J. Reid Meloy, PhD

Mass Shooters and the Psychopathology Spectrum

In search of a silver lining to the recent focus on “mental illness” as a primary antecedent to mass shootings, we are hopeful that a much-needed dialogue about mental health might be stimulated. Characterizing mental illness in a way that is demystifying and readily understandable is challenging for mental health professionals, let alone the lay public. Nevertheless, we go in search of a place to begin our dialogue, and broad concepts seem better suited for a starting point than do highly granular views. In this vein, we would like to offer a dimensional approach that is now receiving vigorous attention-a single dimension view of mental health.

Although this is not a new concept, there has been a burst of research around dimensionality and mental illness, leading some to assert it may be “superior” in terms of future scientific study.

Dimensional approaches vary, but one approach aggregates psychiatric symptoms into three domains along a single dimension of psychopathology: 1) internalizing, 2) externalizing, and 3) psychotic experience. This tripartite dimensional approach is appealing-not only because of the robust research supporting it, but also because it can be used as an overarching structure by which much of mental functioning can be understood. The 

 shows this dimensional approach, along with observations on how key psychological concepts cluster along what we should like to call a “spectrum of mental functioning.” This model is essentially old wine in a new bottle. Freud originally used this terminology in his paper, “The Loss of Reality in Neurosis and Psychosis.”

 Freud wrote that “neurosis does not disavow the reality, it only ignores it; psychosis disavows it and tries to replace it.”

 Thus, along our spectrum of mental functioning, Freud might point out that in each domain there is loss of reality-it is simply a matter a matter of how much. For the psychotic domain, the psychosis puts itself forth to replace reality entirely. In contrast, in the internalizing domain, only a piece of reality is shielded behind the relevant defense mechanism.

Such a dimensional approach may be used to measure an individual’s vulnerability to different types of mental disorder, comorbidity among disorders, persistence of disorders and severity of symptoms. Another way of viewing this approach is to see it as a big picture perspective, allowing for more readily understandable explanations of mental functioning along a spectrum. The model may also help make sense of the comorbidity frequently observed between certain disorders (i.e., anxiety and depression). Determining accurate diagnoses of mass shooters is difficult, largely due to the often-retrospective nature of the task and the lack of reliable psychological or psychiatric data on them. However, the use of a dimensional model to categorize their mental functioning may be an acceptable alternative method when key data sources are limited. This approach may also help clear up misconceptions about the rate of psychosis in mass shooters, as well as which population of individuals carry more risk. For example, a testable hypothesis might be that most mass shooters fall into the externalizing domain, given their personality structure, defense mechanism use, absence of clear psychotic symptoms and inability to internalize and process their intrapsychic conflict in a prosocial manner.

Taking Dr Pies’ vignette of 19-year-old Tyler, we can apply the dimensional model to understand his likely position on the mental functioning spectrum, as well as analyze some of his proximal warning behaviors.

 Tyler’s strong beliefs about being targeted for mistreatment and resentment over life being stacked against him suggest he is likely heavily weighted towards externalization. When under stress, it is possible he might regress along the spectrum towards developing mild to moderate thought distortions and/or worsening paranoia. Turning to his proximal warning behaviors, we find evidence of conducting research and planning (pathway), an increasing pathological preoccupation with a cause (fixation), and admiration for previous shooters (identification). These three warning behaviors have been found in most school shooters and lone actor terrorists, and in particular, pathway and identification have discriminated between attackers and nonattackers.

 We also see he has a personal grievance toward his high school, as well as a recent loss of a job. He has expressed ideological beliefs that may further his intent to act (anger towards minorities, resentment towards his school). Given his rants on social media, it is possible he has developed a dependence on a virtual community which supports and encourages his beliefs. These are further indicators of risk, particularly among lone actor terrorists.

As a thought experiment, let us apply the same approach to better understand the Las Vegas (LV) shooter who opened fire into a crowd from the 32nd floor of the Mandalay Bay Resort and Casino on October 1, 2017.

 This case was notable for many reasons, not the least of which was the shooter’s purported absence of motivation and apparent “private nature.”

 The Las Vegas Review Panel (LVRP) found no evidence suggesting the LV shooter was motivated by ideological or political beliefs. However, the panel concluded that his “intention to die by suicide was compounded by his desire to attain a certain degree of infamy via a mass casualty attack.”

 It was also found that he had stressors of declining physical health, a substantial need for control, and a history of manipulating others. Of note, he had demonstrated an ability to maintain some interpersonal relationships and did not completely isolate himself. He displayed at least some amount of concern and responsibility for his girlfriend and certain family members. There was no evidence he had ever experienced psychotic symptoms. He was intelligent, methodical and had achieved significant financial success in the real-estate business. He also applied his intellect to a favorite pastime-gambling-and claimed to have won significant sums by applying algorithms he had discovered to gambling on machines. The FBI noted that he “displayed minimal empathy throughout his life and primarily viewed others through a transactional lens of costs and benefits”-an interesting finding given his biological father’s history of psychopathy and criminal infamy.

However, in his final months he appeared to be misusing alcohol, seemed despondent and was experiencing financial stress. He had also obtained prescriptions for diazepam from his physician. He was an avid firearms enthusiast and collector, and there was at least one report that he was concerned about escalating government restriction of firearm ownership. The FBI found that he “engaged in significant, methodical, Internet-based research regarding site selection, police tactics and response, and ballistics.”

 He also applied his methodical intellect to conducting in-person site surveillance and meticulously planned and ensured he would be in control of his own suicide. It did not escape the FBI’s attention that he was likely influenced by the memory of his father who had “achieved” significant criminal notoriety and was diagnosed as a psychopath by a psychiatrist in 1963. What is not said in the FBI report is the possibility of heritability of psychopathy in the shooter, given his father’s absence as an actual parent, yet biological contribution to his son’s personality.

In applying the mental functioning spectrum to this case, we begin with his arguable “successful” psychopathy. His capacity for delaying gratification well enough to become financially successful in real estate, his lack of any significant criminal record, and his capacity for at least modest interpersonal relationships gives some pause. There is no evidence to place him in the psychotic domain, so we surmise that he would fit somewhere in the overlap between externalizing and internalizing. With mounting stressors and alcohol misuse, he would be likely to regress more squarely into the externalizing domain towards the end of his life. The externalizing domain would be associated with what Melanie Klein

 called the “persecutory position.” Per developmental theory, healthy development requires a transition away from Klein’s persecutory position to the “depressive position,” which would be more consistent with the internalizing domain.

Biopsychosocial impediments to psychological development can cause violent offenders to become relatively fixed in the persecutory stage, or what Klein has called the 

 In this stage, much of an offender’s worldview is based on feelings of injustice and frustration over what is perceived as “intentional” harm, or purposeful withholding of gratification by the societal structure imposed by others. Fixation at this stage is associated with strong feelings of envy, resentment and the use of externalizing defense mechanisms such as projection, acting out and splitting. In contrast, the depressive position is associated with the capacity for regret, victim empathy and reconciliation with society. The depressive stage is associated with more internalizing, mature defense mechanisms such as sublimation, delaying gratification and anticipation.

The violent offender who functions in the externalizing domain often suffers from strong feelings of envy: what Klein referred to as the wish to destroy goodness. This offender may or may not be envious of other’s possessions or social status but will be very likely to be envious of the way in which others are able to enjoy their apparent status. Thus, the externalizing/envious offender’s goal is “to destroy the Other’s ability/capacity to enjoy” the prized object or status.

 There may come a point for such individuals when their resentful, nihilistic mindset leads them to feel that their “self” is already dead, and the death of their body is of little consequence. Such dynamics ultimately undermine the capacity for undistorted judgment, finding meaning in life, and sublimating aggression. They are now ready to override the survival instinct and fully embrace a drive towards death. 

which seeks to destroy everything and embrace nothingness. A pointed example would be the mass murderer who attacked Congresswoman Gabriel Giffords in Tucson, AZ. He was increasingly drawn to nihilism as a philosophy and developed paranoid beliefs that the government was controlling the meaning of words. This case illustrates a violent offender who resides in the psychotic domain mental functioning.

Returning to the LV shooter, we suspect that he may have been an individual who initially functioned more in the internalizing domain. However, given his genetic predisposition for psychopathy and externalizing symptoms, he would have been at risk for regressing to the externalizing domain. As the FBI noted, the LV shooter had an “inability or unwillingness to perceive any alternatives” to carrying out his attack. We suspect that his regression to the externalizing domain and his nihilistic, obliterative mindset ensured his inability to inhibit his trajectory toward murder-suicide.

Recently, it has been reported that the LV shooter sent text messages to a girlfriend only two days prior to carrying out the attack.

 The alleged texts were sent to a 29-year-old woman with whom he had been having an affair, while at the same time having a long-term relationship with his girlfriend.  If the texts are genuine and credible, they appear to provide further support to our hypothesis that the LV shooter was functioning in the persecutory, obliterative mindset.  In the texts, he acknowledges having become a “recluse” because others in society could only be expected to hurt and disappoint him.  He states: “The best way to live life is with a wall between you and everyone else. So when they do hurt you, the sting isn’t so bad.” His persecutory mindset had become so entrenched and prominent by that point, that his use of externalizing defense mechanisms, such as externalization and projection, can be clearly seen.  For example, he states: “People these days are evil . . . It really doesn’t matter who they hurt in the process . . . People always eventually disappoint and hurt you.” The theme of projecting “evil” outside onto “society” is striking, and his comments may be seen as distorted references to himself: “People in society have become evil, self-loathing, selfish and entitled . . . They are more concerned with . . . the lives they see on the television [and] they don’t have a second thought about who they destroy on the way.”

Finally, from a psychological viewpoint, it is tempting to speculate he was motivated to some degree by a desire to achieve criminal infamy as his father had done, and perhaps Oedipally triumph over a father who attained notoriety for being on the FBI’s Ten Most Wanted. The shooter’s father held a “record” of sorts, having been on the FBI’s Ten Most Wanted list for about eight years (most wanted criminals were taken off the list in less than six months).

 The father remained a fugitive for many years, having escaped from a federal correctional institution. Like his son, he greatly enjoyed gambling and was last arrested in 1987 for racketeering related to his “bingo business” and fraud.

The tripartite dimensional approach has stimulated a burst of recent research. Here, we draw on its overarching structure and combine it with evidence-based research on mass shooters to better understand the level of their mental health functioning, as well as their underlying psychodynamic structure. We have emphasized a dimensional approach to mental functioning, focusing on the usefulness of conceptualizing mental problems as psychotic, externalizing, or internalizing. This provides a means by which the mental health professional can discuss mass shooters who evidence psychological problems but fall short of a formal psychiatric diagnosis with other nonclinicians and members of the public.

Dr Knoll is Director of Forensic Psychiatry and Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, NY. He is Editor in Chief Emeritus of 

Dr Meloy is Clinical Professor of Psychiatry at University California San Diego, La Jolla, CA.

The authors report no conflicts of interest concerning the subject matter of this article.

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2. Conway CC, Forbes MK, Forbush KT, et al. A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research. 

3. Freud S. The loss of reality in neurosis and psychosis (1924). Collected Papers. 1961(2):277-282.

4. Meloy JR, Hoffmann J, Guldimann A, James D. The role of warning behaviors in threat assessment: an exploration and suggested typology. 

5. Meloy JR, Goodwill A, Meloy MJ. Some TRAP-18 indicators discriminate between terrorist attackers and other subjects of national security concern. 

6. Meloy JR, Gill P. The lone-actor terrorist and the TRAP-18. 

7. U.S. Department of Justice: Key Findings of the Behavioral Analysis Unit’s Las Vegas Review Panel. Federal Bureau of Investigation. 2019. 

https://www.hsdl.org/?abstract&did=820782

8. LVMPD Preliminary Investigative Report Mass Casualty Shooting. Las Vegas Metropolitan Police Department. October 1, 2019. 

https://www.lvmpd.com/en-us/Documents/1_October_FIT_Report_01-18-2018_Footnoted.pdf

Envy and Gratitude, and Other Works. 1946-1963.

Cruelty, Violence and Murder: Understanding the Criminal Mind.

12. Anderson MK. The death of a mind: A study of Shakespeare’s Richard III. 

13. Crick A, Boyle L. 'There are so many people who don't deserve to be alive.' Chilling texts Las Vegas shooter Stephen Paddock, 64, sent to his secret 29-year-old mistress before he opened fire and killed 58 revealed. 

https://www.dailymail.co.uk/news/article-7887401/Las-Vegas-killer-Stephen-Paddock-64-sent-chilling-texts-mistress-29-mass-murder.html

14. Wallace A, Wallenchinsky D. Most Wanted by the FBI. 

https://www.newspapers.com/clip/14160036/statesman_journal.

15. Bernstein M. Las Vegas shooter's dad, on FBI's Most Wanted list, was arrested in Oregon in '78. 

https://www.oregonlive.com/today/2017/10/las_vegas_shooting_suspects_da.html

Articles

A tripartite dimensional approach may be used to better understand the mental functioning of those who commit mass violence.

The Mass Shooter and His Mental Functioning

For the past 15 years, my colleagues and I have conducted research on adolescents and adults who commit mass murder (see our 

). We define mass murder as the intentional killing of 3 or more individuals, excluding the perpetrator, during one event, and have studied cases in both the US and overseas, wherein this criminal phenomenon has its roots in the ancient behaviors called 

 mass murder has passed, it is important to note the public misconceptions about this rare and frightening act. In this article, I would like to shed some light on what I consider the 7 myths of 


Immediately following a mass murder, there is a steady stream of newspaper headlines and what I call “entertainment profilers” who appear on television and proclaim that the perpetrator “snapped.” There is no known psychological term called “snapping,” but it appears to be the assumption of many that anyone who commits a mass murder has done it impulsively, without any planning or preparation, and has completely lost control. The hidden premise is that anyone who gave such behavior any thought, even if emotionally troubled, would not engage in such behavior, since it is so horrifying and antithetical to the general goodness of the human spirit.

This is a myth in virtually all mass murders. Our research, and others’ studies, have consistently shown that mass murderers, whether adolescents or adults, will research, plan, and prepare for their act of targeted violence over the course of days, weeks, and even months. In fact, the fantasy of committing a mass murder may have been incubating in the mind of the mass murderer for years-even though the time, place, and target of the killings was not yet determined by him.

The act itself usually occurs after there has been a major loss in love or work, and I think this may actually “start the clock” for final detailed preparations. I have forensically evaluated a number of mass murderers in prison or forensic hospitals, and with few exceptions, there was no evidence of a high state of emotional arousal when the killings occurred. We have confirmed this by studying the interviews of witnesses who have survived mass murders, and they invariably describe the shooter as cool, calm, and deliberate: a lack of emotion that is a corollary of violence that is planned and purposeful.

Myth 2: They can easily be divided into “psychopaths, psychotics, and depressives”


David Cullen, the journalist and author of 

 an excellent book on the high school mass murder in Colorado in 1999, has asserted this formulation. Unfortunately, his diagnostic classification of these individuals is much too simplistic. Most of those we have studied in our research, and I have evaluated for court purposes, are complex in their motivations and psychopathology and cannot be placed in such simple categories. In our language, they often have both mental disorders and personality disorders.

Mental disorders range from chronic psychotic disturbances, such as paranoid schizophrenia diagnosed in the Jared Loughner case, to major depression, other depressive disorders, bipolar disorders, and other paranoid disorders, such as persecutory delusional disorder. Fully understanding the range and complexity of these individuals’ disturbances is critical.

Personality disorders also abound in this group of dangerous individuals. We have found that personality disorders in mass murderers are often a mixture of antisocial, paranoid, narcissistic, and schizoid traits-someone who habitually engages in criminal behavior, is suspicious of others’ actions, is self-centered and grandiose with little empathy for others, and is chronically indifferent toward others and detached from his emotional life. It takes little imagination to see how such an individual, in the right circumstances, could intentionally kill others.

What Cullen has done is a disservice to the millions of individuals in the US and overseas who are clinically depressed or have a psychotic disorder, and pose no more risk of violence to others than your neighbor who is ostensibly normal. I have told a number of groups when I speak that Jared Loughner has given paranoid schizophrenia a bad name-many other factors contributed to his attempted assassination and mass murder. Schizophrenia is quite treatable with medication and other psychotherapeutic support, and few people with schizophrenia are violent.

Myth 3: Incidents of mass murder are increasing


When a mass murder occurs, it receives worldwide news coverage that is instant and pervasive. Unfortunately, we human beings are prone to overestimate the frequency of an event by its prominence in our minds, and mass murder is no exception. This is a very rare phenomenon, and is neither increasing or decreasing in the US. Since 1976, there have been about 20 mass murders a year. Casualty numbers vary considerably with each event, and typically the more people killed, the more press coverage the event receives. Violence sells: 2003 was the most violent year for mass murder, with 30 incidents and 135 victims. One of the quietest years for mass murder was 2001-if the 9/11 terrorist attacks are not considered.

The Washington Navy Yard, Virginia Tech, 

, Edmund Oklahoma, and San Ysidro still resonate in the public consciousness, however, reminding us that these events do happen, perhaps all the more frightening because of their perceived randomness. A positive counterpoint, moreover, is that rates of all violent crime have significantly decreased over this same time period, from 48 victims per 1000 persons in 1976 to 15 victims in 2010. What was the most lethal school mass murder in US history? It was in Bath, Michigan, in 1927, and the bombing resulted in the deaths of 45 people, mostly children in the second to sixth grades.

 by which people can easily kill themselves and others. Mass murders are typically committed with firearms or explosives, whether in the US or internationally. Perpetrators usually bring 2 or 3 firearms to the scene of their massacre. Assault weapons were the killing instruments in both Aurora, Colorado, and 

 in 2012; a shotgun was initially used at the Washington Navy Yard. Banning assault weapons, however, will unlikely reduce the 

Between 1994 and 2004, when the federal assault weapons ban was in effect, there was no decrease in the average number of mass murders per year; however, there were no studies as to whether there was a specific decrease in the use of assault weapons in such crimes. The trend line remained flat. However, limiting firearms 

would likely reduce the number of casualties at any one massacre-Jared Loughner was tackled by 3 senior citizens in Tuscon when he attempted to reload. What should be center stage is regulation of firearms. It is more difficult to buy the over-the-counter drug Sudafed than a semi-automatic pistol.

As a gun owner, and a supporter of the 2nd amendment, I find it appalling that virtually anyone can purchase a firearm with little effort, money, or time in the US. Can we drive an automobile without a license? Do we have to demonstrate competency in its use before we can obtain a driver’s license? Can automobiles be utilized as lethal weapons through negligence or intent? Affirmative. I would much rather have a drunkard riding a bicycle than driving a car in our neighborhood. I think firearms ownership is a right with limits (as most US Constitutional rights are): demonstrable competency in firearm use and mental stability.

Myth 5: Psychotic individuals cannot plan in a precise and methodical manner


Although this may seem an academic point, when it comes to mass murder, it has been disproven time and time again. The majority of adult 

-not adolescent shooters-are psychotic, meaning they have broken with consensual reality, and now perceive the world in an idiosyncratic and often paranoid way. Yet they may research the internet for the appropriate weapons, practice video games to sharpen their marksmanship, purchase weapons and ammunition online, conduct surveillance of the target, probe for security protecting the target, and tactically carry out their mass murder, 

. Paradoxically, delusions may help the mass murderer eliminate any ambivalence in his mind, and commit him irrevocably to a path of homicidal destruction. Our research has also found that mass murderers who are psychotic have a higher casualty rate than those who are not. Typically they will select victims who are complete strangers, yet in their mind those strangers make up a “pseudocommunity” of persecutors bent on their destruction.

Myth 6: It must be the drugs they are abusing


It is true that most violence involves drug use, particularly alcohol. In cases of spousal homicide, either the victim or perpetrator, or both, are often intoxicated at the time. In mass murder, however, drug use is minimal, whether alcohol or other illicit substances. We think the reason for this counterintuitive finding is that the mass murderer does not want any drugs to cloud his consciousness at the time. Drugs would interfere with his planning, preparation, and most importantly, his tactical success, which is often to maximize his casualty rate. We have even found that in 2 cases the mass murderer had utilized therapeutic amounts of sedating drugs-benzodiazepines or phenobarbital-to help him remain calm during the shooting: data gathered from toxicology reports following the perpetrator’s autopsy.


Unfortunately this will never happen given the simple fact that we cannot predict such an extremely rare event. If we attempt to do so, we will grossly overpredict its occurrence, and perhaps infringe on the freedoms and the rights of those wrongly accused, or the population at large. However, we can 

 such events by paying attention to behaviors of concern. “If you see something, say something.”

This stopped Richard Reid from bringing down an airplane over the Atlantic in December of 2001, when a passenger sitting next to him noticed he was trying to light his sneaker with a match. It contributed to the prevention of another ideologically driven mass murder in Times Square on May 1, 2010, when 2 street vendors noticed a suspicious van parked on a busy corner and alerted the police-2 days later law enforcement arrested Faisal Shahzad at Kennedy airport as he sat onboard a plane bound for Dubai.

Such situational awareness is critical to interdict someone in the final stages of an attack. But there is another warning behavior that is quite frequent: mass murderers, both adolescents and adults, will leak their intent to others. This 

 has been defined by us as the communication to a third party of an intent to attack a target; put more simply, it is a phrase expressed to another, or posted on the internet, that raises concern. It may be overt: “I’m going to kill my supervisor and his cohorts tomorrow”; or it may be covert: “don’t come to work tomorrow, but watch the news.” The logical consequence of such comments should be to alert someone in a position of authority; however, most people don’t. The sad reality is that the leakage surfaces after the event, with the rationale, “I just didn’t think he was serious.” Words matter. Trust your emotional reactions of anxiety, wariness or fear; clinically probe for more objective data as to whether or not the threat is serious; and exercise your legal obligations and best treatment practices to mitigate risk.


Mass murder specifically, and gun violence in general, is a hard problem in the US: its difficulty is matched by its importance. The way forward may be to treat gun violence as both a criminal and a public health problem, with primary prevention focusing upon risk factors in the general population (poor public mental health care, lax regulation of firearms, no demonstration of competency to purchase or use a firearm); and secondary prevention focusing on individuals of concern who may be planning or preparing an act of targeted violence. In the latter case, behavioral threat assessment may offer the best hope, where prevention is the goal rather than prediction.

Along these lines, the American Psychological Association’s 

Gun Violence: Prediction, Prevention, and Policy

, published in December of 2013, is the most comprehensive and balanced report published to date, and should be read by all mental health clinicians.

[Editor's Note: An earlier version of this article appeared on the Oxford University Press (OUP) blog. 

http://blog.oup.com/2012/09/seven-myths-of-mass-murder

Dr Meloy is a forensic psychologist and the co-editor of the 

International Handbook of Threat Assessment

 (Oxford University Press; 2014). He is President of 

It is important to note public misconceptions about the rare and frightening act of mass murder. This article sheds some light on what the author considers the 7 myths of mass murder.

J. Reid Meloy, PhD

Articles

The Mass Shooter and His Mental Functioning

The Seven Myths of Mass Murder