The rare and little understood phenomenon has been called amok or running amok, a phrase derived from the Malay word mengamok, which means "to do furious battle." This week, several experts said Sueng Hui Cho's shooting rampage at Virginia Tech reminded them of a long list of other amok cases.
....................For the better part of two centuries, Western observers thought the phenomenon was limited to "primitive" cultures in Asia, the Caribbean and native America, but this notion has been demolished in recent years. Those who study amok say it now occurs mainly in Western countries.
"The truth of the matter is this occurs in every culture," said Los Angeles forensic psychiatrist Manuel L. Saint Martin, who said he has tracked about 50 cases. "It seems to be occurring more commonly now in Western, industrialized cultures rather than in the Southeast Asian islands where it was first noticed."
Cho's rampage had the classic signs, said Saint Martin: "It is very likely this was a case of amok. Amok is the end product of mental disorder where you get homicidal-suicidal behavior."
Other examples include a massacre at a Luby's cafeteria in Killeen, Tex., in 1991 and the so-called McDonald's Massacre in San Diego in 1984 -- in both cases, a lone gunman violently vented his grievances by killing strangers before killing himself or being killed.
Julio Arboleda-Flórez, head of the psychiatry department at Queens University in Canada, said the Virginia Tech case was just like others he has studied in North America, including that of the University of Texas student who climbed a tower on the Austin campus in 1966 and opened fire on passersby, killing 13 before he was himself gunned down.
"The pattern starts with a period of brooding, distress, preoccupations and depression," said Arboleda-Flórez. "After a period, the guy grabs a weapon and starts a non-provoked outburst of attacks." He "just attacks and kills and maims and then commits suicide."
Many psychiatric experts were cautious about linking Cho's rampage to amok because it is described in the current American Psychiatric Association manual of mental disorders as a "culture-bound syndrome." Besides the problem of stereotyping that raises, they argued that using the construct might suggest Cho was not suffering from a mental illness, when in fact he seemed deeply disturbed.
Francis G. Lu, a psychiatrist at San Francisco General Hospital, said the classification of amok needs to be reconsidered in the psychiatry manual, which is now being revised.
..............Gerald P. Koocher, a former president of the American Psychological Association, said Cho may have been suffering from a personality disorder that has some similarities to schizophrenia. Cho's reclusiveness and extreme tendency to blame others for his problems suggest elements of delusional thinking, Koocher said.
Harvard psychiatrist Richard Mollica said the tragedy underscored the extent to which depression in America goes untreated.
In late 2005, Cho received a mental health exam that suggested he was emotionally flat and depressed. He denied being suicidal.
Laurence J. Kirmayer, a psychiatrist at McGill University in Montreal, said Cho, like countless other young people, had likely constantly gotten the message that the loner who acts out violence on the world through martial arts or gunplay is a hero. Kirmayer pointed to James Bond movies such as the recent remake of "Casino Royale," in which "a vicious sociopath is okay because he is working for British intelligence."
......................Amok cases seem to follow a fairly fixed pattern, said Saint Martin and Arboleda-Flórez. The first ingredient is susceptibility to depression or other serious mental illness. After brooding over suicidal and homicidal thoughts for months or even years, the person starts to put together a plan.
"It may just be taking a knife and stabbing people, and it may be firearms," said Saint Martin. "It may be an elaborate thing as this person did at Virginia Tech. By the time they put the plan into action, it is impossible for anyone but law enforcement to intervene. There is no way to intervene psychiatrically."
Unlike the behavior of serial killers, amok involves a desire by the perpetrator to die. Unlike suicide bombers, who also kill others while killing themselves, amok is about the grievances of a solitary individual, experts said. The fact that most amok cases end with the person killing himself or getting killed is one reason researchers do not understand the phenomenon very well, said Arboleda-Flórez.
Joseph Westermeyer, a University of Minnesota researcher who did some of the early work showing that cases of amok were not limited to any particular culture, said, "The amok concept may have relevance for this case, although it's more a descriptive concept or 'syndrome' rather than a concrete entity."
Part of the reluctance to associate Cho's rampage with amok stems from the term's historical baggage, said Byron J. Good, a Harvard anthropologist who has studied the behavior.
Colonialists sometimes misused the term to describe violent acts of resistance among Malays -- which is why it is now a loaded term, Good said in an e-mail from Indonesia, where he is doing research. Experts have also used the term in different ways -- the psychiatry manual, for example, describes amok as a "dissociative episode" -- and various observers have disagreed about the amount of planning that typically goes into an amok outburst.
Read this indepth article by Shankar Vedantam Staff Writer of Washington Post.
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