For reasons of understanding and possibly prevention, the question of what was wrong with the perpetrator is taxing people’s minds--including mine. There has been plenty of speculation over the last week, including such colloquial, yet very stigmatizing terms as monster, miscreant, and madman. Such terminology suggests how difficult it is to empathize or feel any compassion toward such a person, although that is part and parcel of what it takes to be a psychiatrist and to understand and treat patients.
How, then, might a psychiatrist look at this from both a diagnostic and motivational perspective? Can we even do so ethically? After all, the Goldwater Rule prohibits us from analyzing public figures and making diagnoses, presumably even of those who are dead, without having examined them and gotten their permission.
Yet other mental health professionals and the public make such dramatic speculations in our absence. What if we just commented on these speculations, which would indirectly convey our potential expertise? After all, doing what we can to help potential mass dangers to society may be an even higher ethical priority. This dilemma has caused some psychiatrists to break rank in terms of commenting on what they think is mentally wrong with President Trump.
In the case of the Las Vegas massacre, where almost unthinkable damage occurred, what was some of the armchair psychologizing over the past week, and what did I think about it?
On Tuesday, October 3:
This pronoucement by President Trump:
He didn’t say why he made that conclusion, but it is a religious, not political, conclusion. Psychiatry usually doesn’t talk about evil. I only started to do so when I worked in a prison. As I wrote in a blog here a few years back, for a couple of patients, no other explanation seemed to fit their longstanding actions.
Another is by the Las Vegas Sheriff.
To a psychiatrist, a psychopath is like a sociopath or, in diagnostic terms, someone with an Antisocial Personality Disorder. It includes a lifetime of harmful behavior without remorse, which is not yet apparent in the shooter. We have learned that his father seemed to have a history of robberies and escape from prison, and there also seems to be some genetic predisposition. Consciously or not, the shooter outdid his father.
The collective verdict:
Many made this conclusion. The usual suspects, such as schizophrenia, were not mentioned. The shooter was prescribed Valium, suggesting a concern with anxiety.
A diagnosis of Gambling Disorder requires gambling that is out of control. The perpetrator’s gambling did not seem to fit this description.
On Thursday, October 5th:
“BUT NOT PSYCHOTIC”
So said a neighbor, who also said that “he was just a cold loner fish . . . a little bit weird”. Sounds a bit Aspergerish?
On Friday, October 6th
The shooter's girlfriend apparently told the FBI that “he would lie in bed, just moaning and screaming, “Oh my God!” If true, this suggests intermittent psychological and/or physical pain. Makes me wonder about the admonition that when we psychiatrists can’t seem to make a psychiatric diagnosis, then perhaps there is a hidden, hard to diagnose medical one. Like a rare slow-growing brain tumor that would compromise his judgment, I wonder? There are copy-cat resemblances, as brought up in the recent blog of Dr. Ronald Pies, to the Texas Tower sniper, Charles Whitman, of over 50 years ago, who had a brain tumor discovered on autopsy. However, the Las Vegas shooter blew up his brain, so anything useful from an autopsy seems unlikely.
Many, in the meantime, concluded that he “didn’t fit the profile of a mass killer” either, and he didn’t have a criminal history.
On Sunday, October 8:
“A METICULOUS, CONTROLLING NATURE”
The shooter’s younger brother was quoted in an article that appeared on the front page The New York Times article entitled, “I wish I could tell you he was a miserable bastard.” That suggests some obsessive-compulsive characteristics.
On Monday, October 9:
CNN reports on the shooter’s own words in a 2013 deposition. He claimed he was the “biggest video poker player in the world.” Whether true, he did become the biggest mass murderer. Whenever we hear someone claim they are the “biggest” in anything, we think of excessive narcissism. When humiliated, such narcissists often turn to revenge of some sort.
With all these possibilities, as of today, maybe we just have to conclude that what we know is not yet consistent with any common diagnosis, but rather take some comfort that this may fortunately be a rare individual of mixed characteristics that turned out to be lethally combustible. We should watch to see if further information clarifies what we can learn and apply from this tragedy.
Or, perhaps you have other ideas. If so, let us know in a way that is hopefully consistent with the Goldwater Rule.