9/11 10th Anniversary: A Mortality Salience Reminder

3rd Annual SUNY Upstate Forensic Conference

3rd Annual Forensic Conference - SUNY Upstate

Stalking: Risk and Prevention

http://www.youtube.com/watch?v=1mXO9U9A8xA

Inside the Mind of Britain's Most Violent Prisoner

Tales From the New Asylum: Pascal's Wager

Calling Death's Name

The Political Diagnosis

The Death of Abel

Death's Conviction

(Psychiatric Times Article)

Kafka & Fighting Transience

Above: Franz Kafka
Below: Ramses II

Nothing beside remains.
Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away

- Ozymandias (Shelley)

"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)

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

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

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"

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:

1. The revenge fantasy “provides sadistic gratification, and perhaps has an evolutionary basis (p. 608).”
2. 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.
3. 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.
4. 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?

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.