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