What causes someone to one day go out and kill as many apparently random victims as they can? Here in this country, we've seen this pattern repeatedly in recent years: Columbine, Virginia Tech, Northern Illinois University, the Omaha mall shootings, etc. (See my previous post.) Just this past Sunday, it happened in Japan, a country where violent crime rates are far lower than those in the United States and other industrialized nations.

In Malay culture, there is a term for this at once mystifying, terrifying, fascinating phenomenon: the amok syndrome, in which a person is suddenly, uncharacteristically and almost irresistibly possessed by a blinding, homicidal rage. This "running amok," in which the person more or less indiscriminately attacks and kills others--sometimes subsequently committing suicide--sounds remarkably similar to some of the lethally violent outbursts occurring in America and now other westernized cultures. Presumably, the affected individual--due to cultural, moral or religious prohibitions--has denied his or her aggression, anger and rage to such a degree as to become dangerously predisposed to destructive possession by the long-dissociated fury. Not unlike the evil, murderous Mr. Hyde hijacking the good and kind Dr. Jekyll. Frequently the precipitating trigger for these fatal eruptions of madness, of dangerously repressed rage, is some stressful life situation in which the ego defenses seem to suddenly breakdown or dissolve, unleashing the murderous impulses. In certain cases of mass murder, paranoid delusions drive the person to pre-emptively attack those whom they believe intend them harm.

Psychosis--or "madness," as it is colloquially called--has a long- running and close association with anger and rage. In the English language, this enduring relationship can be seen in the synonymous use of the term mad for angry. Social psychologist Carol Tavris (1982) acknowledges this historical connection in her book Anger: The Misunderstood Emotion, noting that "the match is psychological as well as linguistic, because in many cultures (including our own) an enraged individual and an insane one are both regarded as being out of control, unable to take responsibility for their actions." But Tavris disputes the validity of this linkage, posing the question : "What role does the belief in the similarity between rage and madness play?" She points out that in other cultures, such as the Eskimo, "a person who is legitimately insane cannot be expected to control himself, but one who is merely angry can and must control himself." But this distinction does not take into account the difference between normal anger and pathological rage--madness--which can at times take over the entire personality.

Tavris also argues that syndromes such as amok--in which a period of depression and brooding is abruptly followed by a furious flurry of violent rage, mayhem and murder--are not true madness or psychosis at all. She bases her opinion in part on the fact that the pengamok (those Malay perpetrators who actually run amok, the origin of amuck in English) are occasionally dissuaded from acting on these destructive impulses by the threat of capital punishment; and on one study in which the victims of the pengamok appeared not to be randomly selected but logically chosen targets toward whom the perpetrator had, at least in their own mind, some recognizable prior reason to be hostile.

Dr. Tavris and I disagree on these and other points, as discussed in my book Anger, Madness, and the Daimonic. For me, as a forensic psychologist, the crucial fact in almost all such cases is that these perpetrators repress their original anger and rage to the point of harboring bitter resentment, and hence, become pathologically prone to a violently explosive expression of that hatred. The only thing clearly demonstrated by Tavris' analysis is that there is meaning in madness. This meaning may be found not only in the subjective symptoms of madness, such as hallucinations and delusions, but in the bizarre, impulsive and sometimes violent behaviors of the mentally ill and severely emotionally disturbed.

A perfectly polite, well-mannered Malay man, with no prior history of mental illness or violence, "out of the blue" takes up traditional weapons and slaughters five people for no apparent reason. An Australian, Scottish, or American man, in decidedly different cultures, strides deliberately into an office building, restaurant, post office, mall, school yard, classroom or commuter train, gunning down everyone in sight. Ostracized and angry high school and university students take up arms against their fellow students and teachers at campuses across America in a wicked rage for recognition and revenge. Recently, in eastern Japan, a person was stabbed to death and at least seven others injured by a man who went on a rampage wielding two knives near a shopping mall. Several months earlier, in January of this year, a knife-wielding sixteen-year-old boy assaulted five people in another shopping area. There have reportedly been an alarming rash of knife attacks in Japan's schools, the worst occurring in 2001, when a man with a history of mental illness murdered eight children and wounded fifteen teachers and students at an Osaka elementary school. And now Tomohiro Kato, a 25-year-old male factory worker, is charged with viciously ramming pedestrians with a rented truck and then randomly stabbing seventeen bystanders, killing seven, in Tokyo's popular Akihabara district. In this case, the killer, about whom little is yet known, literally telegraphed his intentions by posting several explicit messages on an internet bulletin board just prior to his attack.

These are the kinds of cases typically seen by forensic psychologists and psychiatrists daily here in the U.S. Despite the extraordinary drama surrounding them, they have tragically become a routine part of our work. I fear that Japan and other non-Western cultures may soon be experiencing a similar trend: the madness of so-called senseless violence. But, like most human behavior, violence and destructiveness have psychological meaning. They only seem "senseless," random or meaningless to the extent we are unable--or dogmatically unwilling--to decode evil deeds.