Colorado killings: Could this have been prevented?
The suspect in the July 20, 2012, massacre at the movie theater in Aurora, Colo., has been charged with 142 crimes, including 24 counts of murder — two for each fatality. In the aftermath, we wonder: Could this tragedy have been prevented? We are not talking about controlling assault weapons or high-capacity magazines, but about a different problem: identifying people with murderous intentions.
Can they be spotted in time for preventive measures to be taken?
Don’t expect miracles, was the theme we heard from people who know about such things. “I wish I could be more optimistic,” says Scott Lilienfeld, a professor of psychology at Emory University. “We know from a lot of literature that we are not very good at predicting violence,” says Lilienfeld, who studies personality disorders.
Lilienfeld says he is “cautiously optimistic. There may be things we can do to improve, but … human behavior is hard to predict, and severe violence is a bit like a plane crash. Many, many things have to go wrong at the same time for someone to engage in horrible violence. And in some ways, predicting violence is harder because human behavior is more unpredictable than the behavior of machines.”
Just because an act — like gunning down a member of Congress or shooting a semi-automatic rifle in a crowded movie theater — is insane in the common-language meaning of the term, does not prove that the perpetrator is actually insane.
In fact, only 10 percent of violence is related to mental illness, says Edward Mulvey, a professor of psychiatry at the University of Pittsburgh, who sees little difference in the type of violence among people who are, and are not, mentally ill. “There is an idea that they do a lot more violence against strangers, but mostly it’s related to an acquaintance, a family member, the same as for non-mentally ill people.”
Mulvey focuses on the prediction of crime among individuals with mental health problems 1.
Mulvey concedes that mental illness may play an outsize role in mass killings, but says that’s little help in identifying the next spree killer. “Although the prevalence of the mentally ill is higher among mass killers looking backward, having a mental disorder is not terribly predictive going forward.”
“No, you cannot identify [spree killers] in advance,” says Virginia Aldige, a professor of sociology at North Carolina State University. “Statistically, to predict any rare event is almost impossible.”
The mentally ill may be more violent for many reasons, says Aldige, who studies criminal behavior among this group. “They tend to be poor, substance abusers, are often homeless, living under extremely deprived conditions, without social support, without anything to do. They hang around dangerous places with dangerous people, and get into fights.”
And, she adds, “research shows that people with severe mental illness are more victims than perpetrators.”
The United States is unlikely to see movement toward controlling the highly lethal military-style weapons and large-capacity magazines used in Aurora. A Pew Research Center poll this April found “49 per cent of Americans said it was more important to protect the rights of Americans to own guns, while 45 per cent said it was more important to control gun ownership.”
And that returns the focus to prevention: Can dangerous people be identified in time?
Declining rates of violent crime
A problematic prediction
All the experts we spoke to cautioned that they knew little about James Holmes, who’s been charged with the Aurora shootings, but the emerging picture shows a student who was “smart, nice and always prepared but … somewhat of a recluse.”
Although Holmes looked dazed and confused at his hearings, this profile contains few “behavioral pleas” for help that psychotics commonly send, says Emanuel Tanay, a retired clinical professor of psychiatry at Wayne State University. “An infant does not communicate verbally, and psychotics often don’t communicate verbally. They don’t say ‘Help me, I’m psychotic,’ they behave in a bizarre manner that attracts attention; that’s a plea for help through behavior.”
These pleas “can be anything that’s bizarre,” Tanay says. “I heard about a man saying he was the second Jesus Christ. That was not just a harmless little fantasy, that was a delusion. He stabbed people after he had promised them resurrection, and was surprised when they objected to being stabbed.”
But most psychotics are “most dangerous to themselves,” says Aldige. “When they are dangerous to another, it’s more likely to be a threat, pushing, biting, throwing things, pulling hair, it’s so rare, so rare, that they pull a knife or use a gun.”
Some tell-tales of impending violence include extreme anger, frustration, cruelty to animals, aggression, blaming, bullying, fascination with firearms and fantasies about revenge.
And being male — less than 5 percent of multiple murderers are female.
Although it’s not clear that James Holmes was a classic loner, isolation often plays a role in severe mental illness, says Mulvey. “A lot of times they have burned bridges with family, friends and behavioral health providers. They are out there being more and more isolated; that’s a very dangerous situation.”
In American society, he adds, “A lot of people exist apart from regular daily contact with others; that’s no different for the mentally ill and for non-mentally ill individuals. Instead of chatting at the bus stop, they have something [electronic] in their ears.”
Isolation takes a particular toll on people who are “ruminating, caught up in delusions,” Mulvey says.
“Isolation is part of the pathology, and it also contributes to the difficulty of finding them” in time to stop the killing. “The closer you are to this person, the more likely you are to see when trouble arises, but the natural tendency is the opposite: to find them and then not be connected at all!”
Privacy laws and looser statutes for involuntary commitment can also get in the way. Privacy obligations for mental health practitioners can only be breached if they demonstrably endanger themselves or the public.
Tanay, who practiced in Michigan, says involuntary commitment laws have become less protective of the public. “In Michigan, if you noticed a member of your family acting in some unusual manner, there was an office that you notified, and they sent out a physician. The physician could get a three-day order and the person would be picked up and evaluated in the hospital, to determine whether he or she should be committed to an institution.”
A voice in the wilderness
If we are unable to predict violence by people who are mentally ill, should we turn the clock back 50 years and rebuild state mental hospitals? Yes, says Tanay, who worked in them as a young psychiatrist. “We cannot predict who will commit a dangerous act, but we are smart enough to determine who is severely mentally ill. The institutions, asylums, were established to provide care for the mentally ill … to be a community of mentally ill people. Now, if I go to the local library, there are a dozen homeless psychotics outside or inside.”
Beyond the issue of danger, Tanay says, “It is sufficient for me as a person who cares about other human beings to say that we will be better off if they are in a state hospital. When I worked at the state hospital in Ypsilanti (Mich.) 50 years ago, there were homicidal patients on the wards, but they were not dangerous. We have changed the whole approach.”
Currently in Michigan, says Tanay, “you have to file a petition, establish that the person is suffering from mental disease and is dangerous, and has manifested that dangerousness by an overt act. But an overt act that shows dangerousness leads to arrest, and they go to prison.”
Prisons, indeed, confine at least 350,000 mentally-ill people. According to National Public Radio, “More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers.”
That’s not ideal. The criminal justice system “was never built to handle people that were very, very ill, at least with mental illness,” Florida Judge Steve Leifman told All Things Considered. Prison conditions can intensify symptoms or even initiate mental illness.
With state mental hospitals closed, prison prone to making problems worse, and involuntary commitment rare, some communities are implementing an intermediate solution called a “crisis center.”
Intended to help during a psychiatric crisis, these places could also play a role in crime, says Mulvey. “When you see someone ruminating, feel they were wronged, you can try get them to help, to a sympathetic provider.”
Crisis centers are sometimes called a “23-hour bed,” because patients “don’t go through the whole hospital admission, as at a psychiatric emergency room, where they have to keep you 24 hours,” Mulvey adds. “These places are less threatening; people will not think they are going to be locked up and strip searched when they walk into the door. These are the best places we have now.”
In asking whether we can identify these killers in advance, we recall that three recent mass murderers had previously come to the attention of mental-health authorities, with little benefit:
Seung-Hui Cho (Virginia Tech massacre, 2007, 32 killed)
Nidal Malik Hasan (Fort Hood shooting, 2009, 13 dead)
Jared Loughner (Gabby Giffords shooting, 2011, six dead)
Indeed, a federal study of school shootings, performed after the 1999 Columbine High School massacre (13 killed), found that at least one outsider knew of the killer’s plans in 75 percent of the cases.
Crazy, or monstrously misguided?
Not every mass killer is criminally crazy. In a fascinating interview, Paul Mullen, an Australian forensic psychologist, suggested that killers are following “cultural scripts” that allow them to commit suicide “in a blaze of glory.”
“Violence is harder to predict than a plane crash; human behavior is more unpredictable than machine behavior.”
“They’re almost all male, there is one exception,” said Mullen. “They’re young. They tend to be in their 20s. They are typically social isolates. They very rarely have close friends or confidants. They almost never have an intimate relationship, although they sometimes have had brief relationships, which have usually failed.”
The obsessional personality leads to intense planning that could suggest a route to identification, Mullen said, based on predictable patterns of Internet browsing of websites focusing on weapons and survivalism. Correlating that behavior with purchases of guns and ammunition could produce an interesting list of potential killers (along with a larger number of people without criminal intentions).
Instead of classifying individuals as dangerous, Mulvey would focus on changes in risk over time. “There are people with a history of violence who do fine for several months because their lives are working okay for them. There are others who don’t appear to be at terribly high risk but have a pileup of issues, a traumatic pressure of living that is too much to bear. We need to find when to intercept people at those times, versus taking 2 percent of the population and labeling them so everybody knows they are dangerous.”
As we said, psychology offers no panacea for the terrifying but extremely rare spree killers. Mass murderers often “come out of families that settle differences by fights,” says Aldige. “In Arizona, the [Congresswoman Gabriel] Giffords shooter was from a strange family, but you can’t go locking up all these strange people. Suppose there had been some signs: how would you force them into treatment? And treatment does not work for everybody, or it can work only for a while …”
— David J. Tenenbaum