denverdoc said:
Before reading the accounts I would have guessed that Cho had bipolar disorder, which is often aggravated this time of year by the mismatch in circadian rhythms one experiences because of rapid photoperiod lengthening during equinoxes,(the sin/cos relation at play here between length of day and rate of change). In fact suicide rate amongst bipolar patients surges in March, April to something like 10x the average rate.
Thanks for reminding me of the details on this. I was talking to someone else on the phone about the story, and they commented about the timing being similar to Columbine. I remembered there being a seasonal component to bipolar disorder, but was fuzzy on the details, and
thought it was an increase in mania in spring as they came out of the winter depressive state (possibly a comorbidity with seasonal affective disorder). When I had come across a paper on it a year or so ago, I wasn't sure if it was a sufficiently large study to make that conclusion definitive or if it was regularly observed in psychiatric practice (there are a lot of studies that report a seasonal effect on this that or the other thing, and then you'll find other studies that report exactly the opposite or no effect, and it turns out it's just a sample bias with small groups of people in some studies, or cultural influences rather than biological in a particular population).
Anyway, as for what could have been done, I keep hearing conflicting reports in the news as to whether he was under the care of a psychiatrist. They do seem to all concur that he was at some point involuntarily committed based on suicidal threats, but it sounded like that was only a day and then he was released again for outpatient treatment.
The most frustrating part of getting someone help if you're NOT a psychiatrist is that the psychiatrist you refer them to isn't allowed to tell you if they have followed through with seeing them and continue to do so due to doctor-patient confidentiality, so you're somewhat left in the dark as to whether the person you know needs help is actually receiving it unless they volunteer that information to you. Or, they could lie and tell you they are going when they aren't.
In this case, it wasn't his writing alone that sounded warning bells, but the accompanying affect. But, it sounds like his professors had done what they could have done and had him referred for treatment. So, I don't know what more could be done in a case like that on the part of the university anyway.
As for whether his psychiatrist should have known he was an immediate threat to himself or others, again, only his psychiatrist is likely to know that. We don't know if he ever expressed these plans in a session with the psychiatrist, or when he last saw the psychiatrist relative to when he started to form the specific plan. And, he may have come across as potentially suicidal, but never gave any inkling that he would consider taking others with him. Sometimes you get highly intelligent people with mental illnesses who can hide their illness. There may be some signs that something is "off" about them, but they know enough of what to say or not say to people to keep them from knowing their real thoughts.
It is entirely possible that either starting a new medication or the change in seasons helped make it possible for him to go from suicidal thoughts to actually acting out his plan. Someone very depressed often lacks the motivation to do anything, and as they are on the recovery process from depression, they begin to have the motivation or energy to do things but unfortunately still have the depressive thought process going on, so the thing they act out on is the self-destructive thoughts.
About the only thing that comes to mind, if it wasn't done already, is that if the campus psychological services receives information or calls of concern about a student from multiple sources, that they bring together the people making these reports, along with other professors of theirs or roommates, etc., and have a conference session to piece together as much information as possible to see what patterns exist. Some people just appear weird in some contexts, but nothing is wrong overall. For example, a creative student might write a violent story in a writing class, but not be violent themselves. If you get together with their roommates and other professors, you could find out that there is no pattern of concern and it's just an isolated issue not likely to mean anything. On the other hand, when their roommates tell you they are weird and never make eye contact, and other professors tell you they won't even share their name in class, or that they've felt threatened or nervous around this person (we're used to encountering painfully shy students, and can tell if there's something more brooding than just shyness to some extent), and you have reports from other students saying they were receiving harrassing calls from him that were a lot like stalking, etc., it starts to paint a clearer picture that this is a truly troubled student when these behaviors are consistent in all facets of their life and interactions with others.
However, what would be the way to deal with it from there? Is that cause to have him involuntarily committed again? Or do they decide it's cause to expel him from school, in which case he may have gone on the shooting rampage anyway, or been prompted to do it even sooner in his anger at the school for expelling him?
The problem with cases like this is they are very rare. It's hard to find patterns and make predictions and identify rules to follow to prevent it when there just aren't enough cases to study to find patterns.
