Tuesday, April 17th, Oregon State held a Candle light vigil for those lost in the Virginia Tech tragedies. I don't think I've ever been as affected by a shooting as the Virginia Tech tragedy two days ago. Possibly because it's was the deadliest one in US history, or maybe because it's my first year in college, the thought that it could have been here at Oregon State just gives me chills. Right now, we could be without a parent, a sibling, a friend, a spouse, a professor. This has impacted everyone, and it's so sad that something like this had to happen. My condolences to all who were affected by this massacre. Our hearts are with you. Original source: http://www.flickr.com/photos/jenniferle/464807005/ Photo Courtesy of Jennifer Le
Permission: Jennifer Le http://www.flickr.com/photos/jenniferle/464807005
This photo was taken at the Oregon State University vigil for Virginia Tech. Original source: http://www.flickr.com/photos/jenniferle/464807017/in/photostream/ Photo Courtesy of Jennifer Le
Permission: Jennifer Le http://www.flickr.com/photos/jenniferle/464807017/in/photostream/
By: Jenny Pedersen Posted: 4/18/07 Let's be honest: this isn't my original column. I was up late last night scribbling down something about "relationship people" and trying to finish a paper. Like most of us I didn't get enough sleep, I woke up late and barely rolled into lecture. In spite of the usual college stresses, I still managed to start smiling after my morning latte. However, all things changed once I read the morning news. In the state of Virginia, lattes are not enough to make anyone smile. I've been to Virginia; it's where my favorite high school history teacher grew up, and one of my best friends attends a college two hours north of Virginia Tech. The state was green, the people were friendly and I had an amazing fudge sundae at a place called Shoney's. Virginia Tech has been described as a quiet place where not much happens. It is an agricultural school in a small town similar to Davis and the school website shows pictures of students feeding large groups of mallard ducks just like the ones that patrol our own campus. We both have slightly ridiculous mascots - we're the UC Davis Aggies and they're the Virginia State Hokies. We have The California Aggie and they have The Collegiate Times. Much like us, students online discuss the lack of nightlife options in the mountain town of Blacksburg, Va. and jokingly point out that the town doubles in size when school is in session. Instead of an annual Picnic Day, in Virginia they host the International Street Fair each April. I imagine before yesterday Hokie students could easily have complained about bored Blacksburg cops breaking up their parties, citing them for noise violations and other such superfluous things, just like we were probably ecstatic about the start of spring because nobody knows what to do with themselves in a small town when it's cold. They're college students just like us in a community much like ours. They had no idea that this would change for them on any other Monday morning in April. The last time I checked, 32 people were killed; two outside of residence halls and 30 inside classrooms. The students of Virginia Tech experienced a violation of their safety in the worst way. They lost friends and faculty on their campus, in their classrooms, at their college, the place they go to gain skills for their future, to learn the tools that will help them for the rest of their lives. Education is what we hope will make the world a safer place; it is an institution we count on to protect us and our children from the likes of global warming and terrorism. The parents who lost children to the shooting probably thought there was no safer place in the world for their children to be than attending school in a small town in the United States. They weren't serving in Iraq, or living in "crime-ridden" big cities, and still they were not entirely safe. I'm not saying that we should all be paranoid and I have no suggestions for preventing school violence. What I am saying is that as fellow students we have a certain responsibility to the memory of those lost at Virginia State. If only for the rest of this week I want to acknowledge this responsibility and show appreciation for a campus that hasn't known fear or violence. I'm going to smile at strangers, students and staff because they are happy, healthy and here. I'm going to appreciate that the last time I talked to my mother it was to ask her about tax forms and not to tell her that I was injured in open fire. I'm going to appreciate that because I live and breathe, I have the luxury of fighting with my roommates and procrastinating on Facebook. Most importantly I'm appreciating the fact that it still only takes a latte to make me smile. -- Original Source:The California Aggie - April 18, 2007
Well, what with April 16th coming up, and classes being canceled for us on that day, even though I wasn't here last year, I decided to make a "Live for Speed Tribute" to the students who were killed last year. The video might seem a little off topic but if you watch it through to the end I think it has a good meaning. http://www.youtube.com/watch?v=lwgflD3z2cM&fhm18 The logos on the cars are of different colleges/universities stateside. A lot of effort went into making this video, and I think it turned out very nicely.
By Jeremy Siegman Apr 27 2007 Cosmology on the Rocks It always feels weird swallowing real-world events like the Virginia Tech massacre in the hazy cosmopolitanism of Uris Library. Cornell and its libraries, after all, are fleeing from the bustling Manhattans, from the culture of CNN and even the busy humming of our own town. It feels like fleeing from all that is extremist, religious or vulgar. And the Promised Land is the Hill, which, legend has it, is populated by a super-strong Atlas who can not only pick up the planet, but also stop it from warming too, and just foster utopia in general, all at the reasonable rate of only $40,000 a year (tax-free if you use Big Red Bucks!). This detached cosmopolitan Cornell is proud, richly endowed, but can be shaken. When an English major murders 32 people at a university, our university shakes. Finally, something has hit home; but utopianism hits back. Our president responds in the eloquent universalism we know best: "We are one; one community, one people, one planet." This is me responding, stuck in Uris Library because it's raining outside; I'm stuck, too, in this Skortonian universalism, as I consider the murderer, his condition and ours too. "Three Pro-Gun Bills Pending in Nevada Legislature!" exclaims a headline from NRA.org. You should press your senators to pass them, urges this National Rifle Association writer, so people can have the freedom to not register their handguns! Gun activists argue that Cho Seung-Hui should have been lawfully prevented from buying his .22-caliber and 9mm guns because of his mental illness. They also argue that gun-control laws should be toned down! This is utterly strange, this exaltation of the Second Amendment at a time like this. Considered in a vacuum, there's really nothing wrong with the right to bear arms. But when the bald eagle of America is made to hold rifles in its talons (the NRA logo) — a powerful symbol is crafted. It speaks loudly for a lot of Americans. The symbolic exaltation is poor form, with poor results: the nation that made Terminator I-III, Rambo, Quentin Tarantino and Cho too. Tarantino is not Cho — a talented artist, not a murderer. He doesn't shoot, he makes aesthetics. But what is his aesthetic? It is images of Cho and for Cho. Aesthetics broadcast culture, and culture affects people. What Cho most needed was probably medication. But what he needed second most was a culture that says, "don't shoot." This he did not quite have; rather, he had Kill Bill. And he had a precedent of almost 20 school shootings in America in the past 10 years. Add this to the list of things in which we lead the world; Germany is a not-so-close second, with only three. We have a cult of violence in this country. We also have a cult of hyper-individualism: the kind that cherishes individual rights like not having to register your gun. Violence could exist without this cult and so could mental illness; but I merely suggest some cultural change wouldn't be a bad thing. Diversity within Cornell works because the lack of religious and ethnic unity is compensated for: the minute you get here you are hit over the head with Freshman Orientation. You are explicitly told, that despite the diverse backgrounds and different colors — we are all friends. You are showered with programs and people your age, with your interests, your intelligence ... But diversity in the real America is ugly at times — the same diversity is extant, but there's no Freshman Orientation. There's no one really saying we are all friends. (In fact, we compete with out neighbors for almost everything.) We lack, then, a common language with which to tell the school shooters, "don't shoot." The American suicide murderer has no cause — unlike those who blew up themselves and 191 Iraqis in Baghdad just days after Virginia Tech. But perhaps what an American rebel with no cause needs is ... a cause. And a peaceful one to boot. In America, everyone has a different moral code — from the Bible to Gandhi to Oprah. The only normative force we share is our secular law: don't shoot because you'll go to jail. But Americans feel oppositional towards the law anyway: the under-21 collegiate "elite" could proudly drink most baby boomers under the table. The law is not enough. If there's anything that could work it might be Christianity; but America is no longer Christian. So why not just let each denomination speak its piece? A chorus of don't shoots in different languages and moralities? We already have this multiplicity, and Cho falls through the cracks. To add to our diversity, we a need language more common, so widely held that it can be strong enough to speak to the next Cho. If Americans are so different, it's only knowledge of each other that will bring that commonality. It's a university, or at least a good high school, that will bring that knowledge. It's getting everyone, even the poor, into those schools ... Consider, then, our Cornellian cosmopolitanism — "We are one; one community, one people, one planet" — turning around with the Hokies and the citizenry and facing reality, facing Cho, facing his Columbine counterparts Dylan and Eric. Consider gathering the psychological knowledge of their sickness, the practical knowledge of how to make society safe and the moral knowledge that murder is wrong. Consider gathering all this and broadcasting it mercilessly on TV, alongside images of eagles with no rifles in their talons. This might take a really long time — culture does — and there will always be psychological violence. But if the relative peace of this campus on a Hill is any paradigm, then let's take the reigns of the real world. Let's be powerful the way we know how. Let's create some ideology, disseminate it and brainwash everyone. If we're good enough at it, we'll even reach the next Cho: mental illness could resist even a culture of peace, but it'd be quite a bit harder. Yes, we'll pick up where the sixties left off: we'll brainwash them into thinking we are all one. Maybe, in fact, we are. Jeremy Siegman is a sophomore in the College of Arts and Sciences. He can be contacted at jas367@cornell.edu. Cosmology on the Rocks appears alternate Fridays. -- Original Source:Cornell Daily Sun - April 27, 2007
Jonny Lieberman <jdl46@cornell.edu>, <lieberman.jonny@gmail.com>
Outside the Box with the Managing Editor By: Jeremy Stern Posted: 5/7/07 I have been looking forward all year to writing this, my final column. A last hurrah before I graduate. An opportunity to thank all those who have helped me get to where I am today: my professors, parents, wife, God, yadda yadda yadda... But then 27 college students and five of their professors were gunned down in Virginia, and Yeshiva students barely stirred. It took a day and a half before any sort of response took place on either of our undergraduate campuses; two days before a respectable, public commemoration. On Monday morning the blood of 32 victims smeared the walls of dormitories and classrooms at V-Tech. Not until Tuesday night did fewer than two dozen Yeshiva students find it important enough to take twenty minutes out of Night Seder for a prayer rally. I know that people are murdered every day. 104 American soldiers died in Iraq during the month of April alone, and who knows how many tens of thousands are suffering today in Darfur. But the Middle East and Northern Africa are distant, with unfamiliar victims with whom we have difficulty relating. That leaves us with no excuse when the deadliest shooting in U.S. history is perpetrated on an American college campus. How can we explain our silence, when thousands of our peers at NYU, Columbia, Brandeis, and Penn responded within 24 hours with arrangements for candlelight vigils, memorial services, solidarity rallies, and condolence books? If there is one thing that we do well, it's Tehillim (Psalms) rallies. Why was one not organized for the Main Beit Midrash at 12 p.m. on Tuesday? I was appalled at the lackadaisical response from some student leaders to requests for immediate action. Lest you think urgent coordination was impossible, by 6 p.m. on Monday afternoon - only a few hours after the last bullet was fired - the Yeshiva Security Department sent out a blast email notifying the campus community that, in conjunction with the New York Police Department, precautions were being taken to heighten overall campus security. On the other hand, President Joel's sincere and eloquent email to the president of Virginia Tech took more than two days before arriving in our Inboxes. (For comparison, 29 ystuds were sent out in the interim.) We are talking about college students and professors. These were not foreign people with aspirations wholly different from our own. At the very least, this tragedy should arouse our concern for our own campus safety. Massacres like this are notorious for copycats who yearn to have their names on the front page of newspapers nationwide, and Yeshiva, as a yeshiva, could be a primary target. But, I expect more from us than self-centered concern. We must empathize because these victims were part of the greater collegiate community. As sensitive human beings, and as sensitized religious Jews, we must feel their pain because of our shared experience. Just as we expect more from Israel than any other country to serve as a safe-haven for Sudan's refugees who have fled for their lives, we must expect more from ourselves because this tragedy occurred to people who are much like us. If we are not empathetic, then how does that speak of the enhanced morality which our Torah learning is meant to instill within us? Sure, some of us eventually prayed, and a meaningful moment of silence was held at the Town Hall Meeting, but what was our initial instinct? Were we shocked and gripped by pain? Did we stop what we were doing and, perhaps, cry? What explains our anesthetized state? The problem is with our identification, or lack thereof. Because some of us do not view ourselves as members of a "real" university or a "real" college, we fail to identify with the broader community of college students. Yeshiva certainly provides a distinctive undergraduate experience compared with that of other universities, but that dissimilarity makes it no less real. Were we only to appreciate our differences as attributes, would we begin to realize that a world exists, of which we are an integral part, outside of the bubble at 185th and Amsterdam or 34th and Lex. We have a lot to be proud of. When I transferred here from Brandeis five semesters ago, I could not imagine the opportunities which Yeshiva would provide for me. The relationships which I have established with peers and professors, the academic excellence to which I have been exposed, and the enriching environment which has encouraged me to thrive have truly exceeded my expectations. Every Wednesday of the school year for the past four semesters I have led campus tours for prospective students and their parents. I conclude every tour as follows. Since arriving on campus almost four years ago, President Joel has inspired all aspects of the university to no longer subsist on mediocrity but rather to strive for greatness. I consider myself fortunate to attend Yeshiva now and not four years ago, because I have benefited tremendously from President Joel's initiatives and leadership. However, I am truly jealous of the students who will be here in another four years, because the school will certainly be that much better. I am confident that President Joel's vision of the big tent will soon materialize, with the student body's recognition that it cannot stand idly by while blood is spilled on other college campuses. -- Original Source: The Commentator - May 7, 2007
Por Jesús Dávila Corresponsal Publicado el 04-23-2007 San Juan — El féretro con los restos del ingeniero Juan Ramón Ortiz, muerto en la masacre de virginia tech el pasado día 16, fue transportado ayer sábado a Puerto Rico, pero su viuda, Lizelle Vega, y demás familiares pidieron a la prensa que les dejen en paz para poder comenzar el "proceso de sanación" luego de la tragedia. Vega hizo el llamado en una rueda de prensa en la que indicó que el velorio será en una funeraria de Bayamón, ciudad natal de su esposo, y el entierro tendrá lugar el martes en el cementerio católico Porta Coeli, del mismo municipio. La también ingeniero, quien junto a su esposo cursaba estudios avanzados en la universidad de Virginia, expresó agradecimiento para todos los que le han apoyado ante el dolor -tanto en Virginia como en Puerto Rico- además de hacer reconocimiento de la labor que han realizado los medios noticiosos. Pero, pidió que durante los próximos días se permita a la familia su espacio de intimidad y que no se hagan entrevistas en la funeraria o el cementerio. El pedido de Vega coincide con las instrucciones emitidas por la dirección de virginia tech de que a partir del lunes estará prohibido que los reporteros o fotógrafos entren a los edificios universitarios ni camiones de transmisión televisada podrán estar en el campus para dar espacio a que comience "el proceso de sanación". Las instrucciones especifican además que cualquier pedido de entrevistas a personas en el campus universitario respete los sentimientos de las personas. Vega dijo que no quería hacer declaraciones sobre lo que pasó y que sólo quería limitarse a recordar a su marido por su alegría. Sobre su futuro, indicó que todavía no ha tomado una decisión pero especificó claramente que no piensa demandar a la universidad, ni ahora, ni nunca. Entre las alternativas que ha ofrecido la universidad a los estudiantes afectados por la masacre está obtener la nota de fin de semestre con los trabajos realizados hasta el momento en los cursos. El día de los hechos, Vega se encontraba en el edificio donde cursa estudios en geotecnia, mientras Ortiz asistía a clases de hidrología avanzada en el edificio del frente, donde se produjo el segundo tiroteo. Según había narrado previamente, no escuchó los disparos y sólo vio el movimiento de los policías, luego de lo cual se enteró que su esposo era una de las víctimas fatales. © EDLP -- Fuente Original: Diario La Prensa - Chicago http://www.laraza.com/news.php?nid=43410&clave=a%3A1%3A%7Bi%3A0%3Bs%3A13%3A%22virginia+tech%22%3B%7D
Jorge Mederos Executive Editor La Raza Chicago Inc. jorge.mederos@laraza.com August, 13 2007
This is a picture of a car wash fundraiser for the Hokie Spirit Memorial Fund. The tennis team from South High in Minneapolis, MN hosted the benefit. The team is coached by 1997 VT graduate, Jesse Morgan.
Photo by: Jessica Lum Students stand in De Neve Plaza on Thursday night for a vigil in memory of those who lost their lives in Monday's shootings at Virginia Tech. Speakers and students expressed sympathy for the victims' families and for the university.
Photo by: Jessica Lum Samara Leader, a second-year political science student and Sarah Peters, a first-year mathematics and economics student share in a moment of silence.
Obituary: Former APL Staff Member Among Virginia Tech Shooting Victims
Kevin Granata, who began his professional career at the Johns Hopkins Applied Physics Laboratory, was among those killed in the Virginia Tech shootings on April 16. A professor of engineering science and mechanics, he was considered one of the nation's top researchers working on movement dynamics in cerebral palsy. He was 45. Granata joined the Lab in 1986 and worked on low-frequency performance issues for long towed arrays in the former Submarine Technology Department (now the National Security Technology Department). His initial work helped to form the justification for the series of Doppler signal suppression experiments that were conducted by APL in 1990 and 1991. He was very interested in biomechanics and left the Lab in 1989 to obtain a PhD in biomechanics from Ohio State. "He was a bright young guy who came here from school, had a lot of energy and was very capable," Joseph S. Lombardo, his APL supervisor and now director of the Lab's Center of Excellence in Public Health and Informatics, told The Baltimore Sun. "Kevin had a very good scientific background and was able to do a substantial level of analysis." Granata, who had received his bachelor's degree in engineering physics and electrical engineering from Ohio State and master's in physics from Purdue, went on to an esteemed career in teaching and research, first at the University of Virginia and then at Virginia Tech. He lectured nationally and internationally and had numerous publications and research grants. A runner and cyclist, he enjoyed participating in biathlons and triathlons. He also loved reading and coaching his sons' lacrosse teams. Survivors include his wife, Linda; two sons, Alex and Eric; a daughter, Ellen; and his parents, Mildred and Joseph Granata. Memorials can be made to the Kevin P. Granata Memorial Trust, 1872 Pratt Drive, Blacksburg, VA 24068. -- Original Source: Johns Hopkins Gazette - April 23, 2007
Reflections on a Mass Homicide (Commentary)
(PDF, 30KB; Full text below.) Commentary Reflections on a Mass Homicide Jimmy Lee,1 MBBS, MMed (Psych), Tih-Shih Lee,1,2 MD, PhD, FRCP (C), Beng-Yeong Ng,1 MBBS, MMed (Psych), FAMS 1 Department of Psychiatry, Singapore General Hospital, Singapore2 Duke-NUS Graduate Medical School, Singapore Address for Correspondence: Dr Tih-Shih Lee, Department of Psychiatry, Singapore General Hospital, Singapore, Outram Road, Singapore 169608. Email: tihshih.lee@gms.edu.sg Introduction The names "Virginia Tech" and "Cho" will be associated forever with the tragic mass homicide of 32 persons cum suicide by Seung-Hui Cho on 16 April 2007. In the aftermath, many questions have been posed: "What happened and why?", "Was he crazy?", "Could it have been prevented?", "Could it happen here?" This was the third mass killing in a US campus, with the largest number of fatalities. The first was in 1966 in the University of Texas with 16 dead and 31 wounded, then the Columbine High School shooting in 1999, in which 13 students were killed. We do not profess to know more about what happened in Blacksburg, Virginia, or Cho's neuropsychiatric condition than whatever is published in the popular press.1 But through a series of questions, we reflect on this tragedy, attempt to place it into a human and psychiatric perspective, and offer insights into if, and how, it can be averted in the future. Question 1: Was Cho insane? Cho was described as a shy and quiet child, who was good in mathematics, but struggled with English. There were allegations of him being taunted and bullied in school since young. Both his pastor and relatives had suspected he might be autistic and suggested professional assistance. There was no record of him being involved in overt violence except that he had harassed 2 female classmates, one of whom called in the campus police. He expressed suicidal ideation and was involuntarily committed by a judge in a mental health facility briefly for assessment. A psychiatrist wrote in his chart, "Affect is flat and mood is depressed" and "Insight and judgment are normal," and released him. He was supposed to have been on some treatment regimen but may not have adhered to it. In English Literature classes he wrote on haunting themes of violence and death. Moreover, from the rantings of his final macabre video, it can be inferred that he had grandiose and persecutory thoughts. One could conceivably argue that anybody who murders en masse and then commit suicide must be insane. But insanity is an imprecise term that is no longer in the psychiatric lexicon. So we ask if he met criteria for a diagnosis based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) or International Classification of Disease-10 (ICD-10)? Or was he of a criminal antisocial or psychopathic mind? Unfortunately without having interviewed him or having access to his records, we cannot say for sure. We could speculate that he was depressed with delusional thoughts, and perhaps had undiagnosed Asperger's disorder (a mild variant of autism), or was taking illicit substances. But we do not have enough evidence to be certain of a definitive psychiatric condition that could account for his extremely violent behaviour. Question 2: Was it due to psychosocial developmental difficulties? Cho emigrated at the age of 8 years from South Korea and had difficulty speaking English. He was reportedly ostra-cised by his classmates and was isolated. The effects of migration on mental health are well described in the litera-ture. In the US, alienation is a problem for many Asians. Among Southeast Asians, the Hmong feel the most alien-ated, followed by Cambodians, Laotians, and Vietnamese.2 Many symptoms could be due to acculturative difficulties, racism, and overwork. A migrant faces difficulties with 3 main areas; changes in social environment, changes in interpersonal relations, and cultural differences.3 Reports from those who knew Cho strongly supported the roles of these 3 factors in his maladjustment to the new country. From his video and writings, it is evident that he had tremendous envy and rage projected onto better-adjusted and well-to-do American kids. Southeast Asian refugees have higher rates of brief reactive psychosis and paranoid psychosis compared to other Americans.4,5 Sometimes paranoia develops among Southeast Asians when they are dealing with a new environment and experiencing "varying degrees of miscommunication, fear of rejection, and feeling mistreated, slighted or discriminated against".6 Psychosis among Southeast Asians can take the form found in many ethnic groups, e.g. "Aliens' paranoid psychosis", a syndrome characterised by a usually short-lived xenophobia and by feelings of persecution because one belongs to an ethnic minority group.7 On the other hand, the overwhelming majority of immigrants and minorities are well-adjusted and functioning, despite having endured many of the same stressors that Cho endured. In particular, his sister, who shares much of his genetic substrate and environmental milieu, had apparently been doing very well. Many immigrants may have coping difficulties, but they do not usually resort to violence. The other 2 campus mass murderers were neither immigrants nor from minority groups. So, whereas difficulties relating to migration probably played a part in his violence, it would be simplistic to attribute it to primarily these stressors. Instead it would be a disservice to the large immigrant and ethnic minority communities. Question 3: What factors may have precipitated Cho's sudden outburst? There is a small literature considering situational factors and triggers that have consistently been found to be important in initiating a homicidal episode. Triggers for murder in Ressler et al's study8 included financial, legal, employment, marital and other conflicts. Emotional states such as frustration, anger, hostile moods, and feeling agitated and excited were reported at a lower frequency. Levin9 has offered a four-factor model of sudden indiscriminate mass killing. First, the potential offender has led a "life of frustration"; second, he has access to, and the ability to use, firearms; thirdly, there is a significant destabilising experience of a loss of "social controls", such as moving to a new area or the loss of an important relationship; fourth, there must be a precipitating event such as unemployment or divorce. Gresswell and Hollin10 have suggested that a more useful way of conceptualising the "firearms" component would be to consider that a fascination with weapons indicates a style of coping with stress, frustration, and low self-esteem that includes violent fantasies involving weapons. In such cases, the nature of such fantasies may be the best predictor of a homicidal response to a stressful event. Questions 4: Is there a neurological basis for aggression? Aggression refers to behaviour that is intended to cause harm, and is the behavioural manifestation of disturbances in the brain or mind. We now have some, though incomplete, appreciation of various neuroanatomical structures that may be involved in aggression. These structures include the prefrontal cortex, amygdala, hypothalamus, and temporal lobe. In particular, some evidence suggests frontal lobe dysfunction in violent and criminal behaviour, especially in the presence of focal orbitofrontal lobe injuries.11 Brower and Price11 proposed that clinically significant focal frontal lobe dysfunction is associated with aggressive dyscontrol. Orbitofrontal syndrome is associated with behavioural excesses, impulsivity, disinhibition and mood lability. Outbursts of rage and violent behaviour occur after damage to the inferior orbital surface.12 Abnormal brain concentrations of the neurotransmitters serotonin, dopamine and gamma-aminobutyric acid are implicated in impulsivity and aggression.13 Pharmaco-therapy with selective serotonergic reuptake antagonists, antipsychotics as well as mood stabilisers have all been used in treatment, with mixed results. Studies of aggression in patients with brain injury suggest that their aggression tends to be (1) reactive, i.e., triggered by modest stimuli; (2) non-reflective, i.e., not premeditated or planned; (3) non-purposeful, i.e., does not serve long-term goals; (4) explosive; (5) periodic; and (6) ego-dystonic.12 Some of these features describe Cho's aggression. But we do not know, and may never know, if a definable lesion was present in Cho's brain, or if present, whether that was severe enough to account for the violent behaviour. With the evolving science on aggression, a discussion about "nature versus nurture" often arises, i.e. whether murderers are born or bred. Research has now demonstrated that genetic aberration per se is not the sole reason leading to violence; environmental factors such as childhood adversities play a significant part in the development of violent behaviour.14 Gene expression is influenced by environmental factors, and brain circuits are affected by life experiences. Question 5: How is dangerousness assessed? Psychiatrists are often called upon to determine how much a threat someone will pose to others and society, also known as dangerousness. Dangerousness is a subjective assessment of the element of danger attributed to a particular person and is qualitative in nature. Predicting dangerousness, particularly in an extreme form such as mass homicide, has been an elusive goal for those investigators who have attempted it. It is often said that "Hindsight is 20/20". When a person is exposed to be a murderer, we tend to focus on those warning signs in his character and biography that were previously ignored. For a category of violence such as mass homicide, however, the low base rate and consequent likelihood of finding false-positive results are overwhelming.15 Just as in Cho's instance, numerous questions were raised about the concerns of his teachers and the psychiatric assessment in November 2005. It must be emphasised that the assessment of dangerousness is not an exact science, and cannot yield a black-and-white result of "dangerous" versus "not dangerous". In our psychiatric assessments, we weigh various factors such as past history of violence, history of mental illness, personality, social background, context and state of mind in which dangerous behaviours manifest. Past behavioural patterns provide the best insight into future behaviours. However, the accuracy of dangerousness assessments quoted in the literature is as low as 0.33.16 Mossman17 in 1994 extracted 58 datasets from 44 published studies, and revealed that mental health professionals' violence predictions were better than chance. Current risk assessment tools such as the Historical/Clinical/Risk Management 20-item (HCR-20)18 and Psychopathy Checklist (revised) (PCL-R)19 offer a structured and more systematic approach to violence prediction, but none could tell with consistent (surely not 100%) accuracy that a person would re-offend. Homicide is clearly the most serious of all crimes. Approximately two-thirds of homicides involve the killing of a victim by a partner, relative, friend or acquaintance. This may partly explain why the clear-up rate for these crimes is particularly high - the police do not need to look very far in order to solve the majority of murders.20 The relation between mental illness and dangerous behaviours has been overemphasised, especially in the eyes of the public. There is a tendency to believe that murderers are mentally ill. However, a recent study among homicides in Singapore showed that 57% of murderers have no mental illness. Out of the 110 charged with murder, depressive disorders accounted for 9.1% and schizophrenia, 6.4%.21 The proportion of foreigners (defined here as non-citizens and non-permanent residents) who committed murder in Singapore was significantly higher compared with locals, which supports the earlier point about the stressors of migration. Also, foreigners tend to suffer from more serious psychiatric disorders, are less likely to have a known history of violence, and are more likely to be new to psychiatric services.22 This implies that the first violent outburst is usually the first presentation to psychiatric services. Cho did not have a history of overt violence prior to April 16. Question 6: What about the psychological trauma to family and friends of the victims? For those who saw their friends getting shot and killed, those who were injured and those who survived unharmed, the families and friends of the victims, it would be very difficult to collectively summarise the ordeal they went and are still going through, as each will have their own individual experience of it. Some may be at high risk of posttraumatic stress disorder (PTSD), but others will cope fairly well with milder symptoms. But it is safe to say that life will never be the same again. And we must not forget the hapless and unfortunate family of Cho, whose suffering cannot be fathomed. There were positive measures taken by the school and public authorities in the aftermath that are worth learning. The measures included leave from school, time and ceremony to grief, and the provision of counsellors to all students of the school. School events such as examinations and convocation ceremonies continued as usual in an attempt to restore normalcy. The telecast of Cho's video on national TV was highly controversial. Many others around the world later saw Cho's nefarious video and images of the "massacre". The national broadcast potentially traumatised viewers and re-traumatised survivors. In addition, it helped Cho achieved his aim of broadcasting his views, possibly achieving "martyrdom", and it may inadvertently encourage copycat murderers, as if a race were on to increase the body count. We would strongly urge that TV network companies and their regulating agencies revisit the guidelines and regulations on such telecasts. Question 7: Can it happen to us? Mass murder in a US school or college is a relatively rare event - three times in 40 years, despite the widespread availability of firearms and the large numbers of disenfranchised youths. Hence, it can be described as a low-probability, catastrophic-outcome event, like an earthquake occurring on a given day. The probability of its happening is very low, but once it hits, the results may be catastrophic. For countries with strict firearm and explosive control laws, the risk of a mass murder on the same scale is much lower. With the benefit of hindsight, to discuss what the psychiatrist or the judge should have diagnosed or done is moot now. There was and always will be a balance between protection for society and infringement of the individual's civil liberties. This dilemma is all the more difficult if the assessment is made before a crime is actually committed. It would be virtually impossible for a psychiatrist to predict which of the patients would commit violence, least of all mass murder. If the decision is to commit the patients as a preventive measure, how long should the internment last, and who would set him free? Nevertheless, for psychiatrists and all doctors, this is a timely reminder to be thorough and diligent in the assessment for dangerousness, and to acknowledge that we are far from perfect in our assessments. Under Section 34 of the Mental Disorders and Treatment Act (1973, revised in 1985), any registered physician in Singapore may refer a patient suspected to be of unsound mind or requiring psychiatric treatment to the Institute of Mental Health (IMH) for evaluation and treatment. IMH is the only gazetted mental hospital that has the statutory authority to hold patients involuntarily, should the person be deemed to be suffering from a mental illness, and detention serves the person's best interests and those of other persons. For the majority of patients who are deemed not to need involuntary hospitalisation, there is little we can do to enforce treatment, other than relying on the family to supervise medications and appointments. If we suspect that a patient may pose a specific threat to another person, we may face an ethical dilemma with regard to confidentiality. This issue brings us back to the landmark Tarasoff case where the Californian courts found the therapist negligent for not warning the intended victim of a threat.23 Kok et al24 discussing this case with regard to the applicability of the Tarasoff ruling in Singapore, concluded that in the absence of local case law, a psychiatrist caught in this situation should consult the Singapore Medical Council prior to breaching doctor-patient confidentiality. The Cho case also brings to mind the problems of troubled youths in Singapore - a combination of disengagement from society, low self-esteem, poor coping with rising expectations, and academic pressures. These forces predispose them to seek alternative forms of release and validation, such as using illicit substances and joining street gangs. Therefore, parents and school authorities should always be on the lookout for troubled or poorly adjusted youths. If need be, they should be referred to mental health professionals for evaluation and treatment. Another lesson in the local context would be for us, as a society, to be more tolerant and empathic to those who are less well-adjusted and successful, especially foreigners and migrants, so as to minimise resentment and wrath. Conclusion In summary, as we try to make sense of this apparently senseless violence, we find ourselves in the recurring debate of nature versus nurture. We probably will never know what Cho was really thinking when he pulled the trigger repeatedly, or nor can we be sure if he had a psychiatric condition that fulfilled DSM IV or ICD-10 criteria. Our hypothesis is that he had an underlying neurobiological or genetic vulnerability; he endured developmental psychosocial stressors in a chronic invalidating environment; and that finally some yet unknown "third-hit" triggered his rampage. Nevertheless, we highlight the need for thorough assessments of dangerousness by mental health professionals despite the limitations of our tools; the need for a system to attend to the psychological anguish of the survivors and loved ones of the victims; and the need for us collectively to adopt a more empathic stance towards our less fortunate brethren. We also remember the 33 lives extinguished and countless more traumatised on that Spring day in 2007. REFERENCES Thomas E. Special Report: Making of a Massacre. Newsweek April 30, 2007:18-30. Nicassio P. Psychosocial correlates of alienation: study of a sample of Indochinese refugees. J Cross-cultural Psychol 1983;14:337-51. Moilanen I, Myhrman A, Ebeling H, Penninkilampi V, Vuorenkoski L. Long-term outcome of migration in childhood and adolescence. Int J Circumpolar Health 1998;57:180-7. Nicassio P. The psychosocial adjustment of the Southeast Asian refugee: an overview of empirical findings and theoretical models. J Cross-Cultural Psychol 1985;16:153-73. Westermeyer J. Paranoid symptoms and disorders among 100 Hmong refugees: a longitudinal study. Acta Psychiatr Scand 1989;80:47-59. Lin KM. Psychopathology and social disruption in refugees. In: Williams C, Westermeyer J, editors. Refugee Mental Health in Resettlement Countries. Washington, DC: Hemisphere Publishing, 1986. Tung TM. Psychiatric care for Southeast Asians: How different is different? In: Owan T, editor. Southeast Asian Mental Health: Treatment, Prevention, Services, Training, and Research. Washington, DC: US Department of Health and Human Services, 1985:5-40. Ressler PK, Burgess AW, Douglas JE. Sexual homicide: patterns and motives. Lexington, MA: Lexington Books, 1988. Levin J. Why his last shot blew the truth away. The Sunday Times, London 1987, August 23, p23. Gresswell DM, Hollin CR. Multiple murder: a review. Br J Criminology 1994;34:1-14. Brower MC, Price BH. Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review. J Neurol Neurosurg Psychiatry 2001;71:720-6. Silver JM, Yudofsky SC, Anderson KA. Aggression. In: Silver JM, McAllister TW, Yudofsky SC, editors. Textbook of Traumatic Brain Injury. Washington, DC: American Pychiatric Publishing, 2005. Swann AC. Neuroreceptor mechanisms of aggression and its treatment. J Clin Psychiatry 2003;64 Suppl 4:25-35. Reif A, Rosler M, Freitag CM, Schneider M, Eujen A, Kissling C, et al. Nature and nurture predispose to violent behaviours: serotonergic genes and adverse childhood environment. Neuropsychopharmacology 2007. Fox JA, Levin J. Serial murder: myths and realities. In: Smith MD, Zahn MA, editors. Studying and Preventing Homicide: Issues and Challenges. California: Sage Publications, 1999. Monahan J. The prediction of violent behaviour: Toward a second generation of theory and policy. Am J Psychiatry 1984;141:10-5. Mossman D. Assessing predictions of violence: Being accurate about accuracy. J Consult Clin Psychol 1994;62:783-92. Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20: Assessing risk for violence (version 2). Burnaby, BC: Mental Health Law and Policy Institute, Simon Fraser University, 1997. Hare RD. The Psychopathy Checklist-Revised. 2nd ed. Toronto, Canada: Multi-Health Systems, 2003. Ainsworth PB. Psychology and Crime: Myths and Reality. Edinburgh: Pearson Education Ltd, 2000. Koh KG, Gwee KP, Chan YH. Psychiatric aspects of homicide in Singapore: a five-year review (1997-2001). Singapore Med J 2006;47:297-304. Koh KG, Peng GK, Huak CY, Koh BK. Migration psychosis and homicide in Singapore: a five year study. Med Sci Law 2006;46:248-54. Tarasoff v Regents of University of California. California Report 1976;118:129. Kok LP, Yap HL, Cheang M. Mental disorders and public safety of the community at large - does the Tarasoff principle apply in Singapore. Ann Acad Med Singapore 2002;31:535-6. -- Archived with permission of the editor. Original Source: Annals, Academy of Medicine, Singapore, June 2007, Vol. 36 No. 6 http://annals.edu.sg/PDF/36VolNo6Jun2007/V36N6p444.pdf
Jimmy Lee, Tih-Shih Lee, and Beng-Yeong Ng
Kirat Kaur (Ms) Editorial Executive Annals, Academy of Medicine, Singapore annals@academyofmedicine.edu.sg
People put a wreath on the wall of the Burrus Hall to remember the victims on April 20.
On April 24, one week after the shooting, people hung numerous flags on the War Memorial Chapel to remember the victims
White flowers express our sadness to the victims and their families.
One week after the shooting,people set six flags on the lawn of the drillfield to mourn the victims.
After the vigil,people left candles and flowers on the drillfield to express their sadness and grief.
Handmade memorials were placed on one of the corners of the drillfield.
Flowers around Hokie stone memorial site
After the shooting,people volunteered to come to campus and placed flowers and gifts around the Hokie stone memorial site to remember the victims.