April 20, 2007

The Loss of Life in Virginia, and How it Could Have Been Prevented

Whenever a tragedy happens such as the recent shootings in Virginia, the question inevitably turns to why did it happen, and how could it have been prevented. We try to answer these questions below.

While some reports (such as here, here and here) have suggested the shooter in this tragedy - Cho Seung Hui - might have suffered from psychotic depression, schizophrenia or bipolar disorder - its impossible to know with the limited amount of evidence available today, and even after all the evidence is reviewed it will never be known for sure.

From what has been reported it does, however, seem that he was seriously depressed and socially withdrawn, and had some significant delusions of persecution and paranoia. These symptoms could add up to a serious mental illness such as schizophrenia.

With regard to the question of why did it happen - it is of course impossible to know for sure. But at the same time research into mental illness and brain disorders does point to some possible answers.

The path towards mental illness (any mental illness) is a complex one with many different factors - from genetic predisposition and pregnancy factors, to early life stresses and environmental toxins, to social stresses. We have more information on this in our "Preventing Schizophrenia" - but fundamentally the factors that nudge people towards mental illness are many and varied. The factors that have been conveyed about the life of Cho Seung Hui suggest that early life experiences could have been factors. Here are some of the relevant points that have been discussed in the news:

1. A Difficult Early Life - news on the family has suggested that they had a difficult (very low-income) family life in Korea which prompted the move to the US when the parents had a young family. A low income life that motivates a young family to leave a country - is likely to be a high stress environment - a factor that could contribute to mental illness. A low-income family life is also associated with many prenatal / pregnancy risk factors associated with increased risk of schizophrenia (such as low Vitamin D, and Folic Acid levels associated with poor nutrition, and parental stress also impacts child brain development).

2. Social stresses of immigration to the US (many studies out of the UK have indicated that immigrants frequently face extremely difficult social challenges in new countries due to a lack of understanding of social norms (as well as racism) - which causes a great deal of social stress and significantly higher rates of mental illness.

3. Cho Seung Hui's father and mother worked in a Dry Cleaning company - and the family may have been exposed to higher levels of dry cleaning chemicals - which have been linked to neurological damage.

Additionally, on a related topic, Dr. Michael Merzenich, the Neuroscientist at UCSF - comments in his blog on the important issues related to the violent social environment that is also a factor in the extremely high levels of gun violence and deaths in America - a level of violence that is typically 300% to 600% higher than in other developed countries:

"Our jurisprudence is based on the principle of “blame” for behaviors that should by hypothetically controlled by our “free will”. Alas, human observers and psychologists (and with increasing clarity, we brain scientists) have understood from the beginning of time that your or my “will” is not entirely “free”. The boundaries of “good judgment” are defined by a combination of the inherited factors governing our brain function, by our physical brain status (2 million head injuries/annum in the US alone!), and the brain’s own plasticity-embedded experiences. For most of us, our genetics combined with fortuitously not busting our skull in the wrong place and with our particular plastic, experientially-driven brain ‘history’ adequately protects us from serious transgression. At the same time, in our (and other) contemporary society(ies), we tolerate conditions that result in millions of young men and women being reared with an experiential history that is NOT adequate to keep THEM safe from offending. THIS IS THE PART OF THE EQUATION THAT IS UNDER OUR (SOCIETY’S) CONTROL. We’re doing a bad job with it. In fact:

1) We live in a violent society chock full of models of behavior (a violence & fear-obsessed media, violent films, gangsta rap, et alia) that are well outside any rational societal norms. The mass murder of children on school campuses is one our MANY rather spectacular modern American-violence inventions with little historical precedent.

2) We tolerate the hardening of young brains to otherwise-not-tolerable bloody, shoot-em-/slash-em-up violence as an acceptable source of intensive training “fun” in the heavily-rewarded game-play of millions of our children. All that intensive training is somehow supposed to be just fine for the child and their brain?! Those tens or hundreds of thousands of violent repetitions in rewarded behaviors just don’t matter a whit? Stuff and utter nonsense.

3) We continue, collectively, to find innumerable ways to shame children in their young lives as “failures”, “weaklings”, “misfits” or “oddballs” in school and in life.

4) We send juveniles and young adults off to crime school (prison) at an extraordiarily high (and growing) rate.

Sometimes I think that we could hardly be doing a better job of training young people to misbehave. When they do, we hold them to a universal high standard of acceptable behavior that they may actually have had little experience with, in their own path through life, in our very own society."

Lastly - there is the issue of easy access to guns in the US - which when combined with all the above factors makes for an extremely toxic mixture. Easy access to guns results in high death rates in shootings; death rates that are typically 500% to 1,000% higher in the US than in other civilized countries, as can be seen in the diagram below.

National Comparisons for Selected Countries Homicide Rates Per 100,000 Population
Source: Corrections Service Canada

As New Scientist Magazine notes "Scientific studies have demonstrated over and over that owning a gun makes it significantly more likely that you will be shot. The US has the highest rate of firearms-related homicide in the industrialized world – Americans are literally sacrificing hundreds of innocent citizens each year upon the altar of the Second Amendment."

Are any of these factors preventable? Yes - of course they are - but the actions are costly and complex. To prevent these types of tragedies takes:

1. Better education of the public about how to achieve mental health for their children,
2. Early and easy treatment for mental disorders with early testing and screening in schools,
3. Good insurance coverage so that people can actually get their mental health problems addressed. The US is the only developed country in the world that severely limits coverage of mental health problems. Better and easier access to high quality mental health therapies is a great need in the US.
4. Laws that make it possible for mentally ill people to get treatment, even though they may not understand the need.
5. A reduction in the culture of violence in the US (a movement to reduce violence in movies, on TV, and in video games). Read: In denial about on-screen violence, and Why video games really are linked to violence, for more information.
6. Strict gun controls that take the millions of hand guns and assault rifles off US streets, and that will make it more difficult for the people who become mentally ill or who have psychiatric disorders - to obtain guns. As was recently noted in a Swedish newspaper ""What exactly triggered the massacre in Virginia is unclear but the fundamental reason is often the perpetrator's psychological problems in combination with access to weapons,". People will always have psychological problems, and in every country in the world they do - but only in the US do people have easy access to powerful handguns designed for mass killings. Approximately 29,000 US citizens are killed by hand guns each year. (see Statistics, Gun Control Issues, and Safety for more information)

The answers are relatively clear - but whether we actually do anything about it is up to you. You can vote for politicians that will work to implement these changes. You can make advocacy efforts to change the system.

Related Reading:

World Reacts to U.S. School Shooting

Mental Health, the Law and Predicting Violence (NPR)

America's tragedy - Its politicians are still running away from a debate about guns (The Economist)

Mayors urge Bush to tighten gun control laws

Stricter gun control after shootings at U.S. university - not going anywhere fast

Relationship of US gun culture to violence ill-understood

Violence may be a 'socially infectious disease'

Fewer cheap guns = fewer criminals with guns


The question here is not GUN CONTROL. It is the psyche of the Killer in virginia tech who PLANNED, PREPARED, AND METICULOUSLY CARRIED OUT HIS KILLING AND PUBLISHED HIS LAST TESTAMENT.
Is he mentallyill? If not then why he was sent to a mental health institution TWICE for evaluation and treatment? Did those drugs excaerabate the symptoms as in some cases? did he have a proper followup? why the other students FEARED HIM? He stalked two woman . Let us not hide behind gun conrol.
Let us discuss violence in mentalillness especially in HOMES which are hidden from prying eyes due to stigma.This person was staying in a hostel and so his vilence came out against the entire hostel(home for him) as it happens in HOMES.
The greatest killings due to domestic violence happens in america because of the President kennedy act which has GIVEN THE RIGHT TO TREATMENT TO PERSONS WHO DONOT HAVE KNOWLEDGE OR INSIGHT TO TAKE A DESCISION ON THIS MATTER.Also the 1,80,000 mentallyill prisoners are in America because of this OSTRICH IN SAND MENTALITY OF AMERICA.

Posted by: captainjohann at April 20, 2007 08:14 PM

Actually, it may have been his medications. Antidepressants are known to cause suicidal/ homicidal ideation in certain patients, and Cho was on them!

Arianna Huffington examines this in her blog (there are almost 300 comments): http://www.huffingtonpost.com/arianna-huffington/virginia-tech-aftermath-_b_46280.html

Posted by: Anonymous at April 20, 2007 09:43 PM

Here is a way that the violence on that large a scale might have been avoided....


Posted by: Naomi at April 21, 2007 07:27 AM

Thank you for that excellent explanation about this case in Va. When I heard about the rumor going around that Cho Seung Hui may be mentally ill and the media automatically plugged him as having an Axis I diagnosis when it is obviously he suffered from an Axis II diagnosis. He may have had features of an Axis I diagnosis but what criminal doesn't? The need to educate the public is way past due and I plan to do what I can to do exactly that.
Thank you very much for the article.
Jacquie, New Jersey

Posted by: Jacquie Sanford at April 21, 2007 07:20 PM

"From Mental to Murder", foxnews

The video Headlined "From Mental to Murder" of foxnews, Dr. Manny investigates how the misdiagnosis Cho Seung-Hui's mental illness may have led to his violent behavior. In the video, Dr. Igor Galynker, Psychiatrist, Beth Israel Hospital of New York, commented about Cho's mental problem: prodromes of schizophrenia and the medication.

Posted by: Sunshine at April 22, 2007 04:31 PM

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