Sunday 16 December 2012

The psychology of mass murder (a brief overview)

We Need to Talk About Kevin - 2011
In a sort-of update to my previous post, I thought I would briefly and tentatively dissect a minute aspect of a multi-layered problem: mass-murder. Much of my thoughts contained herein stem from this article, which talks about psychopathy. I don't believe there is any meaningful conversation to have regarding the link between mental illness and mass-murder, but perhaps by looking at what tenuous links there are, I might educate some people.

Another devastating mass-shooting has taken place in the United States, this time in Sandy Hook, Connecticut, one of the safest states in the country.


In amongst the usual liberal vs. conservative/libertarian arguments over gun-control, I've witnessed a gradual but steady rise in calls for bringing the discussion of mental illness to the table, to make it more "public", as though it were a dirty secret. This comes in the wake of reports that Adam Lanza, the perpetrator of the Sandy Hook shooting, purportedly had a form of autism, or was at the very least "socially awkward", a term often used to describe the kind of "lone, deranged killer" types we're accustomed to hearing about on the news.
The argument, then, is presumably that by raising awareness about mental illness, we can address the issue that REALLY matters, i.e. screening for the wealth of undiagnosed nut-cases stockpiling weapons all around us?

It's fair to say this argument is mostly put forward by conservatives wishing to steer the debate away from the issue of gun-control. This short but sweet response from DSM 5 contributor Dr. Frances sums up my feelings on the matter.

Nonetheless, a troubling and touching account was published today by a mother whose 13-year old son she feels exhibits strong signs of becoming a future Adam Lanza (her article is somewhat dramatically titled "I am Adam Lanza's mother"). She argues that
It's time for a meaningful, nation-wide conversation about mental health.
What would this conversation be about, in the context of mass-murder, and what outcome would it have? Could we screen for and prevent potential mass-murderers?

Firstly, I think it is important to note that a person with a diagnosis of mental illness is more likely to be a victim of violence rather than the perpetrator.

Secondly, there is not much in the way of literature on the psychology of mass murderers (discounting analyses of historical atrocities like genocide). Seeing as mass murders are relatively few and far between (despite what the media may have you believe), the best we have are case-studies conducted on high-profile individuals after the fact, such as the two perpetrators of the Columbine shootings. 
Eric Harris and Dylan Klebold, 18 and 17 respectively, have had their motives and minds analysed in a number of books and reports, some less reputable than others. Taking an aggregate of what I've read/heard over the years, the two shooters appear to fit the criteria for psychopathy, or at the very least narcissistic personality disorder.
The year before the massacre, Harris and Klebold had been caught breaking into a van. They avoided prosecution through a “diversion programme” involving counselling and community service. Each wrote a letter of apology, with Harris stressing his empathy for his victim: “I believe you felt a great deal of anger and disappointment.”
But Harris’ journals revealed his true feelings: “Isnt america supposed to be the land of the free? how come If im free, I cant deprive a stupid fucking dumbshit from his possessions If he leaves them sitting in the front seat of his fucking van out in plain sight and in the middle of fucking nowhere on a Frifuckingday night. NATURAL SELECTION. fucker should be shot (sic).”
Hence by joining a few dots in an unscientific way, we could conclude that psychopathy predicts mass-murder...
I doubt it would be the first time, and you might even say it's an obvious deduction, but it's worth remembering that there are a panoply of possible reasons for wanting to go out and kill people, some of which I'm sure we all secretly and shamefully share (bullying, vengeance etc.).
There is no crime of which I do not deem myself capable - Goethe, Johann Wolfgang Von, 1749 - 1832
Nonetheless, only a rare minority of us actually goes out and does it. Through the gradual medicalisation of human behaviour, Psychiatry has identified a key set of personality traits that taken together can potentially account for some of the extreme violent acts that the media loves to sensationalise: Psychopathy (often wrongly called Sociopathy in the media).

Ted Bundy
I'm not going to go into it here, but psychopathy is a controversial diagnosis (as are personality disorders in general) some people think it doesn't exist (it is after all a composite of traits from other personality disorders), others swear by Robert Hare's patented Psychopathy checklist.

Regardless, the construct has built up quite a hefty empirical basis over the years, and is very useful for describing and preempting some of the frighteningly manipulative and cold-blooded behaviour of violent people (friends of mine who have worked with such a population have quite the stories to tell).

We're now accustomed to hearing about men in their late 20s and 30s committing a spate of grizzly crimes, the psychopath tag being an easy fit. But what about relatively young (often male) perpetrators of cruel, violent acts? The conventional wisdom would be to hold off on a diagnosis and blame external influences (video games, music, etc.), assuming that youth equates with impressionability. The research is beginning to challenge this accepted wisdom.
“To me it seems a no-brainer,” says Essi Viding, professor of psychology at University College London. “Nobody’s going to get psychopathy as a present when they turn 18. Of course you’re going to see some precursors. 
Essi Viding is actually professor of Developmental Psychopathy at UCL, and the bulk of her research is dedicated to examining the early markers for later development of antisocial personality disorder, a component of adult psychopathy. Particularly strong markers are Callous-Unemotional traits (CU).
According to Paul Frick, who so named the Callous-Unemotional traits based on parents' descriptions of their children,
The difference between children with conduct disorders and this particular group lacking in empathy can be seen in two referrals that he recalls. Both had been cruel to animals. One child had shot and killed a cat in a tree, in a reckless attempt to get it down. The second had, little by little, cut pieces from a cat’s tail to see how it would respond.
Viewed in terms of severity, the first child is worse, having killed the cat, Frick says. But it is the dispa
ssionate cruelty of the second that indicates callous-unemotional traits.
I have to say, I find that second story particularly unsettling. It's worth noting however that only 2 to 4 percent of children have conduct disorders, and only a third of these display the aforementioned traits, so it is relatively rare. Here are the traits in full:
“One is lack of guilt. They just don’t seem to show remorse or guilt. A person doesn’t feel bad or guilty, unless they’re expressing guilt when they’re caught.
Second, a lack of empathy. They have a disregard for the feelings of others. Third, they are unconcerned about how well they do in their school work. And fourth, shallow and deficient affect. They don’t show emotions except if emotions will get them something. These kids are often described as cold.”
As alarming as these traits are, to start labelling children as psychopaths is problematic, as psychopathy has historically been seen as an untreatable illness, the only solution being preventative incarceration. An example of this can be seen when a murderer pleads insanity, thinking they'll spend a reduced sentence in a medical facility, ending up spending the rest of their life in a high-security institution like Broadmoor Hospital, due to a diagnosis of psychopathy.

Nonetheless, Professor Viding's research indicates that CU traits and Antisocial Behaviour (AB) are not only present in early childhood and predictive of adult psychopathy, but based on adoption and twin studies appears to have a strong genetic basis as well, particularly CU.

The CU and AB traits could well describe an Adam Lanza, or the Virginia Tech killer, and it is chilling to think that the signs arrive so early in life, even in the absence of bad parenting. In this regard, the film We Need to Talk About Kevin is remarkably perceptive in presenting an ambiguous account of a mother struggling with her CU child, feeling guilty for her suspiciousness and lack of emotional connection with Kevin, despite him being, in clinical parlance, a little shit. And when the titular Kevin commits the heinous acts his short life has been building up to, the ensuing community backlash towards the mother is all the more painful to watch.


I would argue that culturally, we assume children are born innocent and naive, becoming damaged or warped by whatever neglect and abuse they suffer over time. Viding's research would argue for a strong heritability of the C-U trait, which may then exhibit itself in early childhood. This contrasting image of a child essentially born "evil" is hard to swallow, as this article explains
It is clear that our growing understanding of callous-unemotional traits in children presents a massive challenge to schools: to accept that children can be without remorse or regard for others’ feelings
So are we to assume that these young, budding psychopaths are irreparably damaged goods, with close monitoring and eventual incarceration the only solution?

The added benefit of early identification is the opportunity for early intervention. As it happens there is already an intervention that claims to produce meaningful change in behaviour (if not in underlying psychology): positive reinforcement. This may come as a surprise, given the received wisdom:
Faced with some of the most serious misbehaviour, teachers and parents are asked not to reach for their most instinctive response: punishment.
Laura Warren is an educational psychologist who, like Frick, became frustrated that the methods she had been taught were increasingly failing on children with conduct disorders.
At the time, teachers would universally attribute bad behaviour to low self-esteem, she says. “What I was finding was that usually the children who were the most disruptive didn’t have low self-esteem. If anything, it was over-inflated. They thought they were fantastic. Overly high self- esteem is a bigger predictor of aggression than low self-esteem.”
A grandiose sense of self-worth is in fact one of the characteristic traits of adult psychopaths. Viding points to an anecdote from Robert Hare, a psychologist who developed one of the leading tests for psychopathy. He met a prisoner who insisted that he was going to swim for Canada in the Olympics, despite the disadvantages of being overweight, unfit and serving a life sentence.
 Hence, the need for a solution that plays into the interests of this rather unique population:
The programme, called Let’s Get Smart, replaces sanctions with rewards. Some teachers were uneasy. “Some teachers felt that punishment happens in the real world; if they misbehave in the real world they will still go to prison. Why are we setting them up for unrealistic expectations?” says Jones. “Our point is that it doesn’t work.”
By offering regular rewards, perhaps three times a day, controlled by the adult in authority, it aims to provide a rational, self-interested motivation for pleasing adults where that motive is emotionally absent. “The adult becomes the clear intermediary between the child and what the child wants,” Warren says. The rewards are tailored to each child’s interests.
These children often have a strong desire for control and teachers have to resist attempts to negotiate, because any concession just leads to more demands. “I teach parents and teachers to say, ‘It’s not open for discussion, go away.’ Adults don’t like to dismiss children,” Warren says.
All this is backed by role play and other exercises that are intended to build children’s capacity to pay attention to and respond appropriately to others’ emotions. Video playback helps the children to see their behaviour as others do, often to their surprise. (“I do swear a lot,” one girl told Warren.)
Promising, although the article describing this intervention points out that it took the children's' behaviour from being in the worst 99% to the 89th percentile. Additionally, as they rightly point out, the approach plays directly into the children's preponderance towards cold, rational self-interest (mini-economists, if you will), without attempting to change their underlying psychological make-up.
Still, it's positive to hear that something works at all, given that historically psychopathy has been considered untreatable.

To summarise, it would appear that psychopathy is rare, has a strong genetic component, and the signs can be detected early. What's more, leading researchers in the field are collaborating to develop and empirically support interventions that will help curb the cruel, calculating behaviour of psychopathic children. 
If awareness needs to be raised as has been suggested, it would be amongst schools, parents, and clinicians, so that any eventual programs tailored to the needs of such children could be introduced without the fear and hysteria that one might expect if we simply start labelling callous children as psychopaths.

So, regarding a "meaningful" conversation about mental health, it seems that if there is any connection to be made between mental illness and mass-murder, psychopathy is the best one we have, but it's a tenuous link at best.
As interesting and valuable as all of the research on psychopathy is, none of it links directly with mass murder. Equally, none of the interventions and measures I've discussed have anything to do with preventing mass-murder. As Dr. Frances explains
Psychiatry has no way of predicting or preventing rare and fairly random acts of senseless violence—it is simply impossible to find needles in haystacks. We must accept the fact that a small cohort of deranged and disaffected potential mass murderers will always exist undetected in our midst. The only questions are how often will these ticking time bombs go off and how much damage will they do when detonated.
As is hopefully clear, I decided in this post to focus on explaining the roots of psychopathy, in part because I read an article written by a mother whose young son she fears will become an Adam Lanza. I have a feeling her son may simply be displaying Callous-Unemotional traits (albeit severe ones), and by taking her jump in logic seriously, I hoped to show that no direct link actually exists between psychopathy and mass murder.

Mental illness is but one small component (if it is at all) of a complex and nuanced problem. Wanting to understanthe psychology of  extreme acts like mass-murder may help bring a sense of control in the midst of confusion and chaos, but ultimately it distracts from other, more worthy causal factors (like Adam Lanza's mother being a survivalist with a large gun collection, for example).

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