The Las Vegas massacre and the Mass Shooting Derangement (MSD) syndrome by Miguel A. Faria, MD

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Thursday, October 5, 2017

The recent Las Vegas shooting massacre has left us in a state of shock. How can anyone be driven by personal demons to massacre innocent people to such a horrific extent?  In the context of this heinous carnage, many of us experienced in astonishingly rapid succession the five stages of grief for the victims, as described by the late Dr. Elisabeth Kübler Ross — i.e., denial, anger, depression, bargaining, and acceptance. Except some of us instinctively and categorically reject four of the stages as unacceptable. So that now only anger remains towards the killer, deranged or not.Stephen Paddock with caption

We know that 64-year-old mass shooter Stephen Craig Paddock, who opened fire on innocent victims attending an outdoor music festival, killed 59 people, injured another 538, and then turned the gun on himself. His body was found on the 32nd floor of the Mandalay Bay Resort with an arsenal of weapons. Reportedly he used a bump fire or “trigger activator” device to convert his semi-automatic weapons to full automatic action, simulating machine gun fire. Fully automatic weapons have been tightly regulated since the Firearm Act of 1934 (updated in 1968 and 1986) and are not legally obtainable without a full background check and written permission from local law enforcement authorities. Fully automatic weapons are in fact the true assault rifles used in combat and not generally found in the American civilian population.

This latest shooting rampage was reminiscent of the University of Texas Tower shooting in 1966 when Charles Whitman, a former marine sharpshooter, shot sixteen people and injured thirty-one others from atop the 28th floor observation deck of the Main Building tower at the University of Texas at Austin. Whitman was killed by police and at autopsy was found to have a brain tumor that may have contributed to his derangement.

The shooting rampage in Las Vegas surpassed the 2016 jihadist terrorist shooting at the Pulse nightclub in Orlando, Florida, as the deadliest mass shooting by a single gunman in American history. We need to find ways to identify these deranged individuals before they strike and the simple parroted solution of the gun prohibitionist movement — i.e., more gun control — is not the answer. We have had plenty of guns in American society; and yet, this type of mass murder at one time was very uncommon. I have coined the term Mass Shooting Derangement (MSD) syndrome for a violent disorder that needs to be studied in a hurry, as we did with AIDS, utilizing sound medical, mental health, and criminal research — not public health — so that effective solutions can be found. The public health model for the study of gun violence was applied — or rather, misapplied — for over three decades and was found wanting, riddled with faulty, preordained, politicized gun research masquerading as science.

Three mass shootersMass shooting deaths, enormous in human pain and suffering and tragic as they are, represent approximately 1% of all homicides in the U.S. Shooting rampages come in generally three distinct types. The first type is the politically motivated shooting, as with the 2017 infamous Republican Congressional baseball practice shooting in which House Majority Whip Steve Scalise was shot and wounded along with three other people. The second type are those motivated by terrorism, which in our day is almost always Islamic terrorism inspired by jihad, whether home grown or foreign. The third type and the most common in the U.S. is the MSD syndrome, which I have come to categorize as a mental disorder, and this article concerns only this last type.

Paddock’s motives are yet to be ascertained but we now know he was “a high stakes gambler,” which I take to be a gambling disorder as categorized in psychiatry in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Details are slow to come in but according to police, “his casino transactions were in the tens of thousands of dollars prior to the shooting.”

Equally puzzling and requiring further investigation is that Paddock’s father was a bank robber who escaped from a federal prison and made it onto the FBI’s most-wanted list in 1969, and was described by the FBI as “psychopathic” with “suicidal tendencies.” Suffice to say we are only beginning to study psychopathy and unprovoked human aggression with biochemical and genetic markers, radioisotopes, and neuro-imaging techniques. Much work still needs to be done with these techniques to add to what we know from neuropsychiatry and clinical psychology.

In my investigations of mass shootings and their media reporting, I believe these shooters are either deeply deranged individuals, prone to criminal acts seeking celebrity status, even if achieving it ends with their death; or they are disturbed or malcontented persons who have a bone to pick with society and blame others for their personal failures and shortcomings in life. They take it upon themselves to hunt down and kill innocent victims to find deadly outlets for their pent up resentment, satisfy their own sense of dissatisfaction, and even fulfill their morbid fantasies in the process.

Informed consent from these inmates who have been convicted of mass murder (and their families when appropriate) should be obtained to study them. Federal grants should be awarded to private psychiatric facilities that agree to diagnose, treat and study those mentally ill shooters who survive the attacks. These facilities should be secure for that purpose. These are dangerous individuals. The fact these psychopaths-sociopaths might be diagnosed with the MSD syndrome does not in anyway nor should it be construed as proof of mental incompetence or insanity, which are legal and not medical terms. The MSD syndrome should be considered within the context of a severe Antisocial Personality Disorder (APD; DSM-5). Rather than overtly displaying some of the characteristics of APD, some of these individuals are able to hide these traits until they finally explode. But, they have carried with them their inherent psychopathic tendencies, such as secretiveness, mendacity, unconcern for others, violent tendencies, etc., as well as sociopathic motivations, such as resentment and the blaming others for their own personal failures and mishaps in life. When they finally act, these sociopaths meticulously plan their violent acts, in this case mass shootings, with complete lack of empathy or consideration of the lives of others; and if they survive, display a dispassionate lack of remorse for the people they hurt and the innocent lives they have taken. They should therefore be considered competent and legally sane when the acts are committed despite the underlying diagnosis of psychopathy — MSD syndrome. Those who succeed in carrying out such heinous acts should know they would be stigmatized as sociopathic freaks of nature and not gain the desired fame and notoriety they so much yearn.

Mental health research needs to be intensified with a multidisciplinary approach in the study of the MSD syndrome, including not only psychologists but also sociologists and criminologists. Just the fact that we categorize the MSD syndrome as a mental disorder, subject to medical investigation and studies, may serve enough of a deterrence to many of those seeking notoriety and inflicting misdirected punishment on society for their personal failures.  We must find effective alternative medical and law enforcement solutions to the MSD syndrome without curtailing liberty from the rest of society.

Written by Dr. Miguel Faria

Miguel A. Faria, M.D. is a retired clinical professor of neurosurgery and long time medical editor. He is the author of Vandals at the Gates of Medicine (1995); Medical Warrior: Fighting Corporate Socialized Medicine (1997); and Cuba in Revolution — Escape From a Lost Paradise (2002). His website is http://www.haciendapub.com.

This article may be cited as: Faria MA. The Las Vegas massacre and the Mass Shooting Derangement (MSD) syndrome. HaciendaPublishing.com, October 5, 2017. Available from:  http://haciendapub.com/articles/las-vegas-massacre-and-mass-shooting-derangement-msd-syndrome-miguel-faria-md 

Shorter versions of this article were also published in GOPUSA.com and The Telegraph (Macon) on October 5, 2017

Copyright ©2017 Miguel A. Faria, Jr., M.D.

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Comments on this post

Study them as lab rats!

From GOPUSA

Dickyllyes: I believe the shooter had just started on SSRI’s. He was a perfect candidate for this medication. One of my favorite stories is of a 70 something man who held up a Savings and Loan where he had tens of thousands on deposit just after starting SSRI’s.

Somebody needs to cover this. Dozens, possibly hundreds, of cases settled against big pharma with results sealed. Apparently there is a period just after starting them when for some people the effects can be intense, and one of the effects is that those on them are reluctant to tell others what is happening.

I think there is a certain type, which I think could be discovered through more personal discussion with the subject, that will experience an intoxicating effect beyond anything they ever thought possible, while leaving them physically able to exert a huge amount of effort and planning to carry out their plans to get even. Mean drunks that don’t pass out or stagger who think they have finally understood the cause of their problems.

Ituser: Great article Dr... And I agree, more study needs to be done.. Preferably with brains being chopped up into slices and studied to see if there are any markers that might link all these shooters...

BUT you can bet if there are any, the left will rail that "THIS IS PROOF THESE PEOPLE ARE not guilty for their crimes."

Oldshooter: The shooter was not on SSRIs, although he had received,and filled, a prescription for Valium several months earlier. A Dr. Patterson in Reno commented that “marksmen” often use such drugs to calm their nerves. In 55+ years of shooting, I have never encountered either a competitive civilian or military shooter who did so, probably because it would impair your performance, and frankly, I think the idea is pure BS.

The whole idea that psychotropic drugs are a likely culprit, makes zero sense. Since anyone willing to carry out such a heinous act, is obviously psychologically disordered,it is reasonable to expect them to be receiving treatment, usually including psychotropic drugs. Why would any thinking person assume that a mental case who acted out was driven to do so by his medicine, rather than his psychological disorder? When a cancer patient receives radiation therapy and subsequently dies, you don’t blame the radiation therapy, do you? When a crazy psychiatric patient acts crazy, the odds are that it wasn’t caused by his treatment either. It just suggests the treatment failed.

Dido: I agree old shooter. Yes, why were they on those drugs to begin with? They are psychopaths on treatment, but as Ituser says we need to study the brains of these lab rats.

Mass murderers, sick?

As usual, Dr. Faria looks at things from a fresh angle. Instead of glorifying mass murderers, or merely expressing anger (even though well-deserved), let us treat them as a variety of psychopathology. "You're sick!" is not a compliment, even for a criminal. But we have to be careful not to allow this to provide an insanity defense. That could be a problem.
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Our system has already the insanity defense but what these individuals don't have is a medical (psychopathologic) diagnosis. But, as always, you make a good point, and it offers me the chance to state that the tentative MSD diagnosis should not be construed to imply that they these individuals are insane and not legally responsible for their actions. On the contrary, in the inserts in the article, the two shooters who survived were found guilty and are serving long prison sentences. Psychopaths are usually deranged, knew what they were doing with logical premeditation and planning, competent, and sane. I don't know of any recent cases of mass murderers being executed. As such, I think they should be studied as long as they are secured in those facilities.---Miguel A. Faria, MD