Cho Likely Schizophrenic, Evidence Suggests

Renowned forensic psychiatrist Michael Welner has examined some of the most notorious mass shooters of recent years. As details emerge about Seung-Hui Cho, the chairman of the Forensic Panel is following the case for ABC News and sharing his insights from his experience and current medical literature. Using the latest informaton, Welner believes the evidence strongly supports that Cho had paranoid schizophrenia.

What does the notion of a South Korean assailant do to the staple notion of a white male assailant as the likely perpetrator of a mass shooting?

Cho reportedly came to the United States in 1992. We know little of his upbringing, but many immigrants are nurtured in cloistered communities.

A person with little ties to the United States draws less from destructive icons, be they Rambo, the Terminator or others whose manhood ties closely with superior firepower and the capacity of one to destroy many. What a forensic psychiatrist would want to know is, how socialized he was into American cultural icons of manhood and militarism?

We cannot generalize about South Koreans. It is an advanced nation with an ambivalent cultural relationship to the United States. Many South Koreans have a tremendous appetite for American culture. There is no greater sense of identification with American culture than choosing America for his college years.

So culture matters?

Absolutely. An assailant who carries out a crime of the alienated, the emasculated, the rejected may have been inspired to a destructive path precisely because of how much he associated mass shooters with the American iconography. I examined Byron Uyesugi, a Xerox repairman who killed seven people in a November 1999 workplace shooting. He was Hawaiian-born of Japanese descent but was educated in the mainland and very much took to the soldier of fortune culture.

A lot of people compare this attack to Columbine. Is this a typical school shooting?

A typical school shooting occurs in high school. The dynamics of a student resentful of a school he is attached to and deeply alienated from have fueled previous high school shootings.

Clearly, the Virginia Tech gunman targeted a classroom building. The more specific a target choice, the more it links to his emotional conflict. We would have to understand his relationship to the school. Was he overly invested in scholastic success and facing impending failure? Or was his failure to succeed, and his relationship to any of the students or groups at the university a source of emotional defeat?

So if the perpetrator here killed with the same dynamics as a high school shooter, does that suggest someone with that developmental level of maturity?

College-age men have a better developed capacity for anticipating long-term consequences, appreciation for the rights and bodily integrity of others, and a better developed conscience than an adolescent. A college-age man is developmentally better able to brake a violent fantasy before it grows into a plan and an elaborate modus operandi to carry out a catastrophe.

Therefore, when a 23-year-old shows an impaired capacity to stifle a fantasy before it develops into a complex mass shooting plan, as a forensic psychiatrist I wonder about the sources of his developmental limitations.

Are you saying that the shooter was a schizophrenic?

Not enough has been released to tell for sure. Paranoia, in my professional experience, is the most important element to understand in the possible motives of mass shootings. Virtually all mass shooters are paranoid to some pathological degree. Some of them have suspicious personalities but otherwise maintain a connection to reality. Others have paranoid delusional disorder and have irrational and fixed false ideas about a particular theme. The most extreme of those with paranoia have schizophrenia, a condition that may be associated with intense hostility and different degrees of emotional and mental limitation and — particularly important to mass shooting — progressive and humiliating decline and alienation.

What then leads you to believe Cho had schizophrenia?

How he related to his roommate was just too bizarre to be depression. The bizarre content of his plays -- mashing a half-eaten "banana bar" in someone's mouth, the hypersexual, nihilistic (death obsessed) obsessions in the absence of depressive guilt or tearfulness are another clue. The progressive decline of a period of years. Those with schizophrenia, especially in their earliest years, are not readily recognizable as such -- their condition is evolving. But here was someone who, as early as 2005, was carrying himself so strangely that he was a spectacle. The depressed withdraw and disappear. Those who are so peculiar in their manner so as to be inappropriate (taking cell phone pictures of his teacher, speaking inaudibly, pulling a cap low over his eyes) exhibit signs and symptoms more indicative of schizophrenia. He was communicating in a rambling manner reflective of what we appreciate as autistic thinking -- characteristic of schizophrenia. In a similar vein, Mr. Cho's stilted communication in his homicide note (deceitful charlatans -- not the language of a 23-year-old college kid) is also the manner of a schizophrenic's communications, as is his pronounced delay in responding to questions.

What explains that?

The most obvious reason for a college-age man acting with the maturity level of a self-absorbed high school or middle school student is a major mental illness such as schizophrenia, which arrests psychological development from the point of its dominance in a person's life. A person who develops full-blown schizophrenia at 15 or 16, for example, will mature at a far more arrested pace than a person without such an affliction.

Is mass shooting only a matter of paranoia ?

No, because despair contributes to a person's resignation that his lot will not improve. While many mass shooters have depression, many do not. And depression is not what sparks the mass shooting, hopelessness is.

We also are left, as forensic psychiatrists, with having to understand why something happened on that particular day. There may be a clear conflict; in my experience, there is also an unconscious trigger as well. That trigger may be all the more lethal because mass shooters may be less likely to introspectively reflect that they are wrestling with other conflicts as well.

The unconscious trigger, inspiring a sense of life failure and hopelessness, is always elusive and especially so because the killer takes the secret with him when he dies.

Those rampage killers that I have interviewed, typically in connection with them facing the death penalty, are moreover very cautious about disclosing the conflicts of their despair. Ronald Taylor, a black man who was convicted of killing three white men in a racially motivated shooting rampage in Wilkinsburg, Pa., had a paranoid personality and was positively teeming with fury over whites. However, he did not have a psychotic condition, and was actually quite street smart. He had contemplated a mass shooting for many months. But what actually triggered the shootings, in my professional opinion, was his failure to woo a staff member at a social service center he attended; his "secret admirer" letters were quite frightening to her, and when he was exposed and shooed away he felt humiliated. Within a week he was shooting all of the whites he happened upon in his predominantly black neighborhood.

So do you attach importance to reports of the shooter having killed a romantic interest?

In my professional experience, rejection from a romantic target is a very common and underestimated homicidal trigger for young men, be it mass shooting, killing of friends or even intrafamilial shooting. The assailants are reluctant to speak of the emotionally loaded issue after the fact — particularly because they may have had an intense reaction to a rather unimpressive emotional connection.

And that is precisely the point. Alienated, paranoid individuals have great difficulty connecting with others because of their social awkwardness, rage and negativism, and because of the depression that many who later go on rampages also have in addition. Reminders of their failure to connect with others are very painful to them. Richard Baumhammer -- who targeted minorities in a shooting spree that left five people dead in April 2000 was so starved for relationships with women, for example, that he would pay girls from escort services to simply come to his home and sit with him.

It is a sad quality of the paranoid that they have such great difficulty tolerating intimacy. Stress triggers their paranoid defenses which may be wholly irrational.

What does a mass shooting that targets a classroom building have to do with a lost romantic interest?

It doesn't actually. The person contemplating a mass shooting does so because of how alienated he is. Those feelings arise independent of romantic feelings for another. The shooter experiences rejection in his own mind but reacts to it most intensely when he experiences it from someone he cultivates intense emotions for.

Mass shootings are set off with a personal conflict, which may seem relatively minor by comparison. However, the person who kills to end the confrontation with the last word cartwheels, in my professional experience, into a mass shooting because he also happens to harbor tremendous rage that he has long directed at a particular group or the general community — and he has already killed and recognizes he is facing life in prison, or worse.

So is the solution to isolate the paranoid in order to prevent mass shooting?

Absolutely not. It is the level of increasing isolation that fuels the destructive fantasies. However, for people who are specifically targets of paranoid thinking, they should engage someone else to keep the paranoid, weapon-obsessed and beligerent connected to humanity, while they themselves step back until that individual stabilizes.

That person could be a benign and detached presence — just someone nonthreatening who can slowly defuse the ticking bomb. In my professional opinion, the dynamics of such interactions are very similar to what is done with those who paranoid and rageful individuals who take strangers hostage.

Is there evidence that the shooting was the product of a psychotic mindset?

Actually, the available evidence reflects substantial premeditation and planning to maximize casualties. The medical literature reflects that the more deaths in a mass shooting, the less likely an assailant was psychotic at the time of the crime. The more organized the behavior (in this case, chaining the entries to classroom buildings shut and controlling an entire building, quietly progressing from room to room, armed with changes of clips, Kevlar vest), the less likely a person was acting at the time with psychotic thinking.

In my professional experience, as exemplified in the Richard Baumhammers mass shooting, a person can have a major mental illness (in his case delusional disorder) and still not be psychotic at the time of the attack.

How is it possible for a person to have a psychotic condition, but not to be psychotic at the time of the crime?

For some — those who respond to a hallucination or who shoot only folks they have delusions about — psychosis is an element of the offense. Paranoid schizophrenia and paranoid delusional disorder are commonly implicated in mass shootings.

However, especially with schizophrenia, hostility is also a major component of the condition and the person with teeming hostility and rage is commonly quite alienated and emotionally alone. If that alienation advances into a resentment of a community in general, or a specific ethnicity or nationality, a person who carries out a mass shooting may be principally discharging rage — not acting under the influence of his psychosis. Baumhammers, for example, had a number of paranoid delusional ideas. He also, however, was politically anti-immigrant, resentful of minorities, deeply identified with family roots (from Nazi Latvia) and had a childhood history of burning a cross on a black family's lawn. He is an example of someone who had a psychotic condition, but when he carried out his condition acted on the objects of his rage, not the aspects of his psychosis.

This story has been updated to clarify the condition suffered by Richard Baumhammers.

Dr. Welner is chairman of the Forensic Panel, a national forensic science practice. An associate professor of psychiatry at New York University School of Medicine, he is developing an evidence-based test called the Depravity Scale, http://depravityscale.org, which invites Americans to participate in surveys that are used to form a legal standard of what represents the worst of crimes.

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