Cho’s Case Sim­i­lar to Other Mass Killings by Lon­ers

The Washington Post Sunday - - Shooting Rampage At Virginia Tech - By Shankar Vedan­tam

For more than two cen­turies, ex­plor­ers, trav­el­ers and re­searchers have tracked the dis­turb­ing phe­nom­e­non of in­di­vid­u­als who act out their rage against the world in an abrupt burst of homi­cide against to­tal strangers. In­vari­ably, the vi­o­lence ends with the per­son get­ting killed or tak­ing his own life.

The rare and lit­tle un­der­stood phe­nom­e­non has been called amok or run­ning amok, a phrase de­rived from the Malay word meng­amok, which means “to do fu­ri­ous bat­tle.” This week, sev­eral ex­perts said Sueng Hui Cho’s shoot­ing ram­page at Vir­ginia Tech re­minded them of a long list of other amok cases.

Think­ing of Cho’s be­hav­ior in the con­text of amok is one of many ways men­tal health ex­perts have been strug­gling to make sense of the Vir­ginia Tech tragedy. More con­ven­tional ex­pla­na­tions have sug­gested he may have been suf­fer­ing from a psy­chotic dis­or­der or per­son­al­ity prob­lems — one prac­ti­tioner’s di­ag­no­sis in 2005 sug­gested Cho was de­pressed.

Ex­perts who con­sider the Cho case an ex­am­ple of amok are not sug­gest­ing it is a com­pet­ing di­ag­no­sis as much as a way to de­scribe a pat­tern of be­hav­ior. For the bet­ter part of two cen­turies, West­ern ob­servers thought the phe­nom­e­non was lim­ited to “prim­i­tive” cul­tures in Asia, the Caribbean and na­tive Amer­ica, but this no­tion has been de­mol­ished in re­cent years. Those who study amok say it now oc­curs mainly in West­ern coun­tries.

“The truth of the mat­ter is this oc­curs in ev­ery cul­ture,” said Los An­ge­les foren­sic psy­chi­a­trist Manuel L. Saint Martin, who said he has tracked about 50 cases. “It seems to be oc­cur­ring more com­monly now in West­ern, in­dus­tri­al­ized cul­tures rather than in the South­east Asian is­lands where it was first no­ticed.”

Cho’s ram­page had the clas­sic signs, said Saint Martin: “It is very likely this was a case of amok. Amok is the end prod­uct of men­tal dis­or­der where you get homi­ci­dal-sui­ci­dal be­hav­ior.”

Other ex­am­ples in­clude a mas­sacre at a Luby’s cafe­te­ria in Killeen, Tex., in 1991 and the so-called McDon­ald’s Mas­sacre in San Diego in 1984 — in both cases, a lone gun­man vi­o­lently vented his griev­ances by killing strangers be­fore killing him­self or be­ing killed.

Julio Ar­boleda-Flórez, head of the psy­chi­a­try de­part­ment at Queens Univer­sity in Canada, said the Vir­ginia Tech case was just like oth­ers he has stud­ied in North Amer­ica, in­clud­ing that of the Univer­sity of Texas stu­dent who climbed a tower on the Austin cam­pus in 1966 and opened fire on passersby, killing 13 be­fore he was him­self gunned down.

“The pat­tern starts with a pe­riod of brood­ing, dis­tress, pre­oc­cu­pa­tions and de­pres­sion,” said Ar­boleda-Flórez. “Af­ter a pe­riod, the guy grabs a weapon and starts a non­pro­voked out­burst of at­tacks.” He “just at­tacks and kills and maims and then com­mits sui­cide.”

Many psy­chi­atric ex­perts were cau­tious about link­ing Cho’s ram­page to amok be­cause it is de­scribed in the cur­rent Amer­i­can Psy­chi­atric As­so­ci­a­tion man­ual of men­tal disor­ders as a “cul­ture-bound syn­drome.” Be­sides the prob­lem of stereo­typ­ing that that raises, they ar­gued that us­ing the con­struct might sug­gest Cho was not suf­fer­ing from a men­tal ill­ness, when in fact he seemed deeply dis­turbed.

Francis G. Lu, a psy­chi­a­trist at San Fran­cisco Gen­eral Hospi­tal, said the clas­si­fi­ca­tion of amok needs to be re­con­sid­ered in the psy­chi­a­try man­ual, which is now be­ing re­vised.

Lu, Saint Martin and Ar­boledaFlórez also em­pha­sized that Cho’s Korean eth­nic­ity was a red her­ring in this con­text. The fact that ex­perts once be­lieved amok was lim­ited to Asian cul­tures said more about the bi­ases of those ob­servers than the cul­tures they pur­port­edly stud­ied, Ar­boleda-Flórez said.

While it is dif­fi­cult to di­ag­nose Cho af­ter the fact, there were sev­eral signs he suf­fered from se­ri­ous men­tal ill­ness, Lu said, adding that the videos Cho made sug­gest “he was grossly delu­sional with para­noia and psy­chotic.”

While cau­tious about the stereo­typ­ing im­pli­ca­tions, Lu said amok could de­scribe a pat­tern of be­hav­ior among peo­ple who suf­fer from a range of un­der­ly­ing disor­ders.

Ger­ald P. Koocher, a for­mer pres­i­dent of the Amer­i­can Psy­cho­log­i­cal As­so­ci­a­tion, said Cho may have been suf­fer­ing from a per­son­al­ity dis­or­der that has some sim­i­lar­i­ties to schizophre­nia. Cho’s reclu­sive- ness and ex­treme ten­dency to blame oth­ers for his prob­lems sug­gest el­e­ments of delu­sional think­ing, Koocher said.

Har­vard psy­chi­a­trist Richard Mol­lica said the tragedy un­der­scored the ex­tent to which de­pres­sion in Amer­ica goes un­treated.

In late 2005, Cho re­ceived a men­tal health exam that sug­gested he was emo­tion­ally flat and de­pressed. He de­nied be­ing sui­ci­dal.

Lau­rence J. Kir­mayer, a psy­chi­a­trist at McGill Univer­sity in Mon­treal, said Cho, like count­less other young peo­ple, had likely con­stantly got­ten the mes­sage that the loner who acts out vi­o­lence on the world through mar­tial arts or gun­play is a hero. Kir­mayer pointed to James Bond movies such as the re­cent re­make of “Casino Royale,” in which “a vi­cious so­ciopath is okay be­cause he is work­ing for Bri­tish intelligence.”

Saint Martin said his study of amok cases in South­ern Cal­i­for­nia showed that many who ex­hibit the be­hav­ior fol­low the same pat­tern as Cho — even if they cause much less car­nage. Saint Martin of­fered a num­ber of ex­am­ples in­volv­ing whites, Lati­nos and African Amer­i­cans.

“Most of th­ese in­di­vid­u­als be­come sui­ci­dal . . . but for dif­fer­ent rea­sons, homi­ci­dal thoughts get in­volved,” he said. “They are sui­ci­dal, but they also have a lot of anger that has to be di­rected at some­one or some group that they per­ceive as per­se­cut­ing them.”

Amok cases seem to fol­low a fairly fixed pat­tern, said Saint Martin and Ar­boleda-Flórez. The first in­gre­di­ent is sus­cep­ti­bil­ity to de­pres­sion or other se­ri­ous men­tal ill­ness. Af­ter brood­ing over sui­ci­dal and homi­ci­dal thoughts for months or even years, the per­son starts to put to­gether a plan.

“It may just be tak­ing a knife and stab­bing peo­ple, and it may be firearms,” said Saint Martin. “It may be an elab­o­rate thing as this per­son did at Vir­ginia Tech. By the time they put the plan into ac­tion, it is im­pos­si­ble for any­one but law en­force­ment to in­ter­vene. There is no way to in­ter­vene psy­chi­atri­cally.”

Un­like the be­hav­ior of se­rial killers, amok in­volves a de­sire by the per­pe­tra­tor to die. Un­like sui­cide bombers, who also kill oth­ers while killing them­selves, amok is about the griev­ances of a soli­tary in­di­vid­ual, ex­perts said. The fact that most amok cases end with the per­son killing him­self or get­ting killed is one rea­son re­searchers do not un­der­stand the phe­nom­e­non very well, said Ar­boleda-Flórez.

Joseph Wester­meyer, a Univer­sity of Min­nesota re­searcher who did some of the early work show­ing that cases of amok were not lim­ited to any par­tic­u­lar cul­ture, said, “The amok con­cept may have rel­e­vance for this case, al­though it’s more a de­scrip­tive con­cept or ‘syn­drome’ rather than a con­crete en­tity.”

Part of the re­luc­tance to as­so­ci­ate Cho’s ram­page with amok stems from the term’s his­tor­i­cal bag­gage, said By­ron J. Good, a Har­vard an­thro­pol­o­gist who has stud­ied the be­hav­ior.

Colo­nial­ists some­times mis­used the term to de­scribe vi­o­lent acts of re­sis­tance among Malays — which is why it is now a loaded term, Good said in an e-mail from In­done­sia, where he is do­ing re­search. Ex­perts have also used the term in dif­fer­ent ways — the psy­chi­a­try man­ual, for ex­am­ple, de­scribes amok as a “dis­so­cia­tive episode” — and var­i­ous ob­servers have dis­agreed about the amount of plan­ning that typ­i­cally goes into an amok out­burst.

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