford University Press, 2013).
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By Kathleen M. Heide, Ph.D.
The mass shooting in Newtown, Connecticut is a tragic event that is particularly painful as it comes at a time when people across the world are trying to focus on the upcoming holidays as the season of peace bringing good tidings of great joy.
Three factors about the Newtown school shooting are noteworthy. First, it was a mass murder. Second, it appears to have been precipitated by the killing of a parent (parricide). Third, it was committed by a 20-year old man. All of these factors are relevant in making sense of what appears to be inexplicable violence.
What drives a person to take an assault rifle into an elementary school and open fire on very young children and the teachers, some of whom died protecting them? Individuals in these cases are typically suicidally depressed, alienated, and isolated. They have often suffered a series of losses and are filled with a sense of rage. All too frequently they see themselves as having been wronged and want to play out their pain on a stage. The fact that mass shootings are routinely covered in depth by the media is not lost on them. They are typically aware that their name will go down in history for their destructive acts. Their murderous rampage is an act of power by an individual who feels powerless. Unable to make an impact on society in a positive way, the killer knows that he can impact the world through an act of death and destruction.
The fact that the first victim was reportedly the victim’s mother is significant. The first victims in other adolescent school shootings have also involved parents in some cases. My research and clinical practice has indicated that there are four types of parricide offenders.
- The first type is the severely abused parricide offender who kills out of desperation or terror; his or her motive is to stop the abuse. These individuals are often diagnosed as suffering from post-traumatic stress disorder or depression.
- The second type is the severely mentally ill parricide offender who kills because of an underlying serious mental illness. These individuals typically have a longstanding history of severe mental illness, often along the schizophrenia spectrum disorder or might be diagnosed as having depression or bi-polar disorder with psychotic features.
- The third type is the dangerously antisocial parricide offender who kills his or her parent to serve a selfish, instrumental reason. Reasons include killing to get their parents’ money, to date the boy or girl of their choice, and freedom to do what they want. These individuals are often diagnosed as having conduct disorder if under age 18 and antisocial personality disorder if over age 18. Some meet the diagnostic criteria of psychopathy. Psychopaths have interpersonal and affective deficits in additional to antisocial and other behavioral problems. They lack a connection to others and do not feel empathy. They do not feel guilty for their wrongdoing because they do not have a conscience.
- The fourth type is a parricide offender who appears to have a great deal of suppressed anger. If the anger erupts to a boiling point, the offspring may kill in an explosive rage often fueled by alcohol and/or drugs.
Interestingly, most parents are slain by their offspring in single victim-single offender incidents. Multiple victims incidents are rare. In an analysis of FBI data on thousands of parricide cases reported over a 32 year period, I found that on the average there were only 12 cases per year when a mother was killed along with other victims by a biological child. In more than 85% of these cases, the matricide offender was a son.
The actual number of victims involved in multiple victim parricide situations was small, usually two or three. Murders of the magnitude as seen in Newtown, CT that involved a parent as a first victim are exceedingly rare.
Assessment of the dynamics involved in the killing of parents is also important in terms of prognosis and risk assessment. The first victims of some serial murderers were family members, including parents. Serial murderers are defined as individuals who kill three or more victims in separate incidents with a cooling off period between them. If the parricide offender intended to kill his parent and derived satisfaction from doing so, he represents a great risk to society. (This type of killer is known as the Nihilistic Killer.)
The gunman’s age (in Newtown’s case, he was 20 years old) is also an important factor in understanding how an individual could engage in such horrific violence. Research has established that the brain is not fully developed until an individual reaches the age of 23 to 25 years old. The last area of the brain to develop is the pre-frontal cortex. This area of the brain is associated with thinking, judgment, and decision making. A 20-year-old man filled with rage would have great difficulty stopping, thinking, deliberating, and altering his course of action during his violent rampage. He is likely to be operating from the limbic system, the part of the brain associated with feelings. Adam Lanza was likely driven by raw feeling and out of control when he sprayed little children with rounds of gunfire. Simply put, it would be very difficult for him to put the brakes on and desist from his violent behavior.
Events like the shooting in Newtown leave society once again asking what can be done to stop the tide of senseless violence. Clearly Adam Lanza and other mass killers have been able to kill dozens of people in a matter of a few moments because of high powered weaponry. It is time to ask whether our nation can continue to allow assault weapons appropriate for our military to be easily available to citizens in our society. It is time for us to ask what can be done to increase access to mental health services to those who desperately need them. My prediction is, when the facts are more clearly known, risk factors will be identified in the case of Adam Lanza and missed opportunities to intervene to help Adam will be uncovered, contributing to the profound sadness that we are experiencing in the United States and across the world.
Kathleen M. Heide, Ph.D., is Professor of Criminology at the University of South Florida. Her lastest book, Understanding Parricide: When Sons and Daughters Kill Parents, was published in December 2012 by Oxford University Press.
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