Transcript NMETH526 Test File - University of Washington

UNIVERSITY OF WASHINGTON SCHOOL OF NURSING
NURS 509
Killers
School of Nursing
Jeff Tebbs
Eric Pauli
Page Collins
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• http://www.youtube.com/watch?v=nJ4
hdCkQ7EI
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KILLERS
‘‘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)
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Killers
• Outline
– Introduction/Definitions
– Types & Theory
• Components
• Theory
• Female Killers & HCP
– Biological Theories
– Infanticide
– Conclusion
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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)
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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
– 302
1800-1979
1980-1995
(Castle & Hensley, 2002)
0.2
20.1
case/yr
case/yr
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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)
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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)
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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)
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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)
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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)
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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).
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Episodic Aggression Patterns
1: ritualistic behavior
2: masks of sanity
3: compulsivity
4: search for help
5: severe memory disorders
6: chronic inability to tell the truth
7: suicidal tendencies
8: sexual assault hx
9: sexual deviance/hypersexuality
10:head injuries or birth injuries
11:chronic drug or alcohol abuse
12:substance-abusing parents
13:victim of abuse
14:cruel parenting
15:result of unwanted pregnancy
16:product of difficult gestation
17:interrupted bliss or no bliss in
childhood
18:cruelty to animals
19:arson tendencies
20:neurological impairment sx
-evidence of genetic disorders
21:powerlessness/inadequacy.
(Norris,1998; Castle & Hensley, 2002)
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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)
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Psychopathy
1991 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)
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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:
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anger
hostility
frustration
low self-esteem
feelings of inadequacy
(Hickey, 1997; Castle & Hensley, 2002)
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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)
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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
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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)
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Frustration Theory
Amsel (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
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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
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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
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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
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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)
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Learning Theory
Dollard & 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
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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
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Military Training
• Servicemen were not very inclined to kill
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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:
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brutalization
classical conditioning
operant conditioning
role modeling
(Grossman, 1996)
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Military Training
• Classical Conditioning
– Violence=pleasurable consequences
– Japanese Military
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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)
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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)
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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)
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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)
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Female SK Cases
• In 34 cases of US female serial killers 1795-1988
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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)
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Female SK Casese
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•
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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’)
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Categoiries
(Frei et al, 2006)
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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:
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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)
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Narcissism
• Psychodynamic perspective
– primitive defence mechanism of malignant
narcissism
• Narcissistic personality structure
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Grandiosity
need for power
unrestrained aggression
antisocial behavior
ego-syntonic sadism has been associated
(Haller, 1999; Turco, 2001; Frei et al, 2006)
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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)
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ASD Link?
•
Onset: early childhood
– More apparent/disabling as social skills more important
(Berney, 2004)
•
Case studies most commonly describe sexual and physical violence
•
Theory of Mind and Empathy:
(Siponemaa et al., 2001)
– Lack of understanding another person’s thoughts/feelings underlies ASD
aggression
(Murrie et al., 2002)
•
Antisocial & schizoid PDs: differential diagnoses of Asperger’s
•
Schizoid PD and Asperger’s closely related
•
The distinction b/t PDs and ASD is challenging when sx are mild
(Berney, 2004)
(Wolff, 2000)
– More blurred as etiological models for both disorders have moved closer
together
(Frei et al, 2006)
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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)
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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:
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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)
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CASK Review
•
•
Significant concern beyond a few shocking, isolated incidents
Of 90 worldwide prosecutions (1970-2006)
•
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
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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
– There are an additional 80 murder charges & 26 assault charges
– There are an additional 242 suspected victims
(Yorker et all, 2006)
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CASKs by Profession
(Yorker et all, 2006)
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CASK Cases by Method
(Yorker et all, 2006)
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CASKs by Injection
(Yorker et all, 2006)
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Risk/benefit
•
•
Very few of the killers had a criminal record
many had histories of falsifying their credentials or background
•
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HCP misrepresentation a serious risk factor
Influenced by shortage of nurses
Risk management favors policies geared toward preventing lawsuits:
•
Cost of defending an employment rights lawsuit:
– 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
– wrongful termination, denial of employment, or defamation.
– Often several hundred thousand dollars.
– Cost appears to have influenced current risk management policies.
(Yorker et all, 2006)
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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?
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• http://www.youtube.com/watch?v=kXk
ZMA73-2U
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• 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.
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• "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.
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• 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.
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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.
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• 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).
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• 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.
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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.
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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 thrilloriented serial killer who increases the frequency of
his murders.
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"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
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• 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.
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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.
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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.
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• 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 mutantaggressive behavior, there is not
much evidence that links the X or
Y chromosome to serial killers.
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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.
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• 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.
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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 history
and in all societies.
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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
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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.
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Art?
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For the kids
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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."
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
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• http://www.youtube.com/watch?v=djeo
abid7s4
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http://www.youtube.com/watc
h?v=kmeULp1M85c
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References
Bateman, 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.
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Symptom Overlap
PTSD is not necessarily the most common disorder, but its onset is most easily defined
(Foa, Stein, & McFarlane, 2006)
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Symptom Duration
“Acute stress reactions are normal & expected responses, seen in the majority of cases.”
(Foa, Stein, & McFarlane, 2006, p. 15)
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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)
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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)
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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)
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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)
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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)
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References
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•
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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.
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School Shootings: Survivalism
By: Eric Pauli
NURS 583
University of Washington
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Bowling for Columbine
http://www.youtube.com/watch?v=H6Welsq8vZM
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School Shooting
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.
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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.
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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.
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• 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 socialcognitive processes, antisocial behavior, early pattern of
aggressive behavior*, etc.
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Media Coverage
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Media Violence
-Children in U.S. have unprecedented access to
both new and traditional media.
-By 18, the average American will have viewed
200,000 acts of violence on TV.
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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.
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School Shooting
• Between 65-86% Students, teachers,
administrators who are victims of
catastrophic school shootings will most
likely experience Posttraumatic stress
and not PTSD.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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• 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."
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I Don’t Like Mondays
http://www.youtube.com/watch?v=GCml
dZM2ZK4
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References
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Anderson, M., Kaufman, J., Simon, T. R., Barrios, L., Paulozzi, L., Ryan, G., et al. (2001). Schoolassociated 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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QUESTIONS?
School of Nursing