Cho’s Case Similar to Other Mass Killings by Loners
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.