Psychiatric Considerations in Colorado Shooting

Early in the morning of the Colorado shooting, I received phone calls from various news outlets asking me to give an instant psychiatric opinion on the shooter in the terrible incident in Colorado. I knew nothing about the incident and could never comment specifically on a person I had not examined and of course couldn’t talk about someone that I did examine.

Violence in mental illness
I understand that there is a strong public interest when something like this happens. There is a natural inclination to believe that the shooter must have been “crazy,” meaning a person with a mental disorder. This is a way of distancing oneself from abhorrent behavior. The fact is, 1 of 5 people in the US are believed to have significant mental problems. But it is also true that people with severe mental illness (usually defined as schizophrenia, often with delusions, bipolar disorder, or severe depression) are no more likely to show violent behavior than those without these conditions. Such persons should be even less inclined to violence when they have been properly treated. Even when one looks at the relatively small incidence of violent behavior seen in people discharged from a psychiatric hospital, [this behavior] is usually directed at people known to the patient rather than random violence.

My reading of the scientific literature doesn’t tell us anything about this particular alleged shooter in Colorado. The suspect may very well have been psychotic (out of touch with reality) and have ideas and thoughts that led him to do this act. Whether or not he was psychotic, I am confident if we knew everything about his life experience, inner feelings, and thoughts, we would be able to understand his anger or his fantasies that led him to plan and carry out this horrible deed. There is also the possibility that he used alcohol and or drugs that disinhibited him or even made him psychotic. Although his lawyers may very well mount an insanity defense and try to prove that he was under the influence of a mental illness, they will have a difficult task, especially because this was obviously planned and deliberately carried out rather than impulsively done. Even if we can understand the psychological determinants of this behavior, it doesn’t in any way justify or excuse it.

Columbine and other school shootings
People will no doubt make comparisons with the Columbine High School shooting that by coincidence occurred in nearby Littleton, Colorado. There also were several other similar type school shootings in recent memory. The US Secret Service conducted a comprehensive study of the attackers and the circumstances involved in 37 incidents of targeted school violence that occurred between 1974 and 2000. They concluded that a history of having been the subject of a mental health evaluations, diagnosed with a mental disorder, or involved in substance abuse did not appear to be prevalent among the attackers; however, most of the attackers showed some history of suicidal attempts or thoughts, or a history of feeling extreme depression or desperation. Most of the attackers felt bullied, persecuted, or injured by others before to the attack.

The Texas Tower shooter
There also was the well-known 1966 case of Charles Whitman, the Texas Tower sniper. He was a student at the University of Texas in Austin who killed 16 people and injured 32 others before he was killed by the police. It turned out that he had a dysfunctional family and used amphetamines, but he was also determined to have glioblastoma, which is an aggressive brain tumor. It was believed that this brain tumor played a role in his actions.

The traumatic effects will linger
The event in Colorado is obviously a tragedy for the victims and their families which will never be forgotten by those close to anyone touched by this event. It will cause painful grieving among the families and friends of those who lost their lives. It will also cause symptoms of PTSD in persons who witnessed this event in person as well as many who will be impacted as they follow the story in the media. Young people will be particularly vulnerable as they identify with people like themselves who were looking forward to an enjoyable fantasy movie and instead were confronted with a reality that they could have never imagined.

Editor's note: This article was originally posted on Dr Blumenfield's blog. You may Join the Conversation below or comment on Dr Blumenfield's website.