Exploring the mind of a mass murderer

Mass murders are becoming a depressingly familiar routine in the United States — we can now expect to experience a media grabbing shooting about once a month. And the frequency can only increase as future cohorts of copycat killers are spawned by the seductive opportunity to temporarily gain the spotlight.

Amidst the anguish and heartbreak felt by the victims’ families, there are always two haunting questions. What motivates someone to kill strangers wholesale in a seemingly senseless way? And what, if anything, can we do to stop these tragedies from recurring?

The accumulating large sample of mass murderers and their eagerness to explain themselves in print and videos provides a rich data base. Dr. James Knoll, a leading forensic psychiatrist with special expertise in mass murderers will describe the pattern of their demographics and psychological profiles.

Dr. Knoll writes: “In 2013, the Congressional Research Service (CRS) issued a report on public mass shootings. The CRS used as its working definition incidents “occurring in relatively public places, involving four or more deaths.” The CRS identified 78 public mass shootings in the U.S. since 1983 that had resulted in 547 deaths and 1, 023 casualties.

Most perpetrators are young males who act alone after carefully planning of the event. They often have a longstanding fascination with weapons and have collected large stores of them. The shootings usually occur in a public place and during the daytime.

Individual case studies involving psychological autopsy and a careful analysis of the often copious communications left behind suggest common psychological themes. The mass murderer is an injustice collector who spends a great deal of time feeling resentful about real or imagined rejections and ruminating on past humiliations. He has a paranoid worldview with chronic feelings of social persecution, envy, and grudge holding. He is tormented by beliefs that privileged others are enjoying life’s all-you-can-eat buffet, while he must peer through the window, an outside loner always looking in.

Aggrieved and entitled, he longs for power and revenge to obliterate what he cannot have. Since satisfaction is unobtainable lawfully and realistically, the mass murderer is reduced to violent fantasy and pseudo-power. He creates and enacts an odious screenplay of grandiose and public retribution. Like the child who upends the checkerboard when he does not like the way the game is going, he seeks to destroy others for apparent failures to recognize and meet his needs. Fury, deep despair, and callous selfishness eventually crystallize into fantasies of violent revenge on a scale that will draw attention.The mass murderer typically expects to die and frequently does in what amounts to a mass homicide-personal suicide. He may kill himself or script matters so that he will be killed by the police.

The frequency of mental disorders in mass murderers is controversial because it is not clear where to draw the line between “bad”‘ and “mad.” The paranoia exists on a spectrum of severity. Some clearly do not meet criteria for any mental disorder and often may justify their acts on political or religious grounds. Others have the frank psychotic delusions of schizophrenia. Many perpetrators are in the middle, gray zone where psychiatrists will disagree about the relative contributions of moral failure versus mental affliction. Thanks so much Dr. Knoll for clarifying our first question on the demographic and psychological factors that help explain what motivates the mass murderer.

Which brings us to our second question. Now that we know what mass murderers look like, can we use this knowledge to prevent them from becoming mass murderers?

For the most part, the answer is a disappointing no because it is just not possible to find needles in haystacks.

Lots of people fit Dr. Knoll’s demographic and psychological profile, but never act out their fantasies. We can easily predict a high-risk group, but have no way to identify the one specific person who will go haywire, and when it will happen. To prevent the act of the killer who winds up pulling the trigger, we would have to seriously violate the civil rights of the hundreds of thousands of others who resemble him, but turn out to be harmless. Mass murders happen way too often for us to tolerate, but way too rarely to be easily preventable by identifying and isolating the mass murderers. We can’t possibly jail or hospitalize everyone who has violent fantasies.

The best we can hope for is to reduce access to weapons of mass destruction. It shouldn’t be easier for a potential killer to get a gun than get an outpatient appointment. We need to improve both sides of this equation. More treatment, fewer guns.

The only good outcome of the mass murder epidemic has been an increased awareness that mental health treatment is woefully underfunded and inaccessible to most people who desperately need it. It often takes months to get an outpatient appointment and beds are so few that getting into a psychiatric hospital is almost impossible. Improving accessibility to mental health services is a national necessity and may help prevent an occasional tragedy — but it is only a very partial and totally inadequate answer.

The much more effective step is a responsible gun control policy that balances the civil rights of individuals with the safety of the public. It is no surprise that a majority of the population (including a majority of gun owners) favors measures that would restrict high-risk individuals from having such easy access to guns. The only surprise is that the majority of reasonable people can be held hostage by the minority radical faction of the NRA, by the free spending arms makers who sponsor it, and by craven politicians.

For a balanced analysis of the civil rights issues that should be considered in framing a fair, safe, common sense gun control policy, see this article.

The way forward is clear — we need to reduce free access to guns for those individuals who are at high risk to use them irresponsibly. Undoubtedly, this will eventually happen as the mass murders continue to pile up. Sooner or later, public outrage will overcome the NRA radicals and push politicians to do their job. But how much more blood must be spilled before simple common sense prevails over extreme ideology.

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

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  • DeceasedMD1

    Often the families know and can’t do anything about it because the system is so broken. Increase psych beds and allow involuntary holds when necessary like in the recent Santa Barbara case. The mother reported he was homicidal but no one listened nor sent him for involuntary psychiatric assessment. would have saved many lives.

    Recent Seattle case, the pt was hearing voices of the Columbine shooter for a very long time and worked in a shooting range a few years back. There is more that can be done than gun control.

    • guest

      The laws for involuntary commitment vary from state to state. In some states, a person can be involuntarily committed only if they are actively attempting to hurt or admitting to plans to hurt themselves or others.

      In California, a person who, when asked, denies any intent to harm himself or others cannot be committed. So Elliott Rodger could not have been committed, even though he was demonstrably lying when he denied having homicidal thoughts.

      In some other states, a person can also be committed for a third reason, which is generally described as “need for treatment” meaning that the patient requires treatment and is likely to come to some sort of harm without that treatment. In states like this, it is easier to put someone on an involuntary psychiatric hold, and at least one study has suggested that homicide rates are lower in states with this more liberal civil commitment standard.

      • DeceasedMD1

        i can’t agree more with you. It is interesting that no one even Dr. Frances does not realize the point you made. Why do u think?
        I thought California had a term gravely disabled that is legal but no one can really get into a hospital with that anymore. I saw on Cspan there is actually a bill that sounds helpful but wonder what u think. It gives more latitude to families with severely mentally ill family members to grant them the ability to get them assessed and put on a hold. Also makes HIPAA laws looser and in the judgment of the MD to make contact with family. it was created by a psychologist in Pa. and called murphy Bill 3717. I thought it made some sense and would have helped with the Eliott rodgers case as the family would have been able to demand a psychiatric assessment. crazy. the new psychiatrists are the police?!@!

        • guest

          The bill you are talking about is Rep. Murphy’s Families in Mental Health Crisis Act and it is filled with very sensible legislative remedies to many of the problems in our current mental health care system.

          http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact

          Unfortunately the American Psychiatric Association is reluctant to endorse it, because some of its provisions are opposed by patient advocacy groups.

          • DeceasedMD1

            So what the H@ll is wrong with the APA? They are letting pt advocacy groups dictate proper treatment? They sounds pretty lame not that any of the med organizations are.
            What is your take on this? Seems like all these so called med organizations have abandoned both docs and pts alike. But i did notice on his site that he does have “endorsement “by the APA- a letter from them that seemingly endorsed it?

  • safetygoal

    Interesting article, particularly the insights into the commonalities of the recent mass murderers. Would you please cite the reference you for your comment, “a majority of the population (including a majority of gun owners) favors measures that would restrict high-risk individuals from having such easy access to guns”? I would love to learn more about that. Thank you.

  • NormRx

    Sooner or later, public outrage will overcome the NRA radicals and push
    politicians to do their job. But how much more blood must be spilled
    before simple common sense prevails over extreme ideology.”

    I am an “NRA Radical” and over one million more people have joined the “Radical” NRA since Obama was elected. If we used the same rational for a drunk driver that you propose for guns we would outlaws cars or at least have “reasonable, common sense” laws on cars. Drunk driving laws have curbed drunk driving by the responsible person, however it has done nothing to curb drunk driving by the habitual drunk driver. The person that has no assets, no job and is willing to drive without a license. The only way to prevent that person from driving is incarceration.

  • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

    The author contradicts himself, and destroys his own main conclusion:

    “For the most part, the answer is a disappointing no because it is just not possible to find needles in haystacks.

    Lots of people fit Dr. Knoll’s demographic and psychological profile, but never act out their fantasies. We can easily predict a high-risk group, but have no way to identify the one specific person who will go haywire, and when it will happen. To prevent the act of the killer who winds up pulling the trigger, we would have to seriously violate the civil rights of the hundreds of thousands of others who resemble him, but turn out to be harmless.

    vs.

    “The way forward is clear — we need to reduce free access to guns for those individuals who are at high risk to use them irresponsibly. ”

    If there’s no way to know who is going to go off and kill a bunch of people, how do we stop them from possessing guns? Elliott Rodger clearly shouldn’t have had access, but what about Adam Lanza, who had no signs? For that matter, what about Adam Lanza’s mother, who had no warning signs except that she was the mother of someone who is autistic? How do we determine who these “high risk” individuals are?

    On a side note, the numbers are interesting to note: since 1983, 500 people have died in TOTAL from mass shootings. In comparison, 10,000 people die EVERY YEAR from simple firearms use alone. But of course the media doesn’t care about minority kids gunned down every day in our inner cities- they only turn out for the big mass shooting.

    • DeceasedMD1

      There may not be an exact science to this but there is something called common sense. See guest below comment. often the mass murderer is known to the family and if they are listened to, meaning if they have knowledge that their loved one is suicidal or homicidal like the Eliott Rodgers case, they need to be taken seriously and a psychiatric evaluation should be performed –Not a police assessment.I saw on Cspan there is actually a bill that sounds helpful but wonder what u think. It gives more latitude to families with severely mentally ill family members to grant them the ability to get them assessed and put on a hold.

  • http://drsocial.org brettmd

    Although clearly not entirely successful in the prevention of “future crime,” the FBI does a pretty good job. There was a doctor in Texas who was planning on killing the hospital CEO. I think that the 1986 HCQIA probably contributed to it. If he had legal recourse, he probably would have sought it instead of violence. Same thing in reference to the 30+ state medical boards that claim they have received violent threats.

    There was a podiatrist in Florida who was planning on blowing up a Muslim school. Some sort of religious or racial hate, and the FBI caught him while he was planning the crime.

    I’m pretty sure people like that aren’t very transparent. There was Michael Swango, MD… who is in a Colorado prison… Sad that it took so long to catch him. I think since 2001, prevention of such crimes has improved. Swango never published in PubMed either.

    I’ll leave most of getting into the mind of a mass murderer up to the FBI, and not to some random self-righteous, fraud-committing physician, such as those that serve on various regulatory agencies.
    . Interesting how medicine works when those in positions of authority either lie about being compliant, or commit repeated acts of fraud. Can you imagine what it was like for Dr. Antoine Adem who was reprimanded by the medical board through their six acts of fraud. His patient care was appropriate, but they took it upon themselves to not spend 1 hour reviewing the stent guidelines. My impression was they tossed their attorney and had no follow-up regarding the appropriateness of medicolegal decision making.

    If one is a physician that serves on a peer review committee or medical board, it is okay to violate the legal statutes and the AMA Code of Medical Ethics… A lack of accountability is far too prevalent in American Healthcare. The assumption that all administration are honest and competent was implied by the 1986 HCQIA. However, patient harm is occasionally covered up and administrative misconduct are more prevalent than many people openly discuss. If we are to promote a culture of safety we need to speak up for our patients and for justice.

    With respect,
    -brettmd.