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Mass Shootings: The New Manifestation of an Ancient Phenomenon and their Link to Psychiatric Drugs

Individuals perpetrating unspeakable acts of violence is not a new phenomenon. What’s new, rather, are the altered states of consciousness induced by antidepressants and other psychotropic drugs well-documented to promote homicidal and suicidal behavior in susceptible individuals.

Although semi-automatic weapons have enabled the infliction of mass casualties at an unprecedented scale, massacres perpetrated by lone individuals are not new phenomena. Rather, these tragic and inexplicable events may represent an incarnation of a more ancient phenomena called “running amok,” formerly believed to be a culture-bound syndrome isolated to certain societies.

The Resemblance of Mass Shootings to Running Amok

Used in colloquial verbiage to indicate an irrational individual wreaking havoc, the linguistic origins of “running amok” stem from the description of a mentally perturbed individual that engages in unprovoked, homicidal and subsequently suicidal behavior, oftentimes involving an average of ten victims (1).

Although it was not classified as a psychological condition until 1849, amok was first described anthropologically two hundred years ago in isolated, tribal island populations such as Malaysia, Papua New Guinea, Puerto Rico, the Philippines, and Laos, where geographic seclusion and indigenous spirituality were hypothesized to be cultural factors implicated in this culture-bound syndrome. In his eighteenth century voyages, for example, Captain Cook recorded Malay tribesman randomly maiming or executing animals and villagers in a seemingly unprovoked, frenzied attack (1).

Culturally-encapsulated explanations localized blame to spirit possession by the “hantu belian” or evil tiger spirit of Malay mythology, which was believed to have been the source of the involuntary, indiscriminate violence that characterizes amok. In native cultures, sacred healers of the folk sector operated under cultural ideologies where illness was believed to be of supernatural origin, so amok was tolerated as an inevitable element of the cultural experience and offenders were brought to trial (1).

As Western expansion encroached on remote cultures, incidence of amok decreased, reinforcing the biased view that so-called primitive cultural ideas were responsible for its pathogenesis. Meanwhile, episodes of violence in Western civilizations began to escalate, culminating in the unparalleled modern statistics where shootings have become so frequent that those unaffected become numb and desensitized to their devastating effects, and all live with the threat of an impending shooting as an everyday reality. Formerly considered a rare psychiatric culture-bound syndrome, researcher Dr. Manuel Saint Martin (1999) argues that amok is also prevalent in contemporary industrialized societies (1).

Resurgence of this Ancient Construct in Modern Shootings

Saint Martin postulates that the escalating frequency of mass homicides in industrial cultures in the past quarter century represents amok, citing that attackers often have a history of mental disturbance and that modern-day episodes involve similar numbers of victims (1).

He likewise disputes classification of amok as a culture-bound syndrome, since it seems to appear cross-culturally, and argues instead that culture is the mediating mechanism that determines how the violence manifests (1). For example, Jin-Inn Teoh (1972) claimed that amok appears universally but that its mode of expression in terms of weapons and methods used are culture-specific (2). Furthermore, John Cooper (1934) postulated that its affiliation with suicide, a practice transcending arbitrary cultural boundaries, disproves the classification of amok as a culture-bound syndrome (3). Cooper further highlights that amok may be an indirect expression of suicide, induced by the same psychosocial stressors that produced suicide in contemporary cultures (3) In essence, the author contends that amok is a product of mental illness, which has similar etiology and psychosocial precipitants worldwide (3).

In his comparison of amok to modern-day shootings, Saint Martin advocates prevention by identification of individuals with risk factors and treatment of underlying psychological conditions (1). In addition to coworker, neighbor, friend, and family observations of susceptible individuals, Saint Martin states that physicians are uniquely positioned to collect data regarding those vulnerable to amok, since, “Many of these patients preferentially consult general and family practitioners instead of psychiatrists owing to the perceived stigma attached to consulting a psychiatrist, denial of their mental illness, or fear of validating their suspicion that they have a mental disorder” (1). However, the arsenal of tools wielded by the conventional allopathic doctor, with their magic bullet remedies and treatment algorithms, often falls short.

Addressing the Root Cause: Psychiatric Drugs Engender Violence

Although amok explains the deep-seated human tendency to engage in acts of violence, it does nothing to explain the recent increase in frequency. While many argue that access to semiautomatic weapons explains the explosion in mass shootings, one long-neglected element of the conversation is that the recent rise in mass homicides coincides with the greatest use of cognition-altering psychiatric drugs ever observed in human history.

Oftentimes, shooters are branded as bad apples, a narrative that allows for the rationalization of such heinous crimes and marginalizes assailants as social deviants and mentally deranged anomalies. However convenient this rhetoric is for imparting meaning to the unfathomable, it does nothing to prevent future incidents or to understand the trajectory of events or the biological and psychological variables that enabled individuals to perpetrate these tragic acts of terrorism. It enables the system and society to wash their hands of any culpability and critical analysis of how people can commit unspeakable violence.

Due to media distortion, the story line disseminated in public spheres diverges dramatically from the conversations played out in the academic sector and these questions remain largely absent from the mainstream dialogue. A perusal of the academic research, however, reveals that psychotropic drugs may be contributing to the epidemic of mass shootings. In 2011, 26.8 million adults in the United States used pharmaceutical drugs for mental illness (4). Two years later, the Medical Expenditure Panel Survey (MEPS) found that nearly 17 percent of American adults filled at least one prescription for a psychiatric drug.

Psychiatric drugs, many of which are based upon the flawed serotonin theory of depression, send almost 90,000 people to the emergency room yearly as a result of medication side effects ranging from delirium to head injuries to movement disorders, and one in five of these visits culminates in hospitalization (4). This figure is an underestimate, as it excludes visits to the emergency department secondary to drug abuse, self-injurious behavior, or suicide attempts (4).

Preliminary reports from the Las Vegas shooting that left at least 58 people dead indicate that the alleged killer was prescribed Valium, a sedative-hypnotic drug classified as a benzodiazepine (5). Relevant to this insight is a meta-analysis of 46 studies published in the Australian & New Zealand Journal of Psychiatry, which illuminated that, “An association between benzodiazepine use and subsequent aggressive behaviour was found in the majority of the more rigorous studies,” especially in those individuals with an underlying propensity toward anxiety and hostility (6). In addition, a prospective cohort study of nearly one thousand Finnish subjects published in the journal World Psychiatry demonstrated that current use of benzodiazepines elevated risk of homicide by 45% compared to controls (7).

Data compiled from the U.S. Food and Drug Administration (FDA) adverse event reporting system similarly highlights that use of some antidepressant medications is disproportionately related to an increased number of violent events (8). The authors report that, “Varenicline, which increases the availability of dopamine, and antidepressants with serotonergic effects were the most strongly and consistently implicated drugs” in case reports of “homicide, homicidal ideation, physical assault, physical abuse or violence related symptoms” (8).

Psychotropic Drugs and The Absence of Informed Consent

At the epitome of this discussion is that deleterious side effects of psychotropic drugs are ill-publicized and patient do not receive sufficient information about the devastating sequelae that can result from their use. Little of the public knows that in 2004, the Food and Drug Administration (FDA) issued a black-box warning for antidepressants, advertising that they are associated with suicidal ideation and behavior in two to three children out of every hundred who are administered these drugs (9, 10). In fact, a meta-analysis of 372 randomized clinical trials entailing nearly 100,000 subjects elucidated that the rate of suicidal thoughts and action was double in those patients assigned to receive an antidepressant compared to placebo (11).

Notwithstanding the tendency of psychotropic drugs to predispose individuals to homicidal and suicidal ideation is the evidence that antidepressants elevate risk of death and cardiovascular disease, which is often not shared when a physician dispenses a slip from their prescription pad. A meta-analysis of 17 studies published in the journal of Psychotherapy and Psychosomatics found that in the general population, antidepressant medications increase all-cause mortality (death from any cause) by 33% and the risk of cardiovascular incidents (heart attacks and strokes, for example) by 13% (12). According to researchers, “The results support the hypothesis that ADs [antidepressants] are harmful in the general population” (12).

Also rarely discussed with patients is the potential of psychotropic drugs to distort emotional affect. Selective serotonin reuptake inhibitors (SSRIs) have mind-numbing effects, as demonstrated by their ability to blunt emotions and produce apathy, disinhibition, and amotivation similar to a frontal lobe lobotomy, all of which would be consistent with a mindset that might predispose an individual to homicidal behavior (13). As a corollary, SSRIs are known to induce serious movement disorders, including akathisia, dyskinesia, tardive dyskinesia, dystonia, and parkinsonism (14). Pertinent to this discussion is akathisia, a form of severe agitation also induced by antipsychotic drugs, which can cause suicide and violence (15). Further, almost one in ten admissions to hospital psychiatric units have been attributed to antidepressant-induced mania or psychosis (16).

Moreover, it is often not disclosed that antidepressant therapy can exacerbate the severity and chronic nature of depression and lead to poorer outcomes. For instance, one retrospective study of nearly 12,000 patients in the Netherlands revealed that 72 to 79 percent of those who were treated with antidepressants during their first depressive episode experienced relapses (17). It is telling that despite record high rates of antidepressant use, prevalence of depression continues to soar. 

Lastly, meta-analyses, which compile data from placebo-controlled trials, indicate that the differences in levels of symptoms resulting from SSRI use “were so small that the effects were deemed unlikely to be clinically important” (18). Further, a meta-analysis involving 6,944 patients participating in 38 studies underwritten by drug manufacturers found that “Antidepressants demonstrated a clinically negligible advantage over inert placebo” (19). This is all the more shocking, since the efficacy of the drug was likely artificially inflated. Researchers state, “This analysis probably overestimates the antidepressant effect because placebo washout strategies, penetration of the blind, reliance on clinician ratings, use of sedative medication, and replacement of nonresponders may penalize the placebo condition or boost the drug condition” (19).

It is incumbent upon physicians to provide patients with true informed consent as to the potential disastrous consequences of consuming mind-altering psychotropic drugs, to identify at-risk individuals and mobilize support, and to provide alternatives where applicable. For instance, luminary Dr. Kelly Brogan, who has been a pioneer in debunking mythologies of conventional psychiatry, recently published the success of her holistic protocol incorporating mind-body techniques, dietary and lifestyle interventions, detoxification modalities, and targeted supplementation in producing dramatic clinical remission in a patient with bipolar disorder with psychotic features, panic disorder, and premenstrual dysphoric disorder (20). 

Other Risk Factors for Amok and Mass Shootings

Compounding the effect of skyrocketing prescription rates for violence-promoting psychotropic drugs is the unprecedented social isolation that accompanies the digital age. The common thread uniting amok and contemporary mass shootings is what is branded mental illness, which is often inextricably intertwined with social alienation in a chicken-or-egg scenario.

In the anthropological curiosity known as amok, dimensions such as grief, acute loss, and interpersonal stress are intimated to be contributing factors (1). For instance, an 1846 Malay incident was concluded to be caused by an elderly mans bereavement of his wife and child, while the offender in a 1998 Los Angeles incident suffered financial bankruptcy (21). Furthermore, individual characteristics, such as predilection to aggression, and recurring cognitive themes such as persecution and revenge are speculated to constitute instigating elements (1).

Undoubtedly at play in mental illness is that we are divorced from our nuclear families, proverbial islands adrift from the quintessential tribe and support system to which we are evolutionarily adapted. Social ostracism was historically the ultimate ancestral punishment, as an individual was ill-equipped to survive when banished from a community. Moreover, admissions of psychiatric disorders are met with derision and social stigmatization, and the mobilization of social and professional support needed to contend with mental illness is radically deficient. Therefore, many individuals are deterred from seeking professional help.

Initial narratives by amok witnesses chronicled two forms characterized by differential causative factors: “The more common form, beramok, was associated with a personal loss and preceded by a period of depressed mood and brooding; while the infrequent form, amok, was associated with rage, a perceived insult, or vendetta preceding the attack” (1). Many of these traits can be reconciled with the diagnostic criteria for modern psychiatric disorders such as depressive, mood, psychotic, dissociative and personality disorders, as well as paranoid schizophrenia (1). Some argue that psychiatric classifications are not reproducible or diagnosable with objective biomarkers, and therefore do not constitute objectively delineated and non-overlapping categories, but they do have utility in their ability to describe and operationalize behavior in recognizable terms.

According to Saint Martin, “Viewing amok from this new perspective dispels the commonly held perception that episodes of mass violence are random and unpredictable, and thus not preventable” (1). However, the modern medical infrastructure has failed to support these individuals with anything other than pill-for-an-ill psychotropic cocktails and psychotherapy, rather than undertaking a holistic, root-cause resolution approach consistent with the precepts of personalized medicine. Instead of deferring to this standard of care, which has proven inadequate, we would be wise to use these societal tragedies as impetus for revolutionary reform and the heralding of evidence-based natural approaches that address the underlying causes of mental illness rather than applying symptom-suppressive chemical band-aids.

Going Forward: Making Sense of Devastation

In summary, the behavior exhibited in modern mass shootings bears uncanny resemblance to amok, indicating that indiscriminate violence has long been intrinsic to the human psyche. It is fundamental to recognize, when drawing parallels between the two constructs, the role that social isolation, collective disillusionment, violent proclivities, and mental instability play in precipitating this behavior in order to generate effective solutions. More recently, the widespread use of psychotropic drugs no doubt contributes to the rising incidence of mass shootings, yet it is a topic mainstream media outlets fail to broach.

However, the prescribing of these pharmaceuticals is only symptomatic of more upstream causes of psychological imbalance, many of which remain to be elucidated. Fundamental, though, is the profound disparity between the circumstances to which we are evolutionarily accustomed and the modern-day stressors we encounter, such as micronutrient deficiency, toxicant burdens, a genetically engineered and irradiated food supply, and a deeply-entrenched sense of dissatisfaction and loss of social connection.

This is not meant to catalogue excuses for such egregious and monstrous behavior, or to rationalize the very worst in humanity. Nor is it meant to represent an exhaustive survey of all the multifaceted socioeconomic, psychosocial, and geopolitical variables that contribute to acts of mass violence. But rather, this article serves as a commentary on some of those little-discussed instigating variables and the pharmaceutical industry-promulgated predecessors to such tragic events. It also attempts to paint a portrait of how massacres are not isolated to the modern era, and that by using critical analysis of the historical patterns of amok we can garner insight into shared risk factors such as detachment of an individual from the fabric of society and lack of supportive resources or constructive coping mechanisms.

By finding common psychological threads, and exploring their physiological origins, as well as unearthing novel variables such as psychotropic drugs which contribute to the never-before-witnessed frequency of fatal massacres, we can take productive action to prevent their recurrence. We can transform our righteous indignation into meaningful change. Although it is tempting to abdicate all blame and to employ the bad apple narrative, this does nothing to prevent the recurrence of these home-grown acts of terrorism, but rather, represents a society-wide coping mechanism and means of distancing oneself from some of the sources of these ultimate acts of unimaginable aggression.


References

1. Saint Martin, M.L. (1999) “Running Amok: A Modern Perspective on a Culture-Bound Syndrome”. Primary Care Companion to the Journal of Clinical Psychiatry, 1(3), 66-70. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181064/?tool=pmcentrez

2. Teoh, J-I. (1972). “The changing psychopathology of amok”. Psychiatry, 35, 345–351.

3. Cooper, J. (1934). Mental disease situations in certain cultures: a new field for research. Journal of Abnormal Sociology and Psychology, 29, 10–17.

4. Hampton, L.M. et al. (2016). Emergency Department Visits by Adults for Psychiatric Medication Adverse Events. Journal of the American Medical Association Psychiatry, 71(9), 1006-1014. doi:  10.1001/jamapsychiatry.2014.436

5. Harasim, P. (2017). Las Vegas Strip shooter prescribed anti-anxiety drug in June. Retrieved from https://www.reviewjournal.com/local/the-strip/las-vegas-strip-shooter-prescribed-anti-anxiety-drug-in-june/

6. Albrecht, B. et al. (2014). Benzodiazepine use and aggressive behaviour: a systematic review. Australian and New Zealand Journal of Psychiatry, 48(12), 1096-1114. doi: 10.1177/0004867414548902

7. Tilhonen, J. et al. (2015). Psychotropic drugs and homicide: A prospective cohort study from Finland. World Psychiatry, 14(2), 245-247. doi: 10.1002/wps.20220

8. Moore, T.J., Glenmullen, J., & Furberg, C.D. (2010). Prescription drugs associated with reports of violence towards others. PLoS One, 5, e15337.

9. Friedman, R.A. (2014). Antidepressants' Black-Box Warning — 10 Years Later. The New England Journal of Medicine, 371, 1666-1668.

10. Harris, G. (2004). F.D.A. Links Drugs to Being Suicidal. Retrieved from http://www.nytimes.com/2004/09/14/health/fda-links-drugs-to-being-suicidal.html

11. Hamad, T., & Racoosin, J. (2004). Relationship between psychotropic drugs and pediatric suicidality: review and evaluation of clinical data. Silver Spring, MD: Food and Drug Administration. Retrieved from http://www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4065b1-10-TAB08-Hammads-Review.pdf

12. Maslej, M.M. et al. (2017). The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis. Psychotherapy and Psychosomatics, 86, 268-282.

13. Garland, E.J., & Baerg, E.A. (2004). Amotivational Syndrome Associated with Selective Serotonin Reuptake Inhibitors in Children and Adolescents.  Journal of Child and Adolescent Psychopharmacology, 11(2), 181-186.

14. Gerber, P.E., & Lynd, L.D. (1998). Selective serotonin-reuptake inhibitor-induced movement disorders. Annals of Pharmacotherapy, 32(6), 692-698.

15. Shear, M.K., Frances, A., & Weiden, P. (1983). Suicide associated with akathisia and depot fluphenazine treatment. Journal of Clinical Psychopharmacology, 3, 235–236.

16. Preda, A. et al. (2001). Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Journal of Clinical Psychiatry, 62(1), 30-33.

17. van Weel-Baumgarten, M. et al. (2000). Treatment of depression related to recurrence:10-year follow-up in general practice. Journal of Clinical Pharmacy and Therapeutics, 25, 61-66.

18. Moncrieff, J., & Kirsch, I. (2005). Efficacy of antidepressants in adults. British Medical Journal, 331 (155). doi: https://doi.org/10.1136/bmj.331.7509.155

19. Antonuccio, D.O., Burns, D.D., & Danton, W.G. (2002). Antidepressants: A Triumph of Marketing Over Science? Prevention & Treatment, Volume 5(25).

20. Brogan, K. (2017). Resolution of Refractory Bipolar Disorder With Psychotic Features and Suicidality Through Lifestyle Interventions: A Case Report. Advances in Mind Body Medicine, 31(2), 4-11.

21. Burton-Bradely, B.G. (1968). The amok syndrome in Papua and New Guinea. Medical Journal of Australia, 55, 252–256.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.
Sayer Ji
Founder of GreenMedInfo.com

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