The Edge Effect

"If I wish to fight against this world, I must fight against its decisively characteristic element, that is, against its transience."

This statement, from Kafka's "Blue Octavo Notebooks" - jumped out at me. I see so many different meanings of it, and would like to know what he actually intended. But I can't, so I'll take my liberties and hope that he would not disapprove.

"This world" - This had to mean to him the whole of human existence. The entire existential dilemma, fears, joys and pains of life. The way things are, and that could not be otherwise.

The world (one's experience of reality) has a decisive characteristic - which he says is transience. Impermanence. The empty nature of all things.

Why do I say all forms are transient and ultimately empty? It would seem this concept may be even easier to grasp today than in the past. Consider only one example - technology. In the (relative) blink of an eye, rotary phones have become wireless blue tooth devices. Wireless devices will very soon be looked upon like the telegraph when device-free communication is achieved with the help of bio-organic implant technology.

Perhaps a more concrete and less sci-fi style example. Not very long ago, an impressive structure stood to serve the people of a large community. A smaller version of the Roman Coliseum. For many decades, it hosted various entertainment events, but most notably was the home field of "America's Team" - the Dallas Cowboys. As a youth, I thrilled along with the crowds to many a sporting event in this structure. In Texas, where high school football is its own religion, many young men were privileged to play in this stadium during the high school play off season. This was a space and a structure, in and around which, many people's lives unfolded. Who can say how many carried this structure as a familiar internal mental representation? A landmark in time and space, as well as the in the limitless space of the human mind.

But, as Kafka notes, transience is the decisive characteristic - All structures are unstable. Witness a focal point of a large community disappear into the void:

http://www.youtube.com/watch?v=SyXNxwZmmNQ&feature=related

Soon, there will be no trace left that it ever existed.

Fight against the world's transience? One cannot fight with emptiness. One can only collapse into it.

So, Kafka may be saying: You can make a choice about how you would like to deal with the world. Fight or not. Accept or not. Go with the current, or try swimming against it. What he leaves out, conspicuously, but is nevertheless implied: You will eventually be swept away by the current, and finally into the limitless void of non-being.

We wonder, and some Hunter may express
Wonder like ours, when thro' the wilderness
Where London stood, holding the Wolf in chace,
He meets some fragments huge, and stops to guess
What powerful but unrecorded race
Once dwelt in that annihilated place.

- Ozymandias (Horace Smith)

2010-02-18T16:48:00.000-08:00

DSM – “V” – For Vendetta

“There is more behind and inside of V than any of us had suspected.”

- “V For Vendetta”

It has been over a decade, and “V” has finally revealed itself. In the mental health community, the quarrels and contretemps are escalating. This time, my obscure reference may be too inscrutable, but I am begging your indulgence, as it was too tempting to pass up the opportunity to reference a good movie/novel/piece of English history. The novel “V for Vendetta” was made into a movie, and was loosely based on an actual historical event, now celebrated in England every November 5th as “Bonfire Night.”

It turns out that a gentleman by the name of Guy Fawkes was part of an anarchist plot to overthrow England’s aristocratic, Protestant rule. The plan involved using kegs of gunpowder to blow the Houses of Parliament – with the King and nobility inside. Fawkes and other English Catholics felt targeted by a systematic discrimination, carried out by King James I and the Protestant nobility. Although the explosive “gunpowder plot” was thwarted by an anonymous letter with only hours to spare, “Guy Fawkes Night” is still celebrated on November 5th with fireworks displays in parts of the UK. And so just as the Gunpowder Plot was planned and prepared for in secrecy (until the last few hours), so too have the efforts of the DSM-V work group been accused of carrying out most of their “mission” shrouded in secrecy..... until now, and with only a few months to spare.

Only very recently, in early February of 2010, the “DSM-5 Work Group” has posted on the web the “preliminary draft revisions” at: www.dsm5.org. The posting is now “available for public review and comment,” and “viewers will be able to submit comments until April 20, 2010.” So no rush or worry (?!). The greatly anticipated publication of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), promised for “May 2013,” will mark one the most anticipated events in the mental health field. But prior to this date, we have all been given a (very) brief window to review the proposed work product, and are informed that what is currently on the website is “not final,” but “initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups.”

A quick perusal over the DSM-V site quickly impresses upon one that this would appear to be a DSM like no other before it. The suggested revisions are extensive, and the changes striking. Finally, the expectations that harried clinicians perform so-called “dimensional assessments” and scoring “cross-cutting” symptoms during all diagnostic evaluations make for a curious combination, particularly as to how all this will generalize to everyday practice “in the trenches.” The odd, even erratic manner in which this iteration of the DSM has come about has drawn significant attacks from various quarters of the mental health field, as well as other interested parties. This article will provide a brief introduction and summary to DSM-V, as well as some of the major criticisms to date.

Intro to DSM

I assume some familiarity (even expertise) in a substantial portion of the CMHR readership, but by way of quick review: DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association (APA), and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. This is important in that it provides mental health professionals criteria and diagnoses for a common language that can be used to treat patients.

Thus, one goal of the DSM is to help ensure accuracy and consistency of diagnosis. The dsm.org site aptly points out that “Only by having consistent (reliable) diagnoses can researchers compare different treatments for similar patients, determine the risk factors and causes for specific disorders, and determine their incidence and prevalence rates.” Over the past 60 or so years, the DSM has been periodically reviewed and revised since the publication of DSM-I in 1952. Thus, the manual requires periodic updates to reflect any new discoveries and/or advancements.

Major Revisions

The progression from DSM-IV to DSM-IV-TR (Text Revision) was more or less atraumatic. The revisions were quite minor, and did not substantially affect clinical practice. In contrast, it appears that the changes from DSM-IV-TR to DSM-V would be dramatic – that is, if all goes as planned by the DSM-V work group. How dramatic? I’ll give a few examples, but remember that interested persons may go on the web and form their own opinions. Some of the “draft revisions” listed on the dsm.org site include (in no particular order):

♣ A single diagnostic category, “autism spectrum disorders” incorporating autistic disorder, asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder.
♣ Eliminating substance abuse and dependence, and replacing them with “addiction and related disorders.”
♣ Creating a new category, “behavioral addictions,” in which gambling will be the sole disorder. [JK: Sole disorder? Already I’m confused].
♣ A proposed new diagnostic category, temper dysregulation with dysphoria (TDD). The dsm5 site explains that TDD’s “new criteria are based on a decade of research on severe mood dysregulation, and may help clinicians better differentiate children with these symptoms from those with bipolar disorder or oppositional defiant disorder.” [JK: Distinguish from oppositional defiant disorder (ODD)? The first criterion for ODD is: “1) Often loses temper….”].
♣ Major revisions to the description and criteria for personality disorders (see below).
♣ Discontinuing the use of all subtypes of Schizophrenia. [JK: This one simply boggles the mind. The dsm5 website explains that “A powerful argument for discontinuation of the use of subtypes in schizophrenia is that administrative psychiatric practice data collected in the US and Europe show that most are rarely used diagnostically (<5%), with the exception of paranoid schizophrenia (50-75%) and, to a lesser extent, undifferentiated schizophrenia. It could be argued, however, that subtypes may show genuine epidemiological variation and therefore should be retained. The larger question, therefore, is whether there is evidence that subtypes are valid.” In my opinion, this statement is highly revealing. Administrative data?? Are we doing psychiatric science here, or have we completely handed over the field to the “business” of medicine?]

I could continue, but my physician advised me it would exacerbate my TDD. So, the final draft of DSM-V will be submitted to the APA’s Assembly and Board of Trustees for review and approval. The final product is “predicted” to be released in May 2013, but many in the field are not optimistic about this deadline. At this point, you may be wondering: “What process did they use to guide their revisions?” Well, the site has a ready answer for you – the process was guided by “four principles”:

1. The highest priority is clinical utility – that is, making sure the manual is useful to those who diagnose and treat patients with mental illness, and to the patients being treated. [JK: More on the subject of “clinical utility to come..].
2. All recommendations should be guided by research evidence.
3. Whenever possible, DSM-5 should maintain continuity with previous editions
4. No a priori restraints should be placed on the level of change permitted between DSM-IV and DSM-5 [JK: Maintain continuity…. no restrictions on changes? Where is the nearest TDD clinic?]

Points 3 and 4 remind me of the classic Star Trek episode where Captain Kirk defeats a robot by forcing it to consider two contradictory pieces of logic in its programming. The robot begins to sputter nonsense, followed by sparks, smoke and an explosion. Only here – we are that robot. But dsm5 assures us that this absolute contradiction in logic is not what it appears to be, as the site has an explanation for this: “The third and fourth principles may seem contradictory, but both principles are necessary…” [JK: Well now it’s obvious. They are trying to increase the prevalence of TDD…].

And speaking of temper dysregulation, I promised a word about the changes being considered in the controversial arena of personality disorders. In fact, the DSM-V work group has recommended a revised definition of the basic term/construct “personality disorder,” as well as a corresponding revised set of criteria. The new definition of a personality disorder would be a “failure to develop a sense of self-identity and the capacity for interpersonal functioning that are adaptive in the context of the individual’s cultural norms and expectations.” Clear enough? If not, the basic components are further broken down in excruciating detail and defined. Terms such as: adaptive failure, identity integration, integrity of self-concept, and self-directedness, are all handily, albeit hazily defined.

My colleague, Dr. Robert Gregory, a national leader in the study, evaluation and treatment of Borderline Personality Disorder has precisely pointed out to me that personality disorders work group is “proposing a radical redefinition of what constitutes a personality disorder.” But this radical redefining, particularly for Borderline Personality Disorder, uses terms that are closer to common psychoanalytic concepts, as opposed to the DSM-IV-TR approach of leaning more towards simple behavioral descriptors. Now for proponents of psychoanalytic theory (among which I count myself), this would not appear to be a bad thing. However, Dr. Gregory correctly notes that few have the training and/or expertise to apply the relevant psychoanalytic concepts in an effective, meaningful way.

Antisocial or Psychopathic?

Correctional and forensic professionals may be eager to learn more about an old, familiar friend – Antisocial Personality Disorder (ASPD). In contrast to Borderline Personality Disorder, the re-formulation of ASPD does not rely on such psychoanalytically based descriptors. Nor does it resemble the more cut and dry, behavioral descriptors of ASPD found in DSM-IV-TR (long criticized for potentially “capturing” mainly low socio-economic status, underprivileged, minority and “caught/convicted” criminals). So, does DSM-V clarify this personality disorder and give a definition with “clinical utility”? Surprisingly, the work group is recommending that ASPD “be reformulated as the Antisocial/Psychopathic Type.” Now I will admit to possibly missing something here, but I will ultimately plead confusion. It was my understanding that future DSMs were contemplating adding Dr. Hare’s construct of Psychopathy – as it is not synonymous with ASPD, as every correctional mental health professional knows by now.

To my great astonishment, DSM-V appears to want to “blend” these two constructs together – which seems to me to present so many problems, an entire text might written about them. Because of the special interest of this diagnosis to correctional mental health, I will give the proposed revision in some detail. The “reformulated” diagnosis of Personality Disorder, “Antisocial/Psychopathic Type” would be as follows (I underline portions that seem to me especially problematic and open to misunderstanding and/or abuse):

Individuals who match this personality disorder type are arrogant and self-centered, and feel privileged and entitled. They have a grandiose, exaggerated sense of self-importance and they are primarily motivated by self-serving goals. They seek power over others and will manipulate, exploit, deceive, con, or otherwise take advantage of others, in order to inflict harm or to achieve their goals. They are callous and have little empathy for others’ needs or feelings unless they coincide with their own. They show disregard for the rights, property, or safety of others and experience little or no remorse or guilt if they cause any harm or injury to others. They may act aggressively or sadistically toward others in pursuit of their personal agendas and appear to derive pleasure or satisfaction from humiliating, demeaning dominating, or hurting others. They also have the capacity for superficial charm and ingratiation when it suits their purposes. They profess and demonstrate minimal investment in conventional moral principles and they tend to disavow responsibility for their actions and to blame others for their own failures and shortcomings.

Individuals with this personality type are temperamentally aggressive and have a high threshold for pleasurable excitement. They engage in reckless sensation-seeking behaviors, tend to act impulsively without fear or regard for consequences, and feel immune or invulnerable to adverse outcomes of their actions. Their emotional expression is mostly limited to irritability, anger, and hostility; acknowledgement and articulation of other emotions, such as love or anxiety, are rare. They have little insight into their motivations and are unable to consider alternative interpretations of their experiences.

Individuals with this disorder often engage in unlawful and criminal behavior and may abuse alcohol and drugs. Extremely pathological types may also commit acts of physical violence in order to intimidate, dominate, and control others. They may be generally unreliable or irresponsible about work obligations or financial commitments and often have problems with authority figures.

So in summary, this “narrative” description is a confusing amalgam of the DSM-IV diagnosis of not only ASPD and psychopathy, but also Narcissistic Personality. Here, I would like to make a few comments on the sections I underlined, as I believe them to be particularly problematic. Recent (and not so recent) research has clearly suggested that there is not “one” type of psychopath. There may be impulsive/aggressive types, which are distinct from conning, glib, manipulative types. This has been well researched for many years, and it is surprising that it is not reflected in the DSM-V proposed drafts., Instead, we are presented with a hodgepodge of problematic narrative which blends the constructs of ASPD, Psychopathy (both impulsive/aggressive and conning/manipulative types) and Narcissistic Personality Disorder in a confusing manner.

The section on impulsivity/aggression and sensation seeking is simply not observed in all persons with either ASPD or Psychopathy. For those interested, please see the developing literature on “successful” psychopaths, as well as “white collar” psychopaths. In fact, allow me to provide you with the words of the foremost expert in the field, Dr. Hare (developer of the Psychopathy Checklist):

Unfortunately, there is no scientific evidence concerning the number of psychopaths in business….few organizations will provide the sort of access to their staff and files required to do proper assessments….Second, psychopaths have a talent for hiding their true selves, so one could expect many to go unnoticed and uncounted, leading to an underreporting of psychopathy…. Third, psychopathic-like traits and behaviors are also exhibited by some individuals who are not truly psychopathic, which could lead to overreporting…(p. 177)10

Thus it seems unnecessarily confusing to combine two distinct clinical constructs (albeit with some overlap – the majority of persons with ASPD will not be psychopaths, but the majority of psychopaths will meet DSM-IV-TR ASPD criteria) that have long been researched as separate entities. In addition, I need not cite any specific literature to inform you that the label of “psychopath” can have a powerfully damning affect. I would go so far as to say that it has unfortunately become almost synonymous with calling someone “evil.” Are we seeking to paint all persons with ASPD with this ultra-toxic brush stroke? I have some serious, realistic concerns here. No longer will some 50 to 60% of all convicted prison inmates be diagnosed with “Antisocial Personality Disorder” – now they will be “Antisocial/Psychopathic” Types. I contend that this new label is not only confusing, but it is also not in line with the current social science, and likely to produce unnecessary stigma.

Next, the issue of “remorse” has long deserved attention that is more than a mere “gut” reaction and subjective conclusion on the part of the evaluator. The Latin root of remorse – mordere, means “to bite,” as in to feel the bite of one’s own guilt and moral anguish. The importance of remorse in society is that is that when an individual has broken a societal law, the criminal justice system (and society) expects that “they show some contrition,” and thus it “follows that offenders who are remorseful should not be treated more leniently.” Consider too that the concept of “lack of remorse” is a specifically named criterion in the diagnoses of both ASPD and Psychopathy.

Now stop and ask yourself this – do we have scientifically reliable methods of detecting and/or measuring genuine remorse? I realize that the same criticism could be leveled at many other diagnostic criteria. For example, in Major Depression, we have the presence of “depressed mood,” or “inappropriate guilt.” However, it is “remorse” that stands alone as a powerfully influencing impression, with consequences that may involve liberty and even death. In the law, when something is assumed to be true, even though it may be untrue, it is called a “legal fiction.” It has been noted that “Legal fiction is the mask that progress must wear to pass the faithful but blear-eyed watchers of our ancient legal treasures. But though legal fictions are useful in thus mitigating or absorbing the shock of innovation, they work havoc in the form of intellectual confusion.” Similarly, I contend that our current construct of remorse is often both a legal and psychiatric fiction.

In both the law and psychiatry, the determination of the presence of remorse is, more often than not, some combination of intuition, bias and projection. Unless the subject, after the proscribed act, states with conviction: “Yes. I did it, and I don’t feel a bit sorry for it,” remorse can only be indirectly inferred, perhaps from behavioral evidence. But even this is sometimes tricky. I will save for another time the manifold problems surrounding the ease with which remorse may be simulated, or alternatively, be genuinely present yet not expressed in a way that is perceptible (or perhaps acceptable?) to outside observers. I would only leave the reader with my own “cautionary statement” from my forensic travels. If I were to collect a dollar for every instance in which I read a jail mental health progress note describing a seriously mentally ill defendant (still sick and on heavy doses of antipsychotics) as showing “no remorse for his crime,” I would be in a position to develop and publish my own manual of mental disorders. [JK: In fact, my father has already accomplished this on a highly restricted budget, using a community mental health center’s spare office supplies. He has dubbed it the “DSM-K”].

Finally, I must comment on the phrase “acknowledgement and articulation of other emotions, such as love or anxiety, are rare.” This is problematic for several reasons. I will address the easy reason first – as anyone who has worked with antisocial or psychopathic offenders can attest to, many are capable of, and even excel at, “articulating” said emotions. Of course, they may not at all mean what they say, but they are most certainly capable of convincingly articulating, mimicking or pantomiming emotions. I have no doubt that Bernie Madoff was able to generate an “aura” of caring and trust for the victims of his staggering Ponzi scheme. So the phrase “acknowledgment and articulation” seems misleading at best. I could go on about how I’ve encountered inmates who met ASPD criteria and still had the capacity for “love or anxiety,” but I’d put myself at risk of being drummed out of the profession.

Recall the important “principle” that DSM-V diagnoses have “clinical utility” for those hard working clinicians? If one was to consider making the diagnosis of ASPD, and one had circumnavigated the above mentioned confusion, a final task still awaits. The clinician would still need to: 1) rate the patient for how well he/she “matched” the narrative description, and 2) then rate the extent to which certain traits are descriptive of the patient. These ratings take the form of Likert-type scales. For example:

A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle the number that best describes the patient’s personality.

5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply

My thoughts here concern the issue of inter-rater reliability, and how one examiner’s rating of “3” can easily be another’s rating of “5.” Perhaps another time, I will delve into the other constructs that DSM-V is proposing that clinicians assess – such as “dimensional assessments,” and “cross-cutting assessments.” But for now, let me just note that they involve more “scale” ratings of various types of symptoms. The site assures us that these assessments will be “brief,” “simple,” and “useful.” After reviewing the website and the instructions, I am less optimistic. Indeed, I have a genuine concern that adding these extra ratings/assessments to all the paperwork and “chart treating” clinicians already have to contend with will be the breaking point. At best, clinicians may comply, but do so in a half-hearted, slap-dash way. In short, busy clinicians struggling to keep pace in the clinics will simply find all this to be too much.

Serious Criticisms

It’s not just me. The field is currently rumbling with DSM-V criticisms, and I wanted to give the readers some examples of what other mental health professionals are saying. Dr. Frances, former chair of the DSM-IV Task Force and currently professor emeritus at Duke, has given litany of concerns that are worth considering, including:

♣ Poor and inconsistent writing
♣ Problematic “new” diagnoses
♣ Lowered thresholds for mental disorders
♣ Questionable expanding of boundaries of the disorders
♣ Creating higher rates of mental disorder

Dr. Frances’ critique concludes that “DSM5 has been and remains in serious trouble…. What leads us to this pessimistic conclusion? Every step in the development of DSM5 has been secretive and disorganized. The leadership has established a consistent track record of proposing unrealistic plans and impossible to meet timetables―with predictably erratic course changes and repeatedly missed deadlines.” And as regards my concerns about utility for the hard working clinician, this point is again stressed in a more eloquent manner:

It is inherently difficult for experts, with their highly selected research and clinical experiences, to fully appreciate just how poorly their research findings may generalize to everyday practice―especially as it is conducted by harried primary care clinicians in an environment heavily influenced by drug company marketing. They also consistently underestimate the costs and risks of medication treatment when it is given to those who don't really need it…. the DSM5 suggestions display the peculiarly dangerous combination of nonspecific and inaccurate diagnosis

Dr. Frances concludes that now the “responsibility (and opportunity) for rescuing DSM5 falls most heavily on the field at large and on the Oversight Committee. Now that the DSM5 drafts are finally open for wide review, it behooves the field to be active in identifying problems and providing the needed pressure to ensure they will be corrected.” Agreed, but can this be done effectively in short time allotted?

But why am I making such a fuss over all this? Haven’t we been here many times before from DSM-I to DSM-IV-TR? Perhaps, but there are now different forces at play in 2010. As one eminent psychiatrist, Dr. Michael First, told the NY Times: “Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled.”

Does It Help Reduce Suffering?

In my own opinion, the fluctuating boundaries of mental disorders will continue to be debated until we devote sufficient time and attention to developing improved, scientifically valid and reliable methods of testing and effectively treating mental disease. Another highly respected colleague, Dr. Ron Pies, has pointed out to me that treatment efficacy in psychiatry is often grossly underappreciated. Psychiatry’s treatment success rates for certain disorders are sometimes higher than other areas of medicine. For example, psychiatry’s treatment success rate for Panic Disorder, Obsessive Compulsive Disorder and Bipolar Disorder are significantly higher than the treatment success rates of angioplasty or arthrectomy. Ultimately, in psychiatry, what we need are diagnoses that are: 1) practical, and 2) help us “target” an illness, so that we can reduce “suffering and incapacity” in patients. In other words, if the “diagnostic system” does not help us reduce a patient’s suffering and incapacity, of what use is it?20

By the looks of DSM-V thus far, we appear to be at some risk of distancing ourselves from these goals. So what do we have to work with now that we can count on? I would assert that it is the lost art of the masters – the art and skill of the clinical interview. From Kraepelin to Freud to Cleckley – it was their rich clinical descriptions that helped us navigate the foreign terrain. But note well that they came across their insights by spending much time listening, observing and questioning patients – a practice that has been subordinated to ten minute med checks, diagnostic coding and billing. It has been observed that:

All too many training programs in psychiatry are neglecting psychodynamically informed interviewing and clinical reasoning skills. Recently, the American Board of Psychiatry and Neurology eliminated oral interviewing as a requirement for board certification. The rationale has been given that oral interviewing will be evaluated during residency, when problems can be remedied, rather than belatedly at the completion of training. That this rationale would not apply to other skills being taught is curious.

Perhaps the “vendettas” surrounding DSM – “V” are just what we needed to awaken? Our own version of “Guy Fawkes Day.” It is no accomplishment that the highest court in the land, the US Supreme Court, is clearly skeptical of the reliability of psychiatric diagnoses and evidence of mental disorders. , By the looks of it, DSM-V will need far more oversight, feedback and re-working. Thus, I am advocating for a considerable extension of the DSM-V timeline. Instead of the proposed release date of May 2013, I would suggest a new release date: November 5, 2015, in honor of the famous November 5, 1605 Guy Fawkes Day. And on that day, let all the scientifically unsound walls of “psychiatric parliament” fall away.

Remember, remember
The fifth of November!

References (provided on request)

Recent article for Forensic Issue of Psychiatric Times

2009-12-12T16:55:00.000-08:00

http://www.psychiatrictimes.com/display/article/10168/1491864?verify=0

2009-10-18T06:21:00.000-07:00

Repeating the Past....

Please check out latest article for the "Jonestown Report" at:

http://jonestown.sdsu.edu/AboutJonestown/JonestownReport/Volume11/Knoll.htm

Modern Day Mass Murder - The Langauge of Revenge (Or: "Vengeance is Mine... And I'm Willing to Die for It"

2009-09-13T06:59:00.001-07:00

Top: Moby Dick
2nd: George Sodini - Pittsburgh Pseudocommando
3rd: Jiverly Voong - Binghamton Pseudocommando
4th: Cho - Virginia Tech Pseudocommando

The “Pseudocommando” Mass Murderer & the Language of Revenge

“…to the last I grapple with thee; from hell's heart I stab at thee; for hate's sake, I spit my last breath at thee. Sink all coffins and hearses to one common pool! and since neither can be mine, let me then tow to pieces, while still chasing thee, though tied to thee, thou damned whale! Thus, I give up the spear!”

- Herman Melville (Moby Dick)
Chapter 135, p. 477

“I didn't have to do it. I could have left…. But now I am no longer running…. Do you know what it feels like to be torched alive?.... All the [expletive] you’ve given me. Right back at you with hollow points.”

- Seung-Hui Cho (Video Manifesto)

The term “pseudocommando” was used by Dietz (1986) to describe a type of mass murderer who plans his actions “after long deliberation (p. 482).” He most often kills indiscriminately in public during the daytime, but may also kill family members as well. He comes prepared with a powerful arsenal of weapons, and has no escape planned. The pseudocommando appears to be driven by strong feelings of anger and resentment, in addition to having a paranoid character. They are “collectors of injustice” who nurture their wounded narcissism and ultimately retreat into a fantasy life of violence and revenge. Mullen (2004) described the results of his detailed personal evaluation of five pseudocommando mass murderers who, were caught before they could kill themselves or be killed. Mullen noted that the massacres were often well planned out (i.e., not impulsive, the offender did not “snap”), with the offender arriving at the crime scene well armed, often in camo or “warrior” gear, and appeared to be pursuing a highly personal agenda of “pay back” to an uncaring, rejecting world. Both Mullen and Dietz have described this type of offender as a suspicious grudge holder who is preoccupied with firearms.

Mass killings by such individuals are not new, nor did they begin in the 1960’s with Charles Whitman. The news media tend to suggest that the era of mass public killings was ushered in by Whitman at the top of the University of Texas at Austin tower, and have henceforth become “a part of American life in recent decades.” But research indicates that the news media have heavily influenced the public perception of mass murder, particularly the erroneous assertion that its incidence is increasing. Furthermore, it is typically the high-profile cases which represent the most widely publicized, yet least representative mass killings. As an example that such mass murderers have existed long before Whitman, consider a notorious case, the Bath School disaster of 1927, now long forgotten by most. Andrew Kehoe lived in Michigan in the late 1920’s and struggled with serious financial issues, as well as a wife who was suffering from tuberculosis. He appeared to focus his unhappiness and resentment on a local town conflict having to do with a property tax being levied on a school building. After becoming utterly overwhelmed with resentment and hatred, Kehoe killed his wife, set his farm ablaze, and killed some 45 individuals by setting off a bomb. Kehoe himself was killed in the blast, but did leave a final communication on a plaque outside his property. The plaque read: “Criminals are made, not born” – a statement suggestive of externalization of blame and long-held grievance.

Hempel, Meloy & Richards (1999) were among the first to note that the mass murderer with a “warrior mentality” will often “convey their central motivation in a psychological abstract, a phrase or sentence yelled with great emotion at the beginning of the mass murder (p. 213).” To date, the actual communications of the pseudo-commando mass murder have received little detailed analysis. This fact is of interest in that “the words people use … can reveal important aspects of their social and psychological worlds (p.547).” Beyond basic demographic data, the use of language may also suggest different types of mental illness, such as schizophrenia, or depression, and the individual’s overall level of psychological distress. An offender’s use of language may lend clues about his past experience, ethnic background, and primary motivations.

After having examined the final communications of two pseudocommando type mass murderers in detail in an effort to reveal what themes emerge, and whether such communications can lead to greater psychological insights into to the psychology and motivations of the offender, I conclude that Cho, Wong (and Soldini) shared basic pseudocommando characteristics in common, but also some very important differences. This linguistic analysis begins with the assumption that the offender would not have bothered to write down or otherwise communicate his “manifesto” unless it had great personal meaning. In the cases examined, the offenders took the time and effort to deliver their communications to the TV news media, suggesting that it was highly important to them that their “message” be disseminated to the public.

In his detailed case study of five pseudocommando type mass murderers who were caught before they were killed, Mullen (2004) described a number traits and historical factors that these individuals had in common. In particular, they were bullied or isolated as a child, turning into loners who felt despair over being socially excluded. They also were described as being generally suspicious, resentful, grudge holders who demonstrated obsessional or rigid traits. Narcissistic, grandiose traits were present, along with the heavy use of externalization as a way of coping. They held a worldview of others being generally rejecting and uncaring. As a result, they spent a great deal of time feeling resentful, and ruminating on past humiliations. Such ruminations invariably evolved into fantasies about violent revenge. Mullen noted that the offenders seemed to “welcome death,” even perceiving it as bringing them fame with an aura of power. As most all of the literature on the pseudocommando heavily references the offender’s motivation of revenge, a more in depth analysis of revenge from a psychological standpoint may be helpful.

The Psychology of Revenge

“He piled upon the whale’s hump the sum of all the general rage and hate… and then, as if his chest had been a mortar, he burst his hot heart’s shell upon it.”

- Herman Melville (Moby Dick)
Chapter 41, p. 154

The desire for revenge “is a ubiquitous response to narcissistic injury (p. 447).” And so it should be of interest that an emotion as intense and ubiquitous as revenge has received little study relative to other emotional drives. Both psychoanalysis and forensic psychiatry have merely skimmed the psychological surface of this destructive cognition. Yet consider how revenge “hides” in plain sight, at least in Western culture. For example, Greek mythology is “awash in revenge themes.” Revenge is the central motive in at least twenty of Shakespeare’s plays, and a main theme in many of today’s Hollywood movies. The success of movies such as the “Death Wish” series, and more recently the “Kill Bill” series, speaks to the public’s fascination with, and indeed their delight in, “the sweet taste of payback.” That there exists a strong, primal universality of the revenge theme hardly requires in-depth socio-anthropological study. And perhaps its readily evident nature, its conspicuousness, allows it to become more easily dismissed by psychological science. Across almost every culture, the taking of revenge, when “justified,” has assumed “the status of a sacred obligation (p.199).” But in many cultures, since biblical times and before, there has always been the principle of functional symmetry in seeking redress, such as the Old Testament’s admonition of an eye for an eye.

Fear and anger, in the form of the “fight or flight” response, are linked physiologically and psychologically. We will not be surprised that where we find anger, fear may also be found, perhaps obscured in the background. Human aggression, as an expression of revenge, may be traced back to this psycho-physiological link designed to enhance survival. But at this point in the stage of our evolution, affronts to our self-esteem, status, dignity or narcissism are responded to “as though they were a threat to our survival (p. 123).” We have maintained the physiological hard-wiring, which is available for excessive use in situations that do not involve survival of the body, but instead survival of the ego. I use the term ego here to represent the mind’s tendency to create the illusion that there is a “self” or identity that desires to sustain itself, seek pleasure and avoid narcissistic (ego) injury just as zealously as one would attempt to avoid harm to the physical body. This ego survival instinct becomes “sublimated into striving for an enduring sense of self which is an object of value in a field of social meanings (p. 23).” Thus, violent revenge may be viewed as a “fight response” to a particular “perceived threat to the sense of self,” its pursuit of pleasure and its various “immortality projects (p. 25).” Because the self or ego must be defined in the social-meaning field, it is the Other on whom we depend for our highly valued identity. In individuals with vulnerable, fragile egos, conflict with the Other arouses fantasies of, and sometimes actions to, dominate and/or obliterate the Other. The individual whose ego is damaged may harbor and nurture destructive rage that eventually transforms him into an “avenger.” Indeed, it is the frustration of the need to “preserve a solid sense of self,” that is often “the source of the most fanatical human violence [as well as] the everyday anger that all of us suffer (p. 85).”

But this righteous anger is, in reality, a vainglorious “pseudo-power,” as it is merely a reaction to intolerable feelings of powerlessness and humiliation. Nevertheless, there comes a point in time when this pseudo-power is the only defense the avenger has left to ward off the annihilation of his sense of self (ie., his identity and self-esteem). This is why, when the potential avenger’s ego is threatened or hurt “in such a devastating way… the only thing that remains is to persist in the ‘unremitting denunciation of injustice’” (p. 189) For certain individuals, there is no turning back or giving up on the “crusade,” because there is a perverse “honor” in refusing to normalize the perceived injustice. This is, in fact, the “hidden logic of the… avenger” (p. 83-84) – to sustain a perversely heroic “refusal to compromise, an insistence “against all odds” lest his heroic fantasy and fragile ego surrender to the reality of a “self” (or lack thereof) that he finds intolerable (p. 190).

The psychotherapy literature on revenge suggests that fantasized revenge is a familiar cognition in the daily life of humans. It is not at all uncommon for patients in psychotherapy to communicate, either consciously or unconsciously, fantasies of revenge. In the treatment of the various stress response syndromes “clinicians may encounter intrusive and persistent thoughts of vengeance associated with feelings of rage at perpetrators (p. 24).” While the revenge fantasies most often have the emotional content of “hate,” and “fear,” in persons with fragile egos, fear may easily devolve into frank paranoia. Thus, the prognosis of the individual with strong revenge fantasies will always have to consider his particular ego strength, along with the usual forensic factors of social/situational stressors and appropriate risk factors. In very disturbed individuals, revenge fantasies may even include rage at the self, leading to either suicide and/or homicide-suicide.”, Other research findings suggest that people, even today, generally believe in the “utility of aggression (p. 1316).” In particular there is research evidence suggesting that strong anger can serve as an attention-focusing emotion, making it difficult to think about other things. Anger thoughts can thus be a vicious cycle; the more people think about them the angrier they get, and the angrier they get, the harder it is to think about anything else (p.1317).” The psychotherapeutic challenge would seem to be the fact that rumination on revenge fantasies may prevent the individual from “engaging other strategies (e.g., trivialization) that would have allowed them to move on and think about something else (p. 1323).”

But let us return to the utility of revenge fantasies for the pseudocommando, and in particular, why they are so unrelenting in individuals with the ego vulnerabilities of strong narcissistic and paranoid traits. In such individuals, the revenge fantasies are inflexible and persistent because they provide desperately needed positive emotional effects. The avenger can make himself feel good by gaining a sense of (pseudo) power and control by ruminating on, and finally planning out his vengeance. These fantasies may lead the avenger to “experience pleasure at imagining the suffering of the target and pride at being on the side of some spiritual primal justice (p. 25).” There seems to be the promise, perhaps stemming from thousands of years of evolution and stoked by our society’s present day honor of it, that the avenger may resurrect his identity and mortally wounded ego via the revenge scenario, which “functions as a defense against being overwhelmed by sadness, helplessness, and hopelessness (p. 25).” Thus, the revenge fantasy falsely promises a powerful “remedy” to a shattered and humiliated ego. It gives the “illusion of strength,” and a temporary, though false, sense of restored control and self-coherence.

According to Menninger, there are five critical elements prompting an explosion of violent behavior: 1) a narcissistic [ego] injury perceived as grossly unfair, 2) hopelessness about a reasonable resolution, 3) the perception that the limits of toleration have been exceeded and some action must be taken, 4) access to weapons, and 5) disregard for the consequences, combined with a sense of “potent” rage. For purposes of simplification, one might use the example of when a child suffers some type of pain. One of the results is usually that the child “wants to let others know about it… to know exactly how he or she hurts (p. 121).” In other words, the internal dialogue may be represented as: “When I am hurt by you, I want you to hurt like I hurt; therefore if you hit me, I will hit you back (p. 121).”

But in the case of the pseudocommando, the drive for revenge will have no truck with either logic or reasonable consideration of adverse consequences. The type of severe narcissistic rage they experience “serves the purpose of the preservation of the self (ego) (p.124)” that has exceeded its limit of shame, alienation and aversive self-awareness. This pain and rage simply cannot be contained by pseudocommando, who then embarks “on a course of self-destruction that transfers their pain to others (p. 128).” It may ultimately be the intensity and quality of the revenge fantasies, acting in concert with other risk variables, which contribute to “whether vengefulness will be a passing concern or a lifelong quest (p. 449).” Dietz has described these individuals as “collectors of injustice” who hold onto every perceived insult, amassing a pile of “evidence” that they have been grossly mistreated. But there is also another way of thinking about their “collection.” To sustain the revenge “romance,” they must collect the unwanted, hated or feared aspects of themselves. This collection is then re-assembled into the form of an “enemy” who therefore “deserves” to be the target of a merciless, incendiary rage. Thus, the pseudocommando maintains object relations with others which are based heavily upon envy and splitting. As a general rule, a more intense desire for revenge signals a more intense idealization of the hated object(s). Targets of a very intense revenge desire must be made out to be worthy of their fate, and so we should not be surprised to see the pseudocommando portray his victims as barely worthy of being considered human beings, much as Cho portrayed other students (whom he hardly knew) as "hedonistic" "brats" who had "raped" his soul. Yet at the same time, he must view himself as blame free, thereby completing the other half of the splitting and projection dynamic.

We are now at a point where we can summarize some of the main psychic functions that the pseudocommando’s wish for revenge serves:

The revenge fantasy “provides sadistic gratification, and perhaps has an evolutionary basis (p. 608).”
The revenge fantasy helps the pseudocommando obliterate an intolerable reality and aversive self-awareness. His rumination “dominates thought and impels action much as an addiction or erotomania does (p. 605).” The avenger could be said to have “fallen” into romantic/idealized hate. Just as Captain Ahab believed he had been “dismasted” by the whale, he reached the final stages of narcissistic inaccessibility, and plunged irretrievably into a “romanticized” downward spiral of reality-destroying nihilism and death.
The revenge fantasy serves as a defense against feelings of shame, loss, guilt and powerlessness. The pseudocommando not only denies his powerlessness, but also goes even further, gaining “virtually limitless power. An eye for an eye soon gives way to a life for an eye….(p. 603).” In this way, revenge “is an attempt to restore the grandiose self (p. 605).” It allows the pseudocommando’s “omnipotence” to rise triumphantly from the ashes of shame, loss and vulnerability.
The revenge fantasy maintains the status quo of the pseudocommando’s primitive object relations, which are based heavily on envy and splitting. The greater the revenge wish, the greater was the idealization of the hated object. The targets of revenge must be worthy of their fate, and so must be dehumanized, demonized and kept bereft of merit. Yet at the same time, the avenger must view himself as utterly blame free.

The peril associated with these revenge dynamics, especially in a potential pseudocommando, is that they inexorably collide with reality in such a way as to render the defenses ineffectual. Reality will ultimately creep into his life in various ways, threatening him with aversive self-awareness, and requiring that he “feed the monster” – ie., cultivate stronger, more intense feelings of persecution and hostility towards his victims. Once this process becomes well entrenched, the pseudocommando begins to tread down the path of cognitive deconstruction, nihilism and death.

Pseudocommando Psychodynamics: Persecution, Envy & Nihilism

“They do me wrong, and I will not endure it…. I must be held a rancorous enemy.”

- Richard III

Thus far, we have seen how the pseudocommando’s revenge wish is linked to an ego disrupting injury, followed by fantasies of violence in which he struggles to re-establish his sense of identity. Now I should like to focus on the developmental psychodynamics observed in many offenders who have strong paranoid and narcissistic traits, and cling to the position of the aggrieved “victim,” despite overwhelming evidence that their own actions have placed them in their unpleasant situation. These offenders may become stagnated in their own self-pity, anger and persecutory ruminations. It is possible that the harsh early childhoods that some of these offenders endured may have contributed to their impaired ability to trust others as an adult, leaving them with a strong self-centered, paranoid character style. According to developmental theory, a more healthy development necessitates the transition away from What Klein called the “persecutory position” to a more mature stage, called the “depressive position.” The study of violent offenders using this theory has suggested that impediments to psychological development may cause the offender to become relatively fixed in a persecutory developmental stage, or what Klein has called the paranoid-schizoid position. In this stage, most of the individual’s worldview is based on feelings of mistreatment and frustration at what is perceived as “intentional” harm, or purposeful withholding of gratification. Fixation at this stage is associated with the use of more primitive defense mechanisms such as splitting, externalization and projective identification. In contrast, the offender who has reached the depressive position will have developed the capacity to entertain feelings of concern or worry that he has injured or destroyed some aspect of society (eg., his fellow man). Cognitions associated with the depressive position include regret, victim empathy and interests in making reconciliation with society.

The persecutory cognitions of the offender in the paranoid-schizoid position are felt by him as threatening, undeserved attacks upon his “self” (ie., identity or ego). This is of interest in that Dietz has noted that most, if not all men in the U.S. who have killed ten or more victims in a single incident have demonstrated “paranoid symptoms of some kind (p. 480).” Over time, paranoid-schizoid offenders develop strong but primitive defenses to protect against their expectations of being mistreated. Consistent with their feelings of being persecuted, such offenders also suffer from strong feelings of destructive envy. As regards envy, it is important to note that the offender at the paranoid-schizoid stage is not necessarily envious of the Other’s possessions or social status, but the way in which the Other is able to enjoy these things. Thus the offender’s true goal is “to destroy the Other’s ability/capacity to enjoy” the prized object or status (p. 90).” For example, Cho provides an excellent example of this in his manifesto when he chides other students according to his perception that they possessed “everything” they ever wanted, such as “Mercedes…. golden necklaces…. trust fund[s]…. vodka and cognac.” Yet in the same manifesto, he reveals his powerfully destructive envy, stating: “Oh the happiness I could have had mingling among you hedonists, being counted as one of you, if only you didn’t ***** the living ***** out of me.” Via projection, such individuals perceive others as persecutory not only as a result of paranoid cognitions, but also by their views of others as withholding the “goodness” and happiness to which they feel entitled. Similar cognitions were described by Mullen (2004) in his previously mentioned analysis of five incarcerated mass murderers. The offenders were described as suspicious, resentful grudge holders who had strong feelings of persecution or mistreatment. They tended to ruminate over past humiliations, and harbored resentment over old social rejections.

In contrast to the paranoid-schizoid position, the depressive position allows the individual to more smoothly confront reality. It involves the capacity to have feelings of responsibility, guilt and concern over harm done to others. During long-term incarceration, some offenders may eventually take up pursuits suggestive of attempts to negotiate the depressive phase. For example, a man sentenced to life for murder may become involved in running the prison “lifers” group, or take up creative pursuits such as art, music or poetry – all examples of “reparative” activities. Yet empirical experience will assure us that many offenders are unable to achieve an attitude embracing personal accountability and reconciliation. In particular, some of these offenders go on to develop remarkably fixed, chronic feelings of persecution. Clinical observations suggest that some of these offenders who remain fixed in the persecutory position ultimately develop an entrenched nihilistic attitude. This nihilism then pervades their worldview, cognitions about treatment, and life in general. The risk here is that their loss of, or failure to find meaning may result in feelings of hopelessness, suicidality and other self-defeating actions. Thus it might be hypothesized that once the offender reaches some individual-specific level of nihilism, he may demonstrate a significantly reduced ability benefit from efforts designed to extend help, and will have little motivation to self-regulate his behavior. It is important to keep in mind that these offenders feel persecuted by society or “the system,” and therefore have strong feelings of rejection by society. These empirical observations of the adverse effects of social rejection and nihilistic beliefs in incarcerated offenders are consistent with research findings in non-incarcerated populations. For example, social rejection has been found in normal subjects to increase feelings of meaninglessness, decrease self-awareness and lower the ability to self-regulate behavior.,

Social science research has shown that when nihilism and the drive to avoid painful or aversive self-awareness becomes strong enough, there is a significantly increased risk of suicide and/or self-destructive behaviors. This theory has been called the “escape theory” of suicide to denote the suicidal individual’s motivation to escape aversive self-awareness. According to escape theory, when the individual is unable to avoid negative affect and aversive self-awareness, a process of “cognitive deconstruction” occurs in which there is a rejection of meaning (nihilism, hopelessness), increased irrationality and disinhibition. Suicide then becomes the ultimate step in the effort to escape from meaningful awareness and it’s implications about the self. In applying this theory to the psychology of the pseudocommando, the stage of cognitive deconstruction would seem to signal a potentially deadly turning point. Having tried, but failed, to place his aversive self-awareness outside of himself, he redoubles his efforts to externalize. Such efforts return to him as even more powerful persecutory attacks from the outside. In select individuals, this may culminate in a real life physical attack directed outward to avoid what is within. For the pseudocommando laboring under a heavy burden of persecutory ideas and negative affect, consciousness of his true predicament is self-torment. As a conscious being, bits and pieces of reality will ultimately bubble up into awareness, and contemplating them too closely is, for him, the equivalent of an unending suicide. The constant assault by reality, and his own persecutory attacks, results in a collapse of the psyche. This collapse fragments his ego into bits and pieces of unspeakable pain. His existence has become the endless self-destruction of a subject given over to a condition of catastrophic anxiety, fear and rage.

The Obliterative State of Mind

“How can the prisoner reach outside except by thrusting through the wall? To me, the white whale is that wall, shoved near to me.”

- Herman Melville (Moby Dick)
Chapter 36, p. 136

"I didn't have to do it. I could have left. I could have fled. But now I am no longer running.”

- Seung-Hui Cho (Video Manifesto)

Returning briefly to another literary example, Shakespeare’s Richard III is a classic example of a mind committed to revenge, and driven by powerful grievance. His state of mind may be regarded as an “obliterative state of mind,” in that it functions to spread more grievance, destruction and ultimately annihilation. Such individuals may come to embrace a self-styled image based on low self-esteem or negative self-perceptions that may be tinged with an ominous or threatening undertone. That is, they embrace their dark, negative cognitions, and fashion them into a recognizable suit of “black” armor. Just as Richard defined himself by his own deformity, so Cho defined himself by his “outcast” status – even dubbing himself the “question mark kid.” Thus, persons driven by envy and destruction tend to see others “as in the light and [choose] to stay in the dark… (p. 702).” In the case of Richard III, his inner envy and destructive narcissism lead him to consciously adopt the role of reprobate:

“And therefore, since I cannot prove a lover,
To entertain these fair well-spoken days,
I am determined to prove a villain,
And hate the idle pleasures of these days.”

As previously discussed, toxic levels of “envy and narcissism… can fracture the personality, hold it hostage and in thrall, by being fuelled by triumph and contempt…. (p. 703).” However, there is more at work here than envy alone. The developing pseudocommando must hold fast to his “hatred of anything such as growth, beauty, or humanity which is an advance over a bleak, static interior landscape (p. 710).” In addition, Freud pointed out that it might be easy to miss another important psychological motive behind Richard’s decision to “prove a villain.” Specifically, the pseudocommando’s notion that “Nature has done me a grievous wrong…. Life owes me reparation for this…. I have a right to be an exception, to disregard the scruples by which others let themselves be held back. I may do wrong myself, since wrong has been done to me (p. 314-315).” It is this feeling of being an “exception” to the rules, of being entitled to harm others or break societal laws, that fuels the pseudocommando’s obliterative state of mind. And once he has embraced this mindset, he condemns himself to a mental space in which “he cannot envision rescue from this commitment to a killing field externally or internally (p. 709).” The narcissistic injury which is utterly intolerable is “essentially nihilistic: nothing matters, all is despair…. all goodness and substance are obliterated, so that nothingness defines the domain (p. 710).” This is the obliterative mindset – destroy everything, embrace nothingness.

Such individuals require mental “sanctuary” from the oppressive, relentless nihilism that assails them. It is only from such a sanctuary that he has a hope of achieving greater mental clarity, freedom from persecution, reclaiming the notion of the other’s potential “goodness,” and relinquishing his pseudo-empowering revenge fantasies. Sadly, it is the case that some individuals may never be able to relinquish the “Ahab – Richard III” state of mind, as all attempts at empathy may be met with suspicion, defensiveness and contempt. Beyond having internal object relations that are primarily fixated at the paranoid – schizoid stage, it could be said that such individuals’ destructive revenge fantasies and refusal to compromise have reached a fatal and malignant stage. At this point, the individual is unable or unwilling to re-emerge from the “heroic” fantasy of ultimate revenge, with an emphasis on the concept of fantasy. As the pseudocommando comes closer to turning fantasy into reality, he must undergo a process in which he comes to increasingly accept that he will be sacrificing his own life. It may be that this obstacle is easier for him to overcome where: 1) his catastrophic thinking leads him to believe violent homicide-suicide is his only option, and 2) his nihilistic, obliterative mindset has caused him to feel that his “self” is already dead, and the death of his body is simply an inevitability. These dynamics have the ultimate effect of undermining his capacity for undistorted judgment, finding meaning in life, and sublimating aggression. Now he is able to override his survival instinct, and reach the point of “willingness to sacrifice one’s body (p. 73).”

Prior to this point, the pseudocommando’s narcissistic inaccessibility led him to be imprisoned in his own revenge fantasies, which served as a faulty/failing life preserver for his drowning ego. But once he reaches the stage of genuine willingness to sacrifice himself and others, there are no further attempts to reach out to the Other; rather, the individual becomes a vortex into which all data is taken and re-configured to substantiate the grounds of the revenge fantasy. He stands as a living example that “narcissism needs no exchange, but requires the other to collapse into it.” At some individualized point during this collapse, the pseudocommando makes the decision to bring his revenge fantasies into the daylight of reality. It is also at this point that he begins to formulate, if he has not already, his final communications. These communications have great meaning to him, as he realizes they will be the only “living” testament to motivations, struggle and “heroic sacrifice.” Therefore, he puts no little thought into them. He pulls the words from deep down within his shattered psyche, and carefully spreads them out for all to see. Like a poker player who lays down his “royal flush,” he reveals his hate-filled, obliterative hand to the shock and lament of all who bare witness.

Discussion

Both Cho and Wong committed mass murder as defined by the present day, accepted Bureau of Justice definition. Both men killed four or more victims at one location, within one event. Although their violent actions were strikingly similar, their final communications revealed significant and important differences between these two individuals. Both men followed the known pattern of the pseudocommando in terms of being heavily armed, wearing “warrior” gear, committing the act during the day, planning for the act, and expecting to be killed during the mass murder. The final communications of both men also revealed that they harbored extremely strong emotions of anger, feelings of persecution, severely damaged self-esteem, and the desire for revenge. Both had reached the obliterative mindset in which nothing matters, and violent destruction must be the final outcome.

In contrast, careful analysis of their final communications also reveals striking differences between the two pseudocommandos. Wong’s final letter strongly suggests that he suffered from a major psychotic disorder. Even more weight is added to this possibility by his father’s reports of Wong’s psychotic symptoms beginning in his early twenty’s, and Wong’s odd behaviors, some of which are frequently seen in individuals suffering from major psychotic disorders (eg., wearing warm clothing in the summer, isolative behavior, uncharacteristic outbursts of anger). Although he was resentful about the status of his “poor life,” he attributed all of his misfortunes to bizarre persecution by “undercover cops.” He appeared to delusionally believe that it was, in fact, these secret persecutors who had destroyed his chances of assimilating and working successfully in the country to which he and his family had immigrated. In reality, it was likely that his undetected, untreated severe mental illness which prevented him from achieving his goals in his new country. Nevertheless, he could not “accept” his circumstances.

For approximately two decades, Wong felt utterly subject to the cruel and unwarranted harassment of his persecutors (ie., his paranoid delusions). Upon reaching the obliterative state of mind, he reasoned that for once in his life he would not be the passive recipient of persecution. Instead, he would assume the role of persecutor and punishing “judge.” With one act of vengeance, he would show his persecutors that he was not a man who could be tormented forever. His actions would make them “regret” what they had done to him. Further, by killing others, he was able to discharge what must have been a deep abyss full of rage, while psychotically projecting responsibility for the tragedy onto his imagined persecutors. In the case of Wong, we see much less overt envy expressed in his final communication. Rather, his letter dwells mainly on his persecutory delusions and his plan to commit homicide-suicide due to his aversive self-awareness and strong feelings of resentment.

Cho’s final communication is a veritable course on the psychodynamics of envy and social exclusion. He even goes as far as acknowledging his fantasies of being part of the “hedonistic” crowd, who he imagined had unlimited access to all of the pleasurable “debaucheries” in life. Cho’s “manifesto” does not contain any overtly delusional material, although one may argue that his feelings of persecution may have reached delusional or near delusional levels. However, with Cho there is no evidence of bizarre or technological delusions as with Wong. Cho’s letter is rife with externalization, splitting and rage stemming from his feelings of social exclusion. Cho’s letter also contains more direct and overt expression of vitriolic anger as compared to Wong’s letter. But perhaps the biggest difference from Wong is Cho’s romanticized theme of his act as a heroic, grandiose sacrifice. Cho stresses that his own death will not be in vain – rather, he is a Christ figure who is sacrificing himself to “save” the “weak and the defenseless,” which is precisely the way that he likely saw himself – a “pathetic boy” who’s life (and self-esteem) had been “extinguished” by his feelings of social exclusion.

A final contrast between the two is clearly seen in the photos they sent to the media. Whereas the photos sent by Wong consisted mainly of him sitting down holding a gun pointing upwards, Cho’s photos were more numerous and more posed for dramatic effect. For example, Cho aims his gun directly at the camera. In another, he holds two guns with his arms outspread reminiscent of an action movie hero. In sum, Cho’s photos suggest substantially more drama, grandiosity and narcissism. All of this data, taken together with their writings, suggest that Wong primarily suffered from a major psychotic disorder, whereas Cho’s primary psychopathology was characterological. This is not meant to exclude the possibility that Cho had begun to suffer from thought disorder; however, the evidence for this is far less striking than with Wong.

In terms of prevention, the difficult reality is that such events are extremely hard to prevent. Recommendations may represent hopeful or idealistic goals, while the reality is that such events often occur without obvious opportunities for diversion. Yet retrospectively one may sometimes discover “windows” of opportunity that if taken advantage of, may possibly have had a chance of diverting the course of events leading up to the tragedy. Such windows may take the form of family members taking steps to have the potential pseudocommando evaluated and treated, or if necessary, involuntarily treated if mentally ill. Another example might be employees or co-workers notifying authorities once they become reasonably concerned. We live in a society that places a high value on both privacy/individual liberty and safety. This can be a difficult balancing act, yet in the case of an individual who raises the concern of family, friends or co-workers, it would seem that the privacy end of the equation must remain flexible, albeit in a very well reasoned way.

Other prevention efforts may involve: identifying potentially violent, angry, nihilistic persons; identifying communities in which it is more difficult to access adequate mental health services; and improving nation wide research efforts focusing on identifying and preventing such tragedies, as well as fully understanding the long-term public health effects of mass murders. In terms of media responses, it may be helpful to formalize a set of reporting guidelines. For example, it has been suggested that news media should avoid glorifying the perpetrator, and not disclose his methods or number of victims killed. Rather media should emphasize victim and community recovery efforts, and deflect attention away from the perpetrator.

Conclusions

Mass murders are not a recent phenomenon, but have occurred since well before the Charles Whitman shooting in 1966. However, what may be a more modern “twist” on mass murder is the pseudocommando style shootings as first described by Dietz (1986), and more recently by Mullen (2004). Present day access in the U.S. to powerful, automatic firearms, as well as a possible glorification of the phenomenon as a western culture “script” are two factors making these present day mass murders unique.

This article has presented a discussion on the psychology of revenge, with special attention to revenge fantasies in pseudocommando mass murderers. These individuals nurture feelings of persecution, resentment and destructive envy. When they reach the limits of their ability to tolerate or avoid aversive self-awareness, there is a significantly increased risk of cognitive deconstruction and nihilism. The revenge fantasy becomes the last refuge for the pseudocommando’s mortally wounded self-esteem. Prior to carrying out their mass shootings, pseudocommandos often take special care to communicate some final message or “manifesto” to the public or news media. Such communications are rich sources of data about the motives and psychology of the pseudocommando. The field of forensic psycholinguistics may be applied in such cases to better discern primary motivations, the presence of mental illness, and important individual nuances. Analysis of both Cho and Wong’s final communications revealed important similarities and differences between the two mass murderers. It is hoped that careful analysis of the pseudocommando’s final communications may ultimately lead to a better understanding of their behaviors and psychology, as well as future preventive efforts.

I will leave the reader with one final thought - coming from a study by Australian researchers. Chapman et al. (2006), studied mass murders before and after 1996 - the year of a horrendous mass murder in Tasmania. Australia quickly enacted gun law reforms which included removing semi-automatic, pump-action shot guns and rifles from civilian possession. In the 18 years before the gun laws, they found a total of 13 mass shootings. In the 10.5 years after the gun law reforms, there were 0 (zero) mass shootings. Understanding that Australian and U.S. culture have some distinct differences, it still may be very worthwhile to ponder the findings of this (single) study. [Chapman, S., et al: Australia's 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass murder. Injury Prention, 2006; 12: 365-372.]

Female Serial Killers: You've Come A Long Way?

2009-05-03T07:58:00.000-07:00

Top: Stacy Castor - convicted of murdering her husband with antifreeze; suspected of murdering her first husband, and trying to murder her own daughter.

Middle: Shirely Winters - Arsonist & Serial Killer. Pleaded guilty to killing two of her young children, but is suspected of killing five other children.

Bottom: Aileen Wournos - convicted of killing seven men; executed in 20o2.

After my recent involvement in a so-called "black widow" murder case (Stacy Castor), I thought I would give a little update on what we know about female serial killers - a rare breed. The strict definition of serial killer is not quite set in stone, but most proposed definitions share the following elements in common: 1) there have been at least two victims (some definitions require three victims), 2) victims are killed in a non-continuous fashion (i.e., there is an emotional “cooling off” period between murders), and 3) the murders usually involve a sexual component.[i], [ii], [iii] So, technically, Ms. Castor could not be "officially" classified as a serial killer - but she is suspected of killing her first husband in a similar manner (poisoning), and of trying to kill her own daughter by poisoning as well. Here is a link to an interview I did with the show 20/20 on this case: http://abcnews.go.com/2020/story?id=7438161&page=1

In another case I consulted on, a woman named Shirely Winters is suspected of killing no less than seven children, most by different forms of arson. This was particularly interesting to me due to the fact that Ms. Winters herself barely escaped death as a child, while her siblings were killed in an accidental gas/asphixiation type incident (she happened to be the only sibling who was spending the night away that evening). Ms. Winters was a resident of the central NY, who was convicted in 2008 of killing her five-month old son, Ronald Winters III, in 1980 and 23-month old Ryan Rivers in 2007. She has also been under investigation for the 1979 deaths of her two older children and the 1979 deaths of three children of a friend.

Female Serial Murderers

Perhaps the first documented female serial killer was a 1st century Roman woman named Locusta. She was a “professional poisoner” who lived in the time of Nero (54 A.D.), and was ultimately executed.[i]

Relatively little has been written about female serial murderers as compared to their male counterparts. In a review of published literature on female serial murder, the most common motive identified was material gain.[i] Sexual or sadistic motives are believed to be extremely rare in female serial murderers. Psychopathic traits and histories of childhood abuse have been consistently reported in these women.20 In a study of 105 female serial killers, the preferred method of killing was poisoning.[ii] An analysis of 86 female serial killers from the U.S. found that the victims tended to be spouses, children or the elderly.[iii] Sometimes referred to as “black widow” killers, these women tend to be geographically stable and live in the same area where their offenses occurred. Their victims are not strangers, and the methods they use are covert or “low profile.”21 On rare occasions, women may be involved with a male serial killer as a part of a serial killing “team.”[iv]

Perhaps one of the more high profile female serial killers in the U.S. was Aileen Wuornos, who was convicted of killing seven men in separate incidents. Wuornos had claimed that all of the men had raped her (or attempted to) while she was working as a prostitute. Thus, she did not fit the typical profile of a female serial killer. Her case received remarkable media and Hollywood attention. In a detailed case study analysis, it was theorized that Wuornos was biologically predisposed to psychopathy, and her abusive childhood resulted in serious attachment deficiencies.[v] Finally, her aggressive narcissism and antisocial lifestyle predisposed her to situations in which she was able to commit acts of predatory murder. Wuornos was executed by lethal injection in 2002 in Florida.

[i] Meloy J., Felthous A. Introduction to this issue: serial and mass murder. Behav Sci Law 2004 22: 289-90.
[ii] Myers W., Husted D., Safarik M., O’Toole M. The Motivation Behind Serial Sexual Homicide: Is It Sex, Power, and Control, or Anger? J Forensic Sci 2006 51(4): 900-907.
[iii] Douglas J., Burgess A.. W., Burgess A. G., Ressler R. Crime Classification Manual. Lexington Books: New York, NY, 1992.
[i] Newton M. The Encyclopedia of Serial Killers. Facts on File: New York, 2000
[i] Frei A., Vollm B., Graf M., Volker D. Female serial killing: Review and case report. Criminal Behaviour and Mental Health 2006 16: 167-176.
[ii] Wilson W., Hilton T. Modus operandi of female serial killers. Psychological Reports 1998 82: 495-498.
[iii] Kelleher M. Kelleher C. Murder Most Rare: The Female Serial Killer. Praeger: Westport, CT, 1998.
[iv] Holmes R., Holmes S. Serial Murder, 2nd Ed. Wadsworth: Belmond, CA, 1998.
[v] Arrigo B., Griffin A. Serial Murder and the Case of Aileen Wuornos: Attachment Theory, Psychopathy, and Predatory Aggression. Behavioral Sci and Law 2004 22: 375-393.

Craigslist Killer? What do we know about Physician Serial Murderers?

2009-04-26T09:59:00.000-07:00

The so-called Craigslist Killer - hasn't even been convicted, at least not in a criminal court

The Craigslist Killer has been the recent subject of media attention. Since I seem to recall my law professors teaching me that an individual is presumed innocent until proven guilty at trial, I shall refrain from offering worthless speculation and adding to the hype. Instead, I'll try to do what I always do - provide you with some forensic knowledge about the issue in general, like I try to do with juries, and you can take this knowledge and form your own conclusions.

So - what do we really know about physicians who kill?

A physician swears by the hippocratic oath, and also swears to "first, do no harm," while putting his patients' best interests above all else. What could be more unnerving than a person who has taken this oath, looks the part, talks the talk of the helping profession, and appears to walk the walk as well? The truth is that killer doctors are nothing new, yet perhaps the aura of the profession has buffered these individuals from being examined too closely by the research - until relatively recently.

The study of medical serial killers may have gone overlooked due to an unwillingness to perceive sworn “healers” as potential murderers. However, research has revealed that medical killers may actually be the most prolific of all serial killers. Doctors who serially murder their patients are considered to belong to a larger group of “career-assisted killers.” The term “clinicide” has been used to describe “the unnatural death of multiple patients in the course of treatment by a doctor.”[i] Such murders may be difficult to detect, since they often occur in settings where death is expected to happen. Doctors accused of clinicide will be likely to put forth the defense that they were relieving suffering or providing euthanasia. Clinicidal doctors may have extreme narcissistic personalities, and may obtain pleasure by “determining” when a person will die.

One of the most deadly doctor serial killers may also hold the dubious distinction of being one of the most prolific serial murderers to date. Dr. Harold Shipman, a UK physician, was convicted of killing 15 patients with lethal injections of narcotics. In a post-trial investigation, it was concluded that Shipman was responsible for 218 known victims.[ii] Other estimates have suggested the number is closer to 450.[iii] Most of Shipman’s victims were not terminally ill, nor did they have an immediate life threatening illness. Shipman refused to speak to anyone, and no complete psychological assessment was ever performed on him.29 He committed suicide in prison in 2004.

Other healthcare professionals have been implicated in serial murder. In a study of 90 healthcare killers, 86% were nurses and 12% were doctors.[iv] Injection was the most common method used, followed by suffocation, poisoning and tampering with equipment Fifty-four of the 90 cases were ultimately convicted. A total of 2, 113 deaths could be attributed to these 54 convicted healthcare killers.

The motives? Most have speculated that it has much to do with the feelings engendered in the killer by the power of life over death - perhaps the very thing that drew them to the profession in the first place. Does the Craigslist killer appear to fit this profile? Unknown - because a legitimate forensic scientist will not draw such conclusions based only on what the media presents us with. We will just have to wait for the case and evidence to unfold.

[i] Kaplan R. The clinicide phenomenon: an exploration of medical murder. Australasian Psychiatry 2007 15(4): 299-304.
[ii] Esmail A. Physician as Serial Killer – The Shipman Case. N Eng Jour Med 2005 352(18): 1843-1844.
[iii] The Shipman Inquiry. First Report, Volume One Death Disguised. COI Communications, Manchester, 2002.
[iv] Yorker B., Kizer K., Lampe P., Forrest A., Lannan J., Russell D. Serial murder by healthcare professionals. J Forensic Sci 2006 51(6): 1362-71.

Analyzing Threats: Forensic Psycholinguistics

2009-04-24T09:12:00.000-07:00

Above: Threatening letter to a friend intercepted by police

Middle: Rationale of a "Rejected" type stalker

Bottom: Same stalker - ultimately killed his victim

A “threat” may be defined as a declaration of intent to harm. It may be the basis for criminal or civil liability. Threats are common, and most are not carried out. There is only a weak association between threats and violence, but there is an association. Consider the following statistics[1]:

§ 75% of threateners are not violent
§ When a threat is made, there is a 52 – 83% false positive prediction of violence
§ Attacks on public figures are rarely preceded by threats

In contrast to a clinical risk assessment done by a treating mental health clinician, a threat assessment is typically done by an expert with training and experience in the field of threat assessment. Competence in threat assessment comes from: 1) specialized training, 2) familiarity with current literature & research, and 3) experience in the field. The average mental health clinician would not reasonably be expected to perform a formal threat assessment of the type described in this course. The following table lists some differences between threat assessment and clinical risk assessment:

Differences Between Threat & Risk Assessment

Threat Assessment
§ Case-specific
§ Target specific
§ Usually not clinical
§ Goal: protect target, apprehend perpetrator
§ Procedure: threat mgt. plan

Risk Assessment
§ Population-specific
§ Actuarial or Structured Clinical approach
§ Clinical scenario
§ Goal: “predict” likelihood, reduce risk
§ Procedure: risk reduction/treatment plan

There are three possibilities in relation to a threat. The individual:

1. Made a threat, but does not pose a threat
2. Made a threat, and does pose a threat
3. Made no threat, and does pose a threat

Although there are many different types of threats, clinicians may be likely to encounter “instrumental” and “expressive” threats[2]:

Instrumental – made to control or influence the target’s behavior. They can be recognized by their conditional nature: “If you ____, then I’ll ____!”

Expressive – made to control or influence the target’s emotions. They can be recognized by their affective nature (ie., “blowing off steam”): “I could kill you!”

Expressive threats may be easier to spot and abort with management interventions. For example, some therapists handle them by allowing the patient to “vent” in a therapeutic manner, and then invite the patient to come up with nonviolent solutions to the problem. Instrumental threats may be more likely to be used by manipulative and/or antisocial individuals who may be less likely to respond to clinical interventions alone.

In a recent large DOJ study[3], 56.8% of stalkers made no threats, whereas 43.2% did make threats. The most common threats were:

1. Hit/slap/harm – 13.6%
2. Kill victim – 12.1%
3. Harm or kill self – 9.2%

This DOJ study considered stalking only from the standpoint of stalker and victim, and did not involve any stalker typologies. Among all stalkers, the following rates of violence were found:

1. Property damage – 24.4%
2. Attacked victim (hit, choked, raped, used weapon) – 21%
3. Attacked 3rd party or pet – 15%

The 3 Principles of Threat Assessment:

1. Targeted violence is neither impulsive nor spontaneous. Targeted violence results from an understandable process of thinking and behavior.

2. Violence is situational and contextual. Violence stems from an interaction among the potential attacker, past stressful events, a current situation, and the target.

3. “Attack-related” behaviors must be identified. Investigation and resolution depend on identifying the discrete behaviors preceding and liked to the attack. Attack-related behaviors move along a continuum from idea – to behaviors/communications – to preparations.

Key Questions for Threat Assessments:

1. What motivated the subject to make the statements, or take the action?

2. What has the subject communicated to anyone concerning his intentions?

3. Has the subject shown an interest in targeted violence, perpetrators of targeted violence, weapons, extremist groups, or murder?

4. Has the subject engaged in attack-related behavior, including any menacing, harassing, and/or stalking type behavior?

5. Does the subject have a history of mental illness involving command hallucinations, delusional ideas, feelings of persecution, etc. with indications that the subject has acted on those beliefs?

6. How organized is the subject? Is he/she capable of developing and carrying out a plan?

7. Has the subject experienced a recent loss and/or loss of status, and has this led to feelings of desperation and despair?

8. Corroboration – What is the subject saying and is it consistent with his/her actions?

9. Is there concern among those that know the subject that he/she might take action based on inappropriate ideas?

10. What factors in the subjects life and/or environment might increase/decrease the likelihood of the subject attempting to attack a target?

Examining the Data: Communications & Behaviors

The forensic psycholinguistic analysis is best done as a part of a team approach, where the forensic psychiatrist can meet with and obtain feedback from law enforcement, the victim, and the DA assigned to the case. From the outset, the forensic psychiatrist should pay careful attention to the quality of the evidence examined. It is recommended that the forensic psychiatrist obtain the best possible sample of the writing, communication, etc. A trip to the detective’s office may be necessary to view the original evidence.[1] This may also be useful where the detective involved can provide other helpful background information to the investigator in person.
If copies are used, make sure they are high quality and complete. It may be helpful to make multiple copies of single documents so that highlighting, notes, etc. can take place, yet you will still have a clean copy.

Review document(s) carefully, slowly and multiple times. Each review may be done with a different primary purpose. For example, the first review may simply be to obtain a general first impression. Subsequent reviews may be done for:

Identifying themes, motives
Identifying evidence of mental illness
Identifying threatening language, types of threats
Identifying idiosyncratic language or symbol use
Comparisons with other related documents
Identifying basic features, such as type of medium, style of handwriting, dates, drawings, postage markings, etc.
Method of delivery of the threat

After careful, multiple examinations, it may be possible for the investigator to determine important basic information such as the unknown stalker’s: age, sex, ethnicity, geography, educational level, religious orientation, and other valuable data.[2]

The use of language may also suggest different types of mental illness, such as schizophrenia, or depression.[3], [4] In particular, the excessive use of pronouns has been associated with high levels of psychological distress.[5] The use of metaphor or metonymy may also lend clues about an individual’s past experience, ethnic background, primary motivations and level of distress.[6] One psycholinguistic study of threateners from the FBI’s NCAVC database found that higher conceptual complexity and lower ambivalent hostility/paranoia were more strongly associated with predatory violence.[7]

A working knowledge of recent internet communication trends is important, as 25% of victims reported some form of cyber or electronic stalking.[8] For example, even a piece of data as seemingly unimportant as an E-mail address may suggest clues about the stalkers personality structure.[9] Do not fail to listen to any CDs, audiotapes or other recorded media, as stalkers may communicate what they believe are their most “important messages” in seemingly unimportant “gifts.”

Keeping the above principles in mind during the analysis, one should consider paying close attention to the following data[10]:

§ Changes in tone, affect, organization, etc., over time in serial communications.
§ Statements suggesting the stalker has knowledge of victim’s location
§ How the stalker perceives consequences of re-contact
§ Stalker’s responses to any past victim actions
§ Presence/absence of violent intent
§ Duration and intensity of infatuation
§ References to third parties, suggesting some degree of morbid jealousy. Thus, third parties may also be at risk if he perceives them as thwarting his goal.
§ Violation of personal boundaries (visits to the victim’s home or office to deliver communications)
§ Evidence of persecutory delusions coexisting with linear thought processes
§ Evidence of erotomanic delusions, and intensity of intimacy fantasies and unrealistic desires
§ Severity of mental disorder as suggested by communications
§ References to access to weapons or weapon usage
§ Language suggesting that the stalker views himself as an “aggrieved victim.” In some cases, this may suggest a lowered threshold for acting on threats, as the stalker may feel justified in seeking retribution against his perceived persecutors.
§ Evidence of or references to possible substance use
§ Antisocial and Borderline personality styles – (past failure to conform to the law, lack of remorse, fear of abandonment, difficulty controlling anger, impulsivity)
§ Overall personality structure suggestive of an “externalizing” style of coping
§ Statements demonstrating a forceful sense of entitlement (eg., “I’m not going to ask for you, I’m going to take you”)
§ Frequency and intensity of relevant cognitive distortions – (eg., minimization, denial and externalization of blame)

Finally, consider consulting with a qualified forensic document and/or handwriting examiner in difficult cases.

[1] Morris R: Forensic Handwriting Identification: Fundamental Concepts and Principles. San Diego, Calif: Academic Press, 2000.
[2] Smith S, Shuy R: Forensic Psycholinguistics: Using Language Analysis for Identifying and Assessing Offenders. FBI Law Enforcement Bulletin. April 2002, pps. 16-21.
[3] Stephane M, et al.: Empirical evaluation of language disorder in schizophrenia. J Psychiatry Neuroscience, 2007;32(4):250-8.
[4] Pennebaker J, Stone L: Katie’s Diary: Unlocking the Mystery of a Suicide. (D. Lester, Ed.). Ch. 5, pps. 55 – 79; Routledge Press, 2003.
[5] Henken V: Banality reinvestigated: A computer-based content analysis of suicidal and forced death documents. Suicide and Life-threatening Behavior, 1976; 6: 36-43.
[6] Eynon T: Cognitive Linguistics. Advances in Psychiatric Treatment, 2002; 8: 399-407.
[7] Smith S: From Violent Words to Violent Deeds: Assessing Risk From FBI Threatening Communication Cases. In: Stalking, Threatening, and Attacking Public Figures: A Psychological and Behavioral Analysis. (J. Meloy, L. Sheridan, J. Hoffman, Eds.) New York, NY: Oxford Press, 2008; Ch. 20, pps. 435-455
[8] Baum K, Catalano S, Rand M: Stalking Victimization in the United States. Bureau of Justice Statistics Special Report, U.S. Dept. of Justice. January, 2009: pps. 1-15
[9] Back M, Schmukle S, Egloff B: How extraverted is honey.bunny77@hotmail.de?: Inferring personality from e-mail addresses. Journal of Research in Personality, 2008; 42: 1116–1122
[10] This list of evidence consists of both risk factors from the literature, as well as the author’s experience.
[1] Calhoun F, Weston S: Threat Assessment and Management Strategies: Identifying the Howlers and Hunters. Boca Raton, FL: CRC Press, 2009.
[2] Meloy J: Violence Risk and Threat Assessment: A Practical Guide for Mental Health and Criminal Justice. San Diego, Calif.: Specialized Training Services, 2000.
[3] Baum K, Catalano S, Rand M: Stalking Victimization in the United States. Bureau of Justice Statistics Special Report, U.S. Dept. of Justice. January, 2009: pps. 1-15

Mass Murder

2009-04-05T09:00:00.000-07:00

Above: Mass Murder is not new

Middle: Charles Whtiman - died 8/1/66

Below: Life cover of U.T. Austin Tower shooting by Whitman

With the recent tragic mass murder in Binghamton, NY, I felt compelled to post some of basic research knowledge about Homicide-Suicides, of which Mass Murder is a category. My deepest sympathies go out to the survivors and community. I hope that the Binghamton community can come together to grieve, support one another, and not let this isolated act of selfish anger and resentment define them.

There is often the (false) impression in the media that mass murder more or less began with the Charles Whitman incident, but this is simply not the case. They have been occuring probably for longer than we have recorded history available to us. It is simply that the media has become more sophisticated and adept at reporting it (See above table). Here, I will briefly outline the phenomenon of Homicide-Suicide, and then discuss Mass Murder.

Homicide – Suicide is the phenomenon in which an individual commits a homicide, and subsequently (usually within 24 hours) commits suicide (Felthous, 1995; Marzuk, et al, 1992). The dramatic nature of a completed homicide-suicide frequently captures media attention, while efforts at recognition and prevention have received much less consideration. Because the event leaves no living victim or perpetrator, input from a mental health professional is typically not sought.

Most information about homicide-suicide has been gathered from data present in police and coroner’s reports. (Malphurs, 2002; Felthous 2001; Morton, 1998). Few studies have utilized interviews of family members, in addition to record reviews, to enhance the psychological autopsy approach.

The rate of homicide – suicide has been found to vary only slightly throughout the world. In the United States, rates have been reported as more or less consistently between 0.21 to 0.55 per 100,000 (Coid, 1983; Milray, 1995).

Although it is a relatively rare event, it is likely responsible for 1,000 to 1,500 deaths per year in the United States (Marzuk, et al, 1992). Coid (1983) found that countries with a high homicide rate had the lowest rate of homicide – suicide.

In their review of the literature Marzuk, et al (1992) were the first to propose a clinical typology for the classification of homicide – suicide. Their system categorizes perpetrators based on victim – perpetrator relationship, and by class of precipitants or motives. For example, it has been reported that the most common type of homicide – suicide is spousal killing, usually with the male killing his female “consort” due to a breakdown of the relationship (Milray, 1995). Marzuk, et al (1992) have classified this type as a Spousal homicide – suicide of the “Amorous Jealousy” class.

Depression was found to be the most common diagnosis in perpetrators of spousal homicide-suicide. These dyads were commonly characterized as chaotic, abusive relationships. In addition, histories of alcohol abuse and violent behavior are frequently found among this type of perpetrator (Rosenbaum, 1990). The common thread running through this type of homicide – suicide appears to be the precipitating factor of a loss of a previously intimate consort. Indeed, recent estrangement of a partner increases the risk of both homicide and homicide – suicide (Darpet, 1966; Currens, 1991).

Another common type is the Spousal homicide – suicide of the “Declining Health” class. In this group a male, usually elderly, kills his spouse and then himself because of declining health and it’s associated hardships. In actuality, both may be suffering declining health, or conversely, only one has health issues while the other suffers from depression. There may have been some form of threat (eg, financial) to a spouse’s ability to continue functioning in the caretaker role. Beginning in the 1990’s, younger couples suffering from AIDS have been classified in this group. Cohen argues that homicide – suicides of this class are not acts of love or altruism, but of depression and desperation (Cohen, 1998).

Other typologies of homicide – suicide seen with less frequency are the filial, familial, and extra-familial types. Filicide – suicide usually involves the classic scenario of a depressed and psychotic mother who kills her infant in an “extended suicide” (Resnick, 1970; Marzuk, et al 1992). A familicide – suicide is usually committed by a depressed man who kills his entire family. He is likely to view his act as a delivery of the family from continued hardships or stressors (Selkin, 1976).

The Extra-Familial type is sometimes referred to as the “Adversarial” type because the most common event involves an offense against a perceived “enemy” who is unrelated to the perpetrator. Adversarial homicide-suicides typically consist of disgruntled employees, or antagonistic, hate filled individuals. They are likely to be suspicious loners who have had a recent social stressor. They are prone to perceiving themselves as persecuted, and seek revenge in the workplace, or indiscriminately in public (Dietz, 1986; Felthous, 1995; Marzuk, 1992).

Mass murderers who commit suicide would fit into this category, as their relationships to their victims are often extra-familial and adversarial in nature. The U.S. Bureau of Justice has defined “mass murder” as the killing of four or more victims at 1 location, within 1 event. Thus, the following categories of homicide-suicide could also potentially be considered mass murders: 1) the “disgruntled” (ex) employee, 2) the “class room avenger,” and 3) the “pseudo-commando.”

Adversarial Homicide-Suicide (Extra-familial)

This type involves a disgruntled employee who has recently been dismissed or is experiencing work stress. He externalizes blame onto his supervisors or co-workers, and feels wronged in some way. He is very likely to have depression, as well as paranoid narcissistic traits. Actual persecutory delusions may be seen. Variants of this type include disgruntled students, patients, and litigants.

The phenomenon of mass murder described by Dietz (1986) has some over-lap with homicide-suicide. A mass murder occurs when multiple victims are intentionally killed by a single offender in a single incident. The "pseudo-commando" subtype of mass murder can be considered a homicide-suicide in certain cases. The pseudo-commando is usually a man who is feeling strong anger and resentment, in addition to a paranoid character(Dietz). He kills indiscriminately in public during the day time. He uses a powerful arsenal of weapons, and has no escape planned. This may sometimes involve a "passive suicide" in that he forces police to kill him in a last stand "blaze of glory."

Pseudo-commando mass murders have been described as often possessing the following characteristics (Mullen, 2004):

§ Bullied or isolated as a child
§ Loners who are socially excluded and despair over feeling excluded
§ Suspicious, resentful, grudge holders
§ Obsessional or rigid traits
§ Narcissistic, grandiose traits
§ Externalizers – unable to take responsibility for their distress and place responsibility on others
§ Weapons collector, preoccupied with weapons
§ Strong feelings of persecution or mistreatment
§ World seen as rejecting, uncaring
§ Resentful with rumination on past humiliations – “collectors of injustice” (Dietz)
§ Fantasize about violent revenge
§ No significant criminal or violence history
§ No significant mental health history or serious mental illness
§ No significant substance abuse

The massacres carried out by pseudo-commandos are often characterized by the following:

§ Well planned out – not impulsive, did not “snap” (JK: If you investigate closely enough, you will find that no one "just snaps." This is a lay-myth. The act is the culmination of a long period of harboring/collecting resentment and fantasizing about violent retribution)
§ Set out to kill as many people as they can
§ Come well prepared and well armed, often in camo or “warrior” gear
§ Pursue a highly personal agenda of “pay back” to an uncaring, rejecting world
§ Sometimes also against those he has a grievance with

Mullen (2004) raises the possibility that these “autogenic massacres” (mass murders) are unique to western society. Further, subsequent pseudo-commandos appear to have been inspired or influenced by previous ones via the media. The perpetrators “welcome death,” and perceive it as bringing them fame with an aura of power.

Here are more results from some interesting studies:

Mass Homicide & Suicide: Deadliness & Outcome (Lester, ’05)

This study examined a nonrandom sample of 98 Lone “rampage” killers. Lester defined "deadliness" by number of victims.

In terms of deadliness, here's how the perpetrators fell out:

Most deadly: Killed by police
2nd most deadly: Committed suicide
3rd most deadly: Captured by police

Lester also found that perpetrators often showed an interest in guns, had past violence, and demonstrated paranoia or paranoid traits. Interestingly, disgruntled employees were more likely to commit suicide.

Mass Murderer Characteristics (Hempel, ’99)

This study looked at a sample of 30 nonrandom mass murderers and found:

•Paranoid and/or depressive traits
•Personality disorders
•Major loss precipitating the event
•A “Warrior mentality” among perpetrators - coming to the event "decked out" in military-like garb, heavily armed and even sometimes shouting particular "war cries."

Another common theme running through these types of events is the toxic effects of social isolation or rejection. This phenomenon has been well studied by Baumeister, who has shown that social rejection engenders feelings of nihilism, hopelessness, anger, as well as impaired cognition and ability to make cautious decisions.

Masochistic Serial Killers?

2009-03-17T05:27:00.000-07:00

Top: Rader/BTK "becomes the victim"

Middle: BTK's "symbol" (note sexual symbology)

Bottom: Dennis Rader (aka: BTK)

Readers: For a full discussion of this unusual phenomenon, see published paper:

Knoll J, Hazelwood R: Becoming the Victim: Beyond Sadism in Serial Sexual Murder. Aggression and Violent Behavior, 2009; 14: 106-114.

The behavior and characteristics of sexually sadistic serial murderers have been described primarily in relation to their paraphilic arousal to the control and torture of their victims. Sadistic sexual murderers who demonstrate both sadism and masochism have been described, but less is known about this type of offender.

Dennis Rader (aka “BTK”)

Dennis L. Rader, who gave himself the title “BTK” (Bind, Torture, Kill) was born March 9, 1945 in Pittsburgh, Kansas. He was one of 4 sons, and a college graduate with a degree in the Administration of Justice. He received an honorable discharge from the Air Force. He was married to the same woman for 27 years and had two children. His employment history included installing security systems, being a supervisor with the U.S. Census Bureau and a compliance officer for Park City, Kansas. By all accounts, Dennis Rader was a good father to his son and daughter. His family lived in the same home for 25 years. He had no arrest history, was a Boy Scout leader and president of his local church assembly. On the surface, Rader appeared to be a stable, reliable and respected member of his community. Nevertheless, he held that same community in fear from 1974 (when he killed a family of four), until his arrest approximately 31 years later.

Dennis Rader was arrested on February 25, 2005. Rader eventually confessed to murdering 10 victims. Although 59 years of age at the time, he had completed his selection process for an eleventh victim, and was simply awaiting an opportune time to kill again. Regarding his murderous desires, he stated, “It started in grade school. I used to make sketches even back then. Annette Funicello was my favorite fantasy hit target…I had these imaginary stories of how I was going to get her, kidnap her and do sexual things to her…” (Smith, 2006) During the period of time that he was carrying out his offenses, Rader appeared to enjoy communicating with the media, writing anonymous letters to a Kansas TV station. One letter stated that “no one in Kansas is safe because I am omnipresent.” After his arrest, a large volume of materials were seized which documented his sexual fantasies, interests, and crimes. Among those materials were postmortem photographs he had taken of two of his victims along with items of clothing belonging to each of them. Also recovered were photographs of Rader in bondage and cross-dressed in his victim’s clothing. Analysis of the photos of Rader and his victims revealed striking similarities.

Rader Victim A

On April 27, 1985, Rader murdered victim A, a middle aged woman who lived only 6 doors away from him. He told police that he would occasionally see her in her yard. Her body was found, some 9 days after she had been missing, in a ditch seven miles from her home. Authorities later learned that after manually strangling the victim in her home, Rader took her body to his church where he “…played God: controlled her…posed her bound body in lewd positions, and took photographs...” (Wenzl, Potter, Kelly and Hurst, 2007)

In one of the photographs, the victim is lying nude on her back with her ankles and wrists bound. In two other photos, she is in a semi-sitting position with her back against a wall partition. Rader had placed a bra on her and she was bound at the ankles, calves, and above the knees. Her wrists were positioned behind her back, suggesting that they were bound. A black cloth was wrapped around the lower part of her face. Law enforcement recovered a photo Rader had taken of himself almost 4 and ½ years later (Rader had dated the photo himself). The photo showed Rader in his mother’s basement wearing lingerie. He was standing up with his back against a wall, bound at the ankles, calves, and above the knees. His wrists were behind his back, suggesting that they were bound. He was wearing a black cloth over the lower part of his face.

In another Rader photograph, victim A was lying on her right side with her head resting on a pillow and a black cloth covering the lower portion of her face. Her wrists were behind her back, and her knees were drawn up in a fetal-like position with a black cloth tied above her knees. Approximately 5 ½ years later, Rader photographed himself lying on his right side, wearing a bra and a decorative mask with a cloth item covering the lower portion of his face. His head was resting on a white pillow. His wrists were behind his back, and his knees were drawn up in a fetal-like position with a white cloth item tied above his knees.

Rader Victim B

On January 19, 1991, Rader murdered victim B, a 62-year-old widow who lived in a single family residence. Like victim A, victim B was strangled and transported away from her home after her death. Her body was found 13 days later beneath a bridge several miles from her home. A decorative mask with painted black eyebrows, eye lashes and red painted lips was found near the body. Rader took several photographs of victim B after he had murdered her. One photo is of victim B lying on her back with her arms bound behind her back. Her face was covered by the decorative wall mask.

After murdering victim B, Rader photographed himself lying on his back in a grave that he later told authorities he had dug for her, but did not use. The photo shows Rader with his hands behind his back, and fresh dirt covering the lower half of his body. Having left his favorite mask for authorities to find with victim B, the photo shows Rader wearing a different decorative mask with black tape covering the mouth. Photographs of Rader wearing the first mask prior to the murder of victim B were later found police. Upon questioning, Rader told police that he missed the first mask, and had regretted leaving it behind. Another Rader photo shows him at his parent’s basement when they were not at home. In the photo, Rader was wearing victim B’s clothing (Wentzel, Potter, Kelly, and Hurst, 2007).

Discussion of Rader Case

The available photographic evidence shows that Rader placed his victims in specific positions while they were bound and had either a cloth or mask over their faces. Several years after his offenses, Rader made special efforts to photograph himself while carefully imitating the positions, clothing and bindings of victims he had previously photographed. Assuming that Radar, like most SSSMs, was operating from a fantasy script, he would be motivated to re-experience his offenses by memorializing them (ie., photos), as well as by re-living the fantasies as best he could when no victim was available. The latter behavior may suggest that he was using himself as a “stand-in” when no actual victim was available. If one were to stop here, it might be hypothesized that Rader’s behavior corresponds most closely to the substitute victim hypothesis. However, there are still several other key pieces of behavioral evidence to consider, specifically Rader’s use of facial coverings, as well as placing himself in his victim’s intended grave.

Rader’s regret over parting with his mask suggests that he had developed a significant attachment to it. From a psychiatric perspective, this may raise the possibility of a fetish. Fetishism is defined as having “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects.” (American Psychiatric Association, 2000) Fetishistic objects are more commonly women's undergarments, shoes, and leather apparel. A specific “mask” fetishism does exist (http://www.maskme.com/ Accessed on: 9/8/08), although it is not well studied. It has been observed that adult fetishism may develop out of the early childhood developmental phase called the transitional period (Greenacre, 1969). Prior to the transitional period, the infant sees himself and the mother as “one” being. The mother gratifies the infant’s needs without delay, resulting in the illusion of omnipotence. At this stage, the mother-child relationship is entirely symbiotic – the baby feels “merged” with the mother, as well as all powerful.

This “subjective omnipotence” inevitably collides with objective reality. By means of fantasy, the child may find temporary comfort. It is at this point that a so-called “transitional object” (eg., blanket, stuffed animal) may be used to symbolically represent the mother when she is absent (Winnicott, 1971). In this manner, the child clings to the transitional object while he finds a balance between his fantasy and objective reality. Given Rader’s proclivity for his mask and facial coverings, one might speculate about whether his female mask and/or black cloth served as a form of transitional object allowing him to bridge the gap between his fantasy and reality (ie., between torturer and victim). His regret over losing his mask may have been due to the fact that it served as a transitional portal into his world of grandiose, omnipotent control. Additionally, using the mask for auto-erotic activities would allow him to re-create a fusion of torturer and victim at his leisure, thereby prolonging his omnipotent control of his victim. Finally, Rader’s photo of himself in victim B’s grave also shows his desire to fuse himself with her. In doing so, he exerts control over her beyond her death, and in a sense, mocks the limits of death itself. Having become the victim, he achieves God-like power over her, and “proves” that death cannot limit his omnipotence. His wearing of the mask while in the grave underscores its importance to him, and furthers his efforts to re-create a torturer-victim fusion.

Summary Points

§ Clinical forensic case examples suggest that control is the “worm” at the core of sadism.
§ Sadistic sexual murderers who demonstrate both sadism and masochism have been described, but little is known about this type of offender.
§ There are a number of potentially overlapping hypotheses that might explain why some serial sexual murderers would enact the roles of both victim and torturer. These include: 1) trauma related theories, 2) cognitive distortion – implicit theories, 3) the substitute victim hypothesis, 4) the vicarious enhancement hypothesis, 5) the addictive tolerance model, and 6) the grandiose sadism hypothesis.
§ The grandiose sadism hypothesis suggests that some rare offenders assume the identity of the victim to extend their control over the victim beyond life and death.
§ This type of grandiose control provides the offender with a God-like sense of power, as a result of an omnipotent fusion of torturer and victim. The offender is able to control and experience gratification from both sides of the power differential, permitted by his fluid boundaries between self and other.

A Forensic Homage to Professor X

2009-02-28T13:12:00.000-08:00

Above: Photo of Chester Gillette & Grace Brown

Below: Theodore Dreiser

“Life's little ironies are not always manifest. We hear distant rumbling sounds of its tragedies, but rarely are we permitted to witness the reality. Therefore the real incidents which I am about to relate may have some value.”[i]

My college history professor killed himself. He had bipolar disorder, stopped taking his lithium and his life ended tragically. His classes were among the most popular on campus and included enough humor, drama and multimedia to routinely fill the 200 plus seat auditorium. I was never quite sure what to make of him, and this was well before I really knew what bipolar disorder was. I went to all his lectures faithfully – not just because of his captivating lecture style, but also because he never failed to say something outrageously controversial, and I simply did not want to miss out. It was a rare lecture that did not send one or more students stomping out in disgust. In truth, there were many times when I wanted to stomp out in disgust. But I didn’t.

I couldn’t. I was transfixed, I believe, for a number reasons. The most obvious to me was that I had the unnerving sense that something about this man was driving him towards his own personal apocalypse, and I did not know what to do other than bear witness to it. The more subtle dynamic that compelled me involved the search for truths about the human condition. Professor X, as I shall call him, was a true renaissance man. His lectures and assigned readings were sprinkled with literary gems unknown to most college students. One of these gems, which became a sacred find to me, was Theodore Dreiser. Dreiser was an American writer who is most known for dealing with the gritty, raw reality of life. His novels often focused on themes of social inequality.

Professor X was obsessed with social inequality. He beat you over the head with social inequality. But in doing so, he exposed you to some human truths which, if you had patience and tolerance, you might glimpse. Dreiser’s prose contained many of these truths, and Professor X had slipped them into some of his teachings so casually that I might have missed them. I didn’t miss them, partly because they demand to be contemplated in all of their sad and sobering veracity. I later bought an out of print copy of Dreiser’s poetry, and was again transfixed. His short poems were raw, honest and arresting. I am forever grateful to Professor X for the gift of Dreiser. As it turns out, Dreiser had a bit of forensic psychiatrist in him. One of his most famous novels An American Tragedy, was based on the notorious Gillette murder case of 1906, which grabbed national attention just as the Scott Peterson case did in 2005. In preparing to write his novel, Dreiser researched the Gillette case extensively.

The Gillette case bears striking similarities to the Peterson case: Chester Gillette was convicted of murdering his pregnant, 20 year old girlfriend, Grace Brown. The murder trial drew international attention, particularly after Brown’s poignant love letters to Gillette were read in court. Gillette was convicted of the murder, and executed by electric chair at Auburn prison in NY. Dreiser’s adaptation was a novel of naturalism that presented a man struggling against psychological, social and environmental forces. It dealt with subjects most found too uncomfortable to consider at length, such as abortion and capital punishment. Through his novel, Dreiser dared to shine a light on a darker side of the Horatio Alger myth – a side that revealed a national obsession with social and economic “climbing” which promoted greed, selfish ambition and inequality.

In a sense, An American Tragedy is an unflinching examination of the dark side of desire and ambition.[i] In it, as in all of his work, Dreiser tells us not to turn away from parts of the human psyche that we would rather not see. Stand in awe if you must, says Dreiser, but don’t dare turn away. As a naturalist writer, Dreiser always tried to present life exactly as it is, without sermonizing or judgment. In this respect, naturalism overlaps with forensic psychiatric principles. A naturalist writer tries to be objective and detached, while realizing that “pure” objectivity is but an ideal, and next to impossible to achieve.[ii] To the well grounded forensic psychiatrist, this should sound familiar.

I believe that the instincts compelling me to remain open-minded to the example of Professor X were among the same that led me to a career in forensic psychiatry. I now recognize those instincts as: a desire to face and not turn away from the objectionable, and a need to explore the human condition. Why repeatedly and daily bring oneself into contact with the “gritty,” tragic aspects of life unless, among other things, you are in search of some truths? Certainly, some might point to the voyeuristic gratification, which in itself lies a truth of sorts. But voyeurism alone cannot be the answer. It is insufficient to sustain more than mere episodic visitation to the lands of human tragedy. “And what of masochism?” some might ask. Let us temporarily allay this issue by noting that psychiatry is not the only medical discipline who must reckon with this line of inquiry. Further, medicine has a long tradition of making discoveries by examining biological processes that are dysfunctional, or otherwise in extremis. This was how we learned what we needed to in order to defend against disease and suffering. It also how we comforted ourselves – by giving ourselves the illusion of victory over death.

We have a desperate need to deny the reality of death. Throughout the life span, the giving over of one’s cultural values, ideals and sense of meaning is, in essence, a masking over of anxiety about death.[iii] It is no easy task to acknowledge and live with “the full extent” of one’s helplessness and “insignificance in the machinery of the universe.”[iv] But after a point, the flight from reality may become devoid of inwardness and filled with “certainty” in an attempt to avoid tragic reasoning and knowledge.

Tragic reasoning is “the ability to preserve those facts we are reluctant to confront because of the pain they involve and connect them with other facts that escape detection because they would extend and magnify that pain.”[v] Tragic reasoning exposes the fraud of all ideologies and guarantees. It challenges all our ways of knowing and of being. It enables one to glimpse the cruelty and destruction that is in our nature – our heritage from the ancestral struggles of our evolution. The importance of the tragic is that it gives life one of the very few meanings we can discern when we step outside of our own imposed system of guarantees. It is our point of unity: “The tragic is the situation that all subjects face insofar as they are subjects.”[vi] For it is the fact that we can die from within that makes us human, and life can only be lived by internalizing “death so deeply that it becomes not that thing that will happen at some distant point in the future nor that intrusive thing we spend most of our lives forcing out of our consciousness, but that finality that must enter into and transform all of our choices in a way that fully delivers us over to our finitude.”4

Certain aspects of my travails in forensic and correctional psychiatry have always seemed to taunt and mock with the question: “Can you find the beauty in absolute ugliness?” Poetry and writing became one of my attempts to answer this question. I must concede that there have been occasions in which, try as I might, there was no beauty to be found. Still, Dreiser’s message was there for me – “Don’t turn away. Don’t you dare turn away…” And perhaps it is simply in the act of bearing witness where the beauty may be found.

“We toil so much, we dream so richly, we hasten so fast, and, lo! The green door is opened. We are through it, and its grassy surface has sealed us forever from all which apparently we so much crave—even as, breathlessly, we are still running.”1

References:

[i] Dreiser T: W.L.S. In: Twelve Men. 1919. At: http://www.gutenberg.org/files/14717/14717-h/14717-h.htm#WLS
[i] Lingeman R: Introduction to: An American Tragedy by Theodore Dreiser. New York, NY: Signet Classic, 2000.
[ii] Cummings M: Plot summary for An American Tragedy: Study guide. At: http://www.cummingsstudyguides.net/Guides4/Dreiser.html#Top accessed on: 9/14/2008
[iii] Becker E: The Denial of Death. New York: Free Press, 1973.
[iv] Freud S: The Future of an Illusion. J. Strachey, Ed.; New York, NY: W.W. Norton & Company, 1961.
[v] Davis W: An Evening With JonBenet Ramsey. Lincoln, NE: Authors Choice Press, 2003.
[vi] Davis W: Death’s Dream Kingdom: The American Psyche Since 9-11. Ann Arbor, MI: Pluto Press, 2006.

Lifers & the Meaning of Life

2009-02-26T16:56:00.000-08:00

“He who has a why to live for can bear almost any how.”

- Nietzsche (Twilight of the Idols)[i]

“For the mind is its own place, and can make a hell of heaven, or a heaven of hell.”

- Milton (Paradise Lost)

The process of adapting to prison life, or prisonization, has been described as exerting a dehumanizing effect that may result in feelings of hopelessness and alienation.[i] The psychological effects of prison are believed to vary according to the individual. However, it is within the context of imposed institutionalization that the inmate is vulnerable to the development of harmful attitudes such as a negative self-concept, devaluation of life and other generally destructive cognitions. It might be hypothesized that inmates serving life sentences (“lifers”) spend the longest time in prison, and would therefore undergo the greatest degree of prisonization. Whether the life sentence results in an attitude characterized by nihilism or adaptation is unknown at present; however, one could speculate that an individual’s pre-incarceration coping skills and overall constitution play a role.

Persons serving true life sentences (life without the possibility of parole) are a group of individuals living under a unique set of circumstances. Lifers must somehow adapt to the reality that there will be no future release date to sustain hope or a sense of purpose. Because they have been subject to an extreme form of permanent social exclusion, one might speculate that they would have an increased degree of hostility, mistrust, and nihilistic attitudes. However, correctional staff can attest to the fact that this is not always the case. Lifers often have the regard of their fellow inmates, and may be respected for having met the challenge of surviving in prison. Veteran correctional authorities note that some lifers “seem to mature into acceptance of their situation. Many take on a leadership role, setting a positive example…for other inmates.”[i]

To be sure, lifers are also in a position to use prestige and a “nothing to lose” attitude to control and/or manipulate other inmates in less than helpful ways. I will not be so naïve as to ignore my experience that some true lifers with nothing to lose may act as so-called “shot-callers” of inmate gangs. The existence of organized crime in corrections is an unsettled and unsettling dilemma. In fact, U.S. attorneys have had to prosecute leaders and members of highly sophisticated organized crime syndicates operating out of the nation’s prisons. Aryan Brotherhood gang members have been convicted of running an extensive criminal enterprise from behind bars that involved murder, narcotics trafficking and conspiracy in an effort to rule the nation's prisons.[ii] In some worst case scenarios, incarcerated gang leaders have ordered the murders of individuals living in the community. In a study of offending during incarceration, it was found that 40% of inmates were “chronic or extreme career offenders even while incarcerated.”[iii] Further, a small cadre of inmates accounted for 100% of the murders, and 75% of the rapes in prison.

These individuals, by and large, would appear to be fundamentally different from the rest of the prison population. Sure, there will be some overlap. But in general they are different – different from inmates with severe mental illness, and different from non-mentally ill inmates who have a desire to rehabilitate themselves. Further, their impact on the correctional environment, and what is left of rehabilitation, can be substantially damaging. Besides creating a climate of fear which undermines rehabilitative efforts, there is the issue of abusing vulnerable, mentally ill inmates. Psychiatric hospitalizations may be directly precipitated by such abuse. Other very sad cases involve impressionable or otherwise vulnerable mentally ill inmates being “recruited” into gangs so that they might serve as pawns for a gang’s strategic maneuvering. I could go on, but you get the point – these are drastically different populations of individuals, and it is not clear that intermingling them serves a legitimate penological interest, ethical or humanitarian interest.

But let me assure that there are, in fact, a good many lifers with a more pro-social, positive disposition. Little is known about the psychological structure or psychiatric morbidity of lifers from a research standpoint. Even less is known about effective treatment or programming approaches to lifers who struggle emotionally and are otherwise unsuccessful in finding purpose to their “new life” in prison. Why one lifer chooses a more positive path and another a more negative one is interesting to consider. My primary interest in lifers has stemmed from personal observations that life meaning and/or purpose in life appears to influence inmates’ coping styles and, in some cases, their risk of suicide. This interest next led me to the writings of Viktor Frankl who was the first psychiatrist to emphasize the importance of studying meaning in life within a psychological context.[iv] Frankl’s experience as a Nazi concentration camp prisoner led him to conclude that a primary motivation for humans is a “will to meaning,” or a drive to find meaning and purpose in life. A failure to find meaning and purpose may result in feelings of hopelessness, suicidality[v] and other self-defeating actions.

Based on the work of Frankl, the Purpose-in-Life (PIL) Test was constructed to assess or quantify the construct of meaning in life.[vi] Surprisingly, there is little research on this subject as it relates to prison inmates. What research does exist was done primarily in the 1970’s, and much about the correctional landscape has changed since. A 1973 study found that recidivists scored significantly lower on the PIL than did first sentence prisoners who, in turn, scored significantly lower than normal controls.[vii] In a 1977 study, inmates (who were not serving life sentences) were found to have scored significantly lower than normal subjects on meaning and purpose in life.[viii] Subsequent research has found an association between the development of substance abuse problems and a lack of purpose or meaning in life.[ix]

One might speculate that the current abandonment of rehabilitative programming in corrections has only served to further re-enforce the inmate’s diminished sense of self-worth and personal value. Ultimately, feelings of diminished personal worth lead to a questioning of purpose. I have observed that once an inmate reaches some individualized level of nihilism, he demonstrates a greatly reduced ability to participate in and benefit from rehabilitative and treatment efforts (ie., no meaning = no purpose or reason to change). In addition, when an inmate has strong nihilistic beliefs, there is often little motivation to self-regulate behavior.

These empirical observations of the adverse effects of nihilistic beliefs in inmates are consistent with research findings in non-incarcerated populations. For example, social rejection has been found to increase feelings of meaninglessness, and decrease self-awareness and the ability to self-regulate behavior,[x], [xi] and ultimately to suicide and/or self-destructive behaviors.[xii] This theory has been called the “escape theory” to denote the individual’s motivation to escape from aversive self-awareness. The “escape” theory may have relevance to the psychology of inmates, particularly where the inescapable structure and discipline of a prison reduces their ability to use prior maladaptive coping mechanisms to avoid aversive affect and self-awareness.

What Frankl called the “will to meaning” is a highly personal and individual endeavor. Achieving happiness through one’s life purpose often involves an outward focus – that is, it is “other” directed. Admittedly, prison life appears to do little to encourage outward focus, especially in terms of healthy social and societal alliance building. Yet it is precisely through such “other” directed engagement that the stagnating bonds of self-absorption can be loosened, and toxic feelings of societal “persecution” can be overcome. One may wonder if ignoring the opportunity to emphasize life meaning and “other” directed interests may simply foster some inmates’ tendency to go into a “behavioral deep freeze” where misbehavior is reduced during the prison term, only to reemerge in society after release.[xiii]

References

[i] Nietzsche F: The Portable Nietzsche (W. Kaufmann, Ed.). Maxim no. 12 in Twilight of the Idols, p. 468; New York, NY: Penguin Books, 1982.

[i] Stinchcomb J: Corrections: Past, present and future. American Correctional Association, 2005; Versa Press, East Peoria, IL.

[i] Bruton J: The Big House: Life Inside a Supermax Security Prison. 2004; pg. 157. Voyageur Press; Stillwater, MN.
[ii] Richards T.: Aryan Brotherhood Leaders Are Convicted in Murders. The New York Times, July 29, 2006.
[iii] DeLisi M.: Criminal Careers Behind Bars. Beh Sci Law 2003 21: 653-669.
[iv] Frankl V: Man’s Search for Meaning. 1959; Boston, MA. Beacon Press.
[v] Edwards M, Holden R: Coping, Meaning in Life, and Suicidal Manifestations: Examining Gender Differences. Journal of Clinical Psychology, 2001; 57(12): 1517-1534.
[vi] Crumbaugh J, Maholick L: Manual for Instructions for the Purpose-in-Life Test, 1969; Munster: Psychometric Affiliates.
[vii] Black W, Gregson R: Time perspective, purpose in life, extraversion and neuroticism in New Zealand prisoners. British Journal of Social and Clinical Psychology, 1973; 12:50-60.
[viii] Reker G: The Purpose-in-Life Test in an Inmate Population: An Empirical Investigation. Journal of Clinical Psychology, 1977; 33(3): 688-693.
[ix] Waisberg J, Porter J: Purpose in life and outcome of treatment for alcohol dependence. British Journal of Clinical Psychology, 1994; 33: 49-63.
[x] Twenge J, Catanese K, Baumeister R: Social Exclusion and the Deconstructed State: Time Perception, Meaninglessness, Lethargy, Lack of Emotion, and Self-Awareness. Journal of Personality and Social Psychology, 2005; 85(3): 409-423.
[xi] Baumeister R, et al. Social Exclusion Impairs Self-Regulation. Journal of Personality and Social Psychology, 2005; 88(4): 589-604.
[xii] Baumeister R: Suicide as Escape From Self. Psychological Review, 1990; 97(1): 90-113.

[xiii] Bruton J: The Big House: Life Inside a Supermax Security Prison. 2004; pg. 157. Voyageur Press; Stillwater, MN.

"I've seen things.... you humans wouldn't believe." (from Blade Runner)

2009-01-27T07:31:00.000-08:00

Super-Panopticons & the Surveillant Assemblage

2009-01-27T07:02:00.000-08:00

“Quis custodiet ipsos custodes?” (But who will watch the watchmen?)[i]

- Juvenal

Each time humanity explores new territory, encounters change, or makes a significant step forward in terms of technology, the questions fearfully and immediately arise: What will be the power structure? How will control be assured? Can instinctual impulses be contained? This would suggest a fear that powerful instinctual impulses will run amok in new and unfamiliar terrain – a frightening prospect that threatens a “return” to our primeval past. And now consider the notion that we are on the verge of “globalization,” with all of the limitless potential and uncertainty that this entails. Who will be at the top of the power hierarchy? Will China or India surpass the global dominance of the U.S?[i] What will this mean for the future?

Subsequent to 9/11, fear of terrorist attacks have swept the globe, leading to an emphasis on improved “intelligence” efforts. Such intelligence comes from a multitude of rhyzomatic networks of surveillance assisted by orbital panopticons (satellite surveillance) on high alert. Our drive for surveillance has most certainly followed us out into space, where we fear that unlimited consumption and satisfaction of needs will lead to a new brand of “cosmic narcissism.”[ii] By use of surveillance satellites, we have replaced God in the Heavens with an “eye in the sky.”[iii] For those requiring an angry, vengeful deity, they may be comforted by the presence of weapons poised at the ready in “Star Wars” satellite defense systems. In the future, the U.S. may suspend tungsten rods (hailed as “rods from God”) from satellites that can be dropped with pinpoint accuracy to destroy underground nuclear facilities.[iv] Thus, the pattern of sending forth various forms of super ego-like monitoring invariably usher in each new stage of human advancement. From Bentham’s Panopticon to today’s nanotechnology and planetary panopticons, we must carefully “supervise” each new step with a vigilant gaze.

As technology has advanced, it is becoming apparent that the observation will not be centralized as with Bentham’s panopticon, but will be decentralized and spread out diffusely through a variety of technologies. For example, nano-technology may provide various invisible tags embedded into clothing, radio frequency identity chips (RFIDs) and other means of surrounding ourselves with ambient intelligence.[i] This “nano-panopticism” would stretch the web of societal surveillance to new and undreamt of lengths. At some point, one must consider the bewildering implications of the convergence of all the various forms of surveillance technology, which may have the effect of producing a “surveillant assemblage” with the potential to reassemble information flow into virtual “data doubles” of the individual.[ii] Such data doubles can be effectively scrutinized and targeted for select purposes. One has only to purchase a book on Amazon.com to experience this reality. A return to the website will offer a list of recommended books, based on past purchases, which becomes ever more refined as more purchases are made. Thus, a “general tide of surveillance washes over us all,” and has the effect of “transforming” humans into “pure information” which is easier to manage.[iii]

Will it ultimately be the technology of surveillance that is responsible for societal morality as opposed to religion? Will “divine command theory” give way to soul training via surveillance? Consider a case (Kyllo v. U.S.) in which remote sensing techniques allowed law enforcement to detect cannabis growing in a defendant’s home.[iv] Already, the FBI and other forms of law enforcement tap into and commingle various independent, and often commercial databases. The Patriot Act has further enhanced law enforcement authority to procure private, commercial data. Advancing surveillance technology has led to a “disappearance of disappearance,” in which it is increasingly impossible to maintain anonymity and escape monitoring.[v] Financial institutions now monitor and report “suspicious transactions.” Indeed, this data source was the very undoing of former NY Governor Eliot Spitzer, whose own bank was required to report his “suspicious financial activity” to the IRS.[vi] At least it would seem that with this new brand of surveillance-enforced morality, leaders and others at the top of the hierarchy are not exempt – as long as they too are being watched.

In forensic psychiatry, I have been introduced to the power of surveillance technology in its many forms. There is a forensic principle which states, “Wherever he steps, whatever he touches, whatever he leaves, even unconsciously, will serve as a silent witness against him…”[vii] In effect, the criminal cannot commit a crime without either leaving a piece of himself, or taking a piece of the crime scene with him. As surveillance technology advances, this “exchange principle” only gains in its momentum. Criminal suspects are frequently caught by simply following the trail of their credit purchases. I now receive reams of archived text messages, forever retrievable, sent by a criminal defendant around the time of the alleged offense. Surveillance cameras posted in stores and city streets capture the exact date, time and movements of a suspect. Insurance companies regularly hire private detectives to surreptitiously video plaintiffs alleging disabilities.

Of course not every advancement in surveillance technology will seem immediately problematic, and many will appear quite helpful. Planetary panopticons powered by supercomputers will be able to provide more accurate and timely warnings about natural disasters or global warming.[viii] We will be able to monitor our home planet in a more “protective” and altruistic manner. Yet there will certainly be concern that the evolving surveillance technology may be used in unanticipated ways that present serious privacy issues. Indeed, the very notion and boundaries of privacy will, of necessity, evolve. We have already born witness to this with the Internet, as well as patient confidentiality in medicine. Such advances may have the effect of limiting one’s “moral autonomy,” and compromising one’s freedom to present her own self-selected “moral identity.”[ix] Thus, privacy concerns may shift from constraining information flow, to the design and use of continuous surveillance technology.

[i] Juvenal: Satire VI. Loeb Classical Library edition translated by G.G. Ramsay. At: http://www.fordham.edu/halsall/ancient/juvenal-satvi.html (accessed: 5/13/08).
[i] Buruma I: After America: Is the West being overtaken by the rest? The New Yorker. April 21, 2008, pps. 126-130.
[ii] Dickens P, Ormrod J: Outer Space and Internal Nature: Towards a Sociology of the Universe. Sociology, 2007; 41(4): 609-626.
[iii] Weiner T: Pentagon Envisioning a Costly Internet for War. New York Times, November 13, 2004.
[iv] Shainin J: Rods From God. New York Times, December 10, 2006.

[i] Van Den Hoven J, Vermaas P: Nano-Technology and Privacy: On Continuous Surveillance Outside the Panopticon. J Medicine and Phil, 2007; 32: 283-297.
[ii] Haggerty K, Ericson R: The surveillant assemblage. Br Journ Sociology, 2000; 51(4): 605-622.
[iii] Haggerty K, Ericson R: The surveillant assemblage. Br Journ Sociology, 2000; 51(4): 605-622.
[iv] Kyllo v. U. S., 533 US 27 (2001)
[v] Haggerty K, Ericson R: The surveillant assemblage. Br Journ Sociology, 2000; 51(4): 605-622.
[vi] Ross B: It wasn’t the sex: Suspicous $$ transfers led to Spitzer. ABC News. March 10, 2008. At: http://abcnews.go.com/Blotter/story?id=4424507&page=1 Accessed: 5/17/2008
[vii] Locard’s Exchange Principle. Professor Edmond Locard
[viii] Butler D: The Planetary Panopticon. Nature, 2007; 450(6): 778-780.
[ix] Van Den Hoven J, Vermaas P: Nano-Technology and Privacy: On Continuous Surveillance Outside the Panopticon. J Medicine and Phil, 2007; 32: 283-297.

Gaze Symbology

2009-01-27T06:59:00.000-08:00

It is, in fact, the eye which allows for the greatest extension of man’s conscious awareness. With it, he could contemplate the various constellations, and more recently, the physical nature of the universe. Reaching back some 5, 000 years, the symbology of the eye can be found in the Egyptian myth of the Horus-Osiris cycle, where the “eye of Horus” was a ubiquitous talisman of great significance. This myth of death and “rebirth” helped sustain the rule of the Pharaohs for some 3, 000 years, and is believed to have inspired the construction of the great pyramids.

Therefore, we will not be surprised that this myth can be described as a metaphor for the ancient struggle to master death, transcend separation, and master the dangerous aspects of human nature.[i] It has been noted that the word for the eye of Horus – Wedjat – is considered feminine, and eye contact has also been linked to the theme of separation – individuation and object constancy.[ii] (See figure 3) Thus, eye contact can be understood as instrumental for bonding with others. This may help explain an additional meaning (besides castration) of the Oedipus self-enucleation myth – Oedipus’ desire to renounce his capacity for bonding. The psychiatric literature reflects that ocular self-injury is fortunately rare, and often associated with command auditory hallucinations, severe psychosis, religious and sexually-related delusions.[iii], [iv] In addition to the hypothesis about symbolic castration, the eye may also represent a condensation of the entire self.[v] In this sense, self-enucleation may be considered a form of suicide by proxy.

[i] Whitehead C: The Horus-Osiris Cycle: A Psychoanalytic Investigation. Int Rev Psycho-anal, 1986; 13: 77-87.
[ii] Mahler M: The Psychological Birth of the Human Infant. New York: Basic Books, 1975.
[iii] Brown R, Al-Bachari M, Kambhampati K: Self-inflicted eye injuries. Br J Opthal, 1991; 75: 496-498.
[iv] Field H, Waldfogel S: Severe Ocular Self-Injury. Gen Hosp Psychiatry, 1995; 17: 224-227.
[v] Menninger K: Man Against Himself. New York: Harcourt Brace and World, 1938.

The Necessity of Gaze: Development, Comfort, Orientation

2009-01-27T06:29:00.000-08:00

"Mother is the name for God in the lips and hearts of little children."

- William Makepeace Thackeray

“As one whom his mother comforts, so I (God) will comfort you”

- Isaiah 66:13

Recent neuroscience and psychological research focusing on the maternal-infant dyad has revealed important developmental changes, most of which occur during the infant’s first two years of life. These changes are critical to the infant’s healthy development and future mental health, and rely heavily on the mother’s attentive gaze. Research in this area has painted a picture of human infants as innate contingency detectors that rely on the mother to help order and process their environment.[i], [ii] The subtleties of maternal-infant interactions, many of which rely on eye contact, are believed to modulate critical functions such as the infant’s neuroendocrine responses, social orientation, and management of dysphoric affect.[iii], [iv], [v]

Infants as young as 3 and ½ months are able to recognize different emotional expressions, and show a distinct preference for the face and gaze of their own mother.[vi] It could be said that we come into the world with a predetermined gaze “hunger” which we require to orient and prepare ourselves for life on the planet. Though research in the area is still in the early stages, it is interesting to contrast developmental differences between sighted and congenitally blind children. These early studies have suggested that there may be a difference in terms of the congenitally blind children’s attribution of symbolic meanings during play therapy.[vii] In terms of social-relatedness, autistic-like social deficits have been described in congenitally blind children.[viii]

When the vital importance of the gaze and its functioning organ, the eye, are properly recognized, it is of little wonder that we find it given a prominent place mythology and symbology. Metaphors for the divine invariably use descriptions of “gazing upward.” Vertical gaze positions are invoked when people access divinity-related cognitions, and the opposite is true for Devil-like images.[ix] Thus, looking “up” connotes with power, while looking “down” suggests powerlessness.[x] Looking back over the millennia, the eye and ocular surface has frequently been used to symbolize Gods, emission of influence, and reception of knowledge.[xi] The “all seeing” eye of God may be likened to the scrutinizing super ego which transcends mortality.

[i] Fonagy P, Gergely G, Target M: The parent-infant dyad and the construction of the subjective self. J Child Psychol Psychiatry, 2007; 48(3-4):288-328
[ii] Joseph R: Environmental influences on neural plasticity, the limbic system, emotional development and attachment: a review. Child Psychiatry Hum Dev, 1999; 29(3):189-208.
[iii] Swain J, Lorberbaum J, Kose S, Strathearn L: Brain basis of early parent-infant interactions: psychology, physiology, and in vivo functional neuroimaging studies. J Child Psychol Psychiatry, 2007; 48(3-4):262-87
[iv]Feldman R: Parent-infant synchrony and the construction of shared timing; physiological precursors, developmental outcomes, and risk conditions. J Child Psychol Psychiatry, 2007; 48(3-4):329-54
[v] Feldman R, Eidelman A: Maternal postpartum behavior and the emergence of infant-mother and infant-father synchrony in preterm and full-term infants: the role of neonatal vagal tone. Dev Psychobiol, 2007; 49(3):290-302.
[vi] Kahana-Kalman R, Walker-Andrews A: The role of person familiarity in young infants' perception of emotional expressions. Child Dev, 2001; 72(2):352-69
[vii] Bishop M, Hobson R, Lee A: Symbolic play in congenitally blind children. Dev Psychopathol, 2005;17(2):447-65.
[viii] Hobson R, Bishop M: The pathogenesis of autism: insights from congenital blindness. Philos Trans R Soc Lond B Biol Sci, 2003; 358(1430):335-44
[ix] Meier B, Hauser D, Robinson M, Friesen C, Schjeldahl K: What’s “Up” With God? Vertical Space as a Representation of the Divine. J Pers and Social Psychol, 2007; 93(5): 699-710.
[x] Schubert T: Your highness: Vertical positions as perceptual symbols of power. J Pers and Social Psychol, 2005; 89: 1-21.
[xi] Murube J: The Ocular Surface and Its Symbolism. The Ocular Surface, 2007; 5(1): 6-12

Justice as Compromise Formation

2009-01-26T12:34:00.000-08:00

“Injustice is relatively easy to bear; what stings is justice.”

-H.L. Mencken (1880-1956)

“Nobody wants justice.”

-Alan Dershowitz

Justice refers to the proper or fair ordering of things and persons within a society. Another meaning involves conformity to truth, fact, or reason. In describing justice Socrates used an allegory about a ship:

"The unjust city is like a ship, crewed by a powerful but drunken captain, a group of untrustworthy advisors, and a navigator who is the only one who knows how to get the ship to port. The only way the ship will reach its destination – ie., the good or the just – is if the navigator takes charge."

In the statue of Lady Justice – we notice “evil” - in the archetypal form of a snake - is being held to the "letter of the law" (a legal book of societal laws). Justice is "blind" to all but the proper balance. This is the criminal justice view.

As with any great metaphor, there are alternate views. Another view – for those psychologically inclined – is to see the snake as humanity’s unrestrained instinctual impulses, its natural passions. This raw, animalistic desire is restrained against and by man’s rules and regulations. In other words, his morality, or super-ego - the term Freud used to describe man's internalized conscience. Justice, here, is overseeing this operation - but note carefully that she has given up some freedom in doing so.

She no longer has a true free range of movement – she has made a compromise, which is essentially what life in free society requires. In fact, her compromise formation has left her in a potentially dangerous situation. Should she ever become weary or distracted, and let up on her foot, the backlash will be quite unpleasant. She is, in a sense, a prisoner to humanity’s passions, just as so many criminal offenders are prisoners of their own passions and egoic dysfunction.

In the criminal justice system, as in psychiatry/psychology, it is extremely difficult to confront strong egoic dysfunction and remain objective. The "evil" (ie., selfish) deeds of man’s false sense of self scream out for a dramatic reaction, and our own egos are eager and hungry to comply.

The inescapable and recurring formula of the compromise formation was beautifully illustrated by Nietzsche ("But the knot of causes in which I am entangled recurs, and will create me again"), and was later expanded upon by Freud in his writings about the "repetition compulsion."

Wo Es War: Control & Surveillance as Foundation

“Man is born free; and everywhere he is in chains.”[i]

- Jean Jacques Rousseau

That absolute or “total” freedom is incompatible with sustained life is difficult to refute. Rather, this fantasy harkens back to a form of infantile omnipotence and narcissism only viable for a very brief, early period in human life. The study of childhood development has long held that “the child is born feeling omnipotent and only gradually and reluctantly…turns to and accepts reality” sometime by the first 18 months of life.[ii] Thus, life turns toward a process of compromise, and the exertion of whatever control is feasible. The energy of the id, or instinctual impulse, must be harnessed, monitored and controlled by the super ego. Concomitant with the introjection of parental limits, the super ego retains other model features such as the parent’s “severity, [and their] inclination to supervise and punish (p. 167).”[iii] This internalized model then serves as a template for “the endeavors of the ego,” becoming a source of man’s ethics and morality.

These “structures” of the mind are seldom distinguishable until situations of conflict arise.[iv] While man’s ego is greatly concerned with organization and consistency, the id will have little concern with the environment or logical cause and effect. Therefore, the ego must “bring the influence of the external world to bear upon the id.... For the ego, perception plays the part which in the id falls to the drives p. 25).”[v] Thus, the ego has reason to “keep an eye on” the id’s drive for gratification, which has little regard for the limitations or consequences of external reality.[vi] Efforts to strike some acceptable balance require a “compromise.”

It has been noted that this pattern of internal mental surveillance is “the result of a long and painful development over the course of millennia, a development that must be transmitted anew to each new member of society.”[vii] Wherever man’s quests have taken him, he has required efforts to “oversee” his impulses – or, as Freud famously put it: “Wo Es war soll Ich warden” (Where the id was, the ego shall be).

Freud believed that civilization mirrored the individual in terms of super-ego development. Powerful leaders and iconic tales of heroism left an “impression” behind that molded and reinforced the ethical systems of an epoch.[viii] From a cultural perspective, one may think of “ethics” as a command of the extant super-ego of a civilization. Yet similar to the impossible demands of the individual super-ego, cultural ethics has always pressed for “something which has so far not been achieved by means of any other cultural activities (p.90).”[ix]

Ethical systems, like an individual’s super-ego, make unrealistic demands that will have no truck with either reality’s demands or the id’s unrelenting instinctual drives. The impasse, essentially life against instinctual, self-preservation and aggression, led Freud to consider it “the fateful question for the human species,” – the successful outcome depending entirely upon cultural development (p.92).[x] But what kind of cultural development may be required? An ethic of internal virtue for virtue’s sake, or one built upon the scaffolding of a "prosthetic" super-ego? Of course, here I am speaking of society's increasing use of surveillance. The prospect of man's "soul training" via surveillance will be the topic of my next esssay.

[i] Rousseau J: The Social Contract. 1762, Translated by G. D. H. Cole, public domain. At: http://www.constitution.org/jjr/socon.txt Accessed on: 5/12/2008
[ii] Novick J, Novick K: Some Comments on Masochism and the Delusion of Omnipotence from a Developmental Perspective. Journal of the American Psychoanalytic Association, 1991; 39:307-331
[iii] Freud S: The Economic Problem of Masochism. In: The Collected Works of Sigmund Freud.
[iv] Freud A: The Ego and the Mechanisms of Defence. New York: International Universities Press, 1966.
[v]Freud S: The ego and the id (1923). Standard Edition, 19:1-60. London: Hogarth Press, 1961.
[vi] Brenner C: The Mind as Conflict and Compromise Formation. At: http://users.rcn.com/brill/egoid.html#freud3 (accessed: 3/29/2008)
[vii] Brenner C: The Mind as Conflict and Compromise Formation. At: http://users.rcn.com/brill/egoid.html#freud3 (accessed: 3/29/2008)
[viii] Freud S: Civilization and its Discontents. New York: W.W. Norton & Company, Inc., 1961.
[ix] Freud S: Civilization and its Discontents. New York: W.W. Norton & Company, Inc., 1961.
[x] Freud S: Civilization and its Discontents. New York: W.W. Norton & Company, Inc., 1961.

References

[i] Nietzsche F. Thus Spake Zarathustra. In: Kaufman, W ed. The Portable Nietzche. New York, NY: Viking Penguin Books, 1982, p. 333.

Overdosing on Reality

2009-01-23T18:52:00.000-08:00

"Life - Death - Time"

The Human Condition

1. Life is suffering.
2. We create our own tragedies
3. It is really selfishness that is at the heart of what we label “evil”
4. Many life problems are due to an inability to take responsibility. Can all this ultimately be boiled down to impatience? (Kafka)
5. "We are descended from an endlessly long chain of generations of murderers, whose love of murder was in their blood as it is perhaps also in ours." (Freud)
6. "We are threatened with suffering from three directions: from our own body, which is doomed to decay and dissolution and which cannot even do without pain and anxiety as warning signals; from the external world, which may rage against us with overwhelming and merciless forces of destruction; and finally from our relations to other men. The suffering which comes from this last source is perhaps more painful than any other." (Freud from Civilization and Its Discontents, chapter 2, 1930)
7. What we don’t know about ourselves, we do – to the other. (Walter Davis)
8. No one knows the true “meaning” of life or the “purpose” of the universe. Anyone who claims to is lying, mistaken or deluded.
9. Our own self-awareness dooms and condemns us.
10. Every single one of us is flawed to the core.
11. In the evolution of human consciousness, death is the root fear - the lowest common denominator driving human pretensions to happiness and causing most all suffering.
12. This fear of death is actually the ego’s fear of annihilation, and desire to transcend the boundaries of reality. (Ernest Becker)
13. The ego’s fear of annihilation leads to immortality projects that promise to sustain it. The ego does this by creating the illusion that there is a “self” that can sustain itself, become “permanent,” and control reality.
14. Most objects, goals, pursuits in life are ultimately a “fetish.” In other words, a distraction from reality.
15. Each individual must find for him or herself their own "sweet spot" - the perfect balance of undistorted awareness of reality, and (mature) defense mechanisms that allow the individual to function in a healthy way and derive an acceptable level of enjoyment from life.

A Forensic Look at Resilience

2009-01-21T13:49:00.000-08:00

It is, alas, chiefly the evil emotions that are able to leave their photographs on surrounding scenes and objects. And whoever heard of a place haunted by a noble deed, or of beautiful and lovely ghosts revisiting the glimpses of the moon?

- Algernon H. Blackwood

Barn’s burnt down –
Now
I can see the moon.

- Masahide (c. 1688 Samurai)[i]

In forensic psychiatry, one is heavily exposed to the more traumatic and tragic aspects of the human condition. Very often, the deed has been done and there is no turning back. The tragic has unfolded, and one is left only to perform a retrospective analysis of how it could have happened. On rare occasion, one might have a chance to witness a fellow human being demonstrate amazing resilience, and thereby achieve a triumph of human spirit. In this sense, a triumph of the human spirit is less about external outcomes than it is about an internal experience. In terms of mental health, resilience is the capacity to cope with stress, trauma and tragedy. In other words, to be resilient is to bend rather than break – and to be made somehow stronger and more flexible by the process. This sentiment was put most clearly over 2, 500 years ago by Lao Tzu in the Tao Te Ching: “The hard and inflexible are friends of death. The soft and yielding are friends of life.”[i]

Because of psychiatry’s necessary focus on the psychopathology and symptoms of trauma, it has been only recently that phenomena such as resilience have been studied. In the past, resilience was largely thought to occur only rarely, yet more recent research suggests that it is actually a common reaction among (healthy) adults exposed to serious trauma. Such resilience has been associated with an enduring capacity for positive emotion and generative experiences. Interestingly, there does not appear to be a single “resilient type” person. Instead, there are likely multiple and unexpected ways for survivors to be resilient.[ii] Indeed, resilient coping appears to be multifaceted, relying on many variables such as personality, affect regulation, coping, ego defenses, and various other protective factors.[iii]

As a result of large-scale tragedies over the last decade, the field of traumatology has grown rapidly. Posttraumatic Stress Disorder and depression were frequently observed in the aftermath of the September 11, 2001 attacks.[iv] Yet, the research on resilience following the 9-11 attacks remains relatively sparse. Available research does suggest that resilience may be more prevalent than previously believed. In a study examining the prevalence of resilience (defined as having either no PTSD symptoms or one symptom) among 2,752 New York area residents during the six months following the 9-11 terrorist attack, resilience was observed in over half (65.1%) of subjects.[v]

How do resilient people adapt and/or change their worldview to cope? The early research seems to suggest that after a major trauma, people's belief systems are impacted and may be modified. For example, they may experience changes to their view of the world “as they knew it,” their views on human nature, spirituality, and their own identity. Certainly, a grief and recovery process is a necessity, but many will still need to assimilate or accommodate new values.[vi] In essence, it appears as though the resilient survivor copes, in part, by developing new values and beliefs in order to achieve an emotional equipoise. Resilient persons may also find a way to turn the trauma into a “psychic reorganizer,” whereby the trauma becomes the stimulus and opportunity for positive change.

This November 18th will be the 30-year anniversary of the Jonestown tragedy which occurred deep in the jungle of Guyana on November 18, 1978. After California Congressman Leo Ryan visited Jonestown on a fact-finding mission, a volatile situation that had been building finally exploded. Ryan, three journalists and over 900 Jonestown residents were dead at the end of the day.[vii] The Jonestown (JT) tragedy has become woven into the fabric of our culture, and many misunderstandings and inaccuracies have become part of the tapestry. Perhaps the most visible parts of the tapestry are the cultural icons of “drinking the Kool Aid,” and the frightening charisma of Jim Jones. In reality, JT was not a mass suicide, but is more accurately described as a mass murder, followed by the suicides of Jim Jones and a few of his inner circle administrators. The JT mass murder-suicide was the result of a complex constellation of historical, cultural, and psychological factors that continue to haunt and perplex.

Another myth about JT was that everyone there was a “brain washed” cult member who had no will of his or her own. In reality, there were “a variety of reasons why people had joined the Peoples Temple. For some, it was a political statement; Jones offered the promise of a socialist society free of materialism and racism at a time when such a society was particularly attractive. For others, the Temple offered religion, structure, and discipline – a way to escape the violence of the ghetto and the dead end of alcohol and drugs.”[viii] Tim Carter joined the Peoples Temple in 1973. After surviving combat as a marine in the Vietnam War, he returned to America in search of greater meaning. He was driven by an internal need to become a part of something positive and greater than himself: “We shared a passionate idealism to make the world a better place…. We were a reflection of the economic and political and cultural realities and dynamics of the Civil Rights and Vietnam War generation”(p. 155).[ix]

In 2007, Mr. Carter graciously spent time with me to help me get a better understanding of the JT tragedy. He provided a true insider’s view, rich with contextual detail and heartbreaking tragedy. He gave a gripping and enlightening talk on a panel we did together at the 38th annual meeting of the American Academy of Psychiatry and the Law.[x] After meeting Mr. Carter, it became apparent to me that he was a supreme example of resilience and triumph of human spirit. I asked him to help me and other readers better understand how he was able to “bounce back” from a lifetime of trauma that would seem to have crushed most of us. His answers to my questions will be part of a forthcoming article on the subject.

[i] Stryk L: Zen Poetry: Let the Spring Breeze Enter. New York, NY: Grove Press, 1995.
[i] Lao Tzu: The Tao Te Ching. Translated by Brian Walker. New York, NY: St. Martin’s Press, 1995.
[ii] Bonanno G: Resilience in the Face of Potential Trauma. Current Directions in Psychological Science, 2005; 14(3): 135 - 138
[iii] Agaibi C, Wilson J: Trauma, PTSD and Resilience. Trauma, Violence, & Abuse, 2005; 6(3): 195-216.
[iv] Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982–987.[
[v] Bonanno G, Galea S, Bucciarelli A, Vlahov D: Psychological Resilience After Disaster: New York City in the Aftermath of the September 11th Terrorist Attack. Psychological Science, 2006; 17(3): 181-186
[vi] Jordan K: What We Learned From 9/11: A Terrorism Grief and Recovery Process Model. Brief Treatment and Crisis Intervention, 2005; 5(4):340-355.
[vii] Stephenson D: Dear People: Remembering Jonestown. Heyday Books: Berkley, Calif., 2005.
[viii] Krause C: Foreward. In: Layton, D: Seductive Poison: A Jonestown Survivor’s Story of Life and Death in the Peoples Temple. New York: Anchor Books, 1998.
[ix] Carter T: The Big Grey. In: Dear People: Remembering Jonestown (D. Stephenson, ed.). Heyday Books: Berkley, Calif., 2005.
[x] Knoll J, Carter T, Leonard C, Crowder J: Mass Murder & Mind Control: Understanding the Jonestown Tragedy. 38th annual meeting of the American Academy of Psychiatry and the Law; Miami, Florida, October 20, 2007.

Jonestown 30th Anniversary

2009-01-19T11:56:00.000-08:00

While on the subject of the tragic - we recently passed the 30th anniversary of the Jonestown Tragedy in Guyana this past 11/18/08.

For those intrested, here are two in-depth explorations of the largest ever mass murder-suicide in recent times:

The Jonestown Tragedy: What Have We Learned in 30 Years? The Jonestown Report; November 2008, volume 10.
At:
http://jonestown.sdsu.edu/AboutJonestown/JonestownReport/Volume10/Knoll1.htm

The Jonestown Tragedy as Familicide – Suicide. The Jonestown Report; November 2008, volume 10.
At: http://jonestown.sdsu.edu/AboutJonestown/JonestownReport/Volume10/Knoll2.htm

Tragic Reasoning as Ego Annihilator

2009-01-18T09:11:00.000-08:00

“The task is to bring to light what we must ever love and honor....”

- Nietzsche

Suffering, trauma and tragedy have been respected in virtually every culture for their ability to act as a gateway to rebirth in terms of the human psyche. The tragic does this primarily by allowing reality direct confrontation with the ego. The burning light of reality proceeds to evaporate large portions of the ego’s protective shell. Less ego and fewer defenses mean more reality can be perceived. Circumstances of the human condition are more clearly revealed, in all their tragic beauty. This then, is a primary goal of tragic reasoning – to allow the diminishment of the ego and its repair mechanisms. By becoming less, one becomes more – an expansion that makes room for Being to come forward.[i] One can never become entirely free of ego or the need for defenses, but often, awareness alone is enough to achieve diminishment. Initially, this diminishment may result in disillusionment, yet there also comes a loss of restrictive character armor, and a conscious choice to abide in the face of terror.

The existential hero who is able to sustain tragic reasoning gains a clearer perspective: “Instead of hiding within the illusions of character, he sees his impotence and vulnerability. …”[ii] Paradoxically, tragic reasoning brings home an important lesson. Fleeing something inevitably brings it about. Trauma makes action imperative, and so reveals its terms. In stripping away everything else, trauma delivers the subject over to a drama, the initial terms of which can be schematized as follows:

1. To be a subject is to be at issue in a conflict that is defined by a single contradiction: the area of one’s greatest concern is also the area of one’s greatest paralysis;
2. There is a destructive force in us to which we are wedded. That tie is deep and powerful. The traumatic event brings to fruition one’s inability to break it;
3. We aren’t what we know about ourselves – we’re what we do in the face of that knowledge. This is the difficult truth that now defines one’s relationship to oneself.

Tragic joy is the experience that comes to those who might sustain the integrity of this process. They know the truth: there is no exit from the tragic, only a progressively deeper entry into it. Rage has been replaced by compassion. Compassion, in contrast to pity, is that emotion that relates to others in terms of the necessity of the tragic journey, and the attempt to help them sustain it. We now know that to reverse their private hell, every suffering subject must go through the same journey. Compassion is relating to all others in terms of creating that possibility. Qua perception, it means seeing all the ways others are suffering and try to hide or flee that suffering. Qua action, it means offering them overtures to the tragic by relating to the wound in the other rather than to all things the other has become and done in order to flee it. Thus, compassion is that way of relating to others that preserves the tragic logic of change. Our own suffering opens us to the suffering in others as what must be sustained. The logic of suffering is the only logic of change capable of reversing the traumatic wounds that form the origin of the psyche.

“Hence also the torments of life become tuneful tragedy, solemn and soft with music, and garnished with rich dark pictures. But higher still than the activities of art, the intellect in its purity, and the moral sense in its purity, are not distinguished from each other, and both ravish us into a region whereinto these passionate clouds of sorrow cannot rise.”[i]

[i] http://www.emersoncentral.com/tragic.htm

[i] Tolle E: A New Earth. New York, NY: Plume, 2005.
[ii]

Immersion

2009-01-18T09:10:00.000-08:00

“In the destructive element immerse.”

- Joseph Conrad (Lord Jim)

Perhaps one of the worst things about the traumatic experience is the passivity. In comparison, all other passivities seem mild. Tragic self-overcoming begins when, in the deepest passivity, one experiences the upsurge of something that is in radical opposition to that passivity. To delve into the trauma in search of the bitterest truths about human nature and ourselves – that is the only way to transform passivity into activity, because it is the only response that accords one’s disorder the contempt it deserves. Though the choice to immerse oneself in the process of tragic reasoning is the turning point, there is nothing heroic or grandiose about its assumption. This act is only equal to the terror that attends it. The possibility and terms of change are here experienced for the first time as an existential process that involves far more than thought and deliberation. Change is the process of engaging conflicts that have a deeper hold in one’s psyche than anything else. Hamlet can think all day, yet until his thought crashes against the concrete circumstances of his inner paralysis, nothing can happen. Agon is that destiny of the human being which is only engaged when the effort at reversal confronts that within oneself that absolutely resists that effort. This is the battle that must be engaged.

Memory can only take one so far, and ultimately, one must engage the conflicts it recovers. The only way to do so is by immersing oneself in the traumatic space. Minimizing or resolving the situation is the thing most to be feared, since thereby the destructive force is given the power to extinguish anything within that opposes it. What we are is a result of what we do in those situations that are pregnant with the conflicts that define us. This process would have us stand before the prospect of living without the thing the super-ego gives us in return for our obedience: certitude, direction, and the comfort of those guarantees that protect us from the burdens that a free subject must take upon itself. The call of the tragic is the call to suffering. Suffering is the deepest voice within us summoning us to our innermost possibility: to live out the full complexity of our relationship to ourselves by engaging the agons that define and maximize it.

The Traumatic Event: What Is It, That Thing You Most Fear?

2009-01-18T09:08:00.000-08:00

“In order to save your life you must lose it.”

- Matthew, 16:25

When faced with a genuinely feared emotional event, we may do anything we can to avoid it. Beyond the simple root desire to avoid pain lies another challenge that encourages us to flee: the tragic event often possesses the power to destroy the value we place on ourselves and, specifically, the qualities by which we have defined our character. We define ourselves in terms of our service to values, which thereby become properties of our moral character. Our perception of our worth and identity as persons come to depend on remaining true to the conception we form of ourselves in relation to those values that we refuse to compromise. More important than one’s life is the thing that gives one’s life meaning. But often, in the face of a profoundly tragic event, the defenses we have relied upon collapse under the infinitely dense mass of reality. Reality and its undistorted meanings are more fully available to the subject. Until now, ego identity has been a flight from knowing. The truth now assaults us in the middle of the street, and we are left without shelter – all doors and windows rudely shut in our face. The ego, now undefended, is threatened with annihilation. The trauma entails the threat of self-dissolution.

This is the threat at the core of trauma that makes it so terrifying – and why traumatized subjects may clutch at any lie as long as it eases the pain. A tragic agent is one who refuses that option, and maintains the will to assault herself with reality and the truth about herself. In the midst of trauma, the need for deliverance is often overwhelming, and may be experienced as the pull of a system of guarantees. This pull is never greater than when one has come face to face with a trauma that has threatened to dissolve those guarantees. Spinoza’s fundamental insight into emotion is the starting point which takes one to the heart of what we are as subjects: emotional beings forced by that fact to seek the emotions that will release us from the burden and suffering of other emotions. This, in brief, is the source of the terrible things we do to one another and to ourselves. Trauma reveals that fact in a way that puts emotion on trial. We replace one emotion after another, seeking the one that will resolve the problems of the psyche in a way that puts an end to anxiety.

Change, one discovers, is an emotional struggle that requires the overcoming of emotional conditions that have a far deeper hold over us than we had imagined. Freud believed that in any psychological conflict, the strongest emotion would always win. Such observations give quietus to the idea that our emotional life is the harmonious application of an armory of independent emotions to discrete situations. Such is the case only when tension is relatively minor. Get in an area of genuine conflict, and one soon learns that the oppositions between different ways of feeling and the relative strength of different emotions vis-à-vis one another are the defining characteristics of our emotional life. Everything then proceeds, as in Hamlet, to the clash of mighty opposites. Such is the call of the tragic in each of us. To know the actual truth of one’s emotional constitution depends on taking those actions that will engage one’s core conflicts. But the knowledge that one’s situation is irreversible, and that what the traumatized subject initially experiences as the end of the line is actually the turning point.

Tragic Reasoning

2009-01-18T08:54:00.000-08:00

There are questions we could not get past if we were not set free from them by our very nature.

***

Can you know anything other than deception? If ever the deception is annihilated, you must not look in that direction or you will turn into a pillar of salt.

- The Blue Octavo Notebooks by Franz Kafka

The term tragic is used here in its most general existential sense – the tragedy that is the unvarnished human condition. This is a condition of painful self-awareness, should we allow ourselves to view it without guarantees or defenses. For example, in the evolution of human consciousness, death has been and continues to be, the root fear - the lowest common denominator driving human pretensions to happiness and the cause of much suffering.[i] The fear of death is actually the ego’s fear of annihilation, which lead directly to various “immortality projects” that promise to sustain it. In an attempt to transcend the boundaries of reality, the ego creates the illusion that there is a “self” that can sustain itself, and become permanent. In this sense, the human condition may be likened to the role of the tragic hero who sees and understands his unavoidable fate. The hero’s suffering is precisely what gives meaning to a life of inescapable physical and spiritual wounds.[ii]

But this journey through the shadow of the valley, unprotected, is demanding and agonizing in a way that is literally unfathomable. And so it would seem, a complete absence of protection is simply unreasonable. This entails a challenge: how to find one’s balance. How might we understand and accept the tragic without excessively buffering ourselves, thereby creating too much distance from either reality or that which makes us human? The defenses used by the ego are plentiful, but often, our relationship to tragic experience resembles that which Heidegger saw as our relationship to “being” – that is, forgetting. With respect to being we have, according to Heidegger, lost sight of the ontological difference between “being” and beings.[iii] With respect to the tragic, we have suffered what may be an even greater loss: a loss of contact with that within ourselves which opens us to this realm of experience. Often, it seems that we are only willing to give the tragic an audience when a number of guarantees are in place. Foremost among them are the two ideas cribbed from Aristotle that constitute for most people the essence of the tragic: 1) the tragic is the result of a flaw in a particular agent or events, and 2) we accept the painful feelings that tragedy asks us to endure only when we are assured that everything will be comfortably resolved in the end. In this sense, tragedy involves no basic challenge to our identity or our beliefs.

We set down canons of thought and rules of “meaningful” discourse to exclude something else that if acknowledged would have a shattering impact on our understanding of everything. For thought would then revolve on a recognition of its resistance to what may turn out to be the very structure of experience itself. Philosophy sometimes tries to contain the tragic within some other structure. Aristotle remains the clearest and most eloquent example of this; his Poetics is a monument to the effort to impose a non-tragic metaphysics, ethics, and psychology upon the tragic in order to domesticate what would otherwise prove too disruptive.[iv] This line of thought has persisted right through thinkers as different as Hegel and Lacan. The comprehension of experience is determined by the mediation of concepts and categories that are only possible through the repression of a more primary access, one that recovers and sustains the act of existence of the existential subject. Tragic experience enables us to comprehend existence as a structure unlike all others, one that shatters and exceeds the conceptual order, offering us “the knowledge most worth having,” and bringing us face to face with ourselves.

Fear of thinking deeply about the tragic derives from the popular belief that suffering is meaningless and should be avoided entirely. Nothing but pessimism, bitterness, and despair can come of it. If the truth of life is tragic, our duty is to suppress that truth. But what if the opposite is the case? What if the tragic offers us the possibility of the deepest self-reference? To be able to more fully understand what it means to be a subject requires a willingness to engage in the difficult process of tragic reasoning. Tragic reasoning is “the ability to preserve those facts we are reluctant to confront because of the pain they involve and connect them with other facts that escape detection because they would extend and magnify that pain.”[v] Tragic reasoning exposes the fraud of all ideologies and guarantees. It challenges all our ways of knowing and of being. The importance of the tragic is that it gives life one of the very few meanings we can discern when we step outside of our own imposed system of guarantees. The tragic is our point of unity: “the situation that all subjects face insofar as they are subjects.”[vi]

[i]
[ii] Campbell J: The Power of Myth.
[iii]
[iv]
[v] Davis W: An Evening With JonBenet Ramsey. Lincoln, NE: Authors Choice Press, 2003.
[vi] Davis W: Death’s Dream Kingdom: The American Psyche Since 9-11. Ann Arbor, MI: Pluto Press, 2006.

2009-01-18T06:32:00.000-08:00

The Edge Effect arises from the juxtaposition of contrasting environments. The term is most often used in conjunction with the boundary between natural habitats, but here, it is extrapolated to the "environment" of the human psyche and culture.

When an edge is created to any natural system, and the area outside the boundary is an unnatural system, the natural system is seriously affected for some distance in from the edge.

This may affect the system close to the edge by encouraging rampant growth of opportunistic species, thoughts and concepts at the edge.