How Everyone Became Depressed

The rise and fall of the nervous breakdown

Calling a spade a spade:

Homicidal mania

In yet anther American mass violence tragedy, last week a gunman near the University of California campus at Santa Barbara, in a drive-by shooting, killed six people and injured another seven with a semi-automatic weapon. ("California Gunman's Drive-By Attack Leaves 7 Dead and 7 Wounded," NYT, May 25, 2014, A18)

Once again, the authorities are stunned. The sheriff pronounced it to be the work of “a madman.” No quarrel there. But the term “madman” is not a diagnosis in DSM-5.

The young shooter killed himself and is no longer available for psychiatric interviews. But when the usual spokespersons get around to pontificating, some will call it “paranoid schizophrenia,” others a “character disorder.” Both diagnoses are absurd.

The shooter had homicidal mania, which is not a form of mania as we understand it today but a nineteenth-century term for precisely this kind of behavior, in an epoch when “mania” meant violence, not euphoria.

The transformation of mania has left us unable to deal with shooters of this nature. For former generations of psychiatrists, there was actually no problem. In 1858 London psychiatrists Daniel Hack Tuke and Charles Bucknill defined “homicidal mania” as the “most important form of mania.” “The motive lies deep among the feelings, and is here closely associated with the homicidal propensity.” (Tuke and Bucknill, 1858, 192-194, 197) The literature abounded with examples. Tuke and Bucknill reported, “A man attempted to stab a surgeon at the [operating] theatre, whom he had never seen before, but to whom he took a sudden and irresistible dislike.”

These cases are not at all dissimilar to the mass murders today committed by deranged late adolescents and young men. The current perpetrators often have a history of social withdrawal that today would be diagnosed as “autism.” They are often psychotic, and the combination of autism and psychosis has proven deadly, historically and today. (Shorter and Wachtel, 2013)

But in many of the perpetrators there is something more. It is not just a consequence of being socially withdrawn, plus delusional about the surrounding environment – today’s autism plus psychosis. There was, and is, an element of frenzy involved, of delirious rage, that was once seen as the very essence of mania.

In olden times, mania was a diagnosis of violence, not of euphoria. Today, mania means euphoria, plus flight of ideas and hyperactivity in the form of shopping, sex, and other forms of the hyper-consumption of pleasure. This new kind of mania-as-euphoria dates from the work of German psychiatrist Emil Kraepelin in the 1890s, who broke the link between mania, delirious rage, and violence, that once had been seen as the core of mania.

But this behavior hasn’t gone away! Indeed, it’s becoming much deadlier with the access of the citizenry to high-powered weaponry. Much of today’s mass murder involves semi-automatic weapons that did not even exist in the nineteenth century, to say nothing of being accessible to angry late-adolescents.

So, all the handwringing about what’s wrong with modern society to produce such terrible murderers misses the point. The impulse to commit sudden, unreasoning, furious murder has always existed. Only recently, thanks to the new weaponry, has it become mass murder.

Giving high-powered weaponry to these delusional, autistic young men today is an invitation for them to commit carnage – which they do now in increasing numbers as the copy-cat effect sets in.

So we have to come to grips with this. One way is for psychiatry to get away from its fixation upon mood disorders and to return to some of the classic concepts, such as the pathological hardwiring of the brain for violence once called “homicidal mania.” We see homicidal mania about us – tragically – almost every day in the press. Yet our conceptual equipment for addressing it has become impoversished beyond measure.

Postscript:

The shooter has now been identified as Elliot Rodger, 22, son of Hollywood director Peter Rodger.  One can only sympathize with the family's pain.  Elliot had apparently received a diagnosis of "Asperger's," a high-end form of autism. He was clearly delusional, a form of psychosis.  He may, or may not, have acted in a spasm of homicidal mania.  This is breaking news.

Edward Shorter, Ph.D., is the Jason A. Hannah Professor in the History of Medicine at the University of Toronto.

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