CME

Mass and the Violent Paranoid Spectrum

James L. Knoll, IV, MD; and J. Reid Meloy, PhD, ABPP

Annals

Psychiatric

2014 © Shutterstock ABSTRACT themes in their cognitions. For example, ass murder — the killing of Mass murderers who capture media many have been found to be preoccupied three or more victims at one attention often appear to be suffering with feelings of social persecution and Mlocation within one event — from psychosis. However, no research has revenge against their perceived tormen- is a rare but catastrophic phenomenon.1 clearly established that most are psychotic tors. In addition, they share an inability to Factors common to include or even suffering from a serious Copyrightmental ill- accept their apparent circumstances and extreme feelings of anger and revenge, ness (SMI). In contrast, individual case stud- choose to obliterate reality with an act of the lack of an accomplice (in adult mass ies examining the psychological makeup violent revenge. murder), feelings of social alienation, of mass murderers often reveal paranoid In this article, it is suggested that the and planning/organizing the offense. In a psychology of paranoid mass murderers detailed case study of five mass murder- James L. Knoll, IV, MD, is Director of Foren- can be understood as existing on a con- ers who were caught before they were sic Psychiatry, Professor of Psychiatry, SUNY tinuum of paranoia ranging from mistrust killed, a number of common traits and Upstate Medical University. J. Reid Meloy, PhD, to frank paranoid delusions. This can be historical factors were found.2 The sub- ABPP, is Clinical Professor of Psychiatry, Uni- demonstrated by careful forensic psycho- jects had all been bullied or isolated dur- versity of California — San Diego, and Fac- linguistic analysis of the communications ing childhood and subsequently became ulty, San Diego Psychoanalytic Institute. they frequently leave behind. Finally, this loners who felt despair over their social Address correspondence to: James L. Knoll, article seeks to outline a psychoanalyti- alienation. They demonstrated paranoid IV, MD; email: [email protected]. cally informed cognitive progression seen traits such as suspiciousness and grudge Disclosure: The authors have no relevant in paranoid spectrum mass murderers in holding. Their worldview also suggested financial relationships to disclosure. the hopes of delineating stages for earlier a paranoid mindset, as they believed oth- doi: 10.3928/00485713-20140502-07 recognition and possible intervention. ers to be generally rejecting and uncar-

236 | Healio.com/Psychiatry PSYCHIATRIC ANNALS 44:5 | MAY 2014 CME

ing. As a result, they spent a great deal TABLE 1. of time feeling resentful and ruminating on past humiliations. These ruminations Paranoid Spectrum Mass Murderer Cognitive Progression subsequently evolved into fantasies of Stage 1: Perception violent revenge. Threat perception, and expectation of persecution. From an etiological standpoint, the Perceived inadequacy of the self. factors contributing to mass murder are Stage 2: Contemplation broad and so must be approached via a bio-psychosocial model.3 Biological Threat is strong. factors include possible brain pathology, Unlikely to prevail against the threat. as well as psychiatric illnesses such as Stage 3: Decision depression and psychosis. Psychological Inability to accept, compromise, or seek outside help. factors include a negative or fragile self- Abandon hope, increase reliance on revenge fantasy. image, paranoid dynamics, and retreat Stage 4: Resolution into violent and omnipotent revenge fan- Retreat to omnipotent fantasy and/or obliterate reality. tasies. Social factors include isolation, Plan mass murder, acquire materials. possible ostracism by peers, and an ab- Carry out the act of targeted violence. sence of pro-social supports. Given the heterogeneity and paucity of research Annals seen in the spectrum of mass murder, beliefs, to the casual observer, the para- delusions. Some mass murderers, such it is difficult at the present time to draw noid individual’s reality will only appear as Jiverly Wong or Jared Loughner, ap- conclusions beyond the hypothesis that broken around a relatively narrow set of pear to have been clearly in the psychot- it is caused by a “complex interaction” concerns. It is this “gap” that “is filled ic range of the paranoid spectrum.13,14 between psychopathology, traumatic life by the delusional system.”6 Further, the In contrast, others such as Marc Lépine events, and precipitating factors.4 onset of delusions often occurs insidi- or Eric Harris appear to have harbored ously.7 In the process,Psychiatric the paranoid indi- intense feelings of injustice as a result PARANOIA AS A NARCISSISTIC vidual’s ego compromises some degree of perceived mistreatment and social DEFENSE of reality as a self-preserving measure. rejection.15,16 The communications of The narcissistic dimensions of para- In effect,2014 the concession serves to “avoid this latter group are rife with paranoid noia have been suggested by the fact that a rupture by deforming itself, submitting themes, yet they do not rise to the level the persecuted individual believes he is to forfeit something of its unity, or in the of a formal delusion. Dimensionality is a special enough to be singled out, and the long run even to be gashed and rent.”8 truer measure of all personality and per- fact that systematized paranoid cogni- The type of paranoia discussed here sonality disorders and was the original tions result in a self-contained feedback is in relation to mass murderers and intent of the diagnostic changes in the loop that prevents outside informationCopyright involves two important nuances: an as- Diagnostic and Statistical Manual of from dispelling the paranoid belief sys- sociation with violence and dimension- Mental Disorders, fifth edition (DSM-V) tem. It is a persecutory echo chamber. ality. An increased risk of violence has for personality disorder and is presently As Chessick5 notes, the paranoid indi- been associated with paranoia, particu- described as an “emerging measure and vidual walls off the self in order to keep larly with paranoid delusions in certain model” in the new diagnostic manual. emotional distance from others, and to individuals with other comorbid risk It has been observed that most if not protect his fragile self-image. The result factors.9-11 Dimensionality refers to the all men in the U.S. who have killed 10 is a paranoid belief system that allows an concept that personality traits “can be or more victims in a single incident have “encapsulation” of ego pathology. located on the spectrum of trait dimen- demonstrated “paranoid symptoms of Depending upon the individual’s bio- sions,” and so may be present “in dif- some kind.”17 Regardless of where the psychosocial constitution, and particu- ferent degrees rather than being present mass murderer’s psychopathology lies larly his intellectual development, sys- versus absent.”12 Thus, it is not unrea- on the paranoid spectrum, it can be ar- tematization of the paranoid beliefs may sonable to expect that paranoia would gued that the progression of his cogni- be needed to more completely encapsu- exist on a continuum for mass murderers tions leading up to the offense share late the ego deficits. Regardless of the ranging, for example, from suspicious- certain similarities. For the sake of dis- extent and elaborateness of the paranoid ness to frank psychosis with paranoid cussion, the cognitive progression will

PSYCHIATRIC ANNALS 44:5 | MAY 2014 Healio.com/Psychiatry | 237 CME

be parsed into four stages: perception of critical elements prompting such violent plan to live very much longer, just long threat, contemplation of the threat, the behavior: 1) a narcissistic injury per- enough to kill as many of the people that decisional stage, and finally, the stage ceived as grossly unjust, resulting in 2) greedily sought my destruction.”24 of resolution (as outlined in Table 1). hopelessness about a rational solution; An important difference, however, The stages are meant to represent broad 3) the perception that the situation is between the formulations of Menninger periods of mental functioning, since it is intolerable and demands action; 4) ac- and contemporary data on mass murder- unlikely that an individual’s progression cess to weapons; and 5) disregard for the ers is that the violence of the mass mur- will be demarcated by bright lines and derer is not sudden and explosive; but in- predictable transitions. The perception stead, planful, methodical, instrumental, stage involves a combination of per- The study of violent offenders and largely devoid of emotion.25,26 An ceived personal inadequacy and the per- illustrative example of this is the case of ception of an outside threat, either real has suggested that they Anders Behring Breivik, whose terrorist or imagined. In the case of a non-psy- demonstrate an impaired style mass murder in Norway on July 22, chotic mass murderer, threats typically 2011, claimed the lives of 77 innocent involve some form of social rejection by ability to trust and have a victims. Breivik not only planned out peers. Whether delusional or not, these persecutory worldview. his attack over many years, but also used perceptions stimulate feelings of humili- meditation, music, and videos to help ation and anger, if not hatred, contempt, further reduce any lingering emotions at and disgust for those who persecute. consequences, combined with a sense of Annalsthe time of the attacks.27 Thus, the mass In the contemplation stage, the po- “potent” rage.19 To clarify this process, murderer may begin his pathway with tential offender deliberates or “assesses” Menninger20 uses the example of when a intense affect, but following his deci- the risk to himself and whether or not child suffers some type of pain. Immedi- sion to act and withdrawal into fantasy, he is likely to prevail by ordinary, law- ately, the child “wants to let others know he typically embarks on a predatory or ful means. Having concluded that he is about it … to know exactly how he or instrumental pathway to violence. not likely to overcome the threat, he is at she hurts.” The internal dialogue may be To further understand the psychol- a key decisional point. In the decisional represented as: “WhenPsychiatric I am hurt by you, ogy of the paranoid mass murderer, it is stage, he must call upon his internal re- I want you to hurt like I hurt; therefore if helpful to consider the psychoanalytic sources and ego defenses to confront the you hit me, I will hit you back.”21 concept of the paranoid-schizoid (P-S) threat in either a pro-social or an anti- However,2014 in the case of the paranoid position as first described by Klein.28 social manner. He may either accept his mass murderer, the narcissistic injury The study of violent offenders has sug- situation and seek out a nonviolent com- has been so severe that excessive retali- gested that they demonstrate an impaired promise — or staunchly refuse to accept ation and transfer of a disproportionate ability to trust and have a persecutory his circumstances. This latter path inevi- amount of pain to perceived persecutors worldview, leaving them with a strong tably leads to an abandoning of realistic is seen as the only resolution. Further, self-centered, paranoid character style.29 hope and withdrawal into omnipotentCopyright the actual extent of the narcissistic in- These observations are comparable to violent fantasy. If this path is followed, jury may be greatly amplified and sug- the Kleinian concept of the P-S position, the fantasies usually involve the use of gest persecutory themes. For example, in which the individual’s worldview is deadly force to gain retribution. Such in the case of Seung-Hui Cho, his final based on feelings of mistreatment and fantasies may chronically remain as an writing portrayed other students (whom frustration at what is perceived as delib- intrapsychic home of isolative retreat, he hardly knew) as having “raped my erate harm, or purposeful deprivation.30 but in a few cases, there is progression to soul” and having “crucified” him.22 An- The P-S offender demonstrates the use research, planning, preparation, and im- other example can be seen in the case of defense mechanisms associated with plementation of the targeted violence.18 of Atlanta day trader Mark Barton, who paranoia (ie, projection, denial, splitting, This is the resolution stage. shot and killed nine people and injured and projective identification).31 This model of cognitive progres- 13 more in 1999.23 Barton was moti- According to Kleinian theory, P-S of- sion in paranoid mass murderers is es- vated by depression and anger, as well fenders also suffer from strong feelings sentially a “threatened ego” model, and as serious financial and marital troubles. of destructive envy, simply defined by consistent with Menninger’s view on He had developed a highly resentful, yet Klein as the wish to destroy goodness. factors leading up to explosions of rage. hopeless attitude about both his life and Thus, the P-S offender must destroy oth- According to Menninger, there are five career. His note stated, “I don’t ers’ capacity to enjoy the envied object

238 | Healio.com/Psychiatry PSYCHIATRIC ANNALS 44:5 | MAY 2014 CME

or status. For example, in Cho’s mani- can be particularly helpful in analyzing happening more frequently, posted on the festo, he criticized other students due communications from either unknown Internet.49 The messages are rich sources to his perception that they possessed or inadequately understood subjects.38-41 of data providing a deeper understanding “everything” they ever wanted, such as The words and language people use are of the perpetrator’s motive, mental state, “Mercedes…. golden necklaces…. trust a reflection of their biopsychosocial and psychological disturbances. funds…. vodka and cognac.”32 Yet in the makeup, and careful attention to those Acts of extreme violence invariably same manifesto, he demonstrates power- words “can reveal important aspects of have symbolic meaning, and have been fully destructive envy, stating: “Oh the their social and psychological worlds.”42 noted to serve a homeostatic function happiness I could have had mingling For example, the individual who is suf- for a fragile ego.50 Thus, the commu- among you hedonists, being counted as fering from a paranoid delusion yet nications of such individuals may be one of you, if only you didn’t [expletive] maintains the capacity for organized expected to reflect the more primitive the living [expletive] out of me.”33 and linear thinking is likely to be more defense mechanisms such as splitting, As demonstrated by Cho, the P-S of- capable of intentionally planning, pre- projection, and projective identification. fender perceives others as persecutory, paring, and carrying out violence.43,44 Although paranoia and persecution are not only due to beliefs about mistreat- Thus, the language of such an individ- strong themes found in the communica- ment, but also as a result of his view that ual should reflect paranoid themes, yet tions of mass murderers, it is important others are withholding of life’s good- demonstrate organized syntax. to keep in mind that some individuals ness and its associated accoutrements. on the paranoid spectrum may perceive Forensic psycholinguistic analyses dem- PSYCHOLINGUISTIC ANALYSIS OF Annalsmistreatment that is substantially greater onstrating the P-S position of mass mur- MASS MURDER than that which occurred in reality.51 derers Cho and Jiverly Wong have been Hempel, Meloy, and Richards45 detailed elsewhere.34 Next, the proce- were the first to note that mass murder- KIP KINKEL: FORENSIC dure and utility of the forensic psycho- ers seemed compelled to “convey their PSYCHOLINGUISTIC ANALYSIS linguistic method is briefly outlined and central motivation in a psychological Kipland Philip “Kip” Kinkel was 15 applied to the writings of another mass abstract,” sometimes even yelled just be- years old when he shot and killed his murderer, Kip Kinkel. fore the onset of thePsychiatric killings. Since then, parents and two high school students and the writings of many mass murderers wounded another 25 students in Spring- FORENSIC PSYCHOLINGUISTICS have been analyzed and shown to reflect field, OR.52 The shootings at his high Psycholinguistics is a discipline that strong themes2014 of persecution, alienation, school occurred on May 21, 1998, the focuses on the psychological study of envy, and vengefulness.46,47 The foren- day after he had been suspended from language and has its roots in the work sic psycholinguistic analysis of a mass school for possession of a loaded, stolen of psychologist Jacob Robert Kantor’s murderer’s communications begins with handgun. He was ultimately sentenced to 1936 book, An Objective Psychology the assumption that he would not have 111 years without the possibility of pa- of Grammar.35 Kantor was interested bothered to craft and/or communicate a role. Prior to the shootings, Kinkel had in the fact that words were symbolicCopyright manifesto unless it had great personal been treated for depression and was fas- expressions of the individual’s state of meaning. In fact, some make special ef- cinated by firearms. His peers described mind. Further, written language can be forts to ensure that their final communi- him as morbid and preoccupied with vio- viewed as logical propositions reflective cations or manifesto will be transmitted lence. Immediately after being expelled, of thought organization and content. The to and read by others. Kinkel’s father told him he was consider- field has progressed to include various Revenge is often a central motive for ing sending him to military school. disciplines that study the psychological mass murderers, and it has been hypoth- During Kinkel’s trial, there was con- and neurobiological factors of language. esized that these individuals desperately troversy about whether or not he suf- Psycholinguistics began to be uti- need an “audience” to recognize their fered from paranoid schizophrenia. Re- lized for forensic purposes to analyze struggle.48 In this sense, there is a the- gardless of his position on the paranoid threatening communications.36 Current atrical aspect to their vengeance, which spectrum, his pre-offense writings sug- applications of forensic psycholinguis- requires witnessing by the “Other;” they gested P-S dynamics, hopelessness, and tic analysis include threat assessment, not only need a target for revenge, but also a resolution to obliterate reality. Portions authorship identification, false allega- an audience. These messages — or sym- of Kinkel’s pre-offense writings will be tions of victimization, and statement bolic stories of injustice and oppression used to demonstrate the P-S dynamics analysis.37 Psycholinguistic analysis — may be written, videotaped, or, as is and cognitive progression.53

PSYCHIATRIC ANNALS 44:5 | MAY 2014 Healio.com/Psychiatry | 239 CME

ANALYSIS OF KINKEL PRE-OFFENSE are trying to take away some of my guns! ninger’s internal dialogue of the hurt WRITINGS My guns are the only things that haven’t child, Kinkel wished for the other to “Even though I am repulsive and few stabbed me in the back.” feel as he did. In addition, Kinkel’s people know who I am, I still feel that This portion suggests persecution statement suggested heavy use of pro- things might, maybe, just a little bit, get at the hands of a female love object. jection and an element of boundary loss better.” Note that this persecution then became alongside wishes for suicide. In the perception stage, Kinkel re- greatly expanded and generalized, to the “I want to kill and give pain without vealed both a profoundly negative self- extent that he believed God had singled a cost.” image and a threat in terms of social re- him out for “complete misery.” In this This statement suggests a desire to jection. However, he had not yet reached sense, Kinkel placed himself into the obliterate reality, as well as a retreat the stage of abandoning all hope. position of Job, who was tested by God into the stage of omnipotent fantasy. “I feel like everyone is against me, with misery and afflictions. The allegory To murder and cause pain without cost but no one ever makes fun of me, mainly of Job is powerful and timeless, due to is unrealistic and suggests operating because they think I am a psycho. There the fact that it depicts so well the human from a place of omnipotence, where the is one kid above all others that I want to response to “undeserved” suffering. The normal rules of cause and effect do not kill. I want nothing more than to put a sequence of psychological response has touch the actor. Omnipotence has been hole in his head. The one reason I don’t: been observed to be: deprivation/suf- defined as “having unlimited or univer- Hope. That tomorrow will be better. As fering, leading to unknowing, and then sal power, authority, or force.”59 Note soon as my hope is gone, people die.” perhaps transformed awareness.58 This Annalsthe distinction from grandiosity, which Kinkel demonstrates that he perceived can be seen not only in spiritual trans- is “characterized by feigned or affected clearly the threat of social rejection. Like formation, but also in psychological grandeur; pompous,” or having “an in- many mass murderers, he fashioned for transformation. flated appraisal” of one’s worth, power, himself a persona of “black armor” in an The response to the uncomfortable and importance.60 Kinkel’s writing did effort to ward off persecutory threats (“I state of uncertainty and unknowing de- not suggest an inflated appraisal of him- am a psycho”). Further, he began to en- termines whether or not positive trans- self, but precisely the opposite. Thus, ter the contemplation stage, as he grew formation will takePsychiatric place. This critical this statement reflected a last, desperate concerned that his hope may run out. step often depends on one’s bio-psycho- attempt to bolster his ego with powerful, Clinical observations suggest that of- social strengths, resources, and capacity omnipotent fantasy. The defense of om- fenders who remain fixed in the P-S po- to transform2014 the unacceptable challenge nipotence often signals the failure of the sition ultimately develop an entrenched into something meaningful, and thereby defense of grandiosity. From a develop- nihilistic attitude.54 This nihilism then achieve gratitude and feelings of repara- mental standpoint, it is believed that the pervades their worldview, and feelings tion (the Kleinian depressive position). failure to achieve competent interactions of hopelessness may result in suicidality Rather than move toward pro-social with others may relegate the child to a and other self-defeating actions.55-57 meaning and reparation, Kinkelseeks dependence on omnipotent fantasies as “I need help. There is one personCopyright that pseudo-power and comfort in retaliatory he grows older.61 could help, but she won’t. I need to find violence. Indeed, he noted that these ob- “I have just killed my parents! I don’t someone else. I think I love her, but she jects (guns) had never persecuted him know what is happening. I love my mom could never love me.” and had likely given him much comfort and dad so much…. I’m so sorry. I am a The P-S dynamics were revealed here inside his self-enclosed sphere of para- horrible son. I wish I had been aborted. as evidenced by his belief that the other noia and violent fantasy. I destroy everything I touch… I didn’t could help if she chose to, but instead “It is clear that no one will help me. deserve them.” acts in a persecutory and withholding Oh God, I am so close to killing people. These statements were written by manner. Kinkel also revealed that his So close… I want you to feel this, be this, Kinkel shortly after murdering his fantasied source of help and hope was a taste this, kill this. Kill me.” mother and father. They appeared to female with whom he wished to have a With this admission, Kinkel ap- communicate guilt over his actions and loving relationship. peared to be at the end of his decisional a longing for reparation. Whereas many “I gave her all I have, and she just stage, having abandoned the notion of will progress through the P-S stage to threw it away. Why? Why did God just outside help, goodness, or hope. He the depressive stage via an internal, want me to be in complete misery? I sensed that final resolution through psychological struggle, Kinkel acted need to find more weapons. My parents violence was imminent. As per Men- out the conflict physically. There ap-

240 | Healio.com/Psychiatry PSYCHIATRIC ANNALS 44:5 | MAY 2014 CME

peared to be recognition, albeit too late, of acceptance and/or transformed aware- pages or YouTube.69 It may be the case that his parents were loving, and that ness. It is a desperate fight into death to that family members or social contacts he was unable to make use of the good- preserve the ego and could be viewed are the only ones who could reasonably ness and caring they gave him; instead, as the ultimate resistance. It can be said take steps to have the potential offender their goodness stimulated envy in him, that the ego strengthens itself in this way evaluated and treated.70 In the case of an often the therapeutic bind that mental by seeking a form of reverse special- individual who has demonstrated con- health professionals experience in their ness. The paranoid mass murderer be- cerning signs to third parties, the respon- heroic attempts to treat the narcissistic sibility of reporting to law enforcement personality. and/or mental health authorities would Revenge fantasies may seem to outweigh individual privacy RECOGNITION AND PREVENTION concerns. Regarding cases of school or In certain disturbed individuals, re- encompass rage at the self, workplace linked offenders, co-workers, venge fantasies may encompass rage at leading to either suicide and/or teachers, or classmates may consider the self, leading to either suicide and/or notifying authorities and/or human re- murder-suicide.62 The revenge fantasies murder-suicide. source staff once they become reason- may become inflexible and persistent ably concerned. The advent of threat due to the fact that they provide needed assessment teams show real promise to emotional scaffolding, without which comes a lone, shocking protestor against enhance the prevention of such low-fre- the individual’s psyche would further an “unjust” reality. In order to halt the Annalsquency but high-intensity events.71 regress — hence the increased use of progression toward obliteration, such For mental health professionals, care- more primitive defenses. The vengeful individuals require mental sanctuary ful clinical risk assessment and manage- person is able to regulate his mood and from the oppressive, relentless feelings ment may be stressed as a part of overall ward off ego threats with the power he of persecution that assail them. Halting competent psychiatric patient care.72,73 feels by ruminating on, and planning the progression requires recognition and Although future research will undoubt- out, his vengeance. The revenge fanta- intervention as early as possible. edly enhance our awareness of the pres- sy serves as a powerful, but temporary Mass murder isPsychiatric a multi-determined ence of “warning behaviors” for such remedy to a humiliated ego by provid- event with no simple preventive solu- targeted violence,74 mental health clini- ing an illusion of strength and a sense of tion. Such tragedies are exceptionally cians will best serve patients at risk by restored control. Such fantasies are also hard to 2014anticipate and avert.64 Given crafting a risk management plan at clini- enhanced by keeping them secret. Col- the extremely low base rate of mass cally relevant or critical times. Special lins63 has convincingly argued that such murder, psychiatric efforts will be best attention should be given to “availability secret fantasies, accompanied by plan- spent in directions other than predic- of means, planning, preparation, and the ning and preparation, stimulate “clan- tion.65 Thus, prevention must rely on acknowledged commitment to put the destine excitement” in the mass mur- various approaches acting together to words into action irrespective of con- derer, a positive affect that mayCopyright propel provide a widely cast safety net. Ap- sequences.”75 Risk assessments of in- him forward.63 proaches might include enhanced so- dividuals with strong revenge fantasies In the obliterative stage, the revenge cial responsibility, psychiatric efforts, will have to consider the intensity and fantasy promises to wipe clean the indi- and media responsibility.66 quality of the revenge fantasies, “vulner- vidual’s intolerable reality and aversive One aspect of social responsibility ability to ego threats,” and the relevant self-awareness. In a true sense, the main- that may hold promise is timely recog- biopsychosocial variables.76 tenance of reality testing to some degree nition by key third parties. Third parties (typically borderline level at best) exac- often have pre-offense knowledge, yet CONCLUSIONS erbates its punishing feel. Full paranoid remain quiet for various reasons.67 Nev- The psychology of paranoid mass psychosis may function as a refuge for ertheless, “prevention may only be pos- murderers can be explained as exist- such a blighted life, but paradoxically sible when somebody warns that such ing on a spectrum from paranoid traits may bring a commitment and resolve to behavior may occur … Acquaintances to psychotic delusion. Regardless of an carry out the mass murder — a plan that often acknowledge concerns prior to individual offender’s place on the spec- would be filled with ambivalence with- the incident.”68 Messages or leaked in- trum, many share common underlying out such delusions of persecution. tent may be communicated in various psychodynamics. Forensic psycholin- The cognitive process is the antithesis forms, including verbally, or via Internet guistic analysis of paranoid spectrum

PSYCHIATRIC ANNALS 44:5 | MAY 2014 Healio.com/Psychiatry | 241 CME

mass murderers has suggested common media/view_video.php?pk_vid=0000006160. 33. Alfano S. Gunman: “Now you have blood on themes of social persecution, envy, and Accessed December 27, 2013. your hands.” CBS News.com. Available at: 15. Sourour TK. Report of Coroner’s Investiga- http://www.cbsnews.com/stories/2007/04/18/ revenge fantasies. The Kleinian dynam- tion on Marc Lépine. Available at: http:// virginiatechshooting/main2697827.shtml. ics of the paranoid schizoid position are www.diarmani.com/Montreal_Coroners_Re- Published April 18, 2007. Accessed Decem- at work alongside a common cognitive port.pdf. Accessed December 27, 2013. ber 12, 2009. 16. Dutton D, White K, Fogarty D. Paranoid 34. Knoll JL 4th. The “Pseudocommando” mass progression toward omnipotent fantasy thinking in mass shooters. Aggress Violent murder: part II, the language of revenge. J Am and violent revenge. Recognition of this Behav. 2013;18:548-553. Acad Psychiatry Law. 2010;38(2):263-272. progression, either by third party knowl- 17. Dietz P. Mass, serial and sensational . 35. Kantor J. An Objective Psychology of Gram- Bull NY Acad Med. 1986.;62(5):477- 491. mar. Bloomington, IN: Indiana University edge or leaked intent, represents an im- 18. Calhoun F, S Weston. Contemporary Threat Press; 1936. portant potential method of prevention. Management. San Diego, CA: Specialized 36. Miron MS, Douglas JE. Threat analysis: the Training Services; 2003. psycholinguistics approach. FBI Law En- REFERENCES 19. Menninger W. Uncontained rage: a psycho- forcement Bulletin. 1979;48(9):5-9. analytic perspective on violence. Bull Men- 37. Smith S, Shuy R. Forensic psycholinguistics: 1. Burgess AW. Mass, Spree and Serial Homi- ninger Clin. 2007;71(20):115-131. using language analysis for identifying and cide. In: Douglas J, Burgess AW, Burgess AG, 20. Menninger W: Uncontained rage: A psycho- assessing offenders. FBI Law Enforcement Ressler R, eds. Crime Classification Manual. analytic perspective on violence. Bull Men- Bulletin. 2002;71(4):16-21. 2nd ed. San Francisco, CA: Jossey-Bass; 2006. ninger Clin. 2007;71(20):115-131. 38. Smith S. From Violent Words to Violent 2. Mullen P. The autogenic (self-generated) 21. Menninger W: Uncontained rage: A psycho- Deeds: Assessing Risk From FBI Threat- . Behav Sci Law. 2004;22:311-323. analytic perspective on violence. Bull Men- ening Communication Cases. In: Meloy 3. Aitken L, Oosthuizen P, Emsley R, Seedat ninger Clin. 2007;71(20):115-131. J, Sheridan L, Hoffman J, eds. Stalking, S. Mass : implications for mental 22. Excerpts from the video Virginia Tech shooter Threatening, and Attacking Public Fig- health professionals. Int J Psychiatry Med. Annals Cho Seung-Hui sent to NBC News. ures: A Psychological and Behavioral 2008;38(3):261-269. 23. Cohen A. A Portrait of the Killer. Time. August Analysis. New York, NY: Oxford Press, 4. Declercq F, Audenaert K. Predatory violence 9, 1999. Available at: http://www.time.com/ 2008;20:435-455. aiming at relief in a case of mass murder: time/magazine/article/0,9171,991676,00. 39. Stephane M, Pellizzer G, Fletcher CR, Mc- Meloy’s criteria for applied forensic practice. html?promoid=googlep. Clannahan K. Empirical evaluation of lan- Behav Sci Law. 2011;29(4):578-591. 24. Shootings in Atlanta: The Notes. The New guage disorder in schizophrenia. J Psychiatry 5. Chessick R. Psychology of the Self and the York Times. July 31, 1999. Available at: http:// Neurosci. 2007;32(4):250-258. Treatment of Narcissism. Northvale, NJ: Ja- www.nytimes.com/1999/07/31/us/shootings- 40. Pennebaker J, Stone L. What Was She Trying son Aronson, Inc.;1993:182. in-atlanta-the-notes-there-is-no-reason-for- to Say? A Linguistic Analysis of Katie’s Dia- 6. Fenichel O. The Psychoanalytic Theory of Psychiatric me-to-lie-now.html. ries. In: Lester D, ed. Katie’s Diary: Unlock- Neurosis. New York, NY: W.W. Norton & 25. Meloy JR, Hempel AG, Gray BT, et al. A ing the Mystery of a Suicide. New York, NY: Company, Inc.;1972:435. comparative analysis of North American ado- Routledge Press; 2004. 7. Rhodes J, Jakes S. Perspectives on the on- lescent and adult mass murderers. Behav Sci 41. Henken V. Banality reinvestigated: a com- set of delusions. Clin Psychol Psychother. Law. 20142004;22:291-309. puter-based content analysis of suicidal and 2010;17(2):136-146. 26. Borum R, Fein R, Vossekuil B, Berglund J. forced death documents. Suicide Life Threat 8. Freud S. Neurosis and Psychosis. In: Fenichel Threat assessment: defining and approach for Behav. 1976;6:36-43. O, ed. The Psychoanalytic Theory of Neuro- evaluating risk of targeted violence. Behav Sci 42. Pennebaker J, Mehl M, Niederhoffer K: Psy- sis. New York, NY: W.W. Norton & Company, Law. 1999;17:323-337. chological aspects of natural language. use: Inc.;1972:435. 27. Torrissen T, Knoll J, Leonard C, Annas D. our words, our selves. Annu Rev Psychol. 9. Coid J, Ullrich S, Kallis C, et al. The rela- Breivik – Extreme Ideologist or Mentally De- 2003;54:547-577. tionship between delusions and violence: ranged? Presented at: American Academy of 43 Borum R, Fein R, Vossekuil B, Berglund J. findings from the East London First Epi- Psychiatry and the Law 44th Annual Meeting; Threat assessment: defining and approach for sode Psychosis Study. JAMA PsychiatryCopyright. October 25, 2013; San Diego, CA. evaluating risk of targeted violence. Behav Sci 2013;70(5):465-471. 28. Klein M. Envy and Gratitude and Other Law. 1999;17:323-337. 10. Witt K, van Dorn R, Fazel S. Risk factors for Works, 1946-1963. New York, NY: The Free 44. Katsavdakis K, Meloy J, White S. A fe- violence in psychosis: systematic review and Press; 1975. male mass murder. J Forensic Sci. meta-regression analysis of 110 studies. PLoS 29. Kaylor L. Antisocial personality disorder: di- 2011;56(3):813-818. ONE. 2013;8(2):e55942. agnostic, ethical and treatment issues. Issues 45. Hempel A, Meloy J, Richards T. Offender and 11. Appelbaum P, Robbins P, Monohan J. Vio- Ment Health Nurs. 1999;20:247-258. offense characteristics of a nonrandom sam- lence and delusions: data from the MacArthur 30. Hyatt-Williams A. Cruelty, Violence and Mur- ple of mass murderers. J Am Acad Psychiatry Violence Risk Assessment Study. Am J Psy- der: Understanding the Criminal Mind. Lon- Law. 1999;27(2):13-225. chiatry. 2000;157:566-572. don, England: Karnac Books Ltd.; 1998. 46. Knoll J. Mass Murder: causes, classification, 12. Diagnostic and Statistical Manual of Mental 31. Hyatt-Williams, A. Cruelty, Violence and and prevention. Psychiatr Clin North Am. Disorders. 5th ed. Washington, DC: American Murder: Understanding the Criminal Mind. 2012:757-780. Psychiatric Association; 2013. New Jersey: Jason Aronson, Inc.; 1998. 47. Dutton D, White K, Fogarty D. Paranoid 13. Knoll J. The pseudocommando mass murder: 32. Alfano S: Gunman: “Now you have blood thinking in mass shooters. Aggress Violent part II, the language of revenge. J Am Acad on your hands.” CBS News.com, April 18, Behav. 2013;18:548-553. Psychiatry Law. 2010;38(2):263-72. 2007. Available at http://www.cbsnews. 48. Neuman Y. On revenge. Psychoanalysis, Cul- 14. United States Courts for the Ninth Circuit. Unit- com/stories/2007/04/18/virginiatechshoot- ture & Society. 2012;17(1):1-15. ed States v. Loughner, No. 11-10339 (2011). ing/main2697827.shtml Accessed Decem- 49. Aitken L, Oosthuizen P, Emsley R, Seedat Available at: http://www.ca9.uscourts.gov/ ber 12, 2009 S. Mass murders: implications for mental

242 | Healio.com/Psychiatry PSYCHIATRIC ANNALS 44:5 | MAY 2014 CME

health professionals. Int J Psychiatry Med. er’s mind. Contemporary Psychoanalysis. March 19, 2012. 2008;38(3):261-269. 1991;27(3):454-481. 68. Aitken L, Oosthuizen P, Emsley R, Seedat S. 50. Yakeley J, Meloy J. Understanding violence: 59. The American Heritage Dictionary. 2nd Col- Mass murders: implications for mental health does psychoanalytic thinking matter? Aggress lege Edition. Boston, MA: Houghton Mifflin professionals. Int J Psychiatry Med. 2008; Violent Behav. 2012;17:229-239. Company; 1985. 38(3):261-269. 51. Dutton D, White K, Fogarty D. Paranoid 60. Diagnostic and Statistical Manual of Mental 69. O’Toole M. The School Shooter: A Threat As- thinking in mass shooters. Aggress Violent Disorders. 5th ed. Washington, DC: American sessment Perspective. Quantico, VA: Critical Behav. 2013;18:548-553. Psychiatric Association; 2013. Incident Response Group, National Center for 52. Chronology: Kip Kinkle’s life and the events 61. Novick J, Novick KK. Some comments on the Analysis of Violent Crime; 2000. leading up to the horror of May 20-21, 1998. masochism and the delusion of omnipotence 70. Orange R. Anders Behring Breivik’s sis- PBS Frontline website. Available at: http:// from a developmental perspective. J Am Psy- ter warned mother about his behaviour two www.pbs.org/wgbh/pages/frontline/shows/ choanal Assoc. 1991;39(2):307-331. years ago. The Telegraph. Available at: http:// kinkel/kip/cron.html. 62. Horowitz M. Understanding and ameliorating www.telegraph.co.uk/news/worldnews/ 53. Kip’s writing and statements. PBS Frontline revenge fantasies in psychotherapy. Am J Psy- europe/norway/8934136/Anders-Behring- website. Available at: http://www.pbs.org/ chiatry. 2007;164(1):24-27. Breiviks-sister-warned-mother-about-his- wgbh/pages/frontline/shows/kinkel/kip/writ- 63. Collins R. Clues to mass rampage killers: behaviour-two-years-ago.html. Published ings.html deep backstage, hidden arsenal, clandestine December 4, 2011. 54. Knoll J. Treating the morally objectionable. excitement. The Sociological Eye website. 71. Meloy JR, Hoffman J. International Hand- In: Andrade J, ed. Handbook of Violence Risk Available at: http://sociological-eye.blogspot. book of Threat Assessment. New York, NY: Assessment and Treatment: New Approach- com/2012/09/clues-to-mass-rampage-killers- Oxford University Press; 2014. es for Mental Health Professionals. New deep.html. Published September 1, 2012. Ac- 72. Mills J, Kroner D, Morgan R. Clinician’s York, NY: Springer Publishing Company; cessed January 7, 2014. Guide to Violence Risk Assessment. New 2009:10;311-345. 64. Saleva O, Putkonen H, Kiviruusu O, Lonquist York, NY: The Guilford Press; 2011. 55. Edwards M, Holden R. Coping, meaning J. -suicide – an event hard to pre- Annals 73. Swanson J. Preventing the unpredicted: man- in life, and suicidal manifestations: exam- vent and separate from homicide or suicide. aging violence risk in mental health care. ining gender differences. J Clin Psychol. For Sci Int. 2007;166:204-208. Psych Services. 2008;59(2):191-193. 2001;57(12):1517-1534. 65. Dressing H, Meyer-Lindenberg A. Risk 74. Meloy R, Hoffman J, Guldimann A, James 56. Baumeister R, DeWall CN, Ciarocco assessment of threatened amok. New re- D. The role of warning behaviors in threat as- NJ, Twenge JM. Social exclusion im- sponsibilities for psychiatry? Nervenarzt. sessment: an exploration and suggested typol- pairs self-regulation. J Pers Soc Psychol. 2010;81(5):594-601. ogy. Behav Sci Law. 2012;30(3):256-279. 2005;88(4):589-604. 66. Knoll J. Mass murder: causes, classification, 75. Warren LJ, Mullen PE, Ogloff JR. A clinical 57. Twenge J, Catanese K, Baumeister R. Social and prevention. Psychiatr Clin North Am. study of those who utter threats to kill. Behav exclusion and the deconstructed state: time 2012:757-780. Psychiatric Sci Law. 2011;29(2):141-154. perception, meaninglessness, lethargy, lack of 67. Kluger J. Inside a mass murderer’s mind. 76. Baumeister R, Smart L, Boden J. Relation of emotion, and self-awareness. J Pers Soc Psy- Time. Available at: http://www.time.com/ threatened egotism to violence and aggres- chol. 2005;85(3):409-423. time/magazine/article/0,9171,1612694,00. sion: the dark side of high self-esteem. Psy- 58. Andresen J. Biblical Job: changing the help- html. 2014Published April 19, 2007. Accessed chological Rev. 1996;103(1):5-33.

Copyright

PSYCHIATRIC ANNALS 44:5 | MAY 2014 Healio.com/Psychiatry | 243