Pychoanalysis won't fully explain VT killer
Published: Friday, April 27, 2007 Opinion articles By: Carol Duh My parents immigrated into this country in 1982. My parents told me a Taiwanese parable while I attended the same schools as Mike Pohle, one of the 32 victims of last week's massacre. In the story, a teacher took his class on a field trip to the mountains of Taiwan. On the way home, they encountered a swarm of killer bees. The teacher removed his clothing to attract the bees away from the children to his flesh. I heard the echoes of this parable while reading about Liviu Librescu, the professor who blocked the classroom door with his body while the gunman demanded entry. While he did this, students escaped through the windows. No doubt that being stung by bullets was agonizing. There was little dignity in these painful deaths, only in their sacrifice. And what of the bee? The bee who stings out of cowardice dies soon after, so we cannot ask. Panicked, we call in the world-class bee experts to explain the situation. This response, though gratifying, is in vain. Like Wall Street analysts who offer their best predictions after the fact, the analysis will not provide us with the protection we need. The bee and Seung Cho perceived threats that were not real; their behavior escapes appreciation. Let's try anyway. His parents were South Korean immigrants who sent a daughter to Princeton and a son to Virginia Tech — a feat worthy to boast of across many oceans. College is the frame upon which immigrants hang their hopes, but sometimes it comes at a price. The drive that steers us toward hard work is often frustrated by the apparent frivolity that pervades American campus culture. Fraternity keggers, society taps — these seem to be the cornerstones of the American college student's anxiety. To the ethic of a different culture, they are laughable. Seung Cho's complaints, through lunacy, tap the drumbeat of this disappointment. Seung Cho's two defining characteristics continue to be his mental health and his immigration status. Experts dissect the belongings strewn about his dorm room, scrambling for a diagnosis. Depression. Paranoia. Obviously. It is insulting to the millions of positive mental illness survivors to dwell on this. On the other hand, we could further probe the reality of cultural disparity and the specific causes he cited for his intense dissatisfaction with his experience in the United States. Yet to draw conclusions about immigration from his story is an enormous disservice to the core of the nation's foundation and strength. Both of the gunman's prominent characteristics lead to a dead end. I know a man who spent 17 years in prison. He told me that the scariest inmates are the ones who are there for life. The lifers languish in hopelessness, and claim this as license to be brutal and sadistic toward everyone else. Another man I know was born deaf and contracted AIDS in his late teens. A few years ago, Michigan tried to prosecute him for sexual predation when he, with a willful heart, transmitted the virus to 13 different people within the span of six weeks. He remains unrepentant. Why do people sink into despair? The painful simplicity of the answer escapes psychoanalysis: laziness. Seung Cho chose bitterness as his permanent sanctuary, allowing himself to drown. Yes, he was unwanted and weak, and he elicits a kind of sympathy. Perhaps the shore seemed distant and we all know that without constant encouragement, the race is long. But we do it. We brush ourselves off after devastating exams, awkward dates, even outright evidence of human unkindness. As every first-generation student will tell you, we are too lucky to be given so much. As Seung Cho embraced his victimhood, we should embrace this explanation and free ourselves from this futile search into his psyche. How should we, the children in the parable, react to this event? When confronted with people who churn bitterness into poison, the natural reaction is fear. We buy bigger guns, go to college closer to home and dead-bolt our doors. Such malevolence seems intolerable to tempt with risk. Fear is the pulse of Seung Cho's madness, and this is the lesson he expected to teach. Yet Seung forgot his role in the parable — the bee was never a teacher. We see the families of Virginia Tech. Grief is agony, but it will not kill us. Seung Cho underestimated the goodness his psychosis would beget. Enduring traits of the human spirit enable the sacrifice of the Taiwanese schoolteacher and the Virginia Tech professor to transcend cultural borders to show that no matter where you are, the broken heart continues to beat. This country may not always safeguard us, but retreat will not protect us. The teacher's pain was apparent, his message clearer still. Seek comfort not in bitterness, but in courage and hope. We are always safe in their arms. Carol Duh is a senior in Trumbull College. -- Original Source: Yale Daily News - April 27th, 2007
Editor-in-Chief, Yale Daily News - Sarah Mishkin <sarah.mishkin@gmail.com>
Artist's Comments ? Lay me on the ground Fly me in the sky Show me where to look Tell me what will I find... Teach me how to speak Teach me how to share Teach me where to go Tell me will love be there Will love be there? - Shine by Collective Soul This is Seung-hui Cho aka "Question Mark", the gunman of the Virginia Tech Massacre. -- Original submitted to deviantart.com on April 24, 2007: http://www.deviantart.com/deviation/53906656/ Licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 License.
reative Commons Attribution-Noncommercial-No Derivative Works 2.5
Questions arise from tragedy at Va. Tech
In wake of tragedy, nation is encouraged to focus on heroic victims of school shooting By: Megan Cox Posted: 4/20/07 A great atrocity occurred in Blacksburg on the morning of April 16. Cho Seung-Hui, a Korean-born English major at Virginia Tech, shot 62 students and teachers, killing 32 people, wounding 29 and leaving an entire nation in shock and mourning. Many people question how and why a single deranged individual could so proficiently commit "the deadliest rampage in American history." Did the university perform all of its duties to secure the safety of its students? Could a better response have saved any lives? How is the media handling this tragedy? What actions is the president taking? Could gun control laws have prevented this tragedy? Who was Cho Seung-Hui, and why did he commit these murders? Details are now trickling in about the young murderer. In an English class, he wrote plays full of grotesque violence. The playwriting professor and the English department had sought help for the young man. He was detached and troubled. He was admitted to a mental institution in late 2005. Possibly the most disturbing piece of the twisted psychological puzzle is that Seung-Hui sent a multimedia package to NBC News between the killings in the dorm and the massacre in the classrooms. It is too soon, both temporally and emotionally, to delve into all of the issues this tragedy presents. Of course, that a man like Seung-Hui should have such ready access to firearms is disturbing, and that the media is turning a profit by running such intense coverage of the tragedy is indeed unnerving. However, all these questions will pale in comparison to the introspection of human nature that follows such atrocities caused by a single man. There is evil in our midst. Some things, some acts, some people, are so horrible as to merit the use of that overused epithet. Whether people are born into it or are brought into it, whether it is caused by neglect or ridicule, whether it festers or can be cured, there can be little denying that it does surface in our society. One man can come to embody evil in our lives. One man has ended dozens of lives and wreaked havoc on many others. One deeply troubled man can control our lives, drowning us in fear and sorrow. Yet, as we weep over the acts of one disturbed man, we must resist the temptation to gloss over all of humanity as grotesque and depraved. We do have a great capacity for ordinary heroism. Doctor Liviu Librescu was a Romanian-born Holocaust survivor. When the gunman tried to storm his classroom, Librescu blocked the door with his body and told his students to flee. At least nine of his students were able to jump out of the window to safety because of Librescu's actions. Librescu died a hero. Ryan Clark was a jovial psychology major, a member of the Virginia Tech Band and a Resident Advisor in the West Ambler Johnson dorm. He was killed when he came to the aid of another student being attacked by Seung-Hui. Clark, too, died a hero. Every time we think we've reached our capacity as human beings, we need only look at the actions of others to realize that capacity might well be limitless. Heroes exist in everyday life. When put to the test, these people shine. They remind us of the good we all possess, of our capacity to do right even in the face of evil. We must remember to focus on the good of the heroes rather than the evil of the killer in the wake of this tragic event. -- Original Source: The Hullabaloo - April 20, 2007
"Dickson, Drew D." <ddickson@tulane.edu>
This quilt was made by a Sioux tribe woman. Before it left the reservation, it was blessed by two elders from the Crow and Cheyenne tribes. Boys from the St. Labre School performed a Crow ceremony called "Wiping The Tears", which is part of a yearlong ceremony honoring passing. The pattern is called the star of honor.
One of the items on display at the Alumni Center Art Exhibit. On 4/16/08, as part of the Day of Remembrance observance, the Holtzman Alumni Center Museum displayed examples of art, crafts, quilts, and other memorabilia contributed since April 16, 2007. This is one of over 60,000 items that will eventually go to Special Collections at Newman Library. A quilt for the Corps of Cadets sent from Colorado State University with a letter that said: "Dear Corps of Cadets, On behalf of the Arnold Air Society and Detachment 090 at Colorado State University, we would like to send our deepest condolences for those affected by the violence. You have been on our minds a great deal the past few weeks and our hearts go out to you. We wanted to show our support in some way, so we created a quilt that bears the messages from students here at Colorado State University. We passed out thousands of ribbons bearing the Virginia Tech colors, and students and faculty alike signed the quilts and wore the ribbons in support. We collected donations and have sent them to the scholarship fund in the name Matt La Porte. We know that nothing can replace the loss of a loved one, and that only through the support of one another and time will the wounds start to heal. We felt that this was the least that we could do, and we wanted to show our support in some way. You are in our thoughts and prayers. Timothy Vedra AAS C/Major Captain Mark Giles Danielson Squadron Commander Colorado State University Det 090 720.308.7183"
Items left at the memorial plaque of Rachael Hill on the drillfield. Photo taken on 5-1-07. Photo by Teri H. Hoover.
Teri H. Hoover <crystalirisphotos@gmail.com>
Remembering those from Richmond...a girl from the west end. Original source: http://share.shutterfly.com/action/slideshow?a=67b0de21b3292af30542&auto=0&idx=6&m=1&d=1180361637260 Photo courtesy of Krissy Watson
Photo courtesy of Krissy Watson krissywatson@gmail.com
Relief pitcher Edwar Ramirez signs a baseball for fans at the Yankees vs Hokies baseball game on March 18, 2008. Photo by Roger Gupta. -- Original Source http://flickr.com/photos/spector1/2350659089/
April 17, 2007 By IDA JAMSHIDI Reporter Government officials are calling it the deadliest rampage in the history of the United States. Virginia Tech University was the site of a mass shooting Monday, leaving at least 33 people dead, including an unidentified gunman, whom police believed took his own life. Dozens were injured. Baylor Police Chief Jim Doak said it is nearly impossible to predict an incident like the Virginia Tech shooting. But he said Baylor police regularly participate in structured drills so that officers are prepared for this type of event. "We want to act swiftly. We want to be decisive with an active goal of neutralizing or killing the shooter," Doak said. If a person is caught in the midst of a shooting, Doak said the best thing to do is look for a way out. "Preferably, you're looking for an opening," he said. "If you have no way out, your best offense is to play dead. Drop to the floor and lay there motionless." Doak said Baylor students should be aware of their surroundings and not hesitate to report suspicions. "Awareness is the greatest ally of any student," he said. "Students don't normally think in terms of what's around the next corner." The Baylor Police Department receives around 400 "suspicious person" calls every year, said Doak, while 20 years ago, they received only about 25 calls reporting suspicious behavior. Dr. Susan Matlock-Hetzel, a psychologist at the Baylor Counseling Center, said that when people are caught in a dangerous situation, such as a shooting, they might do things they would not normally do. "If people are placed in that kind of emotional, shocking event, our natural tendency is to go into that fight or flight response," she said. "Our mental capacities would go to surviving." Matlock-Hetzel said that the trauma of the shooting will affect each student differently, and the university will have to decide what is best for the majority of the students. "That community will be having multiple phases of responding to this event," Matlock-Hetzel said. "You have your crisis mode and then you have your more long-lasting clean-up." Justin Brown, an Alexandria, Va., junior, has several friends who attend Virginia Tech. He said many of them have posted messages on Facebook and AOL Instant Messenger, writing, "I'm OK," or "I'm alive." Brown said he still hasn't heard from all of his friends, but he is attempting to reach them. "When something's going on around them, you want to make sure they're okay," Brown said. In an e-mail sent out to Baylor faculty and staff from President John Lilley on Monday afternoon, he expressed his remorse for survivors and for the Virginia Tech campus. "While preventing such an attack with 100 percent certainty is impossible, I want to reassure you that we do have systems in place to respond to emergencies, and to minimize harm to our students, staff and faculty," Lilley wrote. He went on to describe that the Baylor campus has 24 fully trained police officers, an emergency public address system in all resident halls and some academic buildings, and a recently installed dual e-mail/voice mail system. -- Original Source: Baylor University http://www.baylor.edu/Lariat/news.php?action=story&story=45273
April 17, 2007 By IDA JAMSHIDI Reporter Government officials are calling it the deadliest rampage in the history of the United States. Virginia Tech University was the site of a mass shooting Monday, leaving at least 33 people dead, including an unidentified gunman, whom police believed took his own life. Dozens were injured. Baylor Police Chief Jim Doak said it is nearly impossible to predict an incident like the Virginia Tech shooting. But he said Baylor police regularly participate in structured drills so that officers are prepared for this type of event. "We want to act swiftly. We want to be decisive with an active goal of neutralizing or killing the shooter," Doak said. If a person is caught in the midst of a shooting, Doak said the best thing to do is look for a way out. "Preferably, you're looking for an opening," he said. "If you have no way out, your best offense is to play dead. Drop to the floor and lay there motionless." Doak said Baylor students should be aware of their surroundings and not hesitate to report suspicions. "Awareness is the greatest ally of any student," he said. "Students don't normally think in terms of what's around the next corner." The Baylor Police Department receives around 400 "suspicious person" calls every year, said Doak, while 20 years ago, they received only about 25 calls reporting suspicious behavior. Dr. Susan Matlock-Hetzel, a psychologist at the Baylor Counseling Center, said that when people are caught in a dangerous situation, such as a shooting, they might do things they would not normally do. "If people are placed in that kind of emotional, shocking event, our natural tendency is to go into that fight or flight response," she said. "Our mental capacities would go to surviving." Matlock-Hetzel said that the trauma of the shooting will affect each student differently, and the university will have to decide what is best for the majority of the students. "That community will be having multiple phases of responding to this event," Matlock-Hetzel said. "You have your crisis mode and then you have your more long-lasting clean-up." Justin Brown, an Alexandria, Va., junior, has several friends who attend Virginia Tech. He said many of them have posted messages on Facebook and AOL Instant Messenger, writing, "I'm OK," or "I'm alive." Brown said he still hasn't heard from all of his friends, but he is attempting to reach them. "When something's going on around them, you want to make sure they're okay," Brown said. In an e-mail sent out to Baylor faculty and staff from President John Lilley on Monday afternoon, he expressed his remorse for survivors and for the Virginia Tech campus. "While preventing such an attack with 100 percent certainty is impossible, I want to reassure you that we do have systems in place to respond to emergencies, and to minimize harm to our students, staff and faculty," Lilley wrote. He went on to describe that the Baylor campus has 24 fully trained police officers, an emergency public address system in all resident halls and some academic buildings, and a recently installed dual e-mail/voice mail system. -- Original Source: The Lariat http://www.baylor.edu/Lariat/news.php?action=story&story=45273
Julie Freeman (Julie_Freeman@baylor.edu)
Recorded Thursday, April 19 (24 MB MP3) We've decided to scrap tonight's planned show (about language post-Imus) in favor of a show about the visual reverberations of the Virginia Tech shooting. Our central prod came from the trusty barthjg, who wrote: I'll pitch a show about Instant Symbols and Icons, based on the Virgina Tech killings. The image of Cho Seung-Hui brazenly holding two handguns, arms outstretched will soon reach iconic status, to be mashed up and shared in all sorts of ways-just like the Abu gharib photos and Che' and everything else that has appeared on t-shirts and ads. How many You Tube videos created in the wake of the shootings? music tributes. every incident enters the mosh pit of creative repurposing. Who is going to write the music, the movie...track every 6 months how pieces of this tragedy filter thru global culture. Watch someone stage the two crazy plays this guy wrote for the drama class he is in. (you can find them on aol.com...i read them last night) barthjg, in a show suggestion to Open Source, April 19, 2007 We're following his lead, and asking: Is there anything to learn about the way we use new technologies in this first mass-murder made, as it were, for YouTube? Are mashups and tributes a form of digital catharsis, a sort of artistic safety valve? Is there a cross-over point where they become pure exploitation, or worse? And what, exactly, is new here? Besides the zeros and the ones, and the ease of dissemination and reconfiguration, is there a difference between a 19th-century suicide note and a 21st-century QuickTime movie? Siva Vaidhyanathan Assistant Professor of Culture and Communication, NYU Blogger, SABEROCRACY.NET Keith Jenkins Picture Editor, The Washington Post Flickr blogger, Burnt Pixel Blogger, Good Reputation Sleeping Founder of the Post's Blog City feature James Der Derian Director of the Global Security and Global Media Project at The Watson Institute for International Studies at Brown University Author of Virtuous War: Mapping the Military-Industrial-Media-Entertainment Network Extra Credit Reading Excerpts from the original footage sent by Cho Seung-Hui to NBC on the day of the shootings (via YouTube): http://www.youtube.com/watch?v=FbDl5_qAj04 anditgoeslike, 2007-4-19, anditgoeslike's LiveJournal: "These pictures of Cho failed to evoke the kind of emotional reaction that a real villain should. I'm sure it would be different if he were actually holding that gun to my head and not to a digital camera with the self-timer innocuously ticking away. I don't know, though. I just imagined him going in front of the mirror and experimenting with various outfits and poses." ntcoolfool, Update, Bryce's Journal, April 16, 2007: "I cannot decide if I should join and get the most up to date information or not. I think when I do, it will then hit me. I must avoid it at all costs. The list still awaits- and several friends have remained silent on facebook updates. Could it be them?" Scottish Right, Old Media Tries To Tarnish New Media With Virginia Tech Massacre, Scottish Right, April 19, 2007: "A madman campus killer making a video and shipping it to a media outlet has absolutely nothing to do with "citizen journalism" or "new media." A sicko video made with a camcorder and sent to NBC is hardly any different than an elaborate suicide note being written and mailed to a media outlet." Momus, The problem lays a floral wreath at the grave of the problem, Click Opera, April 17, 2007: "There, visually represented, is the same horror we heard on the cell phone video footage students recorded. The grim exterior of the building, and that seemingly endless banging. Horror beyond all the platitudes. Horror intimately tied to the braying donkey of the Absurd, the pragmatic, the routine, the logistical — what Hannah Arendt called the banality of evil." nikolrb, in a comment on Open Source, April 19, 2007: "It seems part of this discussion is not about if the images are more prevalent, I don't think they are especially, but how quickly we are digesting and regurgitating and socially processing them. Think of all the movies, plays, songs, etc. made referring to Jeffrey Dahmer, the Zodiac Killer, Son of Sam killings, Jack the Ripper, etc. The entertainment/news cycle seems to be converging (in more arenas than just this.)" Dan Gilmor, Virginia Tech: How Media Are Evolving, Center for Citizen Media Blog, April 17, 2007: "Once again, horror has given us a glimpse of our media future: simultaneously conversational and distributed, mass and personal." Sky News, Copycat: Killer Re-Enacted Violent Film, Sky News, April 19, 2007: "Officers believe he repeatedly watched Oldboy as part of his preparation for the killing spree." -- Archived with permission of the producers. Original Source: http://www.radioopensource.org/re-imaging-violence/
David Miller Senior Producer, Open Source www.radioopensource.org 617.497.8096 david@radioopensource.org
After being advised to stay away from windows and such on April 16, many of the Career Services staff and students who were in our building at the time gathered together in an interior room (our staff lounge). As things were unfolding on campus around us we were watching the news and hearing what was unfolding. This photo was taken as we had just learned of the first seven fatalities in Norris Hall. Everyone was shocked. We couldn't believe what we were hearing. As the morning unfolded an we watched intently we were overwhelmed with grieve that this had happened. We had to be strong for the students who were among us. It was surreal. I took this photo, but it didn't even feel right taking a photo at this time. I only took three photos as it was too upsetting.
Memorial stone of Mary Karen Read on 4/16/08. Photo by Brian Sewell. -- Original Source; http://flickr.com/photos/briansewell/2419986298/in/set-72157604577382666/
Recent Shooting at Virginia Tech: Looking Through Another Lens
By John Williams "A 1st Sergeant handed me an ammo box of 240 rounds: the blood-stained rounds that my best friend had been using when he was shot and killed in an ambush, on a patrol that he wasn't supposed to be on, one day after we were told we were going to be back home." -Toby Hartbarger, Army SPC For me, it was this story that my mind instantly recalled after I heard about the shootings in Virginia last week, for Virginia Tech leads U.S. civilian schools in sending officers to the U.S. Military. It was a terrible tragedy, and I had heard of similar events before, but my thoughts intensified because the killings hit so close to home. I realized then that so many people I know have experienced similar, instantaneously deep connections to other tragedies that have occurred in different ways across the globe. It is these lightning connections, these synapses firing without control, that I would like to address. The tragedy at Virginia Tech (VT) is not an isolated incident, or an anomaly. Though some argue that Cho was insane, and while I have no doubt this might be true, we as a society commit acts of similar insanity on a regular basis. We must take notice of the correlation between a guy like Cho and people like us. The articles I have read about Cho try so hard to push him away from what we are; he was a loner, crazy, friendless, different. We point at the connections between his plays and his actions and wonder why his actions weren't noticed, or prevented. But what if we turn the camera on ourselves? It is much harder to look at the things we do — the video-game realities we spend time in, the films we see and books we read that are bound with senseless killing and violence — and ask the same questions. There is a surge of inspection thrown onto this lone figure, Cho, yet we place hardly an ounce of introspection onto ourselves. I would love to believe that the VT shootings were an isolated incident, that they were an anomaly, that I do not live in a world where such things can happen. But violent destruction is far too common an occurrence for me to believe that this is true. In the span of four days just last week in Houston, Texas, there were three separate incidents of men shooting others before committing suicide. There is constant and recurrent violence in our streets every day, especially in communities rife with poverty and oppression, such as New Orleans. Every day Iraq sustains the level of two Virginia Tech massacres. Only two weeks ago, a student with a bomb killed 40 fellow students at the University of Baghdad. I could go on, but I think most people realize that terrible things are happening, in different ways, to different degrees. Yet so often it seems as if we isolate these incidents, and pretend they don't relate to the world at large. But they do. Last week we ran an editorial urging the country to leave those affected by the VT shootings a litle space. While allowing time for grief is one thing, removing yourself from the collective consciousness is another. Everyone has to spend some time in grief: we all have jobs and classes, lives to live, and I'm not asking anyone to stop all that. What I am asking is for you to take as much time as you can spare to engage in these issues; examine the ways in which you can change, we can change. Change personally, locally, nationally, and globally. Because these are not separate tragedies. Because we are all connected, and everything we do is connected. -- Original Source:City on a Hill Press - April 26, 2007
This piece of art entitled, "Reclaimed Spirit", was accompanied by the following message from the artist: "This work of art is hand forged totally from reclaimed materials. The feathers were forged from angle iron reclaimed from metal pallets from a local tractor dealer. The feathers are attached to a steel ring, the remnants of a feeding device found in a cow pasture. The letters VT are fabricated from square tubing again reclaimed from metal pallets, this time from a local compressor manufacturer. The ribbon of steel was recovered from an old abandoned farmhouse foundation. The copper scroll was formed from what was a door kick plate in its previous life. The paint and finish were the only items purchased new. Truly green art, as the materials are recycled or reclaimed, so goes the victims' spirit. There are 32 turkey gobbler feathers that represent the 32 victims. They are placed in a circle or wreath shape that symbolizes the circle of life. The wreath encircles the VT logo and ribbon. The ribbons' colors are maroon, orange, and black rather than white to symbolize the darkest day in VT's history. The letters VT were finished to match the feathers to signify that VT's Spirit is with those victims. Finally, the copper scroll represents the Honorary Degrees given to all the victims in pursuit of higher learning. This "Reclaimed Spirit" is a tribute to the memory of the 32 innocent students and faculty members who were tragically taken from our Hokie Nation. It is up to those of us left behind to do what we can to "Reclaim their Spirit". Contributed by; Hunter C. Perkinson Jr., Alumni 1980 Bradford C. Van Horn, Alumni 1980" Photo taken at the April 16 Memorial on April 15, 2008. Photo by Brent Jesiek. Licensed under Creative Commons Attribution-NonCommercial-ShareAlike 3.0
Items left at the memorial plaque of Reema Samaha on the drillfield. Photo taken on 5-1-07. Photo by Teri H. Hoover.
Reema's stone is marked by flowers, letters, and memorabilia from loved ones. Original source: http://www.flickr.com/photos/kevincupp/470150247/in/photostream/ Photo Courtesy of Kevin Cupp
Permission: Photo Courtesy of Kevin Cupp http://www.flickr.com/photos/kevincupp/470150247/in/photostream/
Reflections as a Director of a Psychology Training Clinic on the shooting tragedy at Virginia Tech (Written for the Association of Directors of Psychology Training Clinics) On the morning of April 16, 2007, a male student shot to death 32 students and faculty, wounded 17 more, and then killed himself on the campus of Virginia Tech. In the midst of unspeakable grief, the Virginia Tech and Blacksburg community, with tremendous support from many people, did an incredible job of responding as best as it could to meet the needs of those most deeply affected. My purpose of this article is to briefly describe my experiences and reflections on the role of the psychology training clinic and my role as the Director in the days following this particularly tragic event. To better understand our response, a brief description of the type and structure of clinical services at Virginia Tech. Like any major higher-learning institution, Virginia Tech has an on-campus, university-based counseling center, the Cook Counseling Center, which has a staff of 10-12 full-time counselors, 3-5 interns, 3-5 externship students, and 1-2 psychiatrists. The Psychological Services Center of Virginia, of which I am the Director, is an off-campus, community-based training facility for the Ph.D. Clinical Psychology program in the Department of Psychology. At any one time, we typically have 20-25 graduate students in various stages of their training enrolled in clinical practicum and seeing clients. Additionally, the Marriage and Family Therapy (MFT) program also has an off-campus training center for their graduate students. The Cook Counseling Center and the Psychological Services Center (and the MFT clinic) are separate facilities and organizations. Over the years, our relationship with the counseling center has been good especially in terms of reciprocal referral and training opportunities. In response to the shootings, the primary "clinical" responder to the university community was the Cook Counseling Center and the primary care service for the local community was the state operated Community Services Board, whereas the Psychological Services Center was viewed as one of a multitude of secondary "overflow" support systems. The Director of the Cook Counseling Center, who fortunately for Virginia Tech had prior direct disaster response experience, quickly and efficiently took the role as a leader of the psychological first aid response effort for the university. I was part of multiple meetings focused on the university's response to the shootings and my consistent observation was that everything seemed to be well covered by the staff of the Cook Counseling Center and related university systems (e.g., Student Affairs). Similarly, the number of professional therapists, counselors, disaster workers, Red Cross workers, state-mandated mental health crisis team members, state health insurance disaster workers, etc. that came to our town to help was immense. In sum, there was way more supportive/therapeutic help available than was needed, which was a good thing to see and feel as a community. In the meantime, many of our clinical psychology graduate students came to me with questions of what they could do and suggestions for what we could do. As it turned out, a significant subset of students helped out with the Red Cross. Similar to my perceptions about the abundance of "therapists", they noted many more disaster relief workers were available than needed. Another subset of students took to searching for information and developing an information-based manual for crisis response and management. This was a very gracious effort, and probably helped us more in terms of alleviating our own anxiety that we could be helpful than actually imparting previously unknown information. That is, being trained to be a "caring listener" was the most helpful clinical skill during these times. And yet another subset of students found their way into very helpful roles in the aftermath; being a "right hand person" for a disaster relief director; helping to orient visiting families, getting water and food for relief workers, etc. Honestly, our help as a training clinic was not needed or necessary. Being good people, being so close to a tragic event, and the fact that we are trained (or in training) psychologists, we felt driven to help and everyone did their best. I was, and continue to be, extremely proud of how our students reacted by giving of themselves to help others. But between all the service organizations and trained personnel provided by the state, city, and university, all was more than adequately covered. We had a few current and new clients come in for emergency-type sessions, but no onslaught of folks needing therapy. My take on it all now is that our role in helping was not as psychologists or therapists, but as fellow members of a shocked and grieving community. I did two related things that week that, at least I believe, reveal the essence of what was truly important in a time of crisis. One was listening to my wife when she announced two days after the shootings that she was tired of us watching the news and becoming numb, and then preceded to call our good friends and invite them to a casual dinner party that evening. In her own special way, she was saying what we needed to do was be with each other. The second thing, following this same theme, was that I held a meeting of all clinical psychology graduate students and faculty. In that meeting, I expressed my thoughts about the tremendous amount and level of care available to everyone in the community, that I truly appreciated the students' help and many offers of help, and that I was very proud of them. But, at that time, I felt that our path to recovery was to acknowledge that we were also affected by this tragedy, to let others do their job, support each other, and to grieve with each other. In short, be with each other. Moreover, our services will be needed in six months or so, and for many years beyond, and as such, we should focus on our own health and be ready when needed. Many have commented since then that this is what they needed to hear and helped them to move on with their own recovery. Upon reflection, my most effective act as a Director was to let the students know that being a psychologist for the community was not their job, rather, to be a loving partner, friend, student, mentor, colleague, and parent was their duty in such tragedy and sadness, as it was mine. Lee Cooper Director, Psychological Services Center Department of Psychology Virginia Tech
06/08/07 Manny Frishberg • JTNews Correspondent On the morning of April 16, Dr. Liviu Librescu, a 76-year-old Holocaust survivor and aeronautical engineering professor, blocked the door of his classroom in Norris Hall at Virginia Tech so that his students could escape through the windows. One month later, on the shloshim of his death, the University of Washington Chabad brought Rabbi Shlomo Yaffe to the UW campus for a memorial lecture in Librescu's honor that looked at, among other things, how his actions should be viewed through a Jewish lens. Shlomo Yaffe serves as rabbi at Congregation Agudas Achim in West Hartford, Conn. and the founding director of the Institute for Jewish Literacy and the founder of the Connecticut Symposium on Contemporary Legal Issues and Jewish Law in Hartford. He is well known for his ability to make Jewish mysticism accessible to people to make use of it in daily life. After studying rocket science and WWII history, Yaffe turned to Talmudic law and Hassidic philosophy. He has written and lectured on the Judaic perspective of contemporary, legal, scientific and social issues. Rabbi Yaffe is also an expert on secular law and legal ethics who serves as a legal consultant and lecturer for the New York Legal Assistance Group. Rabbi Yaffe began his talk with the question: "From the standpoint of Jewish ethics and law, did [Prof. Librescu] do the right thing? He put himself against the door, which someone could, and did ultimately, shoot through and kill him. Was he really supposed to give his life for others? "This is not such a simple question," Yaffe explained, "because if someone's life is no less valuable than your own, then it's certainly no more valuable than your own." He promised to answer that question, but first took an hour-long digression that began with the question of how German society, with its long traditions of scientific and philosophical leadership, could emerge in the 1930s as the author of the Holocaust, one of the most horrific moments in modern human history. "How did a very large group of people from a highly developed society...engage in and justify such a pervasive, long term abuse of ethics? The Holocaust was not the passionate, vicious bloodletting of the mob that ultimately runs itself out," he said. "It was a cold and calculated societal choice devoted to the extermination, destruction and utter and complete cruelty and disregard, first of all to Jews, but also many others." His answer was that the people making those choices believed that they had evidence that the Jews, the Gypsies, the handicapped, homosexuals and other outcast groups were a blight on the society and, that by removing them, they were improving the world as a whole. Then, like the teacher that he is, he led the dozen or so people that had come to hear him on a journey of exploration into the essential question of what makes a human life inherently worth preserving. "There's this premise that we have that people have a fundamental right to live, that people have a fundamental right to express themselves, that people have a fundamental right to equal opportunities," he said. "The question is: is there really any quantifiable truth to them — can they be proved logically, or should we say scientifically? "Scientifically, differences between human beings on a racial or national level are far less than their similarities. But that doesn't mean anything because someone else might have a different way of looking at things and, like the German scientists of the '20s and '30s, come to the conclusion that the shapes of skulls and the colors of skin and the like may be terribly important," Yaffe said. "And who's to say that it couldn't happen again?" Once an idea becomes entrenched in the scientific or popular beliefs, he explained, the data tend to be read in a way that support that belief. Making a case analogous to the anti-Semitism of Nazi Germany, he said, "I could identify any one of five racial groups that have a much higher rate of indictment, convictions and incarcerations for murder. There are certain minorities that commit crimes and get convicted for them at a much higher rate than other minorities. It probably has nothing to do with race and a lot to do with history....These statistics do exist. "Put yourself in the shoes of these German scientists," Yaffe said. "Once you believe that this group contains a greater percentage of social pathologies and that once you get rid of them you get rid of the social pathologies ... I ask all of you, is there any reason why we should not exterminate this group?" His comments counter the ethical calculus in Jewish tradition that the fundamental belief that human beings are made in the image of God and, as such, each and every one of us is imbued with an inherent value that cannot be reduced by the "greater good" for society as a whole. "We can argue from today to tomorrow about God and religion and everything, but if you do not bring in a being that is the source of everything whose purest expression is in a human being, a being that assigns a special value to the human being, a being that says its most profound and indivisible irreducible expression is in a human being, then you can never, ever find a reason why I should not do something wrong to another person," Rabbi Yaffe said. "The only thing that would seem to guarantee such a thing is that there is a sensibility that assigns an absolute value as part of itself to the human being. That value says there's nothing more precious than a human life, so I need to do everything I can to protect it and preserve it unless that other person forfeits its life by seeking my destruction." Under that precept, he said, one person cannot, under Jewish law, sacrifice his own life for another person's, no matter how much better or more deserving they believe that other person to be. "On the other hand," he said, drawing back to where he began, with the sacrifice made by Prof. Librescu, "can someone risk [his] life to save someone else's life? Yes, as long as it's not a definite one-on-one sort of thing. Can someone risk [his] life to save many? It would seem the answer is yes — that answers the original question that we started with." -- Archived with permission of JTNews. Original Source: http://www.jtnews.net/index.php?/news/item/2808/
Joel Magalnick - JTNews (editor@jtnews.net)
Reflections on a Mass Homicide (Commentary)
(PDF, 30KB; Full text below.) Commentary Reflections on a Mass Homicide Jimmy Lee,1 MBBS, MMed (Psych), Tih-Shih Lee,1,2 MD, PhD, FRCP (C), Beng-Yeong Ng,1 MBBS, MMed (Psych), FAMS 1 Department of Psychiatry, Singapore General Hospital, Singapore2 Duke-NUS Graduate Medical School, Singapore Address for Correspondence: Dr Tih-Shih Lee, Department of Psychiatry, Singapore General Hospital, Singapore, Outram Road, Singapore 169608. Email: tihshih.lee@gms.edu.sg Introduction The names "Virginia Tech" and "Cho" will be associated forever with the tragic mass homicide of 32 persons cum suicide by Seung-Hui Cho on 16 April 2007. In the aftermath, many questions have been posed: "What happened and why?", "Was he crazy?", "Could it have been prevented?", "Could it happen here?" This was the third mass killing in a US campus, with the largest number of fatalities. The first was in 1966 in the University of Texas with 16 dead and 31 wounded, then the Columbine High School shooting in 1999, in which 13 students were killed. We do not profess to know more about what happened in Blacksburg, Virginia, or Cho's neuropsychiatric condition than whatever is published in the popular press.1 But through a series of questions, we reflect on this tragedy, attempt to place it into a human and psychiatric perspective, and offer insights into if, and how, it can be averted in the future. Question 1: Was Cho insane? Cho was described as a shy and quiet child, who was good in mathematics, but struggled with English. There were allegations of him being taunted and bullied in school since young. Both his pastor and relatives had suspected he might be autistic and suggested professional assistance. There was no record of him being involved in overt violence except that he had harassed 2 female classmates, one of whom called in the campus police. He expressed suicidal ideation and was involuntarily committed by a judge in a mental health facility briefly for assessment. A psychiatrist wrote in his chart, "Affect is flat and mood is depressed" and "Insight and judgment are normal," and released him. He was supposed to have been on some treatment regimen but may not have adhered to it. In English Literature classes he wrote on haunting themes of violence and death. Moreover, from the rantings of his final macabre video, it can be inferred that he had grandiose and persecutory thoughts. One could conceivably argue that anybody who murders en masse and then commit suicide must be insane. But insanity is an imprecise term that is no longer in the psychiatric lexicon. So we ask if he met criteria for a diagnosis based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) or International Classification of Disease-10 (ICD-10)? Or was he of a criminal antisocial or psychopathic mind? Unfortunately without having interviewed him or having access to his records, we cannot say for sure. We could speculate that he was depressed with delusional thoughts, and perhaps had undiagnosed Asperger's disorder (a mild variant of autism), or was taking illicit substances. But we do not have enough evidence to be certain of a definitive psychiatric condition that could account for his extremely violent behaviour. Question 2: Was it due to psychosocial developmental difficulties? Cho emigrated at the age of 8 years from South Korea and had difficulty speaking English. He was reportedly ostra-cised by his classmates and was isolated. The effects of migration on mental health are well described in the litera-ture. In the US, alienation is a problem for many Asians. Among Southeast Asians, the Hmong feel the most alien-ated, followed by Cambodians, Laotians, and Vietnamese.2 Many symptoms could be due to acculturative difficulties, racism, and overwork. A migrant faces difficulties with 3 main areas; changes in social environment, changes in interpersonal relations, and cultural differences.3 Reports from those who knew Cho strongly supported the roles of these 3 factors in his maladjustment to the new country. From his video and writings, it is evident that he had tremendous envy and rage projected onto better-adjusted and well-to-do American kids. Southeast Asian refugees have higher rates of brief reactive psychosis and paranoid psychosis compared to other Americans.4,5 Sometimes paranoia develops among Southeast Asians when they are dealing with a new environment and experiencing "varying degrees of miscommunication, fear of rejection, and feeling mistreated, slighted or discriminated against".6 Psychosis among Southeast Asians can take the form found in many ethnic groups, e.g. "Aliens' paranoid psychosis", a syndrome characterised by a usually short-lived xenophobia and by feelings of persecution because one belongs to an ethnic minority group.7 On the other hand, the overwhelming majority of immigrants and minorities are well-adjusted and functioning, despite having endured many of the same stressors that Cho endured. In particular, his sister, who shares much of his genetic substrate and environmental milieu, had apparently been doing very well. Many immigrants may have coping difficulties, but they do not usually resort to violence. The other 2 campus mass murderers were neither immigrants nor from minority groups. So, whereas difficulties relating to migration probably played a part in his violence, it would be simplistic to attribute it to primarily these stressors. Instead it would be a disservice to the large immigrant and ethnic minority communities. Question 3: What factors may have precipitated Cho's sudden outburst? There is a small literature considering situational factors and triggers that have consistently been found to be important in initiating a homicidal episode. Triggers for murder in Ressler et al's study8 included financial, legal, employment, marital and other conflicts. Emotional states such as frustration, anger, hostile moods, and feeling agitated and excited were reported at a lower frequency. Levin9 has offered a four-factor model of sudden indiscriminate mass killing. First, the potential offender has led a "life of frustration"; second, he has access to, and the ability to use, firearms; thirdly, there is a significant destabilising experience of a loss of "social controls", such as moving to a new area or the loss of an important relationship; fourth, there must be a precipitating event such as unemployment or divorce. Gresswell and Hollin10 have suggested that a more useful way of conceptualising the "firearms" component would be to consider that a fascination with weapons indicates a style of coping with stress, frustration, and low self-esteem that includes violent fantasies involving weapons. In such cases, the nature of such fantasies may be the best predictor of a homicidal response to a stressful event. Questions 4: Is there a neurological basis for aggression? Aggression refers to behaviour that is intended to cause harm, and is the behavioural manifestation of disturbances in the brain or mind. We now have some, though incomplete, appreciation of various neuroanatomical structures that may be involved in aggression. These structures include the prefrontal cortex, amygdala, hypothalamus, and temporal lobe. In particular, some evidence suggests frontal lobe dysfunction in violent and criminal behaviour, especially in the presence of focal orbitofrontal lobe injuries.11 Brower and Price11 proposed that clinically significant focal frontal lobe dysfunction is associated with aggressive dyscontrol. Orbitofrontal syndrome is associated with behavioural excesses, impulsivity, disinhibition and mood lability. Outbursts of rage and violent behaviour occur after damage to the inferior orbital surface.12 Abnormal brain concentrations of the neurotransmitters serotonin, dopamine and gamma-aminobutyric acid are implicated in impulsivity and aggression.13 Pharmaco-therapy with selective serotonergic reuptake antagonists, antipsychotics as well as mood stabilisers have all been used in treatment, with mixed results. Studies of aggression in patients with brain injury suggest that their aggression tends to be (1) reactive, i.e., triggered by modest stimuli; (2) non-reflective, i.e., not premeditated or planned; (3) non-purposeful, i.e., does not serve long-term goals; (4) explosive; (5) periodic; and (6) ego-dystonic.12 Some of these features describe Cho's aggression. But we do not know, and may never know, if a definable lesion was present in Cho's brain, or if present, whether that was severe enough to account for the violent behaviour. With the evolving science on aggression, a discussion about "nature versus nurture" often arises, i.e. whether murderers are born or bred. Research has now demonstrated that genetic aberration per se is not the sole reason leading to violence; environmental factors such as childhood adversities play a significant part in the development of violent behaviour.14 Gene expression is influenced by environmental factors, and brain circuits are affected by life experiences. Question 5: How is dangerousness assessed? Psychiatrists are often called upon to determine how much a threat someone will pose to others and society, also known as dangerousness. Dangerousness is a subjective assessment of the element of danger attributed to a particular person and is qualitative in nature. Predicting dangerousness, particularly in an extreme form such as mass homicide, has been an elusive goal for those investigators who have attempted it. It is often said that "Hindsight is 20/20". When a person is exposed to be a murderer, we tend to focus on those warning signs in his character and biography that were previously ignored. For a category of violence such as mass homicide, however, the low base rate and consequent likelihood of finding false-positive results are overwhelming.15 Just as in Cho's instance, numerous questions were raised about the concerns of his teachers and the psychiatric assessment in November 2005. It must be emphasised that the assessment of dangerousness is not an exact science, and cannot yield a black-and-white result of "dangerous" versus "not dangerous". In our psychiatric assessments, we weigh various factors such as past history of violence, history of mental illness, personality, social background, context and state of mind in which dangerous behaviours manifest. Past behavioural patterns provide the best insight into future behaviours. However, the accuracy of dangerousness assessments quoted in the literature is as low as 0.33.16 Mossman17 in 1994 extracted 58 datasets from 44 published studies, and revealed that mental health professionals' violence predictions were better than chance. Current risk assessment tools such as the Historical/Clinical/Risk Management 20-item (HCR-20)18 and Psychopathy Checklist (revised) (PCL-R)19 offer a structured and more systematic approach to violence prediction, but none could tell with consistent (surely not 100%) accuracy that a person would re-offend. Homicide is clearly the most serious of all crimes. Approximately two-thirds of homicides involve the killing of a victim by a partner, relative, friend or acquaintance. This may partly explain why the clear-up rate for these crimes is particularly high - the police do not need to look very far in order to solve the majority of murders.20 The relation between mental illness and dangerous behaviours has been overemphasised, especially in the eyes of the public. There is a tendency to believe that murderers are mentally ill. However, a recent study among homicides in Singapore showed that 57% of murderers have no mental illness. Out of the 110 charged with murder, depressive disorders accounted for 9.1% and schizophrenia, 6.4%.21 The proportion of foreigners (defined here as non-citizens and non-permanent residents) who committed murder in Singapore was significantly higher compared with locals, which supports the earlier point about the stressors of migration. Also, foreigners tend to suffer from more serious psychiatric disorders, are less likely to have a known history of violence, and are more likely to be new to psychiatric services.22 This implies that the first violent outburst is usually the first presentation to psychiatric services. Cho did not have a history of overt violence prior to April 16. Question 6: What about the psychological trauma to family and friends of the victims? For those who saw their friends getting shot and killed, those who were injured and those who survived unharmed, the families and friends of the victims, it would be very difficult to collectively summarise the ordeal they went and are still going through, as each will have their own individual experience of it. Some may be at high risk of posttraumatic stress disorder (PTSD), but others will cope fairly well with milder symptoms. But it is safe to say that life will never be the same again. And we must not forget the hapless and unfortunate family of Cho, whose suffering cannot be fathomed. There were positive measures taken by the school and public authorities in the aftermath that are worth learning. The measures included leave from school, time and ceremony to grief, and the provision of counsellors to all students of the school. School events such as examinations and convocation ceremonies continued as usual in an attempt to restore normalcy. The telecast of Cho's video on national TV was highly controversial. Many others around the world later saw Cho's nefarious video and images of the "massacre". The national broadcast potentially traumatised viewers and re-traumatised survivors. In addition, it helped Cho achieved his aim of broadcasting his views, possibly achieving "martyrdom", and it may inadvertently encourage copycat murderers, as if a race were on to increase the body count. We would strongly urge that TV network companies and their regulating agencies revisit the guidelines and regulations on such telecasts. Question 7: Can it happen to us? Mass murder in a US school or college is a relatively rare event - three times in 40 years, despite the widespread availability of firearms and the large numbers of disenfranchised youths. Hence, it can be described as a low-probability, catastrophic-outcome event, like an earthquake occurring on a given day. The probability of its happening is very low, but once it hits, the results may be catastrophic. For countries with strict firearm and explosive control laws, the risk of a mass murder on the same scale is much lower. With the benefit of hindsight, to discuss what the psychiatrist or the judge should have diagnosed or done is moot now. There was and always will be a balance between protection for society and infringement of the individual's civil liberties. This dilemma is all the more difficult if the assessment is made before a crime is actually committed. It would be virtually impossible for a psychiatrist to predict which of the patients would commit violence, least of all mass murder. If the decision is to commit the patients as a preventive measure, how long should the internment last, and who would set him free? Nevertheless, for psychiatrists and all doctors, this is a timely reminder to be thorough and diligent in the assessment for dangerousness, and to acknowledge that we are far from perfect in our assessments. Under Section 34 of the Mental Disorders and Treatment Act (1973, revised in 1985), any registered physician in Singapore may refer a patient suspected to be of unsound mind or requiring psychiatric treatment to the Institute of Mental Health (IMH) for evaluation and treatment. IMH is the only gazetted mental hospital that has the statutory authority to hold patients involuntarily, should the person be deemed to be suffering from a mental illness, and detention serves the person's best interests and those of other persons. For the majority of patients who are deemed not to need involuntary hospitalisation, there is little we can do to enforce treatment, other than relying on the family to supervise medications and appointments. If we suspect that a patient may pose a specific threat to another person, we may face an ethical dilemma with regard to confidentiality. This issue brings us back to the landmark Tarasoff case where the Californian courts found the therapist negligent for not warning the intended victim of a threat.23 Kok et al24 discussing this case with regard to the applicability of the Tarasoff ruling in Singapore, concluded that in the absence of local case law, a psychiatrist caught in this situation should consult the Singapore Medical Council prior to breaching doctor-patient confidentiality. The Cho case also brings to mind the problems of troubled youths in Singapore - a combination of disengagement from society, low self-esteem, poor coping with rising expectations, and academic pressures. These forces predispose them to seek alternative forms of release and validation, such as using illicit substances and joining street gangs. Therefore, parents and school authorities should always be on the lookout for troubled or poorly adjusted youths. If need be, they should be referred to mental health professionals for evaluation and treatment. Another lesson in the local context would be for us, as a society, to be more tolerant and empathic to those who are less well-adjusted and successful, especially foreigners and migrants, so as to minimise resentment and wrath. Conclusion In summary, as we try to make sense of this apparently senseless violence, we find ourselves in the recurring debate of nature versus nurture. We probably will never know what Cho was really thinking when he pulled the trigger repeatedly, or nor can we be sure if he had a psychiatric condition that fulfilled DSM IV or ICD-10 criteria. Our hypothesis is that he had an underlying neurobiological or genetic vulnerability; he endured developmental psychosocial stressors in a chronic invalidating environment; and that finally some yet unknown "third-hit" triggered his rampage. Nevertheless, we highlight the need for thorough assessments of dangerousness by mental health professionals despite the limitations of our tools; the need for a system to attend to the psychological anguish of the survivors and loved ones of the victims; and the need for us collectively to adopt a more empathic stance towards our less fortunate brethren. We also remember the 33 lives extinguished and countless more traumatised on that Spring day in 2007. REFERENCES Thomas E. Special Report: Making of a Massacre. Newsweek April 30, 2007:18-30. Nicassio P. Psychosocial correlates of alienation: study of a sample of Indochinese refugees. J Cross-cultural Psychol 1983;14:337-51. Moilanen I, Myhrman A, Ebeling H, Penninkilampi V, Vuorenkoski L. Long-term outcome of migration in childhood and adolescence. Int J Circumpolar Health 1998;57:180-7. Nicassio P. The psychosocial adjustment of the Southeast Asian refugee: an overview of empirical findings and theoretical models. J Cross-Cultural Psychol 1985;16:153-73. Westermeyer J. Paranoid symptoms and disorders among 100 Hmong refugees: a longitudinal study. Acta Psychiatr Scand 1989;80:47-59. Lin KM. Psychopathology and social disruption in refugees. In: Williams C, Westermeyer J, editors. Refugee Mental Health in Resettlement Countries. Washington, DC: Hemisphere Publishing, 1986. Tung TM. Psychiatric care for Southeast Asians: How different is different? In: Owan T, editor. Southeast Asian Mental Health: Treatment, Prevention, Services, Training, and Research. Washington, DC: US Department of Health and Human Services, 1985:5-40. Ressler PK, Burgess AW, Douglas JE. Sexual homicide: patterns and motives. Lexington, MA: Lexington Books, 1988. Levin J. Why his last shot blew the truth away. The Sunday Times, London 1987, August 23, p23. Gresswell DM, Hollin CR. Multiple murder: a review. Br J Criminology 1994;34:1-14. Brower MC, Price BH. Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review. J Neurol Neurosurg Psychiatry 2001;71:720-6. Silver JM, Yudofsky SC, Anderson KA. Aggression. In: Silver JM, McAllister TW, Yudofsky SC, editors. Textbook of Traumatic Brain Injury. Washington, DC: American Pychiatric Publishing, 2005. Swann AC. Neuroreceptor mechanisms of aggression and its treatment. J Clin Psychiatry 2003;64 Suppl 4:25-35. Reif A, Rosler M, Freitag CM, Schneider M, Eujen A, Kissling C, et al. Nature and nurture predispose to violent behaviours: serotonergic genes and adverse childhood environment. Neuropsychopharmacology 2007. Fox JA, Levin J. Serial murder: myths and realities. In: Smith MD, Zahn MA, editors. Studying and Preventing Homicide: Issues and Challenges. California: Sage Publications, 1999. Monahan J. The prediction of violent behaviour: Toward a second generation of theory and policy. Am J Psychiatry 1984;141:10-5. Mossman D. Assessing predictions of violence: Being accurate about accuracy. J Consult Clin Psychol 1994;62:783-92. Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20: Assessing risk for violence (version 2). Burnaby, BC: Mental Health Law and Policy Institute, Simon Fraser University, 1997. Hare RD. The Psychopathy Checklist-Revised. 2nd ed. Toronto, Canada: Multi-Health Systems, 2003. Ainsworth PB. Psychology and Crime: Myths and Reality. Edinburgh: Pearson Education Ltd, 2000. Koh KG, Gwee KP, Chan YH. Psychiatric aspects of homicide in Singapore: a five-year review (1997-2001). Singapore Med J 2006;47:297-304. Koh KG, Peng GK, Huak CY, Koh BK. Migration psychosis and homicide in Singapore: a five year study. Med Sci Law 2006;46:248-54. Tarasoff v Regents of University of California. California Report 1976;118:129. Kok LP, Yap HL, Cheang M. Mental disorders and public safety of the community at large - does the Tarasoff principle apply in Singapore. Ann Acad Med Singapore 2002;31:535-6. -- Archived with permission of the editor. Original Source: Annals, Academy of Medicine, Singapore, June 2007, Vol. 36 No. 6 http://annals.edu.sg/PDF/36VolNo6Jun2007/V36N6p444.pdf
Jimmy Lee, Tih-Shih Lee, and Beng-Yeong Ng
Kirat Kaur (Ms) Editorial Executive Annals, Academy of Medicine, Singapore annals@academyofmedicine.edu.sg