THE tragic events in Newtown, Connecticut, beg certain questions: who commits such atrocities and why? How can they be prevented?
The scientific literature describes the characteristics of small, non-random samples in diverse societies with different base rates for homicide and weapon use. Yet broad themes emerge that may help answer these questions.
Spree killings are distinct from serial murder, where repeated homicide occurs over months or years. In spree killings, at least three victims are killed in one act – without any intervening cooling off period.
Some spree killers will kill family members or people at the same workplace, but others’ victims will be chosen by chance, situation or peripheral affiliation.
The term autogenic or self-generated massacre is given to killings carried out by an individual (or very occasionally by more than one person, such as at Columbine), serving the idiosyncratic purposes of the perpetrator and may follow initial specific killing. The massacre in Newtown follows that pattern.
Some experts believe this a recent, developed-world phenomenon, but most see parallels to “amok”, first described in 1516 by Barbosa, who commented there were some Javanese who “take a dagger in their hands, and go out into the streets and kill as many persons as they meet, men, women and children… killing until they are killed”.
This proved to be problematic up until colonial times, when efforts were made to avoid wherever possible to summary execution of the perpetrator. Instead the alternative outcome of psychiatric hospitalisation appeared to reduce the frequency.
Two studies of mass murderers in the United States and Canada identified 30 adult perpetrators and 34 adolescent perpetrators over 49 years.
One in ten adult perpetrators had schizophrenia, while the precipitating event appeared to be work problems in 50 per cent of cases and relationship problems in 23 per cent of cases.
Half the adult perpetrators (54 per cent) killed themselves at the end of the incident and a further third were killed. The authors summed up the adult perpetrators as angry, isolated men who were unhappy with their lot, and who typically had a preoccupation with weapons.
Professor Paul Mullen, from Australia, assessed five perpetrators or attempted perpetrators. In most cases there was an absence of previous episodes of violence, contact with mental health services, direct threats or substance abuse.
He concluded that the autogenic massacre was a planned project for murder to be followed by suicide, which adopts an existing cultural script. It was non-specific revenge directed at the uncaring world, often seeking infamy, with the intention of the individual’s death.
Prof Mullen’s conceptualisation preceded the massacre on the Norwegian island of Utoya Island in 2011, which perhaps marked the emergence of an alternative to suicide as the fantasised ending – the possibility of grandstanding at trial.
But how to tell the potential spree killer from the multiplicity of angry, disappointed, isolated young men who may think of suicide and fantasise about mass murder?
Perhaps most crucially as a clinician, I look for a pre-existing preoccupation with and access to guns. Would-be spree killers also research other spree killings and appear to copy their characteristics, or as Prof Mullen puts it, they display a poisonous self-absorption that cannot tolerate “loss of face”.
But how to prevent such killings? To discourage copycats, we need a shift in the cultural script from identifying such events as horrifying, evil and infamous, to a position where culturally we consider perpetrators as sad, sick, cowardly and foolish. Here the media have a part to play.
There is also a relationship between the lethality of attacks and the lethality of the weapons used. Attacks with knives or swords may have similar intent but do not match firearms for their lethality. Almost coinciding with the Newtown killings was an knife attack at a school in central China – 22 children were wounded but none was killed.
Lethality of firearms is more than simply the rate of firing, but also the amount of ammunition available. The Cumbrian shootings of 2010 did not involve an automatic weapon, but the perpetrator, a taxi driver, remained mobile and killed 12 using a shotgun and a large amount of ammunition.
Despite restrictions on gun ownership in the UK following massacres at Hungerford in 1987 and Dunblane in 1996, there is little regulation on the amount of shotgun ammunition which can be stored.
Yet the relationship, so debated in the North American context, between gun regulation and homicide rates are not always straightforward. Despite the Utoya massacre, Norway has one of the highest gun ownership rates in Europe, but one of the lowest homicide rates.
Variations in the rate of impulsive domestic homicide using guns are also likely influenced by weapon type, its usual storage and use of alcohol. There is evidence from Australia, however, that gun restrictions following the Port Arthur massacre has brought about a reduction in the overall homicide rate.
Although some of the characteristics of perpetrators can be identified, this evidence cannot be used to screen or profile potential killers. The characteristics are too broad, too common and the events too rare.
That is not to say society requires mechanisms that reasonably respond to concerns expressed by professionals or the public.
Such tragic events may not be new, but the lethality of firearms and the availability of material in the media create a new context for the problem.
In essence, it remains a form of aggressive suicide, where the act is all about the perpetrator, his perceived victimhood and his post-incident fantasy. Many suicidal people are ambivalent and public health strategies have been adopted in the UK that impede easy suicide, for example limiting the amount of paracetamol which can be purchased in any one shop.
Perhaps the most successful intervention to reduce these events occurring is to simply make them more difficult to carry out. But such is their low frequency it is unlikely that it will ever be known if any intervention is successful.
It is also unlikely that such tragedies can ever be completely avoided. The US appears to have a choice: to have armed staff and metal detectors outside every childcare facility or reconsider the ease at which semi-automatic weapons are easily available to troubled young men.
• Dr John Crichton PhD FRCPsych is a consultant forensic psychiatrist at the Royal Edinburgh Hospital.