Dr. Judy Kuriansky

The tragic massacre in the Navy Yard shooting could have been averted, if the shooter’s mental illness and violent tendencies had been noticed and treated, says noted clinical psychologist Judy Kuriansky.

The 34 year-old ex-Navy reservist, Aaron Alexis, told police five weeks before his killing spree that he feared that three people could harm him, heard voices coming from the ceiling, walls and floor of the Navy base where he was working, and that a microwave machine was sending vibrations through the ceiling of his hotel room to keep him from falling asleep.

Such auditory hallucinations are hallmark symptoms of a condition called paranoid schizophrenia. The voices and sounds are imaginary, but seem real and can lead to violence if they warn of danger from people ”out to get him” or worse, instruct the person to kill the threats.

I have treated people with such conditions in mental hospitals, who are convinced voices are coming out of lamps or radiators, giving them ominous warnings and instructing them to commit violent acts against themselves or others.

Not every person with a paranoid schizophrenia condition or who hears voices gets violent, but there are warning signs and glaring red flags, like:

A history of behavior misconduct and prior irresponsible gun use. Alexis had many run-ins with the law and the Navy, but basically got away with it. He had been thrown out of an Atlanta nightclub in 2008 for disorderly conduct and was arrested several times, in Fort Worth Texas and Seattle, as early as 2004 and then in 2010. He claimed a fireman he discharged was an accident while he was cleaning it-- a typical excuse. The Navy discharged him after many disciplinary infractions, misconduct, insubordination and going AWOL (absent without official leave), but he wasn’t put into treatment and the discharge was honorable - an inappropriate distinction on the Navy’s part in retrospect and a sad reflection on armed forces’ judgment in my view as an Army brat.
Intense anger. The shooter’s father said his son had ‘anger management issues.” Friends said he was angry about inadequate salary and Navy benefits, and felt like a victim of discrimination.
Playing violent video games, in itself not a sure sign of acting out violence, but in this case, friends said he have talked about shooting people while playing the games, and missed work because of playing.
Rejection. Reportedly, the shooter was rejected by a Thai love interest (he had spent time in Thailand whose culture he supposedly liked). Of course not all people who get dumped go out and shoot people, but some harbor such impulses, that can be triggered especially in the context of other factors outlined above; certainly love rejection has motivated many a murder/suicide.

Many systems failed Alexis. He should have been the subject of better screening, background checks, training, and attention to his condition.

Failed by the VA. He had reportedly been in treatment with the Veterans Affairs since August. Was he getting medication? Anti-psychotic medications can calm auditory hallucinations.
Failed by the Navy. The Navy discharged him from his reservist duty, after all the behavior misconduct, but how egregious that they gave him an honorable discharge and did not insist on treatment.
Failed by the state of Virginia, the legal system, and the firearms store that sold him a gun required to be more restrictive with customers with mental disorder. Stricter background checks and enforcement need to happen. Surely this case adds fuel to those who argue for gun control.
Failed by the police. Five weeks before the shooting, when he told the police in Rhode Island he heard voices in his head and feared three people were going to harm him, he was reportedly told to stay away from whoever was following him. After that, he bought a gun. Police need more training in recognizing mental disorder and bringing someone to the attention of treatment services.
Failed by friends and family, who noticed trouble but passed it off. As in so many other cases of this nature, neighbors, friends, schoolmates and coworkers are shocked – they have called Alexis “friendly,” “caring” and “a nice guy.” Understandably, close friends and loved ones do not want to believe the worst, and see normal behavior: a smiling guy who sings karaoke with them and helps others and meditates at a Buddhist center (traditionally associated with compassion and peacefulness).
Failed by the mental health system to get him adequate treatment.

Schizophrenia, contrary to popular belief, is not technically a “split personality,” but the Jekyll/Hyde appearance is real. The smiling Alexis in photographs can feel so mentally tortured that he becomes a killer. Time and again, people can seem normal yet erupt into a violent rage, especially when haunted by hallucination or delusions. Chemical reactions in the brain take control; rationality disappears and personality changes dramatically.

Signs can be missed. With paranoid schizophrenia -- while a serious psychotic disorder whereby a person loses touch with reality, compared to other psychoses -- the person may still exhibit emotions and function in society.

A paranoid schizophrenic condition can emerge seemingly out of nowhere, from teenagehood into the 30s (Alexis was 34). Or there can be stressful triggering events.

It has been reported that the shooter was suffering from PTSD, possibly from 9/11. Indeed, post traumatic stress disorder including symptoms of hallucinations in severe cases, can emerge from exposure to events like terrorism, natural disasters or other personal traumas, but one would have to know much more about the shooter’s involvement in that event and subsequent behavior to make that association.

Let’s not stigmatize mental disorder. Killers are not always schizophrenic, but can have other disorders, like a psychopathic or sociopathic personality, another psychotic condition, an organic brain syndrome, or drug abuse. Murderers can also be just plain evil.

Since Alexis was killed in the police shootout, we can never get a full psychiatric evaluation based on an interview with him, and have to rely on more information emerging from the VA who treated him, and retrospective recollections from others.

How many more shootings on armed forces bases, in public places, shopping malls, and schools like Sandy Hook and Virginia Tech, do we need before all social systems do better to notice, screen and treat, mental illness?