August 6, 2009 -- Angry. Hostile. Hopeless. Ready to die and get back at everyone.
These are some of the words psychiatrists use to describe George Sodini, the Pennsylvania gunman who shot and killed three women and injured nine others at a fitness center on Tuesday before killing himself.
Chilling blog entries by Sodini, 48, dating back to Nov. 5, 2008, offer a glimpse of Sodini's struggle with feelings of isolation and rejection -- and the seeds of a plan to end his torment.
Based on his writings, experts say there may have been a time when Sodini would have benefitted from professional therapy, but a lack of personal motivation or any close, supportive relationships may have slowly closed off that option.
"Certainly he knew [professional help] was an option, and could afford it," said Harold Koenig, professor of psychiatry and behavioral sciences at the Duke University Medical Center. "He would have been a hard person to counsel, though, given his long-standing negativity about life... These people don't usually seek professional help."
Family May Be The First Line of Defense Against Mental Illness
In cases of mental illness, friends and relatives are often the first to recognize problems and suggest seeking professional therapy. Rahil Briggs, assistant professor of pediatrics at the Albert Einstein College of Medicine, pointed out that mental problems often start when a young child has difficult family relationships and that identifying negative environments early could be preventative.
But Sodini wrote that he was not close to his family, that his father was a "useless sperm donor," his mother "mad and vindictive," and his elder brother a "big bully."
And despite a relatively successful professional career, Sodini said he had trouble relating to people, especially women, and wrote that he had not had a girlfriend since 1984 and had not had sex since 1990.
"I think if someone had befriended him and persisted in the relationship, that might have helped," Koenig said. "At least allowed him to ventilate to somebody else and share his feelings rather than hold them all in."
Sodini References Lists, Plans In His Blog
Over the course of the entries, vague references to "The List" and "the exit plan" as well as more specific entries such as one on Jan. 6, 2009, that read, "It is 8:45PM: I chickened out!... I brought the loaded guns, everything. Hell!" offered hints that Sodini was in the process of planning an event that could be harmful to himself or others.
"It is not hidden that he is angry and contemplating potential homicidal [or] suicidal behavior," said Martin Binks, director of behavioral health at Duke University Medical Center. "He expresses considerable and long-standing hopelessness and the desire to lash out. However, there are periods where these issues seem to subside slightly... He expresses specific intent to harm others and appears to be delaying and at times looking for reasons not to act. In short, it appears he was likely fighting the impulse to do harm for some time."
Sodini did write on May 18, 2009, that he went on a date with a woman he met on a bus, but the entry continued to focus on feeling rejected.
"Women just don't like me," he wrote. "There are 30 million desirable women in the US (my estimate) and I cannot find one. Not one of them finds me attractive... I need to expect nothing from me or other people."
No One Could Have Reached Out to Sodini
Eventually, Koenig said that Sodini may have deteriorated to a state in which he was unable to respond to efforts to reach out to him and had resolved to ignore anything that might shift focus from his "plan."
"Unfortunately, I talked to my neighbor today who is very positive and upbeat," Sodini wrote on Aug. 3, 2009, the day before he opened fire in the fitness center. "I need to remain focused and absorbed COMPLETELY. Last time I tried this, in January, I chickened out. Lets see how this new approach works."
Madelyn Fernstrom, professor of psychiatry at the University of Pittsburgh Medical Center, said that a professional evaluation to determine if talk therapy, medication or an inpatient stay in the case of evidence of self-harm or harm to others would have been the best option for Sodini to help stabilize his behavior.
Professional Counsel May Not Have Been Useful For Sodini
But even an assessment may not be the only step toward separating intent from fantasy in a patient.
"It would clearly be an ethical challenge for a therapist to determine if a patient saying these things fell into the category of 'duty to protect,' [which requires an identifiable victim]," Binks said. "But one would very likely seriously consider involuntary commitment in a case such as this."