Lack of communication is often a key factor in mass murder, according to Phillip Resnick, MD, Professor of Psychiatry and Director of the Division of Forensic Psychiatry at Case Western Reserve University in Cleveland. Speaking at the US Psychiatric and Mental Health Congress in Las Vegas, Dr Resnick, who is also an editorial board member of Psychiatric Times, shared characteristics of those who commit these acts to help clinicians better detect and, hopefully, prevent these tragedies.
Too often, individuals become overly concerned about confidentiality and privacy and lose sight of the bigger picture, he explained. Although HIPAA is important, the safety of the individual and the public should outweigh privacy issues. “Risk to human life always trumps confidentiality,” Resnick said. Where there is danger, he added, a clinician should declare a medical emergency, which in turn overrides the privacy/confidentiality issues.
Case in point—the massacre at Virginia Tech. Seung-Hui Cho had a troubled mental health history.1 Before college, he suffered from an anxiety disorder, selective mutism, and depression. A special education program was established to help him deal with these disorders; he also underwent psychiatric treatment. It was during this time he admitted he wanted to recreate the Columbine killings.
In college, the trouble started all over again, as he isolated himself socially and expressed his revenge fantasies. It was during this time that he was accused of harassment. After campus security addressed the issue with him, he texted a friend about suicidal thoughts. Similarly, Cho started writing disturbing passages about killing people and massacres in one of his English classes. These writings disturbed the teacher and other students so much that he was removed from the class and given instruction privately.
Over the years, Cho displayed and expressed the traits that are common among mass murderers, including paranoia, dreams of revenge, social isolation, and narcissism.2 But the lack of communication between his parents, those who helped him during his middle and high school years, the English professor, and the various clinicians over the years meant nobody saw the big picture unraveling. In fact, Resnick reported that his parents, who were largely unaware of his college troubles, would have pursued care for their son like they did years earlier if they knew of these troubling behaviors.
Clinicians also need to explore deeply and consider their sources when troubling behaviors are reported. Again, in Cho’s case, a roommate contacted authorities regarding the suicidal text. Yet when interviewed by a clinician, Cho said he was just kidding. “When a patient is being admitted to a hospital, you should give more credence to collateral reports,” Resnick explained, since the patient may lie to avoid commitment.
Communication is also key in dispelling myths and therefore allowing increased understanding and vigilance. For instance, although the popular press would have us all believe mass murders are increasing in prevalence, they are not. There have been about 20 mass murders a year since 1976, Resnick explained. The tragedies are “rare but regular.” Yet the media coverage and the ability to cover such events 24/7 give the impression that they have been happening more and more often.
In addition, it is a myth that mass murderers “snap.” These events are carefully planned, usually over weeks, Resnick noted. And only half of those who commit these acts are psychotic; many suffer from depression. More often than not, mass murderers are committed by single/divorced men over the age of 39 years, he added.3 About half of the men who commit mass murder go on to commit suicide.
PsychCongress: Mass Murder and Murder-Suicide
1. Friedman E. Va. Tech Shooter Seung-Hui Cho's Mental Health Records Released. ABC News. http://abcnews.go.com/US/seung-hui-chos-mental-health-records-released/story?id=8278195. Accessed September 30, 2013.
2. Mullen PE. The autogenic (self-generated) massacre. Behav Sci Law. 2004;22:311-323.
3. Hempel AG, Meloy JR, Richards TC. Offender and offense characteristics of a nonrandom sample of mass murderers. J Am Acad Psychiatry Law. 1999;27:213-225.