The Pittsburgh Synagogue Shooting Trial and Other Mental Illness Considerations: Take 2

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About a week ago, my column, “The Pittsburgh Synagogue Shooting Trial and Mental Illness: Take 1,” reviewed the role of mental illness in the Pittsburgh trial. That determination would help the decision as to whether sentencing could be the death penalty or life without parole. Since there was more expert witnessing to come, that was Take 1 on the topic.

At the end of that column, the only psychiatrist called as an expert witness by either side, Park Dietz, was beginning his testimony. As his testimony for the prosecution continued, he maintained that at the time of the crime, the perpetrator did not have a serious mental illness like schizophrenia, or psychotic symptoms, or epilepsy, all of which could have compromised his necessary legal “intent” for the mass shooting, a potential mitigating factor.

However, as his testimony continued, he did add a new diagnostic possibility, that of a schizoid personality disorder, low on the schizophrenic spectrum. That diagnosis—reflected in the perpetrator’s solitude, odd emotions, indifference, and lack of delusions—by itself would apparently not sufficiently limit his legal mental intent for the mass shooting.

Continuing to discuss the role of white supremacist conspiracy theories, Dr Dietz maintained that all the perpetrator’s anti-Semitic beliefs fit in with what he heard online. That begs the question, though, as to why someone with a lack of criminal history would change so quickly in his beliefs within a year or so. Even though the perpetrator came up with his own justification, which was one of the congregation’s support for bringing in white replacement immigrants, no one else conducted such a mass shooting.

The last witness to testify overcame some of the concern about delayed evaluations because he was the jail psychiatrist, Peter Hauser, who interviewed the perpetrator 2 days after the shooting. He found no suicidal ideation and no psychotic symptoms, but rather that the perpetrator felt that President Trump had conveyed a directive to act. The psychiatrist also felt that the perpetrator’s life history was a sad one. He concluded that the perpetrator experienced more of a cultural indoctrination than a delusional belief that would be part of a mental illness like schizophrenia. He received a tentative diagnosis of adjustment disorder and did not prescribe any medication.

It seemed to me from these 2 recent testimonies of psychiatrists that the answer to the mental illness question may lie in how the online conspiracy theories were interpreted. Though I did not hear a discussion about cults and cultish thinking per se, were they powerful cultish beliefs that played on some psychological vulnerability of the perpetrator, or less powerful beliefs and just a cultural context that provided a path to some desired renown?

A colleague pointed out to me that the cultish nature of the perpetrator’s online involvements could contribute to a diagnosis not mentioned and not used a lot in psychiatry, that being “Other specified Dissociative Disorder, 300.15,” with this DSM-5 explanation:

“Identity disturbance due to prolonged and intense coercive persuasion. Individuals who have been subjected to intense coercive persuasion . . . may present with prolonged changes in, or conscious questioning of, their identity.”

By its very nature, therefore, this particular disorder would be likely to reduce freedom of mind in terms of behavior, information, thought, and emotional control, as in the BITE model.¹

Another cultural context that I have not heard discussed is toxic masculinity. This is the traditional view in the United States that males need to be strong and tough protectors, which can then lead to obtaining guns and gun violence against perceived enemies.

Following the upcoming closing arguments today, we will see the conclusions of both sides, then the jury’s eligibility assessment for the death penalty. Perhaps there will be some way to tie together these different perspectives.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.

Reference

1. Hassan S, Caven-Atack J, Shah MJ, Malhotra S. Lone-actor terrorism: understanding online indoctrination. In: Holzer JC, Dew AJ, Recupero PR, Gill P (eds). Lone-Actor Terrorsim: An Integrated Framework. Oxford University Press; 2022.