Tag Archives: Ethics

Anosognosia, Psychopathy, and the Conscience

How people see and understand themselves is likely to have an impact on how they interpret interactions with others. Here, I briefly explore the brain areas implicated in anosognosia, how these areas are also relevant in psychopathy, and why anosognosia is important when considering the crime and the conscience.

ANOSOGNOSIA AND SELF BELIEF

Anosognosia is defined as the impaired ability of patients with neurological disorders to recognize the presence or adequately appreciate the severity of their deficits [1]. Torrey (2012) cites three examples of anosognosic patients; a stroke victim with a paralyzed arm claimed he couldn’t lift it because he had a shirt on; a woman with paralysis in her left arm was asked to raise it, and instead raised her left leg. When this was pointed out to her she responded that some people call it an arm, others a leg, and jokingly inquired as to the difference; the Supreme Court Justice, William Douglas, was paralyzed on his left side. He claimed this was a myth, and was still inviting people to go hiking [2].

NEUROLOGICAL FINDINGS IN ANOSOGNOSIC PATIENTS

Recent research on this phenomenon has identified deficits in the brain of the patients who in all honesty do not recognize that they are in some way impaired. By using fluorodeoxyglucose positron emission tomography (FDG-PET) and single photon emission computed Tomography (SPECT) Perrotin et al. (2015) found that anosognosic Alzheimer’s patients had a disruption in connectivity between the posterior cingulate cortex (PCC) and the orbitofrontal cortex (OFC) [1]. Ries et al. (2007) also implicated a compromised precuneus in anosognosic patients. These midline structures are susceptible to damage in those with Alzheimer’s Disease (AD) and stroke victims. Anosognosia is also experienced by schizophrenic patients; according to Gerretsen et al. (2015), 60% of schizophrenic patients experience moderate to severe illness awareness, and this can lead to medication non-adherence and poor treatment outcomes [4]; they found left hemispheric dominance in the left prefrontal cortex in anosognosic schizophrenic patients and cortical thinning in the temporoparietalocciptal junction (TPO).

There is still much work to be done to determine the mechanistic and functional basis of anosognosia, and to determine the subtleties between illnesses and disorders, but research is starting to identify suspect brain regions. This is useful if anosognosia is questioned in other disorders, because neurological studies exploring the disorder can be explored and legitimate avenues of scientific inquiry explored.

RESEARCH PARALLELS WITH PSYCHOPATHY

A failure to recognize a disorder is also present in those with psychopathy. While anosognosia is yet to be explored thoroughly in those with psychopathy, there are behavioral items on the Psychopathy Checklist (PCL-R) [5] that suggest anosognosia is present; grandiose sense of self-worth, lack of remorse, and failure to accept responsibility. The sense of self-worth and narcissistic traits of the psychopath clearly means that they think very highly of themselves. This negates the idea that the psychopath believes they suffer from a defect or a disorder; at the most they might recognize that most others are different, and perhaps inferior to themselves. If a lack of remorse is experienced, this is an explicit demonstration that they do recognize, at least on an emotional level, the consequences of their bad behavior as being wrong; if they do not believe their behavior is inappropriate, it stands to reason that they believe they behaved appropriately, and thus experience nothing ‘wrong’ about themselves. This aspect of self-belief and self-reflection is also seen in the psychopath’s failure to accept responsibility; if they are always good and right, there is little motivation to make amends.

Based upon this cursory examination of psychopathic behavior, it would seem reasonable to explore the neurological studies of psychopathy and see if there could be some overlap with previous studies on anosognosia, and in fact some of the same compromised brain areas are implicated. Many studies have demonstrated developmental differences in the PFC of the psychopath (for a review, see Umbach et al. (2015) [6]), and the white matter pathways, such as the uncinate fasciculus (UF) connecting to the PFC from the limbic regions [7]. Perrotin et al. [1] hypothesized that Anosognosia can result from a disruption in connectivity in the UF. When exploring connectivity in the frontoparietal network (FPN), Philippi et al. (2015) found reduced connectivity in those with higher scores on the PCL-R, which included the right precuneus. And to further the overlap, Glenn et al. (2009) [8] found that those with who scored high on the interpersonal factors of the PCL-R (manipulative, conning, deceitful), showed reduced activity in the PCC during an fMRI scan when having to make judgments during moral dilemma scenarios.

Anosognosia and psychopathy both demonstrate complex neurological constructs, and it is premature to conclude that the neurological basis for Anosognosia (itself still understood) would tuck neatly into the already known neurological research on the psychopath. However, given the neat juxtaposition of behavioral traits and neurological dysfunction, it is worth bringing psychopathy into discussions of Anosognosia for the following reason. The research on psychopathy is currently deeper and richer than the research on anosognosia, and behavior of the psychopath has been widely observed and studied. If we can reasonably conclude that psychopaths, particularly criminal psychopaths, are also anosognosics, their behavior can be assessed in light of what it means to recognize no disorder or defect within oneself. The parallel is further relevant with psychopathy when considering that a number of those with schizophrenia, and a minority of those with AD, have been known for antisocial, and sometimes criminal, behavior [9, 10].

ANOSOGNOSIA, ANTISOCIAL BEHAVIOR, AND THE CONSCIENCE

Those with schizophrenia and AD also suffer from abuse, but when they have been known to act violently, their behavior and motivations need to be understood. Torrey (2012) has documented extensively the violent acts of those with schizophrenia [2]. There is usually a history of progressively worse episodes of psychosis that can convince the patient that they are receiving supernatural or alien instructions to kill or harm individuals, and more often than not family members. Whether or not the auditory hallucinations slowly convince the patient over time of the necessity for deadly action, or whether the act is impulsive, after the event the patient often remains remorseless and attributes their behavior to necessary and mandated (often divine) reasons. This state of mind is similar to the violent psychopath, who also viewed his violent actions as necessary and fully justified. The problem is never attributed to the self; a disorder or defect is not recognized. While psychopaths are widely regarded as not having a conscience and experience only limited affect, more research is needed on the experience of conscience by schizophrenics, especially understanding the role that psychosis played in circumventing the conscience and providing them with permission to act. It is also crucial to discover how those events are remembered and felt post psychosis, perhaps when the patient has reconvened their medication.

In illnesses and disorders that can be associated with antisocial behavior or aggression, anosognosia could be a partial reason for the event of the behavior. Not recognizing any problems or defects, and thinking that one acted rightly or righteously, will affect personal judgments on the self-evaluation of behavior. This does not provide a fertile ground for remorse or responsibility, and if the behavior was aggressive, the patient could continue to remain dangerous, inflexible to a reasoned and peaceful behavioral change. This makes the search for the neural representation of anosognosia all the more crucial, treatment all the more pressing, and methods of identification all the more necessary.

© Jack Pemment, 2016

 

REFERENCES

  1. Perrotin, A. et al. (2015). Anosognosia in Alzheimer disease: Disconnection between memory and self‐related brain networks. Annals of neurology, 78(3), 477-486
  2. Torrey, E. F. (2012) The Insanity Offense, New York, W. W. Norton and Company
  3. Ries, M. L. et al. (2007). Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. Journal of the International Neuropsychological Society, 13(03), 450-461
  4. Gerretsen, P. et al. (2015). Illness denial in schizophrenia spectrum disorders. Human brain mapping, 36(1), 213-225
  5. Hare, R. D. et al. (1990). The revised Psychopathy Checklist: Reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(3), 338-341
  6. Umbach, R. et al. (2015). Brain imaging research on psychopathy: Implications for punishment, prediction, and treatment in youth and adults. Journal of criminal justice, 43(4), 295-306
  7. Motzkin, J. C. et al. (2011). Reduced prefrontal connectivity in psychopathy. The Journal of Neuroscience, 31(48), 17348-17357
  8. Glenn, A. L. et al. (2009) The Neural Correlates of Moral Decision-Making in Psychopathy. Retrieved from http://repository.upenn.edu/neuroethics_pubs/55
  9. Fazel, S. et al. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med, 6(8), e1000120
  10. Lopez, O. L. et al. (2003). Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. The Journal of neuropsychiatry and clinical neurosciences, 15, 346–353

Humans are the only cruel species?

Since the dawn of cave graffiti, humans have polluted their stories with personal biases, usually because they have falsely labeled all other humans into erroneous categories. And this can be entertaining, seeing how an interesting and provocative character has noted differences in the behavior and appearance of other humans (the reason, incidentally, reality TV shows like to group together conflicting/strong personalities). However, if these perceived differences become more than anecdotal stories, have no factual basis, and become an integral part of ideology and worldviews, these ideas of difference can flourish into sinister prejudices. Within the human canon, this has led to horrific lies about women and those whose skin is not white.

But humans do it with non-humans, too. We have developed a species-ism, comparing all of the things we attribute with ourselves to the gamut of the animal kingdom, and we always find the other animals lacking. Clearly, humans have decided that it is their intelligence that is so superior to rest of the animals, after all, no donkey has built a skyscraper. As an interesting side note, it is only those humans on the far side of the intelligence bell curve that achieve the things that we boast about as a species.

Anyway, to pull myself back on track, it is often said that humans are the only species that are cruel for the sake of being cruel. Humans can be cruel because they like to be cruel. Ironically, I think this is another way we have decided that humans are superior to the rest of the animal kingdom. It’s the price of being so advanced that you have to deal with other humans indulging in abject cruelty. What a strange compliment we pay ourselves!

The question of why humans engage in cruel behaviors can be debated at length, although I think there are three main categories, and they can become interchangeable over time. First, humans are forced to be cruel to other humans. Second, ideology has convinced some humans that the lives of others (usually of a particular group) are not worth as much as their own, and while they might not *like* being cruel to these people, the conscience scarcely vibrates. Thirdly, some humans derive pleasure in being cruel to others. As cruelty typically implies intent, I am ruling out devastating behavior that results from accidents.

We think that all of these reasons are missing in the rest of the animal kingdom.

However, I think it would be a tall order to rule out all of them, even perhaps the most challenging – ideology that devalues the life of others (I refer to this as sociopathy). It has already been widely demonstrated that many other animals use language to communicate with others. Given that humans use language the most to understand their own thoughts, I don’t think this can be ruled out in other species, especially the neurologically complex species. If there are thoughts, there is the potential for worldview, and thus ideology. Couple that with all the ways that animals recognize difference, particularly the use of smell, and there is the potential for very strong and motivating thoughts about those others who are different, and that perhaps provoke thoughts of a threatening nature. These ‘thoughts’ then project necessary behaviors as a response, given the immediate context in relation to those an animal does not like, and this a basis for prejudice. Do other animals value their life and the life of those similar more than those that are different? Of course they do.

What about coercion into cruel behavior?

Within other species, can some members force others into being cruel to other members of the same species? In rat colonies, there is often an aggressive struggle for domination. Aggressive neck grooming, biting, and chasing is very common. In this environment, some rats become dominant, and others subordinate. There are two types of subordinate, those that stay close to the dominant rat (betas), and those that avoid the dominant rat (omegas). If the dominant rat is removed, it has been observed that the omega rats, over the betas, are more likely to become the new dominant rat. The experience of the omega, of being dominated (a history of stress and abuse), results here in the omega now acting dominant. This is somewhat an oversimplification, but it shows how members of the same species can “groom” others into behaving intentionally aggressively to others, no doubt resulting in distress (cruelty).

How about cruelty for pleasure?

This is usually what people mean when they say that humans can be cruel for the sake of cruelty. Nobody is cruel for the sake of being cruel. That’s like the outdated idea of people being evil for the sake of being evil. There are individuals that derive pleasure by doing things that cause another pain and distress, but this can also fall into three categories. First, the pain and distress of the other might be what causes the pleasure, such as the pleasure derived from watching another cry. Second, the action(s) that result in the pain and distress cause the pleasure, such as hunting another human for sport, and thirdly, a combination of both, such as a pathological rapist.

I am willing to grant that humans might be the only species that take pleasure in the expressions of suffering and pain in others, but it is worth noting that from a perspective of power and dominance, fear in the faces of others is affirmation and validation of one’s dominance, which is perhaps *enjoyable* in other species, too.

I am also willing to wager that where you find intellectual curiosity in other species, you will also find pleasure derived in actions that cause others distress. Cats, for example, do not seem all that interested in eating the things that they kill (and in some cases, literally torment to death), such as some of the larger bugs, mice, and birds. A mouse is entertainment, not dinner. And within species, there are other apes that will kill the young offspring of females to make them sexually viable for their own sexual coercion. This is obviously an immense distress for the aggrieved mother, and it was done to facilitate the drives and desires of the murderous male, leading to his own fulfillment.

So, the next time you find yourself wondering if humans are the cruelest species on the planet, just remember that there are plenty of bastards in the animal kingdom, too.

*I also wonder if the bite delivered to human swimmers by sharks is sometimes more than a ‘curiosity’ bite. It is widely known that sharks can hone in and become excited by such a tiny amount blood in the water, and so even though biting a human wouldn’t result in a satisfactory meal, the shark has to get something akin to a buzz from the mouthful of blood. Would it be a stretch to say that at least one shark, in some place and time, enjoyed it?

** Intellectual curiosity has an interesting dampening effect on empathy, with perhaps the best example being the behavior of Nazi scientists. After the war, the scientific research community sought to protect human research subjects, and a first step was in creating the Belmont Report.

Batman and psychopathy

Bat signalI have held off writing about my thoughts on this matter for a while, but the more I think about it, the more it seems to make sense. Clearly, Batman is a fictional character, and one that has appeared in many incarnations, but I believe his overall personality and history seems to make him a close candidate for a diagnosis of psychopath. I’m not a clinical psychologist or a psychiatrist, but here is my case.

Young Bruce Wayne witnessed both of his parents murdered together in cold blood. The emotional trauma of this event and the extreme misery to follow could very easily stymie brain development in profound ways. For a child witnessing their parents die in a grotesquely violent act at the hands of a killer, that killer has also just abused the child in a very serious and disturbing way. Child abuse is one of the primary suspects for the development of serious personality disorders, including those that result in a lack of empathy. Presumably, this act also made the young Bruce develop an obsession with criminals and instill in him the need to make sure they are brought to justice.

I don’t know much about the adolescent Bruce Wayne, perhaps someone who is more familiar with the canon can let me know if he was socially deviant, reckless, and callous.

There can be little doubt that Batman himself is extremely violent. Beating villains into a bloody mess seems second nature. Other than the apparent lack of empathy, it is worth noticing that the violence dished out by Batman is very personal; it is close quarter, bone crunching, skin ripping, joint popping, and back stomping violence. In other words, it’s a very intimate level of violence. This seems to point to him getting a thrill out of hurting people, which makes him a sadist. It is widely known that Batman does not use guns (an aversion that could perhaps be explained by his parents being gunned down), but guns are very impersonal. The irony here, which helps enrich the story, is that the Joker also likes to use personal forms of violence, such as knives, on his victims.

There is also an argument to be had that the adult Wayne (and Batman) lack emotion. Batman is usually very clear-minded, cold, and calculated in his behavior. One often hears it is bad to let “emotion” get in the way of making decisions, but perhaps here, Batman has very little to get in the way. Yet clearly, there is always an explosive rage ready burst out of Batman, usually in the form of fists, feet, and head butts. Arguably, he doesn’t have much of an emotional spectrum, which is perhaps one of the reasons he cannot seem to maintain a good relationship (with the exception of Alfred).

There is a parallel between Batman, and the fictional serial killer from Jeff Lindsay’s novels, Dexter. While Batman does typically withhold from killing, he still has a code that provides the parameters for his violence. These parameters help to keep him socially acceptable, as he’s only going after the bad guys. Although, Batman’s code, like all tyrannical codes, have an element of the greater good. Any philosophy that incorporates the greater good will result in the denial of human rights to at least one, but often many individuals. Depending on the group, one could argue that the temporary denial of their rights is necessary, as politicians often do (although not in these words), but nonetheless it places people on different levels of worth. In fact, prisoners, which were at one time criminals, are an incredibly vulnerable group of individuals because they are very much at the mercy of the state, and in scientific research, the use of prisoners is heavily regulated.

Much of these ideas have already been realized in the superhero comics, especially how morality is very often a slippery slope.

Still, if I was asked to write a Batman story, and part of the story included him being diagnosed using Hare’s Psychopathy Checklist, I don’t think it would be a stretch to convince people of a score of at least 25.

While the promise of thrill seeking is enough to excite your average psychopath, the Bat Signal clearly gives Batman a raging boner.

Jon Ronson discussing psychopathy and mental illness at TED

This is not a bad TED talk by Jon Ronson. In a fairly humorous 20 minute discussion he points out the follies of the DSM and the Psychopathy Check List. He concludes that our obsession to categorize people within narrow mental illness parameters ends up dehumanizing the patient and can lead to fatal outcomes.

 

How biological and psychological perspectives on psychopathy shape public opinion

It is commonly known that when a psychopath is on the stand, the prosecution is going to push for a jail term based upon the idea that the defendant is sane. The defense, on the other hand, will no doubt argue that their client is insane, and so should therefore be sent to a psychiatric institution.

In order to determine if the defendant is a psychopath, very often a test called the psychopathy checklist – revised (PCL-R) will be administered. This test has to be conducted by a trained psychologist who has the time to get familiar with the defendant and their history. However, it has been shown that psychologists hired by the prosecution and the defense can come up with different verdicts that tend to favor their own arguments. If the test determines that the defendant is a psychopath then they have essentially just been tarred and feathered and will meet the full wrath of the law with no sympathy. If the test shows otherwise, that label of psychopath will not be applied, and the defendant is likely to meet some leniency.

Numerous points can be made here, but the point I would like to make is  that the use of the psychological test (the PCL-R), if it determines that the defendant is a psychopath, seems to convince the jury of the worst, and they are likely to reflect this in their judgment. However, a recent article on NPR pointed out that judges tends to be lenient when the biological basis for psychopathy is pointed out. It is indeed true that the neurobiology of the psychopath is different; this has been indicated on the tissue level and the genetic level.

This seems to suggest that a judge can be told that a psychological test has determined the defendant is a psychopath and so causes the worst possible outcome, yet if an explanation is given on the tissue, cellular, or genetic level, they can be swayed back towards leniency. It’s as if biological explanations destroy the facade of an individual and look to the minute building blocks of life (which we have no/limited control over), but the minute psychology appears, the individual is back and suddenly accountable for their actions.

This is one problem with juries when it comes to trying psychopaths. If the level of scientific analysis focuses on the individual, the jury will see the individual, whereas if the level of analysis on the molecular biological level, the jury will see cells and genes (which have a life of their own). I, personally, think it is irresponsible to allow a jury to have to reconcile these differences during the trial, especially if they have no scientific understanding.

**I would like to point out that not all psychologists work at the level of the organism, of course, and even if they do they are likely to be aware of cellular/genetic implications of their work.

Copyright Jack Pemment, 2012

Author, Seeing Red

Neurological models behind (anti)social behavior

Neurobiologists have put forward two neurological models that can be used to understand the development of social behavior; the Violence Inhibition Mechanism, and the Somatic Marker Hypothesis.

The Violence Inhibition Mechanism (VIM)

The VIM was first proposed by R.J.R Blair in 1995 in his article A cognitive developmental approach to morality: Investigating the psychopath. The VIM proposes that individuals (and other organisms capable of empathy) experience stress cues from others, including sad and frightened faces, and these are filtered/processed through the VIM before the  individual’s stress response is activated. Our sense of morality also causes an emotional experience based upon the observance of these stress cues, and the VIM again processes behavioral outcomes before they arise.

In his book The Psychopath: Emotion and the Brain, Blair states that the observance of another’s suffering acts as a form of punishment, which in turn decreases the likelihood of engaging in behavior that caused the suffering (the psychological definition of punishment, unlike reinforcement, is something that results in the decrease of the behavior in question). Empathy, then, creates an emotional experience that should dissuade a person from engaging in acts that cause the suffering of others. If it was violence that resulted in the suffering, the VIM should prevent a repeat of this violence.

This model seems contingent on an observer empathizing with the victim, rather than the aggressor. While empathizing with the victim does seem the most honorable and obvious, if the benefits and pleasure obtained by the aggressor seem desirable, the aggressor’s behavior could reinforce the behavior in question.

Somatic Marker Hypothesis

The somatic marker hypothesis was proposed by Antonio Damasio in his book Descartes’ Error: Motion, Reason, and the Human Brain. This hypothesis is built on the idea that emotional states or feelings mark certain behaviors from experience (and presumably from witnessing the behavior of others), and this is crucial for understanding prosocial behavior and making good decisions.

When a person experiences arousal (positive or negative), the central nervous system becomes active, and communication between brain stem nuclei and the limbic system generate an internal emotional state. These emotional states become tagged to the memories of what the organism was experiencing at a specific time, and are thus re-created when the organism remembers the experience. This emotional re-creation allows us to learn from experience.

It has been argued that psychopaths, who seem to suffer from some kind of affective blunting, are unable to tag memories with or experience emotions that are common to most of us. As the psychopathic brain develops, therefore, the individual is unable to learn right and wrong like the rest of us, and can only approach the subject from an emotionless logical perspective. The brain areas involved in producing these crucial markers (incl. the amygdala, the orbitofrontal & ventromedial prefrontal cortices, and the cingulate) are often found to be dysfunctional or mal-developed in the antisocial brain.

What makes a person snap and go on a killing spree?

In light of the massacre in Aurora, CO, and the more recent massacre at a Sikh temple in Milwaukee, WI, an obvious question seems to be why does this happen?

The first port of call is usually to look at beliefs, but the trouble with beliefs is that they do not always reflect behavior, especially if the behavior involves murder. Even extreme ideologies that promote greater intrinsic value over the life of one group of people than another, such as white supremacy or any religion that promotes an infidel/believer dynamic, would not permit most people to follow through with an act of killing.
This does not mean the adherents to such belief systems would not revel in the death of certain individuals or turn a blind eye, but in terms of carrying out the act, the belief alone does not seem enough.

The potency of a belief (it’s ability to affect behavior) may be determined by the dominant parent culture. If the parent culture endorses or encourages personal beliefs, then the likelihood of them affecting behavior are high, provided of course that the individual agrees with the parent culture. The beliefs and values that make up the parent culture are less likely to come with penalties, and maybe even carry a reward. Theoretically, murder of citizens by citizens in the United States carries very heavy penalties, and so even if a person believes that the murder of some individuals is permissible, the desire to avoid punishment will probably act as a deterrent (unless they’re a psychopath – see bottom of post).

So what else could be going on beyond beliefs?

There are two things that the shootings in Aurora and Milwaukee have in common.

Firstly, the gunmen both experienced potentially life-changing failure. James Holmes, the gunman in Aurora, was a PhD candidate in the Anschutz Medical Center (part of the University of Colorado) and supported by a federal grant. Holmes had also been seeing a psychiatrist, although the reason for his visits have not been made public. As Holmes failed an oral exam, it is probably safe to assume he had been anticipating failure or suffered a great deal of anxiety about the exam. This stress and anxiety was no doubt exacerbated by the pressure of having a federal grant and the subsequent need to maintain a high level of performance.  If his visit to the psychiatrist was for something beyond the anxiety caused by these factors, then the potential state of his mental health becomes even worse.

Wade Michael Page, who killed six individuals at the Sikh temple in Milwaukee, had also suffered potentially life changing failure. He had been demoted and discharged from the US Army and was ineligible to be re-enlisted. After spending six years in the army he was suddenly forced to find another job and no doubt felt a great deal of shame / embarrassment / anger over the discharge (possibly even anger at the US – the parent culture). He was clearly having problems with alcohol, too, as he was disciplined for being drunk on duty and going AWOL.

Both Holmes and Wade, who were both showing signs of mental illness, were forced to shape a different future for themselves from already investing a lot in their current career path.

Secondly, both shooters seemed to treat their massacre as a means to an end. Holmes went quietly and respectfully with the police, and Wade fired at policemen and ended up being shot and killed. Neither one of them showed any regard for a future (one they had been forced to re-shape), and seemed to embrace the US justice system or death, respectively. A terminal outlook of the immediate future can be used to rationalize anything, because one, it doesn’t require much effort or time for a depressed mind to conclude that life is pointless (meaning ALL acts have EQUAL value), and two, the deterrence of a parent culture no longer matters to the individual.

Another point to note about the killings, is that the gunmen clearly had no empathy or regard for life when they mercilessly shot members of the public. There are numerous explanations for this. Firstly, depression / anger / feelings of betrayal led to the shooters feeling like their own lives were not valued; this was then transferred to the victims. Secondly, the terminal end point was of greater value to the shooter than the lives of the victims. Thirdly, personal beliefs devalued the lives of the victims. I think the last reason here was probably apparent with Page, who appears to have been involved with White Supremacism.

It is also worth mentioning the act of suicide, because if the shooters both had terminal goals, then why not just kill themselves without taking the lives of anyone else? I think it is obvious that both shooters wanted to make some kind of violent statement before the terminal end as a manifestation of their anger and as a desire to be taken seriously (something they felt could have been missing before they were rejected).

It is worth taking a brief moment to consider psychopathy. In my opinion, most shooting sprees are not carried out by psychopaths. Killing sprees are not the M.O. of the psychopath. Despite the disregard for the lives of others, psychopaths do not demonstrate the belief in a terminal end point, in fact they love abusing and manipulating others, and would probably prefer to keep doing it and keep getting away it. Psychopaths would only go on a killing spree, therefore, if it was endorsed by the parent culture – which has no doubt happened in various military groups/regimes throughout history.

I would like to point out that attempting to understand why a person kills is not the same as finding excuses or defenses for these despicable acts. But it must be realized that culture and the environment are profoundly powerful forces in shaping minds, and so before disposing of people and subjecting them to an uncertain/unstable future, perhaps an effort should be made to assist them through the transition?