Revenge, retaliation and retribution appear to be prime motivating factors for this and many similar mass shootings. The theme is almost archetypal: The perpetrator, usually male, feels seriously slighted, insulted, rejected, disrespected or otherwise emotionally injured by parents, siblings, teachers, peers, spouses, supervisors, co-workers, or society at large. He nurses this grudge over time, during which what starts out as frustration, irritation, annoyance and anger slowly festers like an untreated fever, turning gradually into resentment, hostility, hatred, rage and an unrelenting inner need for retribution. Though there is often covert and sometimes extensive premeditation and planning, the anger is either repressed (manifesting more like depression for some) or chronically suppressed and kept fairly well concealed from others, Hence, the classic reports of such individuals being so quiet, nice and kind that, following the Hyde-like brutish behavior, family, friends or acquaintances can't even conceive of them being capable of such evil deeds.

Speaking as a forensic psychologist, what I look for when conducting evaluations of such defendants are the sometimes subtle warning signs found in the person's previous behavior patterns. This is why acquiring accurate information regarding his or her academic, social and work history can be so crucial in diagnosing and understanding violent offenders. For example, Mr. McLendon apparently had a long history of employment problems, and reportedly created a possible hit list of former employers and co-workers who had somehow offended him. Some of these incidents occurred years ago. Some were quite recent. McLendon allegedly had a hard time holding a job over the years, and reportedly was forced to resign from his position at a local manufacturing plant in 2003. Investigators have not said why. That same year, he enrolled at the police academy, but reportedly washed out after one week. Since 2007 he had worked at a nearby sausage plant, where he evidently became a team leader and was well-liked by employees. But he abruptly quit his job last week. Tellingly perhaps, included on his lengthy list were people there who had allegedly complained about his work performance.

From a psychodiagnostic standpoint, it would also be essential to learn of any prior psychiatric history, such as having ever seen a psychiatrist, psychologist or other mental health professional, any previous psychiatric hospitalizations and/or psychotropic medications, substance abuse, family history of mental illness, etc. Because forensic psychology and psychiatry frequently attempt a kind of retrospective reconstruction of the defendant's state of mind just prior to and during the alleged crime, it would also be vitally important to collect as much data as possible regarding his behavior, demeanor, sleep and eating habits, and mood in the months, weeks, days and hours prior to the killings. Of course, since the perpetrator in this case, like many others, committed suicide, such an evaluation could only take place postmortem. But studying these incidents postmortem from a forensic perspective can shed desperately needed light on the insidious development of such dangerous states of mind that commonly lead to the commission of evil deeds like this.

The diagnostic manual of the American Psychiatric Association (DSM-IV-TR) has precious few diagnoses that directly and specifically address anger or rage as a primary problem or symptom. Intermittent Explosive Disorder is one. Bipolar Disorder is frequently used for these offenders. Antisocial, Narcissistic and Borderline Personality Disorder are other diagnoses that can include pathological anger or rage. Conduct and Oppositional Disorder in children and adolescents. Yet, none of these diagnoses clearly acknowledge mismanaged anger or rage as being a causal and primary symptom. Nevertheless, such ultraviolent episodes are on the rise in recent decades, and the primary anger disorders that underlie them demand diagnosis and preventative treatment. It is imperative that both diagnosis and treatment recognize the central role that mismanaged anger or rage play in these perpetrators.

One potential diagnostic nomenclature was proposed more than two decades ago by psychologist A. Simon: the Berserker/Blind Rage Syndrome. This behavioral syndrome is named after the Berserker Vikings, elite Scandinavian warriors of the Middle Ages who displayed ferocious fits of rage before and during battle. This diagnosis would describe usually nonviolent, peaceable individuals who suddenly and savagely assault others (often strangers), exhibit extraordinary physical strength and relative immunity to pain or injury, and, by definition, are not intoxicated, neurologically impaired, nor suffering from some other major mental disorder. Another diagnostic option suggested in my book, Anger, Madness, and the Daimonic, would be to perceive such persons as being in the throes of what I term the Possession Syndrome, in which they are almost totally taken over or possessed by repressed rage. Pathological Anger Disorder could be yet another useful diagnostic description for such scenarios. Since much of what leads to these treacherous states of mind has roots in infantile and childhood narcissistic wounding, Narcissistic Rage Disorder would be a very suitable possibility. Still another highly descriptive diagnostic term casually mentioned in DSM-IV-TR would be Amok Syndrome (see my previous post), based on the traditional Malay name for unexpectedly enraged episodes "characterized by a period of brooding followed by an outburst of violent, aggressive or homicidal behavior directed at people and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among males." In my view, the amok syndrome provides valuable clues as to what typically causes violent offenders like Mr. McLendon to run amuck. In part, it is chronically repressed, pent-up anger in response to narcissistic injury. Revenge. And, for some, a wicked rage for recognition.

Psychotic disorders such as Paranoid Schizophrenia, Schizoaffective Disorder or Cognitive Disorders involving neurological damage are frequently diagnosed in these cases. Do all of these offenders suffer from neurological problems or psychosis? Psychosis--or madness as it is commonly called--has always been closely associated with anger and rage. This enduring relationship is evident in the synonymous use of the term mad for angry. Some, though by no means all, of these violent outbursts of anger, rage and hatred are related to what we in western culture call "psychosis." At the same time, one can be angry--even violently enraged--and not necessarily psychotic. The mere fact that someone behaves bizarrely or violently or even homicidally does not, in and of itself, make them psychotic. Nor is there convincing or conclusive evidence that the majority of these troubled individuals suffer from significant neurological conditions or aberration, though some definitely do. Indeed, the possibility of neurological impairment must be carefully considered in every forensic evaluation in such cases, and, when suspected, ruled out or in by neurological examination and neuropsychological testing.

Unfortunately, given the currently grim economic environment here and in Europe, I anticipate such tragic incidents will likely occur with greater rather than lesser regularity. We are a culture under extreme financial stress and pressure, which further exacerbates the frustration and wrath of already angry individuals. Yet, even after decades of such deadly detonations, we still don't have a handle on why they happen and how to prevent them. Certainly, not all violent offenders seek treatment prior to blowing. But some do. Prevention is the key. We need a more descriptive system of diagnosing and, most importantly, treating such angry individuals before they go berserk. Psychopharmacological interventions alone are woefully insufficient. People's frustration and fury--the daimonic-- must be recognized, acknowledged, verbally expressed and constructively addressed in psychotherapy. It is the failure of psychotherapy and of society when anger and rage are excluded, drugged or avoided rather than included as an integral, undeniable and essential part of the healing process--before it becomes so violently explosive.