Homicide-Suicide
• 1,000 to 1,500 deaths/year
• 4% of U.S. homicides
• Over 90% by males
Mass Murder and
Murder Suicide
Phillip J. Resnick, MD
Professor of Psychiatry
Case Western Reserve University
Director of Forensic Psychiatry
University Hospitals Case Medical Center
Cleveland, Ohio
Marzuk PM et al. JAMA. 1992;267(23):3179-3183; Byard RW et al. Am J Forensic Med Pathol.
1999;20(4):323-327.
International Homicide Rates
Homicidality and Suicidality
Males Age 15-24, 1988-1991
• 86% of out-patients with homicidal ideas also
reported suicidal ideas
USA
Israel
Australia
• 91% of patients who had attempted homicide
had also attempted suicide
Spain
Sweden
France
Canada
England
Japan
0
5
10
15
20
25
30
35
40
Homicides per 100,000 Population
Marzuk PM et al. JAMA. 1992;267(23):3179-3183.
Asnis GM et al. Psychiatr Clin North Am. 1997;20(2):405-425.
Poem by a Shooter
Homicide-Suicide
Suicide or homicide,
Homicide and suicide,
Into sleep I am sinking,
Why me?...I’m thinking.
H i id l th
Homicidal
thoughts
ht and
d suicidal
i id l th
thoughts
ht
intermixing,
My life’s not worth fixing.
• 1,000 to 1,500 deaths/year
• 4% of U.S. homicides
• Over 90% by males
Marzuk PM et al. JAMA. 1992;267(23):3179-3183; Byard RW et al. Am J Forensic Med Pathol.
1999;20(4):323-327.
Male Homicide
Homicide-Suicide Categories
• 95% of familicides
• Spouse or lover (uxoricide)
• 78% of spousal homicide
• Filicide and familicide
• 49% of filicide
• Mass murder
Wilson M et al. Aggr Behav. 1995;21(4):275-291.
Spousal Homicide-Suicide
• 20% to 40% of men suicide after killing their
wives
• 50% to 75% are depressed
Spousal Homicide-Suicide
• 9X more with cohabitation
• Increase with age difference
Felthous AR, Hempel A. J Forensic Sci. 1995;40(5):846-857; Rosenbaum M. Am J Psychiatry.
1990;147(8):1036-1039.
Spousal Homicide-Suicide
• 20% to 40% of men suicide after killing their
wives
• 50% to 75% are depressed
• 9X more with cohabitation
• Increase with age difference
Until death do us part
Felthous AR, Hempel A. J Forensic Sci. 1995;40(5):846-857; Rosenbaum M. Am J Psychiatry.
1990;147(8):1036-1039.
Types of Spousal Homicide-Suicide
Conflict-ridden Spousal Type
• Conflict ridden
• Frequent domestic violence
• Elderly mercy killings
• 30% to 70% involve separation
• Dependent attachment
• Avoid shame
Bourget D et al. J Am Acad Psychiatry Law. 2000;28(2):179-182; Malphurs JE et al. Am J Geriatr
Psychiatry. 2001;9(1):49-57.
Othello Syndrome
False belief that
one’s wife is
unfaithful
Conflict ridden 87%
Conflict-ridden Spousal Type
Holland Study
• Frequent domestic violence
• Compared homicide-attempted suicides to
homicides and attempted suicides
• 30% to 70% involve separation
• Dependent attachment
• Majority of uxoricide-attempted suicides were
not premeditated
• Avoid shame
• Filicide-attempted suicides were planned
Bourget D et al. J Am Acad Psychiatry Law. 2000;28(2):179-182; Malphurs JE et al. Am J Geriatr
Psychiatry. 2001;9(1):49-57.
Liem M et al. Int J Offender Ther Comp Criminol. 2009;53(5):497-516.
Impact
• Half of spousal homicide-suicides are committed
in the vicinity of others
• Children experience trauma and become
orphaned
13%
Morton E et al. Violence Vict. 1998;13(2):91-106.
Elderly Spousal Type
• Mean age – 79
• Male care-giving role
• Deteriorating health
• Dominant personality
Filicide and Familicide
Bongar B et al. In: Maris RW et al., eds. Comprehensive Textbook of Suicidology. New York, NY:
Guilford Press; 2000:222-239; Cohen D et al. Am J Psychiatry. 1998;155(3):390-396.
Maternal Filicide-Suicide
Suicide Note
• 16% to 29% of maternal filicides
• Do not kill husbands
• Extended suicide
• Protect from worse fate
Hatters Friedman SH et al. J Am Acad Psychiatry Law. 2005;33(4):496-504.
“Bury us in one box. We belong together,
you know.”
Maternal Filicide-Suicide
Paternal Filicide-Suicide
• 16% to 29% of maternal filicides
• 40% to 60% of paternal filicides
• Do not kill husbands
• 65% also kill their wives
• Extended suicide
• Familicide
• Protect from worse fate
• Psychotic or depressed
• Threatened separation
Hatters Friedman SH et al. J Am Acad Psychiatry Law. 2005;33(4):496-504.
Familicide-Suicide Note
I lost the business
business, the house,
house everything.
everything I
can’t let my family suffer the degradation…
of being thrown penniless into the street.
Hatters Friedman SH et al. J Am Acad Psychiatry Law. 2005;33(4):496-504.
Familicide Note
“Depressed – more every day.
Rock bottom.
Can’t sleep.
Can’t eat.
No job future.
Who will support the kids?
We can’t.
I won’t let them suffer.
God help us.”
Thomas Mangiantini
Paternal Filicide-Suicide
Familicide
• 40% to 60% of paternal filicides
• 65% also kill their wives
• Familicide
• Psychotic or depressed
• Threatened separation
Hatters Friedman SH et al. J Am Acad Psychiatry Law. 2005;33(4):496-504.
The prospect of losing his family through
death strikes the father as no more
disastrous than the prospect of losing
them through desertion. Better, perhaps,
since at least he has called the shots and
has exerted his authority.
Daly M, Wilson M. Homicide. New York, NY: Aldine de Gruyter; 1988:215.
Suicide After Mass Murder
• Unmarried men in 4th decade
• 34% to 53% of mass murderers commit suicide
• About half are psychotic
Mass Murder and Suicide
• Non-psychotic are depressed
Hempel AG et al. J Am Acad Psychiatry Law. 1999;27(2):213-225; Lester D et al. Crisis. 2005;26(4):184187.
Evil
Suicide After Mass Murder
• What most people label as evil is extreme
selfishness
• Unmarried men in 4th decade
• Gratification of our own impulses at the expense
of others
• 34% to 53% of mass murderers commit suicide
• About half are psychotic
• Non-psychotic are depressed
Knoll JL. Mass Distraction: Equating Mental Illness with ‘Evil.’ Medscape Psychiatry, Ethics in Psychiatry.
February 14, 2013. www.medscape.com/viewarticle/779097. Accessed June 21, 2013.
Hempel AG et al. J Am Acad Psychiatry Law. 1999;27(2):213-225; Lester D et al. Crisis. 2005;26(4):184187.
Types of Mass Murder
Workplace Killers
• Disgruntled employees
• White male in 30s or 40s
• Pseudo-commandos
• Lost job or perceives he will
• Identifies with his job
• Often a loner
• Problems with authority
Hempel AG et al. J Am Acad Psychiatry Law. 1999;27(2):213-225.
Kausch O, Resnick PJ. In: Flach F, ed. Malpractice Risk Management in Psychiatry: A Comprehensive
Guide. New York, NY: Hatherleigh Press; 1998:332-346.
Pseudo-Commandos
• Warrior mentality
• Fascination with weapons
• Indiscriminate killing of strangers
• No escape is planned
Charles Whitman
University of Texas Tower Sniper 8/1/66
Dietz PE. Bull N Y Acad Med. 1986;62(5):477-491.
Montreal Massacre (12/6/89)
• Marc Lépine killed 14 women and wounded 10
women and 4 men at École Polytechnique
• Suicide letter – done for political reasons
because “feminists have ruined my life”
San Ysidro McDonald’s
Massacre
7/18/84
James Huberty
Marc Lépine
Mullen Study
• Abusive father had
contempt for women
• Shy, ill at ease
• Military: “unsuitable”
unsuitable
• Socially isolated
• Depression, grandiosity
• Suspiciousness
• Dreams of revenge against a rejecting world
Mullen PE. Behav Sci Law. 2004;22(3):311-323.
Mullen Study
• Interviewed 5 mass-murderers who failed
suicide attempts
“I am going to be
famous now.”
• Persecutory beliefs
• Planned script
Robert Hawkins
• Sense of entitlement
Omaha, Nebraska
mall shooter
12/5/07
Mullen PE. Behav Sci Law. 2004;22(3):311-323.
Narcissism
Martyrdom…is the
only way in which a
man can become
famous without
ability.
ability
• Extensive media attention
• Spectacular shootings get adulation
• Letters of support
Knoll JL. Mass Shootings: Research and Lessons. Psychiatric Times. February 12, 2013.
www.psychiatrictimes.com/mass-shootings-research-and-lessons. Accessed June 21, 2013.
George Bernard Shaw
Seung Hui Cho
• 7th Grade
– Selective mutism
– Social anxiety disorder
• 8th G
Grade
d
– Major depression
– “I want to repeat Columbine”
Seung Hui Cho
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
At VirginiaTech
12/13/05 Evaluation
• Marked isolation
• Harassed 3 coeds
• Committed as suicidal
• Failed to follow mandated after care
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
He emailed a friend yesterday that he felt like
killing himself
himself. States he was just kidding
around. Very non-verbal and did not discuss his
feelings.
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
At VirginiaTech
Pre-Shooting Story
• Marked isolation
Bud says, “l’m a loser.”
• Harassed 3 coeds
“I hate all frauds.”
• Committed as suicidal
“…this is when you damn people die with me.”
• Failed to follow mandated after care
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
Massacre 4/16/07
Cho Killing Tools
• Mailed video to NBC
• 2 handguns
• Fired 174 rounds in 11 minutes
• 400 rounds
• Killed 27 students and 5 faculty
• A knife
• Wounded 17 students
• A hammer
• Shot self when police arrived
• Heavy chains
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
Massacre 4/16/07
• Mailed video to NBC
“I die like Jesus
Christ, to inspire
generations of the
weak and the
defenseless
people.”
• Fired 174 rounds in 11 minutes
• Killed 27 students and 5 faculty
• Wounded 17 students
• Shot self when police arrived
Virginia.gov. Report of the Virginia Tech Review Panel. August 2007.
www.governor.virginia.gov/TempContent/techPanelReport.cfm. Accessed June 21, 2013.
Paranoia
“You forced me into a
corner and gave me
only one option. The
decision was yours.
you have blood
Now y
on your hands that
will never wash off.”
“You have vandalized my heart, raped my
soul, and torched my conscience.”
“You had everything
you wanted. Your
Mercedes wasn’t
enough, you
brats.Your golden
necklaces weren’t
weren t
enough, you snobs.
Your trust fund wasn’t
enough. All your
debaucheries weren’t
enough.”
Social Exclusion
“Oh the happiness I
could have had
mingling among you
hedonists, being
counted
t d as one off
you.”
Failure to Communicate
HIPAA Exception
• Faculty knew of violent writings
• Campus police knew of harassment
• Counseling Center knew of commitment for
suicidality
• Parents knew of Columbine remark
Necessary to lessen a serious and
imminent threat to the health or safety of a
person or the public…
U.S. Department of Health & Human Services. HIPAA FAQ.
www.hhs.gov/ocr/privacy/hipaa/faq/ferpa_and_hipaa/520.html. Accessed June 21, 2013.
Confidentiality
• HIPAA
Risk to human life always trumps
confidentiality
• FERPA: College records cannot be revealed to
parents unless the student is an IRS dependent
U.S. Department of Education. Family Educational Rights and Privacy ACT (FERPA).
www.ed.gov/policy/gen/guid/fpco/ferpa/index.html. Accessed June 21, 2013.
Summary
• Primarily male phenomenon
• Majority are dependent men unable to tolerate
loss of spouse
• Mass murderers are often paranoid
paranoid, resentful
resentful,
and seeking revenge