Blumenau, April 5, 2023: The point of view of psychiatry

Blumenau, 5 de abril de 2023: O ponto de vista da psiquiatria

ABSTRACT

The goal of this editorial is to analyse a recent case of mass murder under the psychiatric perspective.

Murder; killing; homicide; gun violence; workplace violence

RESUMO

O objetivo do presente editorial é o de analisar, sob a perspectiva da psiquiatria, um caso recente de homicídio em massa.

Homicídio; assassinato; violência; comportamento de ataque; violência interpessoal

On April 5, 2023, a 25-year-old man jumped over a 5’ 5’-foot-high wall surrounding a daycare center in the city of Blumenau, Santa Catarina, and hatcheted four children to death. This tragic event triggered an anguished debate about the causes of this type of crime and how to prevent it. Journalists interviewed federal and state officials and experts in child education, aggression, and media violence. Most of the interviewees highlighted the role of hate speech, bullying, misinformation, extremism, and incitement conveyed through online social networks. Violent video games and too much media coverage were also blamed. Recommendations included increased oversight over social networks, banning of violent games, and less emphasis by the press in the reporting of these events.

To the best of our knowledge, no psychiatrists were interviewed by the mainstream press.

We believe, however, that Psychiatry must also have a saying on this issue and will provide in this space our unsolicited opinion.

For several reasons, some individuals will feel at a certain point in their lives a strong drive to kill a large number of their fellow human beings in a single, relatively short-lived act of murderous violence. This urge is not secondary to other criminal behaviors (e.g. gangland disputes) and the perpetrators are not acting on behalf of political or terrorist organizations otherwise. The victims, with very few exceptions, are not family members of the offender.

The descriptions of this kind of behavior antedate the emergence of video games and of social networks, and even that of the modern press itself. Amok is a term derived from the word mengamok, which means to make a furious and desperate charge. The famed Captain Cook was the first to bring amok to the knowledge of Western civilization.

During his 1770 around-the-world voyage, he reported the affected individuals as behaving violently without apparent cause and indiscriminately killing or maiming villagers and animals in a frenzied attack.

The following case reports illustrate the typical violent behavior reported in amok episodes in Malay tribes:

“In 1846, in the province of Penang, Malaysia, a respectable elderly Malay man suddenly shot and killed 3 villagers and wounded 10 others. He was captured and brought to trial where evidence revealed that he had suddenly lost his wife and only child, and after his bereavement, he became mentally disturbed. In 1901, in the province of Phang, Malaysia, a 23-year-old Muslim man who was formerly a member of the police force stole a Malay sword (kris or keris) and attacked 5 individuals while they were sleeping or smoking opium. He killed 3, almost decapitating 1 victim, and he seriously wounded the others.” ¹

The updated avatar of the Amok in modern Western civilization is the mass, spree, or rampage shooter². Usually, a male individual aged 11 to 78 years, acting alone uses one or more firearms to unexpectedly attack a “thematic” group of unsuspecting, unarmed people (“running amok” or “going berserk”, in the American slang vocabulary). The preferred targets are coworkers, churchgoers, immigrants, “homosexuals”, politicians, concertgoers, parade-goers, contentious neighbors, and college & high school students. Several of the episodes of mass shootings are preceded by weeks- or months-long preparation efforts, including meticulous planning, identification, and surveillance of potential targets, acquisitions of guns and ammunition, and even additional training in shooting ranges. Often the attack ends with the attacker committing suicide or being killed by the police (“suicide by cop”). Some attackers leave notes or videos trying to justify their acts, but rarely their rambling accounts are useful to bring some light into their motivations. However, some insights into the dead attackers´ motivations can be inferred retrospectively from the confrontation of his socio-demographic status and life history with the group identity of the victims (e.g. a personal grudge against the boss and some co-workers or a heavy prejudice against a certain religious group or immigrants). Other attackers seem to be less focused on specific groups and may basically seek to bring as much carnage and mayhem as possible.

The poor man’s version of the mass shooter, apparently lacking access to firearms, employs white weapons – knives, spears, axes, box-cutters, bayonets, maces, and meat cleavers – to achieve the same goals³. But even automobiles, airplanes, explosives, arson, and even an improvised flamethrower have been used in rampages.

Worldwide, mass shootings are the rule, and rampages with white weapons are the exception. However, in the People’s Republic of China, where gun control laws are very strict, all mass murders are carried out with knives, axes, hammers, or homemade explosive devices. The main targets are kindergartens and elementary schools since children are easier to be overpowered, injured, or killed than adults. Since 2010, a succession of such attacks has left more than 90 victims dead and some 480 injured⁴.

Mass shooters tend to differ in key aspects from mass murderers using white weapons. Mass shooters are more likely to suffer from non-psychotic mental disorders. Many of them seem to be aggrieved individuals with marked schizoid, paranoid, and/or narcissistic personality traits who feel they have been slighted by others, deprived of the appropriate opportunities or recognition, unjustly dismissed from a job, passed over for a promotion, or denied a much-needed bank loan or much-deserved monetary compensation. In an act of revenge, they usually shoot bosses and coworkers (“going postal”, in the American slang vocabulary), colleagues, bank tellers, teachers, and whomever else they single out as responsible for their grievances. Innocent bystanders can be killed or injured in this process⁵.

In contrast, psychotic symptoms are more prevalent among mass murderers who used white weapons. Since individuals with severe psychotic symptoms usually suffer from functional disabilities and thought disorganization and lack the financial resources and sophisticated social networking needed to acquire firearms, they may have fewer opportunities for successfully planning and implementing mass shootings and use improvised weaponry⁶.

From what has been reported so far in the media, one can infer that the mass murderer from Blumenau was suffering from a psychotic disorder. He not only had a lifelong history of psychiatric treatment but also took the baffling step of delivering himself to the police after committing the crime. An expert psychiatric assessment will be needed to confirm this hypothesis, but it is very unlikely that this crime was committed under the influence of social media or games, rather than under the influence of delusions and hallucinations.

As the Associated Press has reported, “State prosecutors called on news media to refrain from sharing images or identifying the killer, citing research that this can encourage other attackers. Behemoth media conglomerate Grupo Globo announced it would no longer name or portray perpetrators of such crimes in its broadcasts or publications. O Estado de S. Paulo, one of Brazil’s biggest newspapers, followed suit. CNN Brasil and Band also made the change”⁷.

This is old wine in a new bottle. It used to be called “damnatio memoriae”, meaning “condemnation of memory” and indicated that an individual was to be excluded from historical records, including the destruction of depictions and the removal of his/her name from inscriptions and documents. Well-known historical cases included the female king of Egypt Hatshepsut (1479-1458 BCE), the pharaoh Akhenaten (1353-1336 BCE), the Roman emperor Publius Septimius Geta (189-211 CE), and the theologian John Wycliffe (1328-1384 CE). Most recent cases include Leon Trotsky and Zhao Ziyang. A former New Zealand Prime Minister put it succinctly: “He (the mass shooter) sought many things from his act of terror, but one was notoriety – that is why you will never hear me mention his name… he will…, be nameless”⁸.

The “damnatio memoriae” of mass murderers carries some implicit limitations. First, the main responsibility of the media regarding the provision of news and information about the episodes of mass murder should be minimizing the risk of copycat attacks, not effacing the identity of the perpetrator. Second, it assumes that all mass murderers are seeking just notoriety, and not a symbolic redress for imagined grievances, revenge, or suicide, for instance. Second, as Andy Warhol reportedly said 35 years ago: “In the future, everyone will be world-famous for 15 minutes.” The future has already arrived and the expectations of at least fifteen minutes of notoriety seem to have been greatly overblown in our novelty-hungry era. Last but not least, given that information about mass murderers is sparse, even the best research teams rely on lay/popular sources, such as Wikipedia, Murderpedia, and Mother Jones³,⁹. To have the cases of mass murder needlessly shrouded in secrecy would further hinder research and prevention efforts.

Mass murders are shocking but fortunately, very rare events even in countries like the US, Germany, and the People’s Republic of China, where they occur with greater frequency¹⁰, and overreaction to them may be counterproductive. They are also heterogeneous in terms of the perpetrators’ profile, mindset, motivation, resources, and life circumstances. There is no one-fit-for-all solution for preventing them.

Each democratic society should seek a balanced, individualized approach based on the best knowledge available and taking into account its specific social, legal, and political traditions and features. Preferred targets, such as schools and temples, should be carefully protected. Workplace and school bullying and harassment should be banned. Mental health assistance should be amply available. Some socially acceptable degree of gun control is usually desirable although, as the Chinese case record demonstrates, it is far from being a failproof solution. The media should avoid sensationalism and over-dramatization. Only the essential facts and opinions needed for keeping the public well informed should be conveyed. Having no axe to grind and no agenda to push is a commendable editorial policy. Some degree of alertness regarding the potential preparations for a murder spree may be helpful. An attentive FedEx worker once noted that small amounts of ammunition were being repeatedly delivered to the same address and called the authorities, thus helping to nip in the bud a potentially bloody attack. Delving into the merits and drawbacks of internet and video game censorship is beyond the purview of the present analysis, but it is unlikely that this type of wide-scope initiative will reduce the odds of the occurrence of such rare and idiosyncratic events as mass murder certainly is.

H.L. Mencken once wrote: Every complex problem has a solution that is simple, direct, plausible – and wrong. Mass murder is a complex problem. Let’s avoid getting enthralled by proposed solutions that are simple, direct, plausible – and plainly wrong.

REFERENCES

• ¹
  Saint Martin ML. Running amok: A modern perspective on a culture-bound syndrome. Prim Care Companion J Clin Psychiatry. 1999;1:66-70.
• ²
  Hagan CR, Podlogar MC, Joiner TE. Murder-suicide: Bridging the gap between mass murder, amok, and suicide. J Aggress Confl Peace Res. 2015;7:179-86.
• ³
  Girgis RR, Rogers RT, Hesson H, Lieberman JA, Appelbaum PS, Brucato G. Mass murders involving firearms and other methods in school, college, and university settings: Findings from the Columbia Mass Murder Database. J Forensic Sci. 2023;68:207-11.
• ⁴
  Fifield A. More than 50 children and teachers hospitalized in China after kindergarten attack. Washington Post. 2019. Available from: https://www.washingtonpost.com/world/more-than-50-children-and-teachers-hospitalized-in-china-after-kindergarten-attack/2019/11/12/c88bd476-052e-11ea-9118-25d6bd37dfb1_story.html Accessed on: April 24, 2023.
  » https://www.washingtonpost.com/world/more-than-50-children-and-teachers-hospitalized-in-china-after-kindergarten-attack/2019/11/12/c88bd476-052e-11ea-9118-25d6bd37dfb1_story.html
• ⁵
  Marzuk PM, Tardiff K, Hirsch CS. The Epidemiology of Murder-Suicide. J Am Med Assoc. 1992;267:3179-83.
• ⁶
  Brucato G, Appelbaum PS, Hesson H, Shea EA, Dishy G, Lee K, et al. Psychotic in mass shootings v. mass murders not involving firearms: Findings from the Columbia mass murder database. Psychol Med. 2022;52:3422-30.
• ⁷
  Martins L, Binkley C. Brazil’s school violence mirrors US. Its reaction doesn’t. Associated Press. 2023. Available from: https://apnews.com/article/brazil-school-violence-guns-attacks-us-51832f5663d9f7e9591d660ce086205b Accessed on: April 24, 2023.
  » https://apnews.com/article/brazil-school-violence-guns-attacks-us-51832f5663d9f7e9591d660ce086205b
• ⁸
  Dastagir AE. A single decision by New Zealand’s leader may prevent copycat killers. USA Today. 2019. Available from: https://www.usatoday.com/story/news/investigations/2019/03/21/new-zealand-shootings-why-pm-jacinda-ardern-wont-say-shooters-name/3223947002/ Accessed on: April 24, 2023.
  » https://www.usatoday.com/story/news/investigations/2019/03/21/new-zealand-shootings-why-pm-jacinda-ardern-wont-say-shooters-name/3223947002/
• ⁹
  Hesson HM, Shea EA, Appelbaum PS, Dishy G, Cohen-Romano C, Kennedy L, et al. Victimology of Mass Shootings and Mass Murders Not Involving Firearms. Violence Vict. 2023;38:15-24.
• ¹⁰
  Allwinn M, Hoffmann J, Meloy JR. German mass murderers and their proximal warning behaviors. J Threat Assess Manag. 2019;6:1-22.

Publication Dates

• Publication in this collection
  28 Aug 2023
• Date of issue
  Apr-Jun 2023

History

• Received
  01 May 2023
• Accepted
  8 May 2023