U N I V E R S I T Y O F W A S H I N G T O N S C H O O L O F N U R S I N G NURS 509 Killers Killers...

U N I V E R S I T Y O F W A S H I N G T O N S C H O O L O F N U R S I N G

NURS 509 Killers

School of Nursing

Jeff TebbsEric PauliPage Collins


• http://www.youtube.com/watch?v=nJ4hdCkQ7EI


KILLERSKILLERS

‘‘With Canis Minor and a beautiful blue moon. With a smile—stars surround me and peace and love are mine. They can’t be taken or touched. I WIN.”-Gary Evans 1998

(Wolf & Lavezzi, 2007, p. 200)

‘‘With Canis Minor and a beautiful blue moon. With a smile—stars surround me and peace and love are mine. They can’t be taken or touched. I WIN.”-Gary Evans 1998

(Wolf & Lavezzi, 2007, p. 200)


Killers

• Outline– Introduction/Definitions– Types & Theory

• Components• Theory• Female Killers & HCP

– Biological Theories– Infanticide

– Conclusion


Introduction

• “Serial Murder”: popularized ’80s (FBI).

1st: 1400s. Gille de Rais, friend of Joan of Arc torture/murder≈140 children

(Castle & Hensley, 2002; Brinanica, 2007)

Definition: >2-3 victims, common characteristics Different times, “cooling off” (1997)

• No apparent connection to initial killing(Wold & Lavezzi, 2007)

– Sexual attacks & resulting deaths … by male kilers– Follow physical or psychological patterns

(Egger, 1998; Castle & Hensley, 2002)

• Expanded to include women, different motives(Hickey, 1997; Castle & Hensley, 2002)


Killers (fun facts)

• Men ≈ 6-7 X more likely to kill (others) (Frei, Vollm, Graf, & Dittmann, 2006)

• Serial Murder– Relatively rare– Rate ↑ in US (last 20 years)

• enhanced technology/information linkage• media ↑ public awareness (≠ entire increase)

• Of 337 serial murder cases in US:– 35 1800-1979 0.2 case/yr– 302 1980-1995 20.1 case/yr(Castle & Hensley, 2002)


Serial Murder

• 5 elements, in most cases…

#1 repetitive, continued for months or years#2 typically 1:1, some “team killers”#3 rarely b/t intimates

» Typically, no prior relationship.

#4 compulsion to kill» ≠ passion crime» ≠ victim precipitation

#5 ≠ economic motives(Holmes & DeBurger, 1988; Castle & Hensley, 2002)


Serial Murder

• 7 major components:#1 subsequent murder#2 no prior relationship (generally)#3 murders at different times & no apparent connection#4 different geographical locations (usually)#5 motive not material gain BUT power or dominance (men)

#6 symbolic value; killers perceive victims as powerless For this reason…

#7 victims vulnerable, least valued, marginalized: – homeless, prostitutes, homosexuals,

vagrants, missing children, women alone in isolated areas, college students, older women, & migrant workers.

(Egger, 1990; Castle & Hensley, 2002)


The Serial Killer “Profile”According to popular media:

white, late 20s-30s middle-class male

who suffered child abuse,kills strangers,is a ‘‘sexual sadist”

(Wolf & Lavezzi, 2007)


Serial Killers• Most serial killers are not insane

– Legally, vast majority know right and wrong at the time of crime

• <4% of serial killers use insanity defense• 1% found not guilty by reason of insanity

• <1% of all killers used insanity as a defense• Only 25% of these cases were successful

• Some pathological process associated(Carlisle, 1993; Castle & Hensley, 2002)

• Some serial killers may have a neurological disorder– Childhood head trauma– Can cause episodic aggressive behavior

(Norris, 1988; Castle & Hensley, 2002)


Schizophrenia?• Often associated with unprovoked bouts of violence

– d/t hallucinations or delusions

• Command to kill:– David Berkowitz, “Son of Sam,” tried schizophrenia

defense – Claimed neighbor’s dog commanded him to kill (but

recanted) (Newton, 2000).

• Some single homicides CAN be accounted for by schizophrenia, but never an authenticated case schizophrenic serial murder – Paranoia Sx: also senility, seizures, & brain damage

(Brizer & Crowner, 1989; Newton, 2000, Hickey, 1997; Lewis 1998; Castle & Hensley, 2002)


DID? Did not?• DID, AKA multiple personality disorder.

– ≥2 different personalities or personality states– response to childhood trauma– dissociate from pain

• Kenneth Bianchi, Hillside Stranglers (Bianchi/Bruno)– attempted an alternate personality “Steve Walker” – Bianchi was faking DID & was found competent for trial – Seizures started in childhood

• X1 successful defense for single homicide – never authenticated any serial killer

(Hickey, 1997; Castle & Hensley, 2002).


Episodic Aggression Patterns

1: ritualistic behavior2: masks of sanity3: compulsivity4: search for help5: severe memory disorders6: chronic inability to tell the

truth7: suicidal tendencies8: sexual assault hx9: sexual

deviance/hypersexuality10: head injuries or

birth injuries11: chronic drug or

alcohol abuse12: substance-abusing

parents

13: victim of abuse14: cruel parenting15: result of unwanted

pregnancy16: product of difficult

gestation17: interrupted bliss or

no bliss in childhood18: cruelty to animals19: arson tendencies20: neurological

impairment sx-evidence of genetic disorders

21: powerlessness/inadequacy.

(Norris,1998; Castle & Hensley, 2002)


Personality Disorder

• “…enduring patterns of inner experience and behavior that deviate markedly from the individual’s culture”(APA, 1994, p. 629)

• PD is most common psychological SK factor

• Most common SK-linked is antisocial PD

• Historically, the term was psychopath(Johnson & Becker, 1997; Castle & Hensley, 2002)


Psychopathy1991 Psychopath Checklist:• superficial charm• narcissism• pathological lying• manipulation• lack of remorse and guilt• shallow affect• lack of empathy• failure to accept

responsibility for actions

The psychopath’s lifestyle: • parasitic• prone to boredom• poor behavioral controls• lack of long-term goals• impulsivity• irresponsibility• juvenile delinquency• promiscuous sexual

behavior• short-term marriages• criminal versatility(Hare, 1991; Castle & Hensley, 2002)


Antisocial• SK’s may exhibit some but not all traits

• Psychopathy is a broad category– Should not describe SK– Term psychopathy replaced with antisocial PD

• SK pathology commonly includes an ↑ of:– anger– hostility– frustration– low self-esteem– feelings of inadequacy (Hickey, 1997; Castle & Hensley, 2002)


Compartmentalization• Neutralize guilt and remorse

• Separate self from crime

• 2 categories of human beings– those whom they care about – victims

• Learned/used in everyday roles (variation of norm)– eg. cutthroat businessman vs loving husband and father– Nazi doctors “doubling”

(Fox and Levin, 1994; Castle & Hensley, 2002)


Dehumanization• Neutralization method learned by SK to kill w/o guilt

– Nazi’s: victims subhumans of whom the world needed to be rid

– Expendable, sacrificed for scientific inquiry

• In the US dehumanization has justified:– Enslavement, segregation & violence against minorities

• “Subhuman” elements of society selected as victims– Prostitutes, homosexuals & homeless viewed by SK as

subhuman• Dehumanization may also occur after victim’s capture

– objects that SK can rape, torture, mutilate, & eventually murder

• “SK’s behavior can also be learned in different environments”(Fox & Levin, 1994; Castle & Hensley, 2002)

Dr Albert Heim / Dr Death


Humiliation

• Learning theorists: deviant behavior learned – can also be unlearned

• Internal drives of a SK often overlooked– Victims often resemble who caused

humiliation

• SK humiliation can → criminal behavior

• Only if recognized & internalized as a motive(Hale, 1993; Castle & Hensley, 2002)


Frustration TheoryAmsel (1958): • SK internalizes perceived wrong

– justification for murder

• Initial cues associated with later humiliation

• Later humiliation is a nonreward situation

• Nonreward where reward previously occurred– unconditioned frustration response

• Humiliation cues (internal stimuli):– anticipatitory frustration response– Motivates avoidance of humiliating situations


Discrimination Learning

Hull (1943) and Spence (1936): • Reward situations (reinforcement):

– discrimination b/t stimuli – Able to chose behavior to produce reward

• SKs: few/no situations produce reward

• When cues indicate humiliation – SK associates nonreinforcement situation (frustration)

• Abundance of nonreinforcement situations – SK can’t discriminate 1 instance of humiliation from

another


Ascociation-Reinforcement

Burgess & Akers (1966) • Operant principles

– Acknowledgment of contributory cognitive processes– Boot camp: Social context

• Violence & aggression → learning to kill• War & combat strengthen/reinforce learning

• Killing also learned in nonsocial situations:– When reinforcing/discriminating

• Likelihood repeat behavior ← reinforcement


Association-Reinforcement

Burgess & Akers (1966), continued• Learning in groups that control reinforcements

– The military = major source of reinforcements– The military becomes the individuals’ primary social group

• Servicemen learn to accept death/killing

• Learned techniques & attitudes reinforce behavior– Dehumanization/objectification allows killing behavior – Compartmentalization allows life outside of killing

• May be learned by SK in the military → civilian life


Association-Reinforcement

• ↑ Potential for deviant behavior when:– Conforming behavior → normative definitions– And verbalizations have discriminatory value

• Strength of deviant behavior a function of:– amount, frequency, & probability of

reinforcement

• Value of killing positively reinforced• Specific reward may Δ

– but SKs murder because it provides reinforcement

(Castle & Hensley, 2002)


Learning TheoryDollard & Miller (1950): • Instigated behavior → predicted response

• (observed/inferred) consequence– Behavior instigated to seek goal (approval)– Barrier to reaching goal = frustration & aggressive impulse

• Frustration/aggression directed at humiliation source– BUT control & humiliation may prevent this– Therefore, the humiliation becomes internalized if not

corrected – Aggression displaced to ↓ threat object (transference)

• Via generalization– SKs transfer internalized humiliation to victims

• attempt to rectify past humiliation


Theory Applied

Hale (1993) • Transference occurs only if SKs

– recognize – AND internalize humiliation as motive for

murder

• SK confuses cues from the past with present– d/t abundant nonreinforcement situations

Note: victims have some symbolic value for the killers, but not all of the victims resemble someone from their past


Military Training• Servicemen were not very inclined to kill

– CivilWar: vast majority fired over the enemy’s head

– WorldWar II: 15% to 20% able to fire at an exposed enemy

– KoreanWar: shoot-to-kill rate ↑ to 55% – VietnamWar: shoot-to-kill rate > 90%

• Today methods include:– brutalization– classical conditioning– operant conditioning– role modeling

(Grossman, 1996)


Military Training

• Classical Conditioning– Violence=pleasurable consequences – Japanese Military

• Chinese prisoners in a ditch • A few servicemen bayonetted the prisoners• Young servicemen on banks watched and cheered • Afterward, treated to nice meals and prostitutes• Very effective

– associated pleasure with death & suffering.(Castle & Hensley, 2002)


Military Training• Operant Conditioning

– Servicemen & police officers:• Shoot at man-shaped targets (stimulus)• Shoot the target (conditioned response)• Trainees repeat this many times

• Role models– Drill sergeants personify violence and aggression

• Dehumanization– Enemies subhuman/objects– Learned, conditioned responses take over.

• Note: of 354 SK cases, 7% had military background

**only 1 empirical studyexamined possible link between serial murder & military experience

(Castle & Hensley, 2002)


Cyclic Nature

• Ritual – Often leaves SKs depressed & unsatisfied – SKs begin cycle again, to “cure” the

depression… – Rarely do murders leave SKs satisfied rewarded

• Yet, SINCE behavior frequently reinforced– More likely to be repeated

• Military just 1 social group – May provide SKs associations & reinforcements

(Holms & Holms, 1994; Castle & Hensley, 2002)


Female Serial Killers

• Domestic environment: 23% spouse-killing– Suffered long periods of abuse by their partner

Can be reconciled with perception of women as nurturing and vulnerable, and only capable of extreme violence if provoked

• Female SK’s do not fit this stereotype• Aileen Wuornos & PK both fit ‘hedonistic’ or

‘power seeker’(Mercy & Saltzmann, 1989; Trube-Becker, 1982; Frei et al, 2006)


Female SK Cases• In 34 cases of US female serial killers 1795-

1988– ½ had a male accomplice– Mean age 33– 6 were female nurses (17.6%)– ¾ of cases motivated by material gain

• Poisoning was the most common method • Most killed people they knew (Hickey (1997; Frei et al, 2006)

• In 105 female SK• Poisoning most common• Time between the 1st kill & apprehension

was longer (Wilson & Hilton, 1998, Frei et al, 2006)


Female SK Casese• In 86 American cases• victims most commonly children, elderly or spouses.• ‘black widows’• Women had longest average active period – over

10 years(Kelleher and Kelleher,1998; Frei et al, 2006)

Holmes & Holmes (1998): Motives & Patterns• ‘geographically stable’ • lived in area where they killed

– ‘comfort killer’ most prevalent (series of husbands) . – ‘hedonistic’ type was rarely observed – ‘power seeker’ in caring professions (‘death angels’)


Categoiries

(Frei et al, 2006)


Categories & Commonalities

Kelleher & Kelleher (1998):• ‘black widow’ (26%)*• ‘angel of death’• ‘sexual predator’• ‘revenge’• ‘profit or crime’• ‘team killer’ (28%)*• ‘question of sanity’

• Female serial killers have in common with male counterparts: – no one theory can explain the phenomenon. – Positive reinforcement might drive future offences– Psychopathic traits & grossly abusive childhood– Role of a ‘private internal world’ of violent fantasies – Displaced aggression

(Frei et al, 2006)


Narcissism

• Psychodynamic perspective– primitive defence mechanism of malignant

narcissism

• Narcissistic personality structure– Grandiosity– need for power– unrestrained aggression– antisocial behavior– ego-syntonic sadism has been associated

(Haller, 1999; Turco, 2001; Frei et al, 2006)


Neuropsych Development

• Aautistic spectrum disorder (ASD) –• More common in males than females • Characterized by a triad of symptoms:

1) impairment of social interactions

2) communication difficulties 3) restricted repetitive patterns of behavior(e.g. Silva et al., 2002; Silva et al., 2004; Berney, 2004; Frei et al, 2006)


ASD Link?• Onset: early childhood

– More apparent/disabling as social skills more important(Berney, 2004)

• Case studies most commonly describe sexual and physical violence

(Siponemaa et al., 2001)• Theory of Mind and Empathy:

– Lack of understanding another person’s thoughts/feelings underlies ASD aggression

(Murrie et al., 2002)• Antisocial & schizoid PDs: differential diagnoses of Asperger’s

(Berney, 2004)• Schizoid PD and Asperger’s closely related

(Wolff, 2000)• The distinction b/t PDs and ASD is challenging when sx are

mild– More blurred as etiological models for both disorders have moved

closer together(Frei et al, 2006)


CASK

• Cagregiver Associated Serial Killings• ‘‘the most prolific serial killer in the

history of the UK and probably the world.’’

• Harold Shipman, British physician• 218 patient deaths attributed to lethal

administration of Diamorphine (diacetylmorphine)

(Yorker, Forrest, Lannan, & Russell, 2006)


CASK• Charles Cullen RN Killed 40 patients

– 9 hospitals & one nursing home – 16-year period in 2 States

• Common Themes: – Cluster of cardiopulmonary arrests – Suspicions aroused b/c patients suffer multiple MI– The resuscitation rate is unusually high

• Typical scenario: – A common injectable substance in postmortem– OR post-event toxicology screens– Deaths that cluster on the evening or night shift– presence of a specific care provider increased

(Yorker, Forrest, Lannan, & Russell, 2006)


CASK Review• Significant concern beyond a few shocking, isolated incidents• Of 90 worldwide prosecutions (1970-2006)

– 54 convictions– 45 HCP convicted of serial murder– 4 convicted for attempted murder/assault – 5 pled guilty to lesser charges– More CASKs indicted & awaiting trial or outcome not yet published – 8 more charged with serial murder, but with insufficient evidence to

convict – 4 more nurses successfully appealed their convictions for serial murder

• 3 suits resulted in payments of $8 million, $450,000 and $27 million

• In 36 years 2113 (≈ 59/yr) patients died suspiciously while in the care of a convicted healthcare provider– There are an additional 80 murder charges & 26 assault charges– There are an additional 242 suspected victims

(Yorker et all, 2006)


CASKs by Profession



CASK Cases by Method



CASKs by Injection



Risk/benefit• Very few of the killers had a criminal record• many had histories of falsifying their credentials or

background– often not picked up during hiring process– in cases when they were known about, did not seem to present a

significant barrier to hiring. – Fraud or fabrication consistent with sociopathic traits and with

Munchausen Syndrome• HCP misrepresentation a serious risk factor• Influenced by shortage of nurses• Risk management favors policies geared toward preventing

lawsuits:– wrongful termination, denial of employment, or defamation.

• Cost of defending an employment rights lawsuit:– Often several hundred thousand dollars. – Cost appears to have influenced current risk management policies.



Serial Killers: Born Bad University of Washington NURS 509

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• Serial killer Carl Panzram himself wrote: "All of my family are as the average human beings are. They are honest and hard working people. All except myself. I have been a human-animile ever since I was born. When I was very young at 5 or 6 years of age I was a thief and a lier and a mean despisable one at that. The older I got the meaner I got."

• German child killer Peter Kurten had drowned two playmates by the tender age of nine. Are the psychopathic criminals really different from birth?


• http://www.youtube.com/watch?v=kXkZMA73-2U


• Perhaps morality is a complex system of inhibition and activation using portions of the brain designated to both.

• Neurobiology has its work cut out for it. There may be many physical reasons for an individual to be immoral.


• "After I'm dead, they're going to open up my head and find that just like we've been saying a part of my brain is black and dry and dead," said Bobby Joe Long, who suffered a severe head injury after a motorcycle accident.


• Brain defects and injuries have been an important link to violent behavior. When the hypothalamus, the temporal lobe, and/or the limbic brain show damage, it may account for uncontrollable aggression.


Brain Damage

• In many case studies, offenders have been found to have had a history of head trauma and abnormality on Computerised Tomography (CT) scans, Electoencephalography (EEG) scans and neuropsychological testing.

• Among the many serial killers who had suffered head injuries are Leonard Lake, David Berkowitz, Kenneth Bianchi, John Gacy, and Carl Panzram.

• John Gacy had a form of psychomotor epilepsy as a child. Arthur Shawcross had psychomotor seizures related to temporal lobe damage. The EEG abnormality focused on the temporal lobe - an area associated with personality, emotion and behavior.


• One theory is that the psychopathic brain is organized differently as the result of imperfect socialization in the very early years -- arising either from inherited deficits or from a pathological family environment (or both). This could cause attributional differences to occur in the mind of an individual who has been subjected to kindling or other phenomenons.

• The anatomical basis for a classical conditioning mechanism in the brain of these altered individuals could be the proximity and interconnection of limbic structures linked with feeding and aggression (the amygdala), with structures controlling sexual functions

(the hippocampus and septum).


• The diencephalic structures of the thalamus and hypothalamus have been suggested as having a direct role in aggressive behavior, as well as a role in associating positive or negative emotions with incoming stimuli. Abnormalities in the thalamus might explain a serial killer's inability to maintain personal relationships or display empathy for his victims (Sears, 1991). Also, the thalamus has been associated with pathological activation of fearful and combative behavior (aversive experiences) along with oral and sexual functions (pleasant experiences). When one area is stimulated, arousal may extend to other areas, producing pleasurable feelings associated with violent acts. Perhaps the behaviors that the brain rewards itself for have been altered somehow in the mind of the serial killer. If this is so, then the brain itself attributes positive responses to negative actions.


Cold Blooded

• Another interesting finding shows that psychopaths have a greater fear threshold, and are less likely to respond to fear-inducing stimuli. This is not only true for complex situations, but sudden loud noises that would be expected to frighten any individual.

• Psychopath's heart rate and skin temperatures are low, and their "startle reactions" are substantially less than the average person in these situations.


Hypothalamus

• Similarly, the hypothalamus plays a role in the reticular activating system, which may block otherwise stimulating activity from reaching the judgement-related cerebral cortex. It has been suggested that such a mechanism may be what is responsible for chronic underarousal in the psychopath, leading to antisocial behavior in an attempt to increase cortical levels of arousal (Bartol, 1980). This seems to be able to explain the thrill-oriented serial killer who increases the frequency of his murders.


"It was an urge. ... A strong urge, and the longer I let it go the stronger it got, to where I was taking risks to go out and kill people … risks that normally, according to my little rules of operation, I wouldn't take because they could lead to arrest.” Edmund Kemper


• 5-hydroxyindoleacetic acid (5-HIAA), a metabolic bi-product of the neurotransmitter serotonin, may have an abnormally low concentration in the cerebrospinal fluid of persistently aggressive and anti-social males.


The Triad

• Animal Cruelty: Torturing animals is a disturbing red flag. Animals are often seen as "practice" for killing humans. Ed Kemper buried the family cat alive, dug it up, and cut off its head. Dahmer was notorious for his animal cruelty, cutting off dogs heads and placing them on a stick behind his house.

• Pyromania: “What power I feel at the thought of fire! ... Oh, what pleasure, what heavenly pleasure!” -Joseph Kallinger

• Bed Wetting: By some estimates, 60% of multiple murderers wet their beds past adolescence. Kenneth Bianchi apparently spent many a night marinating in urine-soaked sheets.


Extra Chromosome?

• Multiple murderer Bobby Joe Long had an extra X (female) chromosome, otherwise known as Klinefelter's syndrome, which meant he had the female hormone estrogen circulating in higher amounts in his system. His breasts grew during puberty, which caused him great embarrassment.


• Mass murderer Richard Speck's legal defense said he had an XYY genetic makeup, but further tests proved this wrong. While an extra male chromosome seems like a logical explanation for mutant-aggressive behavior, there is not much evidence that links the X or Y chromosome to serial killers.


Right Brain vs. Left Brain

• Noting that the right hemisphere of the brain is specialized for processing the emotional significance of words,

researchers theorized that psychopaths may rely more on the left hemisphere, which "uses a more verbal-analytic strategy." This was found to be the case and indicates fundamental organizational differences in the brain

processes of psychopaths and serial killers.


• Using PET and MRI scans, the function and structure of the brains of 41 murderers and 41 control subjects found that there was lower activity in the pre-frontal cortex of the brains of murderers when compared to that of normal control subjects.

• When the murderers where further divided into affective and predatory groups, both showed higher than normal activity in the sub-cortex.

• The affective group showed lower activity in the pre-frontal cortex while the predatory group showed an intact pre-frontal cortex.


Serial Killer Traits• Dr. Helen Morrison wrote “My Life Among the Serial Killers.” She

completed hundreds of hours of face-to-face interviews. She describes them as having the emotional age of an infant. They are generally charismatic and able to fit in by learning to behave as normal people do, while lacking the empathy most normal people possess. Most serial killers are fluent liars, often protest against the injustice of their incarceration and are unable to understand that they did anything wrong.

• Serial killing has occurred throughout historyand in all societies.


Morrison's list of serial killer traits include:

･ No understandable motive for killing･ No personality structure, no personality development over time･ They are not psychopaths; in some ways they lack self-control, and the ability to think and feel･Most are above average intelligence･ They are psychologically incomplete human beings, but learn to act as though they are･ Not all have been sexually or physically abused･ They are uncontrollably addicted to killing·Frequent instances of hypochondria. ·Remarkable lack of tobacco use or alcoholism


Morrison’s Theory

• She disagrees with or downplays theories that attribute serial killing to complex psychological motives such as suffering child abuse, which is not a consistent factor. She contends that serial killers are so lacking in emotional development that they have no capacity for complex emotional motives. An illustrative example notes that serial killers experience profound physiological events during their crimes that are related to the hypothalamus and that the serial killer's lack of emotion has a similar connection to the hypothalamus. Morrison also describes how serial killers' crimes are similar to drug addiction.


Art?


For the kids


Reform• One of the most outspoken critics of "reform" is a serial killer himself,

the unrepentant Carl Panzram: "I have no desire to reform myself. My only desire is to reform people who try to reform me. And I believe that the only way to reform people is to kill em. My Motto is, Rob em all, Rape em all and Kill em all."

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• http://www.youtube.com/watch?v=djeoabid7s4


http://www.youtube.com/watch?v=kmeULp1M85c


ReferencesBateman, A. L., & Salfati, C. G. (2007). An examination of behavioral consistency using individual behaviors or groups of behaviors

in serial homicide. Behav Sci Law.

Beasley, J. O., 2nd. (2004). Serial murder in America: case studies of seven offenders. Behav Sci Law, 22(3), 395-414.

Geberth, V. J., & Turco, R. N. (1997). Antisocial personality disorder, sexual sadism, malignant narcissism, and serial murder. J Forensic Sci, 42(1), 49-60.

Martens, W. H., & Palermo, G. B. (2005). Loneliness and associated violent antisocial behavior: analysis of the case reports of Jeffrey Dahmer and Dennis Nilsen. Int J Offender Ther Comp Criminol, 49(3), 298-307.

Morana, H. C., Stone, M. H., & Abdalla-Filho, E. (2006). [Personality disorders, psychopathy and serial killers]. Rev Bras Psiquiatr, 28 Suppl 2, S74-79.

Myers, W. C., Husted, D. S., Safarik, M. E., & O'Toole, M. E. (2006). The motivation behind serial sexual homicide: is it sex, power, and control, or anger? J Forensic Sci, 51(4), 900-907.

Silva, J. A., Ferrari, M. M., & Leong, G. B. (2002). The case of Jeffrey Dahmer: sexual serial homicide from a neuropsychiatric developmental perspective. J Forensic Sci, 47(6), 1347-1359.

Silva, J. A., Leong, G. B., & Ferrari, M. M. (2004). A neuropsychiatric developmental model of serial homicidal behavior. Behav Sci Law, 22(6), 787-799.

Wolf, B. C., & Lavezzi, W. A. (2007). Paths to destruction: the lives and crimes of two serial killers. J Forensic Sci, 52(1), 199-203.

Wright, J., & Hensley, C. (2003). From animal cruelty to serial murder: applying the graduation hypothesis. Int J Offender Ther Comp Criminol, 47(1), 71-88.


Symptom Overlap

(Foa, Stein, & McFarlane, 2006)

PTSD is not necessarily the most common disorder, but its onset is most easily defined


Symptom Duration

(Foa, Stein, & McFarlane, 2006, p. 15)

“Acute stress reactions are normal & expected responses, seen in the majority of cases.”


Symptom Resolution

• PTSD is not immediate• May represent a lack of resolution

of the acute stress response • PTSD resolves in 60% of cases

• (Foa, Stein, & McFarlane, 2006)


Public mass-shooting

• Victim’s Sx generalize to perpetrators • Some develop PTSD

– Their violence becomes their trauma• gruesome consequences (bloody body)• unintended severity (accidental death)• social pressure (gang-related)

(Evans, Ehlers, Mezey, & Clark, 2007b)


Perpetrators• 5.7% PTSD

– PTSD rate much lower than victim’s

• 45.7% current intrusive memories of violent offense

• 48% h/o psych disorder hx (vs 23%)

• 58% h/o violent offenses (vs 33%)

• More shame = more severe sx

• Antisocial traits protective against intrusive memories• Supports “discrepancy theories”

(Evans, Ehlers, Mezey, & Clark, 2007b)


Perpetrators

• In contrast to victims:– 6% of the intrusions were about events

immediately preceding the assault– Initiated by perpetrator, not initially

distressing – Trauma usually did not coincide with onset of

assault, but when meaning changed for the worse

– Usually an unintended outcome of the assault

(Evans, Ehlers, Mezey, & Clark, 2007a)


Perpetrators

• Implications for Ψ assessment of offenders

• Relatively precise information about attitudes towards acceptability of violence – generally difficult to elicit

• CONTENT & MEANINGS of intrusive memories may be useful in RISK assessment(Evans, Ehlers, Mezey, & Clark, 2007a)


References

• Bikel, O. (2007). When Kids Get Life. On Frontline [Television Program]. Boston: WGBH Educational Foundation.

• Carlos Otero, J., & Njenga, F. G. (2006). Lessons in posttraumatic stress disorder from the past: Venezuela floods and Nairobi bombing. J Clin Psychiatry, 67 Suppl 2, 56-63.

• Evans, C., Ehlers, A., Mezey, G., & Clark, D. M. (2007a). Intrusive memories and ruminations related to violent crime among young offenders: Phenomenological characteristics. J Trauma Stress, 20(2), 183-196.

• Evans, C., Ehlers, A., Mezey, G., & Clark, D. M. (2007b). Intrusive memories in perpetrators of violent crime: emotions and cognitions. J Consult Clin Psychol, 75(1), 134-144.

• Foa, E. B., Stein, D. J., & McFarlane, A. C. (2006). Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry, 67 Suppl 2, 15-25.

• Herman, J. (1992). Trauma and Recovery. London: Pandora.• Kurtis, B. (2007). A KILLER ON CAMPUS: A BILL KURTIS SPECIAL REPORT

[Television Program]. Manhattan: A&E Television Networks.• Shiloh, R., Stryjer, R., Weizman, A., & Nutt, D. (2006). Atlas of Psychiatric

Pharmacotherapy (2nd ed.). Boca Raton: Taylor & Francis.


School Shootings: Survivalism

By: Eric PauliNURS 583

University of Washington


Bowling for Columbine

http://www.youtube.com/watch?v=H6Welsq8vZM


School shootings have received a disproportionate amount of media attention due to the nature of the settings and the assailants.

Less than 1% of all homicides among school-aged children 5-19 occur in or around school grounds or on the way to and from school.

The epidemic of youth violence actually peaked in 1993.

Homicide rates for 15-19 y.o. have dropped approx. 174% since 1981.

School Shooting


Differ from “typical violence” in that they have taken place in smaller cities and towns, not involved rival gangs, or narcotics trade with the assailants primarily from middle class or affluent families and no previous criminal record.

The residents of these communities considered themselves insulated from lethal youth violence.

Events are infrequent and idiosyncratic making it difficult to profile students or predict behavior.

School Shooting


FBI looked at 18 school shootings including 4 thwarted attacks and determined several common risks factors including poor coping skills, access to weapons, depression, drug and alcohol use, alienation and unlimited television or internet use.

The U.S. Secret Service for the Dept. of Education investigated 37 school shootings since 1974 and discovered that 75% of attackers had told someone of their plans.

School Shooting


• Individual: Kandel found that 80% arrested for violent offenses had a significant hx of birth and delivery complications compared to 30% of property offenders and 47% of nonoffenders. Genetic contribution to violence? Monozygotic twins are higher than dizygotic twins but relationship appears more variable among children, suggesting that common environment may play a more important role. Hypothesized mechanism for genetic transmission of a vulnerability to developing violent behavior include serotonergic neurotransmission that modulates impulsivity. Narcissism, mental illness, hyperactivity, drug and alcohol use, distortions in social-cognitive processes, antisocial behavior, early pattern of aggressive behavior*, etc.


Media Coverage


Media Violence

-Children in U.S. have unprecedented access toboth new and traditional media.-By 18, the average American will have viewed 200,000 acts of violence on TV.


Short and Long-term Effects of Media Violence

• Short-term: ↑ HR and BP & other physiological signs of arousal. Children who observe aggressive behavior are more likely to perform the same act immediately.

• Even brief exposure to media violence can reduce physiological rx to real-world violence.

• Long term-effects: more enduring. Observational learning is extension of imitation, which may explain how children develop a view that the world accepts aggression as an appropriate response. These beliefs are reinforced with chronic exposure to media where violence is perceived as acceptable & without consequences, & these behaviors are resistant to change.

• Fear & anger can become linked through classical conditioning with repeated exposure to violent images leading to diminished emotional rx so that violent scenes become less arousing over time.


School Shooting

• Between 65-86% Students, teachers, administrators who are victims of catastrophic school shootings will most likely experience Posttraumatic stress and not PTSD.


Individual Risk and Protective Factors

• Internal resources: problem-solving skills, cognitive function, intelligence, etc.

• Resilience: ability to use natural healing processes like talking with others, journaling, play, dreams, and community rituals to celebrate life and to mourn loss.

• Past experiences: previous exposure to aggression and violence and parental responses to familial aggression and violence

• Spiritual Beliefs• Psychological well-being: depression, grief or

loss issues, major mental illness.• Physical factors: fatigue, illness, previous use

or abuse of alcohol and drugs.


Family, subsystem, and individual family members’ risk factors

• Availability of personal, family, and community resources

• Culture or subculture• Gender• Economic considerations• Age and developmental level.


Addressing the Development of PTSD

• CISD, EMDR, group treatment, individual and family therapy as well as the positive influence of stress buffers should not be overlooked.

• The behavioral, cognitive, and psychological impact of catastrophic school violence and the needs of the victims and families should be addressed.


Prevention and TX of PTSD

• Psychoeductional groups, single case groups, CBT, REBT, and family therapy.

• Prevention programs like, FAST Track, Positive Adolescent Choices Training, and Viewpoint Training Program.

• ? Prevention and treatment, such as Roberts’ seven-stage crisis intervention model, stress/crisis/trauma model, and CISD.


Stress Buffers• Impact of stress, such as a catastrophic school

shooting, depends on the presence, absence, or level of buffering factors.

• Examples: social support, appraisal support, positive automatic thoughts, physical fitness, sense of humor, optimism, self-esteem, self-complexity, efficiency, coping style, type A characteristics, and health practices.


Resiliency• Individual’s ability to cope, bounce back,

& keep growing, emotionally and psychologically in challenging and traumatic situations.

• Secure attachment serves as primary defense for trauma-induced psychopathology for children & adults. When mature, they are able to self-regulate aroused emotions as well as receive comfort from others.


Resiliency continued

• Serves as a defense for long-term behavioral and emotional problems.

• For a resilient person, a catastrophic school shooting serves as a psychic organizer.


• I was making a statement about America, and it was definitely part of my reaction for being blamed for something like Columbine. I thought the title 'Crop Failure' was appropriate for several reasons. Columbine, some people might know, is a flower. And, obviously, ['Crop' represents] raising up your children and harvesting them properly. Something did go wrong here, and I think the farmers should be blamed, not the entertainers."


I Don’t Like Mondays

http://www.youtube.com/watch?v=GCmldZM2ZK4


References• Anderson, M., Kaufman, J., Simon, T. R., Barrios, L., Paulozzi, L., Ryan, G., et al. (2001). School-

associated violent deaths in the United States, 1994-1999. Jama, 286(21), 2695-2702.• Brener, N. D., Simon, T. R., Anderson, M., Barrios, L. C., & Small, M. L. (2002). Effect of the

incident at Columbine on students' violence- and suicide-related behaviors. Am J Prev Med, 22(3), 146-150.

• Foa, E. B., Stein, D. J., & McFarlane, A. C. (2006). Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry, 67 Suppl 2, 15-25.

• Jordan, K. (2003). A Trauma and Recovery Model for Victims and Their Families after a Catastrophic School Shooting: Focusing on Behavioral, Cognitive, and Psychological Effects and Needs. Brief Treatment and Crisis Intervention, 3(4), 397-408.

• Lickel, B., Schmader, T., & Hamilton, D. L. (2003). A case of collective responsibility: who else was to blame for the Columbine high school shootings? Pers Soc Psychol Bull, 29(2), 194-204.

• Prothrow-Stith, D. (2007). Keynote address: making campuses safer communities for students. J Am Coll Health, 55(5), 300-303.

• Rose, S., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev(2), CD000560.

• Stueve, A., Dash, K., O'Donnell, L., Tehranifar, P., Wilson-Simmons, R., Slaby, R. G., et al. (2006). Rethinking the bystander role in school violence prevention. Health Promot Pract, 7(1), 117-124.

• Verlinden, S., Hersen, M., & Thomas, J. (2000). Risk factors in school shootings. Clin Psychol Rev, 20(1), 3-56.

• Williams, K., Rivera, L., Neighbours, R., & Reznik, V. (2007). Youth violence prevention comes of age: research, training and future directions.


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