COVER Killer instinct: What drives a shooting spree?<span class="Apple-converted-space">&nbsp; </span>

Was he a paranoid schizophrenic? A psychopath? Did he have a brain tumor? What could have turned a college student into a killing machine? In the nearly two weeks since the horrible Monday morning when 23-year-old Cho Seung-Hui unleashed a hail of bullets on students and faculty at Virginia Tech, mental health professionals have weighed in on what may have driven Cho's rampage.

Forensic psychiatrist Michael Lerner was among the first to do so, writing on abcnews.com on Thursday, April 19, that Cho likely suffered from paranoid schizophrenia. "Paranoia," he wrote, "is the most important element to understand in the possible motives of mass shootings." 

Local mental health expert Dewey Cornell agrees with Lerner's assessment that paranoid schizophrenia could have been at the root of Cho's violence. "It certainly sounds like he's seriously mentally ill," says Cornell, a psychologist and expert in school violence at UVA's Curry School of Education. "A lot of his statements reflect symptoms that are familiar to folks who work with severely mentally ill individuals." 

Such symptoms, Cornell says, include grandiosity, narcissism, and nihilistic (death focused) delusions, "that the world is full of sin and they have some kind of mission."

While Cho had never committed violence before his shooting spree, his behavior had worried his teachers and classmates for several years. His writing, which has been reprinted on several sites including thesmokinggun.com, also contains graphic violence. In one play, titled Richard McBeef, Cho, an English major, wrote about a 13-year-old boy who accuses his stepfather of killing his father and being a pedophile, and who eventually provokes the stepfather into killing him. 

One of Cho's professors, poet Nikki Giovanni, had removed him from one of her classes and asked a colleague to tutor him privately because his writing and behavior were so disturbing that only seven of 70 students were coming to class. 

"When I heard the suspect was an Asian student, I knew it was him," she said in a taped interview from Bradley University, posted on CBSnews.com.

Giovanni, who reported Cho to the police to no avail, grew emotional during the interview.

"I taught that boy," she said. "I thought he was evil." 

She wasn't the only one to see warning signs. In 2005, two female students lodged complaints against Cho, who they said was making unwanted contact through email and phone calls. Neither woman pressed charges, according to reports, but after another acquaintance suggested he might be suicidal, Cho was committed to a psychiatric hospital. He was released within days with orders to undergo outpatient treatment. It's not clear whether he ever sought or received that treatment.

Cornell says that despite Cho's hideous crime, he believes professors, psychologists, and the psychiatric hospital where Cho was briefly held did the only thing they could do at the time. "You can't hold him for years," he says. "Legally, you can't hold someone against their will unless there's clear and convincing evidence that they're an imminent danger to themselves or others."

That more than a year passed between Cho's release from the hospital and his shooting spree is proof "they were correct in releasing Cho," he says. Cornell points out that colleges deal with depressed, angry students "all the time." But, he adds, "Most people who are suicidal don't become homicidal. Most quiet withdrawn roommates don't turn out to be homicidal maniacs."

UVA forensic psychiatrist Bruce Cohen says Cho's extreme ideas could be consistent with schizophrenia, but "Not all extreme ideas are delusional."

Cornell says he's troubled by the release of Cho's audio/video manifesto, in which he rages against "hedonists" and "charlatans," and claims they have victimized him. "You had a hundred billion chances and ways to have avoided today," Cho says in one video, "but you decided to spill my blood. You forced me into a corner and gave me only one option. The decision was yours. Now you have blood on your hands that will never wash off." 

The Virginia Tech slaughter resembles the 1999 Columbine High School shooting, and in fact, Cho references the Columbine killers, calling them martyrs.

Cornell says violent acts like these can inspire copycats. "The two Columbine boys have been so popularlized that they've become attractive figres for a wide range of people," he says. "Alienated, disaffected youth who might identify from a distance are also attractive to a smaller number of severely mentally ill individuals who incorporate them into their delusional thinking."  

But despite the similarity in their crimes, Cornell says Cho differs from Klebold and Harris. "They were depressed, and one may have been more psychopathic," says Cornell, "but they didn't have the severe mental disorder."

While paranoid schizophrenia can be accompanied by hallucinations– such as hearing voices– and extremely disordered thoughts, some individuals have only delusional thoughts. Cho was able to methodically plan for several months and then carry out his murderous fantasy, but that doesn't mean he wasn't ill. 

"I've seen severely disturbed people carry out very elaborate plans," says Cornell. "It can occur."

Despite the suspicion of schizophrenia, both Cornell and Cohen say a definitive diagnosis for Cho may never be possible. While research has suggested there may be some differences in the brain structures of those with schizophrenia, there are no universal markers, and it is impossible to determine mental illness from an autopsy. 

A diagnosis of schizophrenia generally relies heavily on a patient's own report of "his subjective mental experiences," impossible in this case since Cho is dead. 

Whatever was wrong with Cho, Cornell cautions anyone trying to make sense of his manifesto.

"People will look into things he said," Dewey explains. "Was he impoverished, did people abuse him?" Cho's videotaped and written claims of being victimized "may be a product of delusional thinking," Cornell adds. "We should resist the temptation to try to make sense of something that's fundamentally irrational."

Experts says Virginia Tech shooter Seung-Hui Cho may have suffered from paranoid schizophrenia.
Photo Courtesy Fairfax County Schools



This guy CHO was a piece of evil crap that deserved to die. It sucks how people want to "figure out" what made him go bad. He was born bad or raised bad it does not matter. He was bad and I hope he is burning in hell right now for being so selfish. If he were a real man he would have gone out in the woods and swallowed a bullet alone.

Stop posting his picture.. you just encourage
other losers to try and get famous at other peoples expense.

He didn't have a killers instinct. Killers like the challenge. pussies like to massacre. I'll bet he spent his childhood smashing frogs with rocks.

Cho should become the slang word for somone who is too big of a pussie to face the real world.

as in " He got fired from his job so he stays home and blames the world like a little Cho"

That's a very mature response, Ben. Good idea. Let's use a common Asian name as an insult because it happened to be this guy's name.

Megan, it seems to me that Ben was saying Cho should be used as an insult because he killed many innocent people like a gutless coward; NOT because Cho is an Asian name. I suspect Ben would have said Dugan should be used as an insult if the killer's last name happened to be Dugan.

I hope that someday mass murderers will be buried in an unmarked grave with their name never revealed in the press. These killers plan on a perverse kind of immortality and we need to stop giving it to them.

Blah, I'm aware of why he thinks we should begin calling people "Cho" as an insult, and I'm suggesting that it's still offensive to other people named Cho who had nothing to do with him. I wouldn't want my family name to become a popular insult, would you? And I'm also suggesting that we stop spending so much time hating him, because that's not going to bring back anyone, and instead focus on helping the families of the victims and seeing what, if anything, can prevent a tragedy like this from happening in the future.

Well said Megan. Obviously some people did not understand your subtle remark. We can only move on by seeking knowledge. Nothing is gained by blaming a raging river for overflowing it's banks.

Megan, stop acting like a CHO!

HaHaHa! I crack myself up sometimes!

Hey Megan, stop hating him? WTF? I bet if any of the 32 people was a direct family member of yours, you would never stop hating him.

Megan, you are taking your political correctness to an extreme level. What is that comment about "we can only move on by seeking knowledge." Knowledge about what? Knowledge about why Cho killed? Is that information going to bring anybody back from the dead? Is it going to help the families stop grieving any sooner? Tell that to the families. I'm sure the response would be something similare to "Knowing why Cho killed a member of my family does not help me get over my grief any sooner." The movement for everything to be PC has overflown its riverbanks.

Gail, I would like to see a form of "shunning" take hold in response to cases like this--like what they do in Amish communities to punish wrong-doers. No one acknowledges the person's existence--don't look at, talk to, interact with the person at all. No references to the person, no attention at all. There should be much more shame and exclusion attached to these people. Right now, we do the exact opposite--we heap attention and reward upon these people. Anyone observing the whole phenomenon can draw the conclusion that the way to get rewarded with attention is to do something like this.

I was furious with the news coverage that all universally opened with a version of the sentence "in the worst massacre ever on U.S. soil, ..."--I mean, way to up the ante for the next guy! Can't we refer to it as the most shameful or the most disgusting act ever? at least attach some modifiers to it that no one finds attractive.

I don't think that trying to understand why Cho did what he did is PC--unless trying to understand how it is that cancer kills people is also just a bunch of PC. It's about trying to advance the bodies of knowledge (psych, bio, neurochem, sociology, all of it) that might help us identify future mass killers. You can't address problem that you don't even understand.

From what I've been reading, many members of the immediate VT community (i.e., students there right now) have been working on forgiveness already--putting up a memorial stone for Cho on the drill field, leaving flowers and notes for him, etc. I'm sure there will be ultra-right-wing condemnations of these acts of forgiveness as just more wimpy PC liberal passivity (a la Neal Boortz), but I think it's pretty amazing and admirable to find room in your heart to pity someone like Cho, and to forgive him. If you've ever had occasion to forgive someone who has harmed you--really, really forgive that person, from your heart--then you know it's an amazing, transformative experience. I hope some of these kids are feeling that.

Sidonie. You stereotype conservatives. Do you really think that there are no conservative christians who have truly forgave somebody? Do you think only the liberal left can really forgive somebody. That seems to be the undertone of your message. If you think that, then I forgive you, but I'll pray you'll change.

forgave = forgiven in above message.

Actually, Steve, the family of one of the victims, Reema Samaha, has already stated that they have forgiven the killer. Of course people are justified in being angry and feeling hate. But slamming Cho and his family on message boards - really, what does that do? Does that help the families move on with their lives? Does it help us to prevent future shootings? Sidonie said it best above, so I'm not going to repeat her words. And I don't agree with the actions of the person who put down the memorial stone for Cho on the Drillfield with those of the victims, I don't think it belongs there. But at the same time, carrying around hatred for him is not going to help us move on from this tragedy and prevent others.

Sidonie might stereotype conservatives, but on other boards I've heard people refer to the girl who put down the stone for Cho as a bleeding heart liberal who should be expelled, killed, etc. If some conservatives think forgiveness is such a horrible "liberal" trait, then it stands to reason that these same conservatives value anger and hatred.

I forgive you to Megan. I will also pray you will include people with differnt values (i.e. conservative) in the group of people you are willing to love and forgive.

Don't feel guilty Megan, I am so used to most liberals preaching forgiveness and then acting in hate against anybody with a different perspective.

Sorry for the post filled with grammer errors and typos above. I hope you will forgive me.

This is a really good article.

Ben: People want to understand what drove him to it SO THEY CAN STOP THIS SORT OF JUNK from happening ever again. Labelling someone or something evil doesn't help stop this from happening again.

Most school shooters have a large amount of paranoia in their belief system. Research into treating paranoia would really help - what if there could be a drug to treat paranoia? Well, hat's just hypothetical.

Society needs to actually take some sort of *action* to provide medical care for those with mental illness, the same as is provided for peple who have things wrong with parts of their body that don't involve the brain.

I know it's horrid what has happened but this will keep happening till these people are found before they commmit and are gotten treatment before they can perpetrate a crime based on their delusions. The person needs forced treatment and to keep taking their meds even after they get back to normal.

We need to find them and get them the medical and social help they need to stay sane.

SPECT and MEG brain scans can help spot people with potential violent problems. Yearly medical checkups need to include have these things in children and adolescents and anyone with prolonged aberrant and disturbing behvaiour would go a long way to stopping this stuff and save lives.

So we could catch them before they go off the rails and save lives of people who would otherwise become their victims.

Sidonie: If Cho did have paranoid schizophrenia, or schizoaffect disorder shunning and social isolation would only make his symptoms worse.

What he needed was forced treatment but the law right now has swung to being too liberal about people with active episodes of psychosis. How can you have free will when you are psychotic and believe all manner of lunacies?

Medically you can't be episodic with a psychotic mental illness and really have free will, because your Will is influenced by your beliefs and if you r beliefs are completely whacked out you're willing to act on these you will do soemthing whacky.

But to the law, you somehow still have free will.

I don't think so! The law can try and ignore medical and psychological research but they are crazy to do so when it could help reduce their case load!

Usually people with schizophrenia are harmless but paranoid schiz and schizoaffect are another enchilada entirely. They are more prone to violence. Schizophrenia is a treatable mental illness but it isn't EASY to treat. Some people don't respond to the drugs and many psychotropics used to treat mental disorders have horrible side effects like giving you diabetes.

One of the hallmarks of schizophreia and schizoaffect disorder is that the person has NO CLUE THEY ARE ILL. they think it's everyone else who's sick and they are fine.

What use is free will if a person thinks others are in control of their behaviour? What use is shunning in these cases when social isolation makes the symptoms (and behaviour) worse?

We can't keep slamming mental illness in a "lets not talk about it" closet and expect it to go away. Being horrified at it and going all slackjawed won't help either.

Most mentally ill people are more of a danger to themselves but a handful are like Cho or Kimveer Gil (who was psychotically depressed before committing the killings at Montreal's Dawson College last fall).

I'm praying the deaths at Dawson and Virginia Tech and Columbine etc. will not be in vain and mental health checkups and treatment (once a month injections of some anti-psychotics are showing some promise) and social supports for those with 'broken brains' will become the norm.

But the systems for mental health in Canada and the US are being cutback. So why is anyone surprised when there is an increase in these crimes id medical help is being flummoxed by governmental cutbacks and legal impediments to treatment during delusional episodes?

"let's not talk about it"

In every school shooting since Kip Kinkle in America, the killer was either hopped up on or withdrawing from SSRI. Let's not talk about that either.

I've read lots of books and got straight A's in my college courses, and got a magic degree in psychiatry. I believe this degree and my connection to it give me special powers. These special powers enable me to determine who is and who has a "broken brain". You don't possess the special powers that I possess because you don't possess the magic degree, so don't challenge my authority.

Expert. I have read more books and have more degrees than you. Na na na na naaaa. You shall now listen to me and agree! Ha ha ha ha ha ha. I will rule the world by forcing psychological exams of the populace and incarcerating those that do not please me.

Well, I have degrees too, and my powers of manipulation and conformity have given me a position higher in the government beaurocracy, so I will be the decider of whose brain is broken. I will decide who gets a gun, and who doesn't. And I feel certain you are both showing signs of univerabnorevertism, which you must buy my book to understand. Cho on that!

In other words, he's evil.