The Tech Tragedy and the Mind

I have had a great many questions about the psychiatric aspects of the terrible tragedy at Virginia Tech.

Many friends and colleagues have swung into action to help with the oceans of grief and the inevitable post-traumatic stress disorder that will follow for many people.

The other questions have all been about the alleged gunman. Perhaps we can now stop saying "alleged."

I mentioned yesterday that the videos and "manifesto" might help us make some sense of the senseless.

What they show is incredible anger that had been building up and, until Monday, had no outlet. That kind of internalized anger can be very dangerous and is sometimes hard to pick up. Experts will often do some very careful "button pushing" to reveal what is going on inside. If a person is challenged, then the anger, disorganization and psychosis can all erupt. But it is a difficult technique unless you are a real expert.

A lot of what he says is disjointed and at times difficult to hear because he whispers and then becomes more and more angry. As expected there is some clear evidence of what we call "thought disorder" or "communication disorder."

You do not need to be a psychiatrist to see that the videos and the "manifesto" were the products of a very sick young person, and that the sickness lead to the tragedy.

Many commentators have asked questions along the lines of, "If he was so angry against the rich, why didn’t he attack the rich?" That would be a good question except for one thing: psychotic delusions are usually "Un-understandable."

This clumsy term was introduced by the German psychiatrist and philosopher Karl Jaspers, since he believed that they were not produced by any kind of coherent thinking. Though not everyone agrees with this idea, it captures something important: it can sometimes be exceedingly difficult to understand the thought processes of the person in the depths of a delusion. We still try to understand their thinking, but it can be tough: some of the normal rules of logic do not apply. And one of the keys to delusions is that people hold them even when presented with evidence that their beliefs are wrong. It is totally different from people who hold odd or eccentric beliefs, but are happy to modify them as more evidence some along.

I am about to give a lecture to a large group of young doctors, and I have been told to expect a lot of questions about what they should do if they ever come across someone like this young man.

Answer: with hindsight the diagnosis seems clear; nobody can diagnose everyone every time. But trust you instincts, get another professional to have a look at the person and above all a it safe.