As many people I have been following the case of the Colorado shooting massacre very closely, especially since I am not only a psychiatrist but also from Arizona, where Jared Loughner went on a shooting rampage only 2 years ago. I have been asked over and over what my thoughts are on what happened, what was his diagnosis, and what could have caused someone to do this. To hear more of my thoughts please see my media page for several recent interview I did at My Media. In short however there is a lot of misinformation being spread in the news and media by people who are frankly not educated or trained in the field of psychiatry.

Most psychiatrists would likely look at the events of the last few days and preceding months and largely agree there were signs and symptoms consistent with a psychotic illness. A lifetime of relatively normal behavior, huge stressor introduced into his life in the form of a move and rigorous academic program, isolation and dropping out of school, beginning to act bizarre and have a change in personality and ultimately dress up like the Joker, dye is hair bright orange and randomly shoot 70 unknown people in a movie theatre playing Batman while he was dressed as the Joker. Then commenting to police when aprehended that “I am the Joker.”  Now if one was to examine a patient in this case, a psychiatrist has no lab tests, x-rays or other ways to make a diagnosis other than what the patient tells them, how the patient has behaved over the recent past and distant past and observations from other people who know him.  Often when a patient is mentall ill, they do not speak or say anything and it is simply the observation of the patient that leads to a diagnosis.

So how this case is any different in an age where we can see up to the second video, interviews, and information regarding all of the above that is used to make a diagnosis if one was actually “examining” a patient is unclear. I personally rarely make a diagnosis so quickly even in person however so for myself, I will often wait until there is more clear evidence before slapping someone with a label.  I will do the same in this case but many people slap a diagnosis on a patient after 5 minutes of “examining” them and is not questioned.   The point is I think it is very reasonable to educate and properly inform the media about some explanation to this chaotic behavior rather than useless speculation pollute the publics mind which only leads to further stigma of psychiatry.

With that said, I do feel he showed clear symptoms of a progressing psychotic illness. Severe bipolar illness and schizophrenia can present like this but delusional behavior of this sort, where the persona of an evil character is adopted and fantasy lived out in reality is more more indicitive of the psychotic delusions in schizophrenia rather than bipolar disorder. However either are possible.

Its also possible drugs could have contributed to either the initial onset of psychosis or the ongoing psychosis, however the symptoms over the course of months are simply not consistent with an explanation entirely due to drug use. Keep in mind many graduate students are using amphetamines such as adderall and ritalin to stay up all night, study and be more productive. These medications in any person can cause hallucinations and delusions when coupled with no sleep. If you have someone with a predisposition to a psychotic illness, this can be the trigger for the start and unraveling of a progressive episode.

Last, which I feel is inappropriate is the speculation that this person had lived a horrible childhood, was abused, angry and lacks empathy-in essence is a “sociopath” or more formally is “antisocial.” I do not think there is any observable behavior or evidence that this is true and this type of statement truly is speculation, especially when the events and behaviors were not consistent with an anti-social person. To diagnosis anti-social (sociopathy for all intents and purposes although there is a difference) one needs to have a history as a child of clear behavior which is disruptive, disregarding human rights, consistently showing no empathy and a long pattern of observable anti-social behavior.  An honors student, who is quiet, shy and “a bit wierd” who starts a phd program and has had absolutely no history of any of this behavior, who all of a sudden over the course of months ends up where he is now, is not at all consistent with someone who was anti-social and quite frankly that is not going to be an explanation in this case and I wish people would stop propogating this in the media.

So what is psychosis? Delusions or hallucinations is a good start. Being out of touch with reality.  Have you ever had an extremely vivid, detailed dream that made absolute sense while dreaming, only to wake up, think about it, and realize it made absolutely no sense? This is the closest glimpse into a psychotic mind you can take without truly being psychotic.  Someone who is psychotic interprets people, his surroundings and his world in a bizzare, often non-sensical fashion, although to them it makes complete sense-just like our dreams often do to us.  This also means that someone who is very psychotic, can be out of touch with parts of reality but not be unable to carry out months of detailed planning, premeditation and organization. Unfortunately that is other erroneous information being spread. You can be very psychotic yet very able to plan and execute an extremely detailed plan which was done in this case.

The bottom line-I do believe this shooter was showing signs and a pattern consistent with the onset of a progressive psychotic illness. I do feel his delusions and loss of touch with reality likely began slowly and involved Batman because that was one of his interests. He likely integrated aspects of Batman and its characters into his delusions and in his mind fantasy and reality m