The two recent deadly rampages in Washington, DC, by mentally ill psychotic perpetrators represent a small sample of many other cases that have striking similarities. A few additional examples include John Zawahri in Santa Monica (6/9/2013); Dylan Quick in Houston (4/9/2013); Adam Lanza in Newtown (12/16/2012); James Holmes in Aurora (7/20/2012); Anders Breivik in Oslo, Norway (7/22/2011); Jared Loughner in Tucson (1/8/2011); and Seung-Hui Cho at Virginia Tech in Blacksburg (4/16/2007).(1)
In DC on September 16, Mr. Aaron Alexis, 34, murdered 12 at the Navy Yard. On October 3, Ms. Miriam Carey, 34, rampaged between the White House and the Capital endangering the lives of hundreds of innocent people including her 18-month-old daughter strapped in her back seat. Both perpetrators were shot to death.
The psychotically mentally ill are at higher risk for violence. Mentally ill perpetrators commit only about 5% of all murders, but many kill in numbers, usually innocent victims including children. Efforts at prevention must go beyond gun control and include focus on the seriously mentally ill. Since about half of psychotic killers receive psychiatric attention prior to their rampages, mental-health professionals can more effectively intervene.
Historically considered two distinct disorders, bipolar and schizophrenia can cause psychosis. The correct diagnosis is critical because the standard-of-care treatments differ. The two DC and other psychotic perpetrators have had manic symptoms in common but were diagnosed with schizophrenia because of the century-old concept that this diagnosis is mandated by hallucinations, hearing voices, or having paranoid, persecutory delusions. These symptoms are explained better by psychotic mania.(1)
Prominent psychiatrists concluded on the September 29 episode of 60 Minutes and in a National Review online article by Dr. Krauthammer on September 19, that Mr. Alexis suffered with schizophrenia. Ms. Carey also had been diagnosed with schizophrenia (and postpartum psychosis).
Both were likely given inappropriate antidepressant medications that may worsen a bipolar disorder; mood-stabilizing medications such as lithium were not mentioned.
Mr. Alexis received trazodone at two Veteran's Administration hospitals for "insomnia," an important symptom of mania. Postpartum psychosis (Ms. Carey) is a common part of a core bipolar disorder and is treated with antidepressants.
Both were psychotic. Mr. Alexis changed hotels three times to escape pursuers whom he believed were harassing him with a microwave machine and keeping him awake "by sending vibrations through the walls." He said that he had heard "voices speaking" to him "through the wall, flooring, and ceiling"; i.e., auditory hallucinations. Mr. Alexis was not sleeping because he was manic.
Ms. Carey believed that President Obama had "bugged her apartment and was stalking her" and that she "was a prophet." Such grandiose and paranoid delusions, common to a psychotic bipolar disorder, motivated her fatal trip to the White House. She was clocked at 80 mph on Constitution Ave, disregarding red stop-lights, police orders to stop, and pursuit by multiple police vehicles with lights, sirens, and gunfire into her car. Her hyperactivity was frantic and her mind must have been racing.
Both had past histories of psychotic manic episodes. Mr. Alexis had two prior irrational firearm-discharge-related law-enforcement encounters. In 2004 in Seattle, WA, he shot the tires out of another man's vehicle in a self-described "anger-fueled blackout." In Ft. Worth, TX, in 2010, he shot through his ceiling into his upstairs neighbor's apartment whom he had previously confronted about her making too much noise. He had not slept for three days in a row around this time. Both episodes suggest mania and predicted his future tragic rampage at the Navy Yard.
A few years ago Ms. Carey was "outside her mother's Brooklyn apartment, clutching a Bible and waling at the sky," consistent with psychotic mania.
Both had past time periods of stability and accomplishments consistent with a bipolar disorder. Mr. Alexis was a former Naval Reservist and a contract employee with Hewlett Packard through The Experts, Inc. He held DOD security clearance and traveled widely to fix government computers. Ms. Carey obtained degrees in Dental Hygiene and Health Nutrition Science and was licensed in both NY and CN. Although fired about a year ago because of "her temper," likely during an episode of mania, her work history had been stable and her boss described her as "always happy." A neighbor said she was "fairly likeable " "very well spoken " she was obviously educated.'" A head injury from a fall was an unlikely contributor to her rampage.
Mania, diagnostic of bipolarity, is defined by episodes of insomnia, increased energy and hyperactivity, racing thoughts, flight of ideas, loss of judgment, spur-of-the-moment decisions with a high likelihood of negative outcomes, irritability, anger, and the potential for lethal violence, cycling with episodes of productivity. The correct diagnosis will enable more effective treatment, enhance prevention, and preclude malpractice lawsuits.
Obsolescence is common to schizophrenia and a covered wagon. by C Ray Lake, MD, PhD