70. Acute psychosis as One Cause of Rampage Violence

September 6, 2021

Rarely do our so-called “mass media of communication” provide such a clear picture of the chain of causation of an event that leaves most people shocked, stunned and confused about what to do next.  I happened to catch todays update to an evolving story in the Wall Street Journal, but it also reflected that reported by many other news stories.

Yesterday’s rampage shooting in Lakeland, Florida, of several randomly chosen strangers, including babies and children, clearly illustrates one kind of rampage shooter who especially mystifies and terrifies people.  Its aftermath always brings many questions about how to prevent recurrences in the future.

These are the elements of yesterday’s events:  1)  The shooter is said to be a young ex-marine sharpshooter, age 33, named Brian Riley, with combat tours in the Middle East.  

2)  Since his discharge from the military he has been working as armed security and has a  concealed weapon permit. 

3)  His girlfriend says he has been suffering from PTSD.

4)  His girlfriend says that not long ago, after working as armed security at a church, he came home and told her that while at church he discovered that he could hear God talking to him –and that since that time he has been able to talk directly to God.

5) On Saturday evening he approached a home not far from his own, and told the person who answered the door that he was there to see “Amber”, whom he said was intending to kill herself.  As there was no Amber in that house and his words and behavior were very disturbing, others in the home came to the door and told him to leave or they would call the police.  He left.

6)  Sunday at about 4 in the morning the police were again called to the house and found the young man inside the home, armed and wearing body armor.

7)  Riley fired on the officers, who returned fire. An intense gunfight ensued between the officers and Riley, who was wounded in the battle.  Police later found 4 dead, as well as other wounded individuals, all presumably having been shot by Riley including an 11-year-old girl with several gunshot wounds.

8) Riley later explained he had gone there on direct verbal instructions from God to kill some people.

9)  While he was receiving medical treatment, it was determined that Riley was using methamphetamines.

Though I am a former State Hospital Forensic Psychiatrist  and have treated patients, murderers,  with key features similar to Riley, what follows will not be a diagnosis of Brian Riley. It will be just my educated guess as to what may have happened.  Hopefully, understanding the actual cause of the violent behavior may suggest, how and whether this kind of thing might be prevented in the future.

This story exactly matches several well established and well understood patterns.  The first pattern is of the acute onset of a psychotic state, wherein the mind is in the grip of either one or both of two things: delusions or hallucinations.

In a psychotic state the strange things the mind sees, hears  or believes are completely real to the psychotic individual.  There is absolutely no insight on the part of the psychotic that they are being imagined or generated within his own brain, and do not exist in the real world.  The delusional belief, in this case that he is speaking directly to and receiving direction from God is literal.  It is not an illusion or a metaphor.  Which is why the law does not hold people accountable for their actions while they are in a psychotic state, as long as they are not aware at that moment of the real-world consequences of their acts, or that the act is wrong.

There can be several causes of psychotic episodes.  Among those that are likely relevant to this appalling story are schizophrenia and certain drugs.

Particularly relevant to the present story is the fact that the incidence of Schizophrenia, resulting from miswiring and malfunction of brain circuits, peaks in males in the late teens and twenties.  Its symptoms are often recognized by family and friends only after weeks and months of increasing bizarre  speech and behavior.  It often takes a long time for them to be able to believe that what their son, brother or friend is doing and believing is really happening and is really abnormal.  

However, following instructions directly from God and hearing God’s voice are classic phenomena associated with psychosis and schizophrenia.

Marijuana use can bring out symptoms of schizophrenia much earlier than they would have otherwise appeared.  And methamphetamine use can produce very severe psychosis even without an underlying schizophrenia.

One of my patients stabbed his 18-month-old daughter to death with a butcher knife while in a meth-induced psychotic state, because his voices, representing God, told him that the baby  was (literally) the Devil and would kill the family if he did not kill her.

When these terrible and disturbing violent rampages happen we ask ourselves, “how can we prevent this from happening again”?

I suggest that the only possibility of prevention depends upon understanding the actual causes.  Those with an agenda, or those with a responsibility for protecting our safety but who lack the requisite knowledge or power to do so will fix the blame anywhere other than themselves.

Often they will suggest it’s “the guns”, and seek to disarm everyone.  

But that makes as little sense as saying, “It’s young men”,  and jailing all males between 15 and 40 to prevent such killings.

In cases like the present one, if schizophrenia is the cause, without knowing a way to predict the future, there is probably no possible way to prevent inevitable recurrences, because these young man look perfectly fine, and as often as not the killings they do are among the first manifestations of their hidden and undetectable illness. 

If the methamphetamine has been the cause of a psychosis, a preventive strategy would be to curtail the use of meth, one of the most prevalent of the abused drugs and the mainstay of many regional drug markets in America.

I offer this case as a suggestion as to how to arrive at actual, effective preventive measures, by first making an accurate assessment of the mechanics of causation.

There are only a few common patterns of homicidal violence.

For example, 1) there is the psychotic rampage exemplified here.  2) There is the mass-murder/suicide rampage perpetrated by people with narcissistic borderline, and sociopathic personality disorders, who take their lives when their characteristic rage has nowhere else to go and turns inward.  And who feel entitled to take others with them.  3) And their is gang-related, drug-related street violence and murder associated with street warfare — and low level political and civil warfare.

Each category requires a different kind of solution.

It wouldn’t be all that difficult.  But I don’t sense that many of our leaders are at all interested  in doing that.