COMMENTARY
This article was written before the mass shooting in Highland Park, Illinois, on July 4th, which requires a separate analysis. -R. P.
It took only 48 hours for the pop psychology “diagnosis” of the Uvalde, Texas, shooter to hit the internet. One headline screamed, “A teenage psychopath is still a psychopath….”1 One prominent politician declared the shooter to be a “psychopath”2 and another upped the ante, describing him as a “heartless psychopath.”3
Several anonymous online comments ran along the lines of, “Who else but a psychopath could murder a room full of innocent schoolchildren?” That is a perfectly understandable question among the general public, but it amounts to little more than a circular argument and plays fast and loose with the concept of “psychopath.”
Psychopath Versus Psychopathy
What does “psychopath” really mean? In professional literature, “psychopaths” were defined by the pioneering forensic psychologist, Robert D. Hare, PhD, as4:
“…intraspecies predators who use charm, manipulation, intimidation, and violence to control others and to satisfy their own selfish needs. Lacking in conscience and in feelings for others, they cold-bloodedly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.”
Hare’s description amounts to a kind of archetype, describing what some have called—perhaps inaccurately—a “cold, heartless, inhuman being.”5 But as Hare himself later demonstrated, psychopathy is not an “all or none” characteristic. Rather, psychopathy is a trait that exists along a continuum of severity and a spectrum of psychopathology. More on this shortly.
A useful psychodynamic definition of psychopathy was provided by forensic psychologist J. Reid Meloy, PhD, in his classic book The Psychopathic Mind6:
“Psychopathy is a deviant developmental disturbance characterized by an inordinate amount of instinctual aggression and the absence of an object relational capacity to bond.”
The Gold Standard of Diagnosis
Psychopathy is not defined in the DSM-5, although the category of antisocial personality disorder (APD) has substantial overlap with psychopathy. The diagnosis of APD requires evidence of conduct disorder prior to age 15 years, and the individual must be at least 18 years of age at the time of diagnosis. The gold standard for the diagnosis of psychopathy is the Psychopathy Checklist-Revised (PCL-R), originally developed by Hare.7 The PCL-R consists of 20 items and is completed on the basis of a semistructured 90- to 120-minute interview. Scoring yields evidence of high, medium, and low levels of psychopathy. The 20 traits are shown in the Table.7
So far as I am aware, no school shooters in recent US history have been evaluated in a semistructured interview using the PCL-R. Many school shooters take their own lives before they can be seen by a mental health professional (ie, in a homicide-suicide). Hence, retrospectively labeling school shooters as “psychopaths” is not supported by the gold standard of objective clinical evidence. Of course, absence of evidence is not evidence of absence. It is certainly possible that a subset of school shooters would indeed score highly on the PCL-R or other measures of psychopathy.
Alternative Ways of Assessing Psychopathy
One trait often associated with psychopathy but not formally assessed by the PCL-R is cruelty to animals. In this regard, Arluke and Madfis studied 23 school shooters from 1988 to 2012 and found reports of prior animal cruelty in the histories of 10 of 23 of these shooters (43%)—a rate almost as high as that in the backgrounds of serial killers. They note, for example, that Columbine killers Eric Harris and Dylan Klebold boasted about mutilating animals for fun.8
But it is far from clear how specific or predictively useful this finding is, given that, in 1 study, 28% of 260 undergraduates admitted to having abused animals when they were children. As Arluke commented, “If we flag every incident of animal abuse, our mental health and justice systems would be overwhelmed with tens of thousands of cases to review.”8
In a study of 10 “rampage school shooters,” investigator Peter Langman, PhD, found that the shooters fell into 3 main types or categories: traumatized, psychotic, and psychopathic. Langman described the psychopathic type as characterized by “…a lack of empathy; a sense of superiority and contempt for others; skill in impression management; pleasure in deceiving others; and sadistic delight in inflicting pain on humans and/or animals.” Of the 10 shooters studied, 3 were traumatized, 5 were psychotic, and only 2 were psychopathic. This study, of course, involved a very small “n” and extended only from 1997 to 2007; generalizing from the data is therefore risky. Nevertheless, Langman commented, “Though it might seem logical to think that mass murderers are psychopaths, most of the school shooters in this study were not psychopathic.”9
Toward a General Understanding of Young School Shooters
Because the Uvalde gunman was killed by US border patrol agents, we will never have a clinically based psychological profile of this individual—the kind of thorough psychiatric evaluation that could clarify the shooter’s personality structure or psychodynamics. Absent a professionally conducted “psychological autopsy,” any claims regarding the shooter’s psychopathology amount to speculation and an unwarranted rush to judgment.10
That said, we can state some general, tentative conclusions about school shooters. It is important to note that I am focusing narrowly on school shooters, most of whom are under 18 years of age, and not on mass shooters in general—a heterogeneous group who are sometimes motivated by racial, religious, or political animus, often inflamed by extremist propaganda.11
Two investigators who have studied school shooters extensively—James Densley, PhD, and Jillian Peterson, PhD—paint this picture of the typical school shooter12:
“Inspired by past school shooters, some perpetrators are seeking fame and notoriety. However, most school shooters are motivated by a generalized anger. Their path to violence involves self-hate and despair turned outward at the world, and our research finds they often communicate their intent to do harm in advance as a final, desperate cry for help. The key to stopping these tragedies is for society to be alert to these warning signs and act on them immediately.”
Note that generalized anger, self-hatred, and despair are not key features of psychopathy, based on the PCL-R item list. At least in that respect, the evidence for psychopathy as a key characteristic of most school shooters appears weak. But there is a caveat here: In recent years, investigators have identified a group of youth with traits that look like precursors to psychopathy—youths who display anger, hostility, and emotional volatility after experiencing serious traumas. That condition is sometimes called “secondary psychopathy,” and this pattern may overlap to some degree with the Densley-Peterson profile previously described. Psychologist Abigail Marsh, PhD, describes this “secondary psychopathy” group as follows13:
“The idea is that they were not born at particularly high risk for psychopathy…but that truly terrible life experiences caused their development to go awry. You tend not to see the fearless temperament in those kids but rather a lot of emotional dysregulation and anxiety.”
Indeed, it appears that many school shooters have experienced childhood traumas such as physical or emotional abuse. Many grew up in unstable families with violent, absent, or alcoholic parents or siblings. Many have been bullied or harassed at school, and most have experienced significant losses.14
Can Neurology Help Identify Psychopathy?
Recently, a more neurologically based understanding of psychopathy has been developed by Nathaniel E. Anderson, PhD, and Kent A. Kiehl, PhD. They argue that15:
“Psychopathy is a neuropsychiatric disorder marked by deficient emotional responses, lack of empathy, and poor behavioral controls, commonly resulting in persistent antisocial deviance and criminal behavior. Accumulating research suggests that psychopathy follows a developmental trajectory with strong genetic influences, and which precipitates deleterious effects on widespread functional networks, particularly within paralimbic regions of the brain.”
Specifically, Anderson and Kiehl cite data linking psychopathy with abnormalities in the ventral-medial areas of the prefrontal cortex, including the orbitofrontal cortex, as well as in limbic structures such as the amygdala and hippocampus, and surrounding paralimbic regions. Not surprisingly, studies examining these brain regions have not been performed in school shooters, who comprise a minuscule proportion of gun violence perpetrators in the United States.
At this stage, there is no clear evidence that most school shooters fit the developmental trajectory or neurological profile posited by Anderson and Kiehl, although some might. We simply do not have the kind of comprehensive neuropsychiatric assessments available to determine this.
Why a Psychopath?
Why were some prominent public figures so quick to label the Uvalde shooter a “heartless psychopath”? The answer seems obvious: They were reacting as shocked human beings to a heinous crime, using a term that expressed their revulsion. Well, yes. But I think there is more to it than that. I believe that the use of this chilling label—psychopath—serves at least 2 defensive functions for the general public: (1) It essentially removes any societal responsibility (eg, in the area of firearms regulation) for the horrific act of the shooter (“There’s really nothing you can do to stop a determined, cold-blooded killer”); and (2) it allows the general public to distance itself from the psychology of the shooter, who is written off as a kind of sick, twisted monster—the feared and despised “Other” who is, of course, “nothing at all like us.” With these 2 defense mechanisms in place, many people can shrug and accept school shootings as simply unavoidable facts of life—the result of “evil in the world”—and then do little or nothing to prevent them.
For Further Reading
Knoll JL IV, Annas GD. Mass shootings and mental illness. In: Gold LH, Simon RI, eds. Gun Violence and Mental Illness. American Psychiatric Association Publishing; 2016:81-104.
Pies RW. Mass shooters and the psychopathology spectrum. Psychiatric TimesTM. February 17, 2020. Accessed July 8, 2022. https://www.psychiatrictimes.com/view/mass-shooters-and-psychopathology-spectrum
Pies RW. Is the plague of mass school shootings in the US here to stay? Psychiatric TimesTM. May 26, 2022. Accessed July 8, 2022. https://www.psychiatrictimes.com/view/is-the-plague-of-mass-school-shootings-in-the-us-here-to-stay-
Moffic HS. Remember John Hinckley Jr: a triumph for psychiatry, but a failure for gun safety. Psychiatric TimesTM. June 16, 2022. Accessed July 8, 2022. https://www.psychiatrictimes.com/view/remember-john-hinckley-jr-a-triumph-for-psychiatry-but-a-failure-for-gun-safety
What Can Be Done to Reduce School Shootings?
To be sure, we will never have the means to prevent all school shootings, but we can take steps to reduce their likelihood and lethality. Most perpetrators of K-12 shootings are male and under the age of 18 years who commit their crimes using unsecured handguns, not “assault rifles.”Indeed,according to Robin M. Kowalski, PhD,handguns were used in more than 91% of K-12 shootings, and almost half of shooters stole the gun from a family member.16 In addition to taking legislative steps to prevent these guns from falling into the hands of seriously disturbed adolescents, we can follow the advice of Densley and Peterson and be alert to the warning signs of impending gun violence and take immediate preventive action.12
A foundational study of active shooters by the FBI found that the majority of perpetrators demonstrated at least 4 to 5 concerning behaviors that were observable to others, such as problematic interpersonal interactions or communicating their violent intent (leakage) through verbal or physical behavior.17 Through collaboration between the public and responsible authorities, some planned shootings can be averted. Indeed, data from 1 study of thwarted mass homicide plots found that the friends, family members, and acquaintances of threateners all played an important role in discovering and thwarting homicidal plots.18
Finally, when a school shooting occurs, we can recognize and resist the tendency to demonize “the Other.” Rather than immediately writing off school shooters as heartless psychopaths, we can view them as damaged and despairing young individuals who urgently need our proactive help and intervention.
Dr Pies is professor emeritus of psychiatry and a lecturer on bioethics and humanities at SUNY Upstate Medical University in Syracuse, New York; a clinical professor of psychiatry at Tufts University School of Medicine in Boston, Massachusetts; and editor in chief emeritus of Psychiatric Times™ (2007-2010). He is the author of several books. A collection of his works can be found on Amazon.
References
1. Larson L. A teenage psychopath is still a psychopath and the public needs to know. KXL. May 27, 2022. Accessed July 8, 2022. https://www.kxl.com/a-teenage-psychopath-is-still-a-psychopath-and-the-public-needs-to-know/
2. Derysh I. Ted Cruz thinks he has a better solution to Uvalde school shooting than gun control: door control. Salon. May 26, 2022. Accessed July 8, 2022. https://www.salon.com/2022/05/26/ted-cruz-thinks-he-has-a-better-solution-to-uvalde-school-than-control-door-control/
3. Ogles J. Florida politicians respond to deadly school shooting in Texas. Florida Politics. May 25, 2022. Accessed July 8, 2022. https://floridapolitics.com/archives/527785-florida-politicians-respond-to-deadly-school-shooting-in-texas/
4. Hare RD. Psychopaths: new trends in research. The Harvard Mental Health Letter. 1995. Accessed July 8, 2022. http://minet.org/www.trancenet.net/hearts/research/psychopath.shtml
5. Martens WHJ. The hidden suffering of the psychopath. Psychiatric Times. 2014;31(10).
6. Meloy RJ. The Psychopathic Mind: Origins, Dynamics, and Treatment. Jason Aronson, Inc; 1988.
7. The Hare Psychopathy Checklist – Revised (PCL-R): Hare, 1991. ClinTools. Accessed July 8, 2022. https://www.clintools.com/victims/resources/assessment/personality/psychopathy_checklist.html
8. Arluke A. How reliably does animal torture predict a future school shooter? The Washington Post. February 21, 2018. Accessed July 8, 2022. https://www.washingtonpost.com/news/posteverything/wp/2018/02/21/how-reliably-does-animal-torture-predict-a-future-mass-shooter/
9. Langman P. Rampage school shooters: a typology. Aggress Violent Behav. 2009;14(1):79-86.
10. Gollom M. Speculation about motive in mass shootings could encourage copycats, some psychiatrists suggest. CBC. April 23, 2020. Accessed July 8, 2022. https://www.cbc.ca/news/canada/nova-scotia-shootings-psychiatrists-motive-1.5540911
11. Norrholm SD, Blotcky AD. Most mass shooters are terrorists, not mentally ill. Psychiatric Times. May 31, 2022. Accessed July 8, 2022. https://www.psychiatrictimes.com/view/most-mass-shooters-are-terrorists-not-mentally-ill
12. Densley J, Peterson J. What we know about mass school shootings in the US – and the gunmen who carry them out. The Conversation. May 25, 2022. Updated June 6, 2022. Accessed July 8, 2022. https://theconversation.com/what-we-know-about-mass-school-shootings-in-the-us-and-the-gunmen-who-carry-them-out-183812
13. DeAngelis T. A broader view of psychopathy. American Psychological Association. March 1, 2022. Accessed July 8, 2022. https://www.apa.org/monitor/2022/03/ce-corner-psychopathy
14. Chatterjee R. School shooters: understanding their path to violence is key to prevention. NPR Illinois. February 10, 2019. Accessed July 8, 2022. https://www.nprillinois.org/generationlisten/2019-02-10/school-shooters-understanding-their-path-to-violence-is-key-to-prevention
15. Anderson NE, Kiehl KA. Psychopathy: developmental perspectives and their implications for treatment. Restor Neurol Neurosci. 2014;32(1):103-117.
16. Kowalski RM. School shootings: what we know about them, and what we can do to prevent them. Brookings Institution. January 26, 2022. Accessed July 8, 2022. https://www.brookings.edu/blog/brown-center-chalkboard/2022/01/26/school-shootings-what-we-know-about-them-and-what-we-can-do-to-prevent-them/
17. Silver J, Simons A, Craun S. A study of pre-attack behaviors of active shooters in the United States between 2000 and 2013. Federal Bureau of Investigation. June 2018. Accessed July 8, 2022. https://www.fbi.gov/file-repository/pre-attack-behaviors-of-active-shooters-in-us-2000-2013.pdf/view
18. Sarteschi CM. An examination of thwarted mass homicide plots and threateners. Aggress Violent Behav. 2016;30:88-93.
