Over the past few months, we've seen stories about a serial-killing former marine and an Army staff sergeant's rampage in southern Afghanistan. Strangely, one set 16 victims as his goal and the other killed 16 villagers. Both had behavioral red flags that, in retrospect, might have been detected with an early alert system. These are separate and distinct cases, certainly, but they raise similar questions about the military's need for regular screening for mental illness.

A few notable veterans have become infamous mass murderers. Their rigid personalities, coupled with depression and hostility, simmered for long periods until some event sent them over the edge. In 1949, Howard Unruh decided to kill people on his "List of Grudges." He walked around his neighborhood in Camden, New Jersey, shooting neighbors and strangers alike. Charles Whitman, a former Marine, climbed the clock tower at the University of Texas at Austin in 1966 and started picking off people on the ground below. He killed 16 and wounded 32 before he was killed.

Over half a century later, Whitman inspired the "OC Killer," also a former marine. Between October 25, 2011, and January 13, 2012, Itzcoatl Ocampo, 23, murdered a woman, her son, and four homeless men in southern California. He'd stabbed each person more than 30 times with a military-style blade. After his arrest, Ocampo told an officer, "I knew I had the killer gene."

Ocampo had eagerly served in Iraq, but was disappointed that during his tour of duty he'd had no opportunity to kill. Following Whitman's example, Ocampo set the number he must kill at 16. One report indicates he heard voices and suffered from severe headaches. Yet his plan had been meticulous and his intent clear. The homeless, he said, were a "blight" and he was perfoming a community service by killing them while proving he was a good Marine. Mental illness was clearly a factor, so how was it missed? There were likely signs while he was in Iraq.

Less obvious is the strange behavior of Army staff sergeant Robert Bales, 38. On his fourth tour of duty to a war zone, he certainly had stress. He'd also endured a traumatic head injury in 2010 and might have been depressed. He was struggling with financial problems, had experienced several significant life failures in the past, and recently had been denied a promotion on which he'd counted. Reportedly, he had not wanted to go on another tour of duty in Afghanistan.

On the night of March 11, Bales slipped away from the base. Some say he'd been drinking. He entered two villages and went into several huts, shooting people inside and setting some on fire. Nine victims were children. Then he returned to base and gave himself up. He'd created a thorny international incident, seemingly for no apparent gain.

Many who served with Bales thought this ten-year, decorated veteran was a model soldier, willing to take risks to save others. The midnight spree was out of character, they insisted. He must have snapped.

Bales' motive remains a mystery, but one psychiatrist, Dr. Jonathan Shay, suggested the possibility that Bales had experienced a rare state of mental derangement. It's a dissociative state of "going berserk," that deadens prosocial emotions while fueling the rage needed for battle... or a killing spree. These "warriors" are unaware of pain or imminent danger. They're focused on destruction. Although such frenzies are not limited to the battlefield, warfare offers the most common context.

What Bales did might also have been a manifestation of post-traumatic stress disorder that, when mingled with depression or frustration, can raise cortisol levels into a heightened state of vigilance and fear. This exhausts the sufferer and affects the emotional areas of the brain. Their judgment can be skewed.

What we have learned about mass and spree murderers over the past half century is that they are typically quite ordinary. They usually have no criminal record. However, they deal poorly with life's inherent unfairness, and might have suffered a serious disappointment that feels to them like the last straw. They let frustration fester into rage, with minor incidents being perceived as major offenses. Some stressor, such as a broken relationship, a grievous loss, sudden debt, or unemployment, can set a rampage in motion. Quite a few rampage killers have had military background.

We do not yet know what behaviors in particular will predict such rampages, but some show up more regularly than others. Thus, certain behaviors offer a way to devise a risk assessment. Professional threat assessment groups have developed protocols from studying violent incidents in schools, workplaces, and communities. The military could benefit from these efforts.

An examination of the backgrounds of many mass murderers makes it clear that their behaviors suggested a ticking time-bomb: The buildup of anger derives from the way they learned (or did not learn) to manage stress and disappointment. Their cognitive processing is key, and some who have a predisposition to hostility, who also have repeated exposure to violence in their environment, have a greater tendency to duplicate it.

We might not learn more details about Ocampo or Bales, but those who have influence in military matters might pressure for better awareness of red flags and the treatment of PTSD, head injuries, and obsessions with violence. Since behavioral patterns in adapting to stress can signal the potential for future problems, it is helpful to identify those individuals in need of improved stress management skills.

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