Psychiatric Annals

CME 

Mass Murder and the Violent Paranoid Spectrum

James L. Knoll, MD; J. Reid Meloy, PhD, ABPP

Abstract

Mass murderers who capture media attention often appear to be suffering from psychosis. However, no research has clearly established that most are psychotic or even suffering from a serious mental illness (SMI). In contrast, individual case studies examining the psychological makeup of mass murderers often reveal paranoid themes in their cognitions. For example, many have been found to be preoccupied with feelings of social persecution and revenge against their perceived tormentors. In addition, they share an inability to accept their apparent circumstances and choose to obliterate reality with an act of violent revenge.

In this article, it is suggested that the psychology of paranoid mass murderers can be understood as existing on a continuum of paranoia ranging from mistrust to frank paranoid delusions. This can be demonstrated by careful forensic psycholinguistic analysis of the communications they frequently leave behind. Finally, this article seeks to outline a psychoanalytically informed cognitive progression seen in paranoid spectrum mass murderers in the hopes of delineating stages for earlier recognition and possible intervention.

Abstract

Mass murderers who capture media attention often appear to be suffering from psychosis. However, no research has clearly established that most are psychotic or even suffering from a serious mental illness (SMI). In contrast, individual case studies examining the psychological makeup of mass murderers often reveal paranoid themes in their cognitions. For example, many have been found to be preoccupied with feelings of social persecution and revenge against their perceived tormentors. In addition, they share an inability to accept their apparent circumstances and choose to obliterate reality with an act of violent revenge.

In this article, it is suggested that the psychology of paranoid mass murderers can be understood as existing on a continuum of paranoia ranging from mistrust to frank paranoid delusions. This can be demonstrated by careful forensic psycholinguistic analysis of the communications they frequently leave behind. Finally, this article seeks to outline a psychoanalytically informed cognitive progression seen in paranoid spectrum mass murderers in the hopes of delineating stages for earlier recognition and possible intervention.

Mass murder — the killing of three or more victims at one location within one event — is a rare but catastrophic phenomenon.1 Factors common to mass murder include extreme feelings of anger and revenge, the lack of an accomplice (in adult mass murder), feelings of social alienation, and planning/organizing the offense. In a detailed case study of five mass murderers who were caught before they were killed, a number of common traits and historical factors were found.2 The subjects had all been bullied or isolated during childhood and subsequently became loners who felt despair over their social alienation. They demonstrated paranoid traits such as suspiciousness and grudge-holding. Their worldview also suggested a paranoid mindset, as they believed others to be generally rejecting and uncaring. As a result, they spent a great deal of time feeling resentful and ruminating on past humiliations. These ruminations subsequently evolved into fantasies of violent revenge.

From an etiological standpoint, the factors contributing to mass murder are broad and so must be approached via a bio-psychosocial model.3 Biological factors include possible brain pathology, as well as psychiatric illnesses such as depression and psychosis. Psychological factors include a negative or fragile self-image, paranoid dynamics, and retreat into violent and omnipotent revenge fantasies. Social factors include isolation, possible ostracism by peers, and an absence of pro-social supports. Given the heterogeneity and paucity of research seen in the spectrum of mass murder, it is difficult at the present time to draw conclusions beyond the hypothesis that it is caused by a “complex interaction” between psychopathology, traumatic life events, and precipitating factors.4

Paranoia as a Narcissistic Defense

The narcissistic dimensions of paranoia have been suggested by the fact that the persecuted individual believes he is special enough to be singled out, and the fact that systematized paranoid cognitions result in a self-contained feedback loop that prevents outside information from dispelling the paranoid belief system. It is a persecutory echo chamber. As Chessick5 notes, the paranoid individual walls off the self in order to keep emotional distance from others, and to protect his fragile self-image. The result is a paranoid belief system that allows an “encapsulation” of ego pathology.

Depending upon the individual’s bio-psychosocial constitution, and particularly his intellectual development, systematization of the paranoid beliefs may be needed to more completely encapsulate the ego deficits. Regardless of the extent and elaborateness of the paranoid beliefs, to the casual observer, the paranoid individual’s reality will only appear broken around a relatively narrow set of concerns. It is this “gap” that “is filled by the delusional system.”6 Further, the onset of delusions often occurs insidiously.7 In the process, the paranoid individual’s ego compromises some degree of reality as a self-preserving measure. In effect, the concession serves to “avoid a rupture by deforming itself, submitting to forfeit something of its unity, or in the long run even to be gashed and rent.”8

The type of paranoia discussed here is in relation to mass murderers and involves two important nuances: an association with violence and dimensionality. An increased risk of violence has been associated with paranoia, particularly with paranoid delusions in certain individuals with other comorbid risk factors.9–11 Dimensionality refers to the concept that personality traits “can be located on the spectrum of trait dimensions,” and so may be present “in different degrees rather than being present versus absent.”12 Thus, it is not unreasonable to expect that paranoia would exist on a continuum for mass murderers ranging, for example, from suspiciousness to frank psychosis with paranoid delusions. Some mass murderers, such as Jiverly Wong or Jared Loughner, appear to have been clearly in the psychotic range of the paranoid spectrum.13,14 In contrast, others such as Marc Lépine or Eric Harris appear to have harbored intense feelings of injustice as a result of perceived mistreatment and social rejection.15,16 The communications of this latter group are rife with paranoid themes, yet they do not rise to the level of a formal delusion. Dimensionality is a truer measure of all personality and personality disorders and was the original intent of the diagnostic changes in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) for personality disorder and is presently described as an “emerging measure and model” in the new diagnostic manual.

It has been observed that most if not all men in the U.S. who have killed 10 or more victims in a single incident have demonstrated “paranoid symptoms of some kind.”17 Regardless of where the mass murderer’s psychopathology lies on the paranoid spectrum, it can be argued that the progression of his cognitions leading up to the offense share certain similarities. For the sake of discussion, the cognitive progression will be parsed into four stages: perception of threat, contemplation of the threat, the decisional stage, and finally, the stage of resolution (as outlined in Table 1). The stages are meant to represent broad periods of mental functioning, since it is unlikely that an individual’s progression will be demarcated by bright lines and predictable transitions. The perception stage involves a combination of perceived personal inadequacy and the perception of an outside threat, either real or imagined. In the case of a non-psychotic mass murderer, threats typically involve some form of social rejection by peers. Whether delusional or not, these perceptions stimulate feelings of humiliation and anger, if not hatred, contempt, and disgust for those who persecute.

Paranoid Spectrum Mass Murderer Cognitive Progression

Table 1.

Paranoid Spectrum Mass Murderer Cognitive Progression

In the contemplation stage, the potential offender deliberates or “assesses” the risk to himself and whether or not he is likely to prevail by ordinary, lawful means. Having concluded that he is not likely to overcome the threat, he is at a key decisional point. In the decisional stage, he must call upon his internal resources and ego defenses to confront the threat in either a pro-social or an antisocial manner. He may either accept his situation and seek out a nonviolent compromise — or staunchly refuse to accept his circumstances. This latter path inevitably leads to an abandoning of realistic hope and withdrawal into omnipotent violent fantasy. If this path is followed, the fantasies usually involve the use of deadly force to gain retribution. Such fantasies may chronically remain as an intrapsychic home of isolative retreat, but in a few cases, there is progression to research, planning, preparation, and implementation of the targeted violence.18 This is the resolution stage.

This model of cognitive progression in paranoid mass murderers is essentially a “threatened ego” model, and consistent with Menninger’s view on factors leading up to explosions of rage. According to Menninger, there are five critical elements prompting such violent behavior: 1) a narcissistic injury perceived as grossly unjust, resulting in 2) hopelessness about a rational solution; 3) the perception that the situation is intolerable and demands action; 4) access to weapons; and 5) disregard for the consequences, combined with a sense of “potent” rage.19 To clarify this process, Menninger20 uses the example of when a child suffers some type of pain. Immediately, the child “wants to let others know about it … to know exactly how he or she hurts.” The internal dialogue may be represented as: “When I am hurt by you, I want you to hurt like I hurt; therefore, if you hit me, I will hit you back.”21

However, in the case of the paranoid mass murderer, the narcissistic injury has been so severe that excessive retaliation and transfer of a disproportionate amount of pain to perceived persecutors is seen as the only resolution. Further, the actual extent of the narcissistic injury may be greatly amplified and suggest persecutory themes. For example, in the case of Seung-Hui Cho, his final writing portrayed other students (whom he hardly knew) as having “raped my soul” and having “crucified” him.22 Another example can be seen in the case of Atlanta day trader Mark Barton, who shot and killed nine people and injured 13 more in 1999.23 Barton was motivated by depression and anger, as well as serious financial and marital troubles. He had developed a highly resentful, yet hopeless attitude about both his life and career. His suicide note stated, “I don’t plan to live very much longer, just long enough to kill as many of the people that greedily sought my destruction.”24

An important difference, however, between the formulations of Menninger and contemporary data on mass murderers is that the violence of the mass murderer is not sudden and explosive; but instead, planful, methodical, instrumental, and largely devoid of emotion.25,26 An illustrative example of this is the case of Anders Behring Breivik, whose terrorist-style mass murder in Norway on July 22, 2011, claimed the lives of 77 innocent victims. Breivik not only planned out his attack over many years, but also used meditation, music, and videos to help further reduce any lingering emotions at the time of the attacks.27 Thus, the mass murderer may begin his pathway with intense affect, but following his decision to act and withdrawal into fantasy, he typically embarks on a predatory or instrumental pathway to violence.

To further understand the psychology of the paranoid mass murderer, it is helpful to consider the psychoanalytic concept of the paranoid-schizoid (P-S) position as first described by Klein.28 The study of violent offenders has suggested that they demonstrate an impaired ability to trust and have a persecutory worldview, leaving them with a strong self-centered, paranoid character style.29 These observations are comparable to the Kleinian concept of the P-S position, in which the individual’s worldview is based on feelings of mistreatment and frustration at what is perceived as deliberate harm, or purposeful deprivation.30 The P-S offender demonstrates the use of defense mechanisms associated with paranoia (ie, projection, denial, splitting, and projective identification).31

According to Kleinian theory, P-S offenders also suffer from strong feelings of destructive envy, simply defined by Klein as the wish to destroy goodness. Thus, the P-S offender must destroy others’ capacity to enjoy the envied object or status. For example, in Cho’s manifesto, he criticized other students due to his perception that they possessed “everything” they ever wanted, such as “Mercedes … golden necklaces … trust funds … vodka and cognac.”32 Yet in the same manifesto, he demonstrates powerfully destructive envy, stating: “Oh the happiness I could have had mingling among you hedonists, being counted as one of you, if only you didn’t [expletive] the living [expletive] out of me.”33

As demonstrated by Cho, the P-S offender perceives others as persecutory, not only due to beliefs about mistreatment, but also as a result of his view that others are withholding of life’s goodness and its associated accoutrements. Forensic psycholinguistic analyses demonstrating the P-S position of mass murderers Cho and Jiverly Wong have been detailed elsewhere.34 Next, the procedure and utility of the forensic psycholinguistic method is briefly outlined and applied to the writings of another mass murderer, Kip Kinkel.

Forensic Psycholinguistics

Psycholinguistics is a discipline that focuses on the psychological study of language and has its roots in the work of psychologist Jacob Robert Kantor’s 1936 book, An Objective Psychology of Grammar.35 Kantor was interested in the fact that words were symbolic expressions of the individual’s state of mind. Further, written language can be viewed as logical propositions reflective of thought organization and content. The field has progressed to include various disciplines that study the psychological and neurobiological factors of language.

Psycholinguistics began to be utilized for forensic purposes to analyze threatening communications.36 Current applications of forensic psycholinguistic analysis include threat assessment, authorship identification, false allegations of victimization, and statement analysis.37 Psycholinguistic analysis can be particularly helpful in analyzing communications from either unknown or inadequately understood subjects.38–41 The words and language people use are a reflection of their bio-psychosocial makeup, and careful attention to those words “can reveal important aspects of their social and psychological worlds.”42 For example, the individual who is suffering from a paranoid delusion yet maintains the capacity for organized and linear thinking is likely to be more capable of intentionally planning, preparing, and carrying out violence.43,44 Thus, the language of such an individual should reflect paranoid themes, yet demonstrate organized syntax.

Psycholinguistic Analysis of Mass Murder

Hempel, Meloy, and Richards45 were the first to note that mass murderers seemed compelled to “convey their central motivation in a psychological abstract,” sometimes even yelled just before the onset of the killings. Since then, the writings of many mass murderers have been analyzed and shown to reflect strong themes of persecution, alienation, envy, and vengefulness.46,47 The forensic psycholinguistic analysis of a mass murderer’s communications begins with the assumption that he would not have bothered to craft and/or communicate a manifesto unless it had great personal meaning. In fact, some make special efforts to ensure that their final communications or manifesto will be transmitted to and read by others.

Revenge is often a central motive for mass murderers, and it has been hypothesized that these individuals desperately need an “audience” to recognize their struggle.48 In this sense, there is a theatrical aspect to their vengeance, which requires witnessing by the “Other;” they not only need a target for revenge, but also an audience. These messages — or symbolic stories of injustice and oppression — may be written, videotaped, or, as is happening more frequently, posted on the Internet.49 The messages are rich sources of data, providing a deeper understanding of the perpetrator’s motive, mental state, and psychological disturbances.

Acts of extreme violence invariably have symbolic meaning and have been noted to serve a homeostatic function for a fragile ego.50 Thus, the communications of such individuals may be expected to reflect the more primitive defense mechanisms such as splitting, projection, and projective identification. Although paranoia and persecution are strong themes found in the communications of mass murderers, it is important to keep in mind that some individuals on the paranoid spectrum may perceive mistreatment that is substantially greater than that which occurred in reality.51

Kip Kinkel: Forensic Psycholinguistic Analysis

Kipland Philip “Kip” Kinkel was 15 years old when he shot and killed his parents and two high school students and wounded another 25 students in Spring-field, OR.52 The shootings at his high school occurred on May 21, 1998, the day after he had been suspended from school for possession of a loaded, stolen handgun. He was ultimately sentenced to 111 years without the possibility of parole. Prior to the shootings, Kinkel had been treated for depression and was fascinated by firearms. His peers described him as morbid and preoccupied with violence. Immediately after being expelled, Kinkel’s father told him he was considering sending him to military school.

During Kinkel’s trial, there was controversy about whether or not he suffered from paranoid schizophrenia. Regardless of his position on the paranoid spectrum, his pre-offense writings suggested P-S dynamics, hopelessness, and a resolution to obliterate reality. Portions of Kinkel’s pre-offense writings will be used to demonstrate the P-S dynamics and cognitive progression.53

Analysis of Kinkel Pre-Offense Writings

“Even though I am repulsive and few people know who I am, I still feel that things might, maybe, just a little bit, get better.”

In the perception stage, Kinkel revealed both a profoundly negative self-image and a threat in terms of social rejection. However, he had not yet reached the stage of abandoning all hope.

“I feel like everyone is against me, but no one ever makes fun of me, mainly because they think I am a psycho. There is one kid above all others that I want to kill. I want nothing more than to put a hole in his head. The one reason I don’t: Hope. That tomorrow will be better. As soon as my hope is gone, people die.”

Kinkel demonstrates that he perceived clearly the threat of social rejection. Like many mass murderers, he fashioned for himself a persona of “black armor” in an effort to ward off persecutory threats (“I am a psycho”). Further, he began to enter the contemplation stage, as he grew concerned that his hope may run out. Clinical observations suggest that offenders who remain fixed in the P-S position ultimately develop an entrenched nihilistic attitude.54 This nihilism then pervades their worldview, and feelings of hopelessness may result in suicidality and other self-defeating actions.55–57

“I need help. There is one person that could help, but she won’t. I need to find someone else. I think I love her, but she could never love me.”

The P-S dynamics were revealed here as evidenced by his belief that the other could help if she chose to, but instead acts in a persecutory and withholding manner. Kinkel also revealed that his fantasied source of help and hope was a female with whom he wished to have a loving relationship.

“I gave her all I have, and she just threw it away. Why? Why did God just want me to be in complete misery? I need to find more weapons. My parents are trying to take away some of my guns! My guns are the only things that haven’t stabbed me in the back.”

This portion suggests persecution at the hands of a female love object. Note that this persecution then became greatly expanded and generalized, to the extent that he believed God had singled him out for “complete misery.” In this sense, Kinkel placed himself into the position of Job, who was tested by God with misery and afflictions. The allegory of Job is powerful and timeless, due to the fact that it depicts so well the human response to “undeserved” suffering. The sequence of psychological response has been observed to be: deprivation/suffering, leading to unknowing, and then perhaps transformed awareness.58 This can be seen not only in spiritual transformation, but also in psychological transformation.

The response to the uncomfortable state of uncertainty and unknowing determines whether or not positive transformation will take place. This critical step often depends on one’s bio-psychosocial strengths, resources, and capacity to transform the unacceptable challenge into something meaningful, and thereby achieve gratitude and feelings of reparation (the Kleinian depressive position). Rather than move toward pro-social meaning and reparation, Kinkel seeks pseudo-power and comfort in retaliatory violence. Indeed, he noted that these objects (guns) had never persecuted him and had likely given him much comfort inside his self-enclosed sphere of paranoia and violent fantasy.

“It is clear that no one will help me. Oh God, I am so close to killing people. So close… I want you to feel this, be this, taste this, kill this. Kill me.”

With this admission, Kinkel appeared to be at the end of his decisional stage, having abandoned the notion of outside help, goodness, or hope. He sensed that final resolution through violence was imminent. As per Menninger’s internal dialogue of the hurt child, Kinkel wished for the other to feel as he did. In addition, Kinkel’s statement suggested heavy use of projection and an element of boundary loss alongside wishes for suicide.

“I want to kill and give pain without a cost.”

This statement suggests a desire to obliterate reality, as well as a retreat into the stage of omnipotent fantasy. To murder and cause pain without cost is unrealistic and suggests operating from a place of omnipotence, where the normal rules of cause and effect do not touch the actor. Omnipotence has been defined as “having unlimited or universal power, authority, or force.”59 Note the distinction from grandiosity, which is “characterized by feigned or affected grandeur; pompous,” or having “an inflated appraisal” of one’s worth, power, and importance.60 Kinkel’s writing did not suggest an inflated appraisal of himself, but precisely the opposite. Thus, this statement reflected a last, desperate attempt to bolster his ego with powerful, omnipotent fantasy. The defense of omnipotence often signals the failure of the defense of grandiosity. From a developmental standpoint, it is believed that the failure to achieve competent interactions with others may relegate the child to a dependence on omnipotent fantasies as he grows older.61

“I have just killed my parents! I don’t know what is happening. I love my mom and dad so much … I’m so sorry. I am a horrible son. I wish I had been aborted. I destroy everything I touch … I didn’t deserve them.”

These statements were written by Kinkel shortly after murdering his mother and father. They appeared to communicate guilt over his actions and a longing for reparation. Whereas many will progress through the P-S stage to the depressive stage via an internal, psychological struggle, Kinkel acted out the conflict physically. There appeared to be recognition, albeit too late, that his parents were loving, and that he was unable to make use of the goodness and caring they gave him; instead, their goodness stimulated envy in him, often the therapeutic bind that mental health professionals experience in their heroic attempts to treat the narcissistic personality.

Recognition and Prevention

In certain disturbed individuals, revenge fantasies may encompass rage at the self, leading to suicide and/or murder-suicide.62 The revenge fantasies may become inflexible and persistent due to the fact that they provide needed emotional scaffolding, without which the individual’s psyche would further regress — hence the increased use of more primitive defenses. The vengeful person is able to regulate his mood and ward off ego threats with the power he feels by ruminating on, and planning out, his vengeance. The revenge fantasy serves as a powerful, but temporary remedy to a humiliated ego by providing an illusion of strength and a sense of restored control. Such fantasies are also enhanced by keeping them secret. Collins63 has convincingly argued that such secret fantasies, accompanied by planning and preparation, stimulate “clandestine excitement” in the mass murderer, a positive affect that may propel him forward.63

In the obliterative stage, the revenge fantasy promises to wipe clean the individual’s intolerable reality and aversive self-awareness. In a true sense, the maintenance of reality testing to some degree (typically borderline level at best) exacerbates its punishing feel. Full paranoid psychosis may function as a refuge for such a blighted life, but paradoxically may bring a commitment and resolve to carry out the mass murder — a plan that would be filled with ambivalence without such delusions of persecution.

The cognitive process is the antithesis of acceptance and/or transformed awareness. It is a desperate fight into death to preserve the ego and could be viewed as the ultimate resistance. It can be said that the ego strengthens itself in this way by seeking a form of reverse specialness. The paranoid mass murderer becomes a lone, shocking protestor against an “unjust” reality. In order to halt the progression toward obliteration, such individuals require mental sanctuary from the oppressive, relentless feelings of persecution that assail them. Halting the progression requires recognition and intervention as early as possible.

Mass murder is a multi-determined event with no simple preventive solution. Such tragedies are exceptionally hard to anticipate and avert.64 Given the extremely low base rate of mass murder, psychiatric efforts will be best spent in directions other than prediction.65 Thus, prevention must rely on various approaches acting together to provide a widely cast safety net. Approaches might include enhanced social responsibility, psychiatric efforts, and media responsibility.66

One aspect of social responsibility that may hold promise is timely recognition by key third parties. Third parties often have pre-offense knowledge, yet remain quiet for various reasons.67 Nevertheless, “prevention may only be possible when somebody warns that such behavior may occur … Acquaintances often acknowledge concerns prior to the incident.”68 Messages or leaked intent may be communicated in various forms, including verbally, or via Internet pages or YouTube.69 It may be the case that family members or social contacts are the only ones who could reasonably take steps to have the potential offender evaluated and treated.70 In the case of an individual who has demonstrated concerning signs to third parties, the responsibility of reporting to law enforcement and/or mental health authorities would seem to outweigh individual privacy concerns. Regarding cases of school- or workplace-linked offenders, co-workers, teachers, or classmates may consider notifying authorities and/or human resource staff once they become reasonably concerned. The advent of threat assessment teams show real promise to enhance the prevention of such low-frequency but high-intensity events.71

For mental health professionals, careful clinical risk assessment and management may be stressed as a part of overall competent psychiatric patient care.72,73 Although future research will undoubtedly enhance our awareness of the presence of “warning behaviors” for such targeted violence,74 mental health clinicians will best serve patients at risk by crafting a risk management plan at clinically relevant or critical times. Special attention should be given to “availability of means, planning, preparation, and the acknowledged commitment to put the words into action irrespective of consequences.”75 Risk assessments of individuals with strong revenge fantasies will have to consider the intensity and quality of the revenge fantasies, “vulnerability to ego threats,” and the relevant bio-psychosocial variables.76

Conclusions

The psychology of paranoid mass murderers can be explained as existing on a spectrum from paranoid traits to psychotic delusion. Regardless of an individual offender’s place on the spectrum, many share common underlying psychodynamics. Forensic psycholinguistic analysis of paranoid spectrum mass murderers has suggested common themes of social persecution, envy, and revenge fantasies. The Kleinian dynamics of the P-S position are at work alongside a common cognitive progression toward omnipotent fantasy and violent revenge. Recognition of this progression, either by third party knowledge or leaked intent, represents an important potential method of prevention.

References

  1. Burgess AW. Mass, Spree and Serial Homicide. In: Douglas J, Burgess AW, Burgess AG, Ressler R, eds. Crime Classification Manual. 2nd ed. San Francisco, CA: Jossey-Bass; 2006.
  2. Mullen P. The autogenic (self-generated) massacre. Behav Sci Law. 2004;22:311–323.
  3. Aitken L, Oosthuizen P, Emsley R, Seedat S. Mass murders: implications for mental health professionals. Int J Psychiatry Med. 2008;38(3):261–269.
  4. Declercq F, Audenaert K. Predatory violence aiming at relief in a case of mass murder: Meloy’s criteria for applied forensic practice. Behav Sci Law. 2011;29(4):578–591.
  5. Chessick R. Psychology of the Self and the Treatment of Narcissism. Northvale, NJ: Jason Aronson, Inc.;1993:182.
  6. Fenichel O. The Psychoanalytic Theory of Neurosis. New York, NY: W.W. Norton & Company, Inc.;1972:435.
  7. Rhodes J, Jakes S. Perspectives on the onset of delusions. Clin Psychol Psychother. 2010;17(2):136–146.
  8. Freud S. Neurosis and Psychosis. In: Fenichel O, ed. The Psychoanalytic Theory of Neurosis. New York, NY: W.W. Norton & Company, Inc.;1972:435.
  9. Coid J, Ullrich S, Kallis C, et al. The relationship between delusions and violence: findings from the East London First Episode Psychosis Study. JAMA Psychiatry. 2013;70(5):465–471.
  10. Witt K, van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS ONE. 2013;8(2):e55942.
  11. Appelbaum P, Robbins P, Monohan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000;157:566–572.
  12. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  13. Knoll J. The pseudocommando mass murder: part II, the language of revenge. J Am Acad Psychiatry Law. 2010;38(2):263–72.
  14. United States Courts for the Ninth Circuit. United States v. Loughner, No. 11-10339 (2011). Available at: http://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000006160. Accessed December 27, 2013.
  15. Sourour TK. Report of Coroner’s Investigation on Marc Lépine. Available at: http://www.diarmani.com/Montreal_Coroners_Report.pdf. Accessed December 27, 2013.
  16. Dutton D, White K, Fogarty D. Paranoid thinking in mass shooters. Aggress Violent Behav. 2013;18:548–553.
  17. Dietz P. Mass, serial and sensational homicides. Bull NY Acad Med. 1986.;62(5):477–491.
  18. Calhoun F, Weston S. Contemporary Threat Management. San Diego, CA: Specialized Training Services; 2003.
  19. Menninger W. Uncontained rage: a psychoanalytic perspective on violence. Bull Menninger Clin. 2007;71(20):115–131.
  20. Menninger W: Uncontained rage: A psychoanalytic perspective on violence. Bull Menninger Clin. 2007;71(20):115–131.
  21. Menninger W: Uncontained rage: A psychoanalytic perspective on violence. Bull Menninger Clin. 2007;71(20):115–131.
  22. Excerpts from the video Virginia Tech shooter Cho Seung-Hui sent to NBC News.
  23. Cohen A. A Portrait of the Killer. Time. August9, 1999. Available at: http://www.time.com/time/magazine/article/0,9171,991676,00.html?promoid=googlep.
  24. Shootings in Atlanta: The Notes. The New York Times. July31, 1999. Available at: http://www.nytimes.com/1999/07/31/us/shootings-in-atlanta-the-notes-there-is-no-reason-forme-to-lie-now.html.
  25. Meloy JR, Hempel AG, Gray BT, et al. A comparative analysis of North American adolescent and adult mass murderers. Behav Sci Law. 2004;22:291–309.
  26. Borum R, Fein R, Vossekuil B, Berglund J. Threat assessment: defining and approach for evaluating risk of targeted violence. Behav Sci Law. 1999;17:323–337.
  27. Torrissen T, Knoll J, Leonard C, Annas D. Breivik – Extreme Ideologist or Mentally Deranged? Presented at: American Academy of Psychiatry and the Law 44th Annual Meeting. ; October 25, 2013. ; San Diego, CA. .
  28. Klein M. Envy and Gratitude and Other Works, 1946–1963. New York, NY: The Free Press; 1975.
  29. Kaylor L. Antisocial personality disorder: diagnostic, ethical and treatment issues. Issues Ment Health Nurs. 1999;20:247–258.
  30. Hyatt-Williams A. Cruelty, Violence and Murder: Understanding the Criminal Mind. London, England: Karnac Books Ltd.; 1998.
  31. Hyatt-Williams A. Cruelty, Violence and Murder: Understanding the Criminal Mind. New Jersey: Jason Aronson, Inc.; 1998.
  32. Alfano S: Gunman: “Now you have blood on your hands.” CBS News.com, April18, 2007. Available at http://www.cbsnews.com/stories/2007/04/18/virginiatechshooting/main2697827.shtml. Accessed December 12, 2009.
  33. Alfano S. Gunman: “Now you have blood on your hands.” CBS News.com. Available at: http://www.cbsnews.com/stories/2007/04/18/virginiatechshooting/main2697827.shtml. Published April 18, 2007. Accessed December 12, 2009.
  34. Knoll JL 4th, . The “Pseudocommando” mass murder: part II, the language of revenge. J Am Acad Psychiatry Law. 2010;38(2):263–272.
  35. Kantor J. An Objective Psychology of Grammar. Bloomington, IN: Indiana University Press; 1936.
  36. Miron MS, Douglas JE. Threat analysis: the psycholinguistics approach. FBI Law Enforcement Bulletin. 1979;48(9):5–9.
  37. Smith S, Shuy R. Forensic psycholinguistics: using language analysis for identifying and assessing offenders. FBI Law Enforcement Bulletin. 2002;71(4):16–21.
  38. Smith S. From Violent Words to Violent Deeds: Assessing Risk From FBI Threatening Communication Cases. In: Meloy J, Sheridan L, Hoffman J, eds. Stalking, Threatening, and Attacking Public Figures: A Psychological and Behavioral Analysis. New York, NY: Oxford Press, 2008;20:435–455.
  39. Stephane M, Pellizzer G, Fletcher CR, Mc-Clannahan K. Empirical evaluation of language disorder in schizophrenia. J Psychiatry Neurosci. 2007;32(4):250–258.
  40. Pennebaker J, Stone L. What Was She Trying to Say? A Linguistic Analysis of Katie’s Diaries. In: Lester D, ed. Katie’s Diary: Unlocking the Mystery of a Suicide. New York, NY: Routledge Press; 2004.
  41. Henken V. Banality reinvestigated: a computer-based content analysis of suicidal and forced death documents. Suicide Life Threat Behav. 1976;6:36–43.
  42. Pennebaker J, Mehl M, Niederhoffer K: Psychological aspects of natural language. use: our words, our selves. Annu Rev Psychol. 2003;54:547–577.
  43. Borum R, Fein R, Vossekuil B, Berglund J. Threat assessment: defining and approach for evaluating risk of targeted violence. Behav Sci Law. 1999;17:323–337.
  44. Katsavdakis K, Meloy J, White S. A female mass murder. J Forensic Sci. 2011;56(3):813–818.
  45. Hempel A, Meloy J, Richards T. Offender and offense characteristics of a nonrandom sample of mass murderers. J Am Acad Psychiatry Law. 1999;27(2):13–225.
  46. Knoll J. Mass Murder: causes, classification, and prevention. Psychiatr Clin North Am. 2012:757–780.
  47. Dutton D, White K, Fogarty D. Paranoid thinking in mass shooters. Aggress Violent Behav. 2013;18:548–553.
  48. Neuman Y. On revenge. Psychoanalysis, Culture & Society. 2012;17(1):1–15.
  49. Aitken L, Oosthuizen P, Emsley R, Seedat S. Mass murders: implications for mental health professionals. Int J Psychiatry Med. 2008;38(3):261–269.
  50. Yakeley J, Meloy J. Understanding violence: does psychoanalytic thinking matter?Aggress Violent Behav. 2012;17:229–239.
  51. Dutton D, White K, Fogarty D. Paranoid thinking in mass shooters. Aggress Violent Behav. 2013;18:548–553.
  52. Chronology: Kip Kinkle’s life and the events leading up to the horror of May 20–21, 1998. PBS Frontline website. Available at: http://www.pbs.org/wgbh/pages/frontline/shows/kinkel/kip/cron.html.
  53. Kip’s writing and statements. PBS Frontline website. Available at: http://www.pbs.org/wgbh/pages/frontline/shows/kinkel/kip/writings.html
  54. Knoll J. Treating the morally objectionable. In: Andrade J, ed. Handbook of Violence Risk Assessment and Treatment: New Approaches for Mental Health Professionals. New York, NY: Springer Publishing Company; 2009:10;311–345.
  55. Edwards M, Holden R. Coping, meaning in life, and suicidal manifestations: examining gender differences. J Clin Psychol. 2001;57(12):1517–1534.
  56. Baumeister R, DeWall CN, Ciarocco NJ, Twenge JM. Social exclusion impairs self-regulation. J Pers Soc Psychol. 2005;88(4):589–604.
  57. Twenge J, Catanese K, Baumeister R. Social exclusion and the deconstructed state: time perception, meaninglessness, lethargy, lack of emotion, and self-awareness. J Pers Soc Psychol. 2005;85(3):409–423.
  58. Andresen J. Biblical Job: changing the helper’s mind. Contemporary Psychoanalysis. 1991;27(3):454–481.
  59. The American Heritage Dictionary. 2nd College Edition. Boston, MA: Houghton Mifflin Company; 1985.
  60. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.
  61. Novick J, Novick KK. Some comments on masochism and the delusion of omnipotence from a developmental perspective. J Am Psychoanal Assoc. 1991;39(2):307–331.
  62. Horowitz M. Understanding and ameliorating revenge fantasies in psychotherapy. Am J Psychiatry. 2007;164(1):24–27.
  63. Collins R. Clues to mass rampage killers: deep backstage, hidden arsenal, clandestine excitement. The Sociological Eye website. Available at: http://sociological-eye.blogspot.com/2012/09/clues-to-mass-rampage-killers-deep.html. Published September 1, 2012. Accessed January 7, 2014.
  64. Saleva O, Putkonen H, Kiviruusu O, Lonquist J. Homicide-suicide – an event hard to prevent and separate from homicide or suicide. For Sci Int. 2007;166:204–208.
  65. Dressing H, Meyer-Lindenberg A. Risk assessment of threatened amok. New responsibilities for psychiatry?Nervenarzt. 2010;81(5):594–601.
  66. Knoll J. Mass murder: causes, classification, and prevention. Psychiatr Clin North Am. 2012:757–780.
  67. Kluger J. Inside a mass murderer’s mind. Time. Available at: http://www.time.com/time/magazine/article/0,9171,1612694,00.html. Published April 19, 2007. Accessed March 19, 2012.
  68. Aitken L, Oosthuizen P, Emsley R, Seedat S. Mass murders: implications for mental health professionals. Int J Psychiatry Med. 2008; 38(3):261–269.
  69. O’Toole M. The School Shooter: A Threat Assessment Perspective. Quantico, VA: Critical Incident Response Group, National Center for the Analysis of Violent Crime; 2000.
  70. Orange R. Anders Behring Breivik’s sister warned mother about his behaviour two years ago. The Telegraph. Available at: http://www.telegraph.co.uk/news/worldnews/europe/norway/8934136/Anders-Behring-Breiviks-sister-warned-mother-about-his-behaviour-two-years-ago.html. Published December 4, 2011.
  71. Meloy JR, Hoffman J. International Handbook of Threat Assessment. New York, NY: Oxford University Press; 2014.
  72. Mills J, Kroner D, Morgan R. Clinician’s Guide to Violence Risk Assessment. New York, NY: The Guilford Press; 2011.
  73. Swanson J. Preventing the unpredicted: managing violence risk in mental health care. Psych Services. 2008;59(2):191–193.
  74. Meloy R, Hoffman J, Guldimann A, James D. The role of warning behaviors in threat assessment: an exploration and suggested typology. Behav Sci Law. 2012;30(3):256–279.
  75. Warren LJ, Mullen PE, Ogloff JR. A clinical study of those who utter threats to kill. Behav Sci Law. 2011;29(2):141–154.
  76. Baumeister R, Smart L, Boden J. Relation of threatened egotism to violence and aggression: the dark side of high self-esteem. Psychological Rev. 1996;103(1):5–33.

Paranoid Spectrum Mass Murderer Cognitive Progression

Stage 1: Perception
Threat perception, and expectation of persecution. Perceived inadequacy of the self.
Stage 2: Contemplation
Threat is strong. Unlikely to prevail against the threat.
Stage 3: Decision
Inability to accept, compromise, or seek outside help. Abandon hope, increase reliance on revenge fantasy.
Stage 4: Resolution
Retreat to omnipotent fantasy and/or obliterate reality. Plan mass murder, acquire materials. Carry out the act of targeted violence.
Authors

James L. Knoll, IV, MD, is Director of Forensic Psychiatry, Professor of Psychiatry, SUNY Upstate Medical University. J. Reid Meloy, PhD, ABPP, is Clinical Professor of Psychiatry, University of California — San Diego, and Faculty, San Diego Psychoanalytic Institute.

Address correspondence to: James L. Knoll, IV, MD; email: knollj@upstate.edu.

Disclosure: The authors have no relevant financial relationships to disclosure.

10.3928/00485713-20140502-07

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