Was Cho a psychopath, a depressive, or a psychotic?

Health and medicine explained.
April 20 2007 3:45 PM

Psychopath? Depressive? Schizophrenic?

Was Cho Seung-Hui really like the Columbine killers?

Today is the eighth anniversary of the Columbine massacre, and it is a particularly disturbing one. With his sadistic creative writing, contempt for snotty rich kids, militaristic posing, and heavily plotted revenge fantasy, Virginia Tech killer Cho Seung-Hui has eerily reminded many Americans of Columbine murderers Eric Harris and Dylan Klebold. Cho apparently saw Klebold and Harris as kindred martyrs, giving the boys two separate shout-outs in his suicide manifesto. But how deep do the similarities run? And what can the multiyear effort to understand Klebold and Harris teach us about Cho?

Like Cho, the Columbine killers left a mountain of writings and videotapes, which seemed confusing when doled out in little sound bites. But in time, and in the context of all the evidence, investigators found Klebold's and Harris' ideas diabolically coherent and cohesive, fitting into highly recognizable patterns. Cho may prove tougher to comprehend, because he wasn't just confusing, but inarticulate. In person, he barely spoke. And the two plays that have surfaced are infantile.

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Yet television analysts have Cho deconstructed already: He's a madman, he's a psychopath, a schizophrenic, a psychotic—or maybe just an angry depressive. Experts have rendered definitive diagnoses on every network—and they are wildly contradictory. The Today show alone has made a grand tour through the diagnostic manual. Thursday morning Matt Lauer proclaimed Cho "clearly a psychotic individual." Lauer described psychosis as an evolution from his previous diagnosis of depression. "We should make the differentiation there," Dr. Lauer advised.

A few hours after Cho's videos were aired on NBC Nightly News, CNN's Larry King hosted a panel on what drove the killer. A distinguished psychiatrist and psychotherapist who works with the mentally ill saw mental illness. "There are a lot of red flags here for some schizophrenialike or psychotic disorders," said Dr. Gail Saltz, psychiatrist at New York Presbyterian Hospital. Criminal profiler Pat Brown, who works with law enforcement, saw a sane, rational actor in control of his faculties. "He's a vicious psychopath," she said. "He wanted lots of power and control." And neurosurgeon Dr. Sanjay Gupta broached the possibility of physical damage to Cho's brain.

Aside from its brevity, King's discussion turned out to be one of the better examinations of Cho this week, because it pulled together the major theories onto one TV set. Experts from the various disciplines have been coalescing around three possibilities for Cho's underlying condition: depression, psychopathy, or psychosis. Those conditions, often conflated, are extremely different and would offer very different explanations for why Cho killed and what made him snap. (Cho's great-aunt added a fresh wrinkle Thursday, suggesting he might have been diagnosed autistic as a child. It remains to be seen whether this diagnosis was accurate or potentially evidence of another developing malady.)

The predominant initial theory, which still retains support, is that Cho suffered from anger fused with depression. With school shooters, the anger almost always begins with a loss. The definitive Secret Service study on school shooters found the killers varied in every trait except two: every shooter was male, and 98 percent had experienced a significant loss, grievance, or sense of failure. Two-thirds felt some sort of failure, and half had lost a loved one—typically meaning they'd been dumped. Everyone gets dumped and gets dumped on. "Most of us get angry, kick a trash can, drink a beer or two, and get over it," said Dr. Dwayne Fuselier, an expert on gunman psychology who headed the FBI's Columbine investigation. But for a few, the anger festers. "Anger turned inward results in depression," Fuselier said, "withdrawing from friends, relatives, etc."

Most get help or get over it; some get worse and kill themselves. But for a tiny percentage, suicide is not enough. The next step up is a "vengeful suicide," like shooting yourself in front of the wedding photo to splatter it with blood and brains. Some men—nearly always men—take it a step further and shoot the offending boss or girlfriend before himself. For a rare few, that still won't satisfy their rage. They blame everyone for their misfortune, and they want to make sure we feel it and that word travels. Life is hell, they insist, and it's not their fault. If they're going to die, you people will, too.

Columbine killer Dylan Klebold was a classic example of the angry depressive. He told us all about it in his journal and videos. Superficially, Klebold seems a lot like Cho: painfully shy, apparently depressive and suicidal. Both resorted to imaginary girlfriends. Klebold had an actual girl in mind—it was the love he imagined; he had never managed to speak to her. According to a roommate, Cho confided that he dreamed up a supermodel girlfriend named Jelly. She called him Spanky. In real life, Cho stalked a series of women, who spurned his advances and called the police. He rarely expressed emotion, but he was bottling up anger at perceived sleights and abuses. It all spilled out in monotone on his suicide videos: "You have vandalized my heart, raped my soul, and torched my conscience. ... You have never felt a single ounce of pain your whole life. And you want to inject as much misery in our lives because you can, just because you can."

 A smaller but significant number of experts see psychopathic traits in Cho. Klebold's partner, Eric Harris, was textbook psychopath. Most psychopaths are nonviolent, but when they do turn to murder, the path is much simpler than for the depressive. They are convinced of their superiority and blame the rest of us for their predicament from the start. Cho demonstrated characteristic psychopathic contempt for his peers: "Your Mercedes wasn't enough, you brats," he complained. "Your golden necklaces weren't enough, you snobs." Vodka, Cognac, debaucheries—"you had everything." Psychopaths are cold, calculating, and ruthless, with no empathy for others, so our suffering bears no weight in their calculations. They are perfectly sane and suffer no mental illness—they just don't care. But Cho exhibited none of the social charm characteristic of most psychopaths. And their trademark manipulation and lying for pleasure remain to be seen in Cho.

And then there is the possibility that Cho was psychotic. Dr. Frank Ochberg, an expert on violence and psychiatry, began to wonder about psychoses when he read Cho's plays. Psychosis is a broad term covering a spectrum of severe mental illnesses, including paranoia and schizophrenia. Psychotics can grow deeply disoriented and delusional, hearing voices and hallucinating. In severe cases, they lose all contact with reality and literally don't know what they are doing. They sometimes act out of imaginary yet terrifying fear for their own safety, or instructions from imaginary beings. Anger management doesn't calm them: They truly cannot help themselves.

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