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Individuals perpetrating
unspeakable acts of violence is not a new phenomenon. What’s new,
rather, are the altered states of consciousness induced by
antidepressants and other psychotropic drugs well-documented to promote
homicidal and suicidal behavior in susceptible individuals.
Although semi-automatic
weapons have enabled the infliction of mass casualties at an
unprecedented scale, massacres perpetrated by lone individuals are not
new phenomena. Rather, these tragic and inexplicable events may
represent an incarnation of a more ancient phenomena called “running
amok,” formerly believed to be a culture-bound syndrome isolated to
certain societies.
The Resemblance of Mass Shootings to Running Amok
Used in colloquial verbiage
to indicate an irrational individual wreaking havoc, the linguistic
origins of “running amok” stem from the description of a mentally
perturbed individual that engages in unprovoked, homicidal and
subsequently suicidal behavior, oftentimes involving an average of ten victims (1).
Although it was not
classified as a psychological condition until 1849, amok was first
described anthropologically two hundred years ago in isolated, tribal
island populations such as Malaysia, Papua New Guinea, Puerto Rico, the
Philippines, and Laos, where geographic seclusion and indigenous
spirituality were hypothesized to be cultural factors implicated in this
culture-bound syndrome. In his eighteenth century voyages, for example,
Captain Cook recorded Malay tribesman randomly maiming or executing
animals and villagers in a seemingly unprovoked, frenzied attack (1).
Culturally-encapsulated
explanations localized blame to spirit possession by the “hantu belian”
or evil tiger spirit of Malay mythology, which was believed to have been
the source of the involuntary, indiscriminate violence that
characterizes amok. In native cultures, sacred healers of the folk
sector operated under cultural ideologies where illness was believed to
be of supernatural origin, so amok was tolerated as an inevitable
element of the cultural experience and offenders were brought to trial
(1).
As Western expansion
encroached on remote cultures, incidence of amok decreased, reinforcing
the biased view that so-called primitive cultural ideas were responsible
for its pathogenesis. Meanwhile, episodes of violence in Western
civilizations began to escalate, culminating in the unparalleled modern
statistics where shootings have become so frequent that those unaffected
become numb and desensitized to their devastating effects, and all live
with the threat of an impending shooting as an everyday reality.
Formerly considered a rare psychiatric culture-bound syndrome,
researcher Dr. Manuel Saint Martin (1999) argues that amok is also
prevalent in contemporary industrialized societies (1).
Resurgence of this Ancient Construct in Modern Shootings
Saint Martin postulates
that the escalating frequency of mass homicides in industrial cultures
in the past quarter century represents amok, citing that attackers often
have a history of mental disturbance and that modern-day episodes involve similar numbers of victims (1).
He likewise disputes
classification of amok as a culture-bound syndrome, since it seems to
appear cross-culturally, and argues instead that culture is the
mediating mechanism that determines how the violence manifests (1). For
example, Jin-Inn Teoh (1972) claimed that amok appears universally but
that its mode of expression in terms of weapons and methods used are
culture-specific (2). Furthermore, John Cooper (1934) postulated that
its affiliation with suicide, a practice transcending arbitrary cultural
boundaries, disproves the classification of amok as a culture-bound
syndrome (3). Cooper further highlights that amok may be an indirect
expression of suicide, induced by the same psychosocial stressors that
produced suicide in contemporary cultures (3) In essence, the author
contends that amok is a product of mental illness, which has similar
etiology and psychosocial precipitants worldwide (3).
In his comparison of amok
to modern-day shootings, Saint Martin advocates prevention by
identification of individuals with risk factors and treatment of
underlying psychological conditions (1). In addition to coworker,
neighbor, friend, and family observations of susceptible individuals,
Saint Martin states that physicians are uniquely positioned to collect
data regarding those vulnerable to amok, since, “Many of these patients
preferentially consult general and family practitioners instead of
psychiatrists owing to the perceived stigma attached to consulting a
psychiatrist, denial of their mental illness, or fear of validating
their suspicion that they have a mental disorder” (1). However, the
arsenal of tools wielded by the conventional allopathic doctor, with
their magic bullet remedies and treatment algorithms, often falls short.
Addressing the Root Cause: Psychiatric Drugs Engender Violence
Although amok explains the
deep-seated human tendency to engage in acts of violence, it does
nothing to explain the recent increase in frequency. While many argue
that access to semiautomatic weapons explains the explosion in mass
shootings, one long-neglected element of the conversation is that the
recent rise in mass homicides coincides with the greatest use of
cognition-altering psychiatric drugs ever observed in human history.
Oftentimes, shooters are
branded as bad apples, a narrative that allows for the rationalization
of such heinous crimes and marginalizes assailants as social deviants
and mentally deranged anomalies. However convenient this rhetoric is for
imparting meaning to the unfathomable, it does nothing to prevent
future incidents or to understand the trajectory of events or the
biological and psychological variables that enabled individuals to
perpetrate these tragic acts of terrorism. It enables the system and
society to wash their hands of any culpability and critical analysis of
how people can commit unspeakable violence.
Due to media distortion,
the story line disseminated in public spheres diverges dramatically from
the conversations played out in the academic sector and these questions
remain largely absent from the mainstream dialogue. A perusal of the
academic research, however, reveals that psychotropic drugs may be
contributing to the epidemic of mass shootings. In 2011, 26.8 million
adults in the United States used pharmaceutical drugs for mental illness
(4). Two years later, the Medical Expenditure Panel Survey (MEPS) found
that nearly 17 percent of American adults filled at least one
prescription for a psychiatric drug.
Psychiatric drugs, many of which are based upon the flawed serotonin theory of depression,
send almost 90,000 people to the emergency room yearly as a result of
medication side effects ranging from delirium to head injuries to movement disorders,
and one in five of these visits culminates in hospitalization (4). This
figure is an underestimate, as it excludes visits to the emergency
department secondary to drug abuse, self-injurious behavior, or suicide
attempts (4).
Preliminary reports from
the Las Vegas shooting that left at least 58 people dead indicate that
the alleged killer was prescribed Valium, a sedative-hypnotic drug classified as a benzodiazepine (5). Relevant to this insight is a meta-analysis of 46 studies published in the Australian & New Zealand Journal of Psychiatry, which illuminated that, “An association between benzodiazepine use and subsequent aggressive behaviour was found in the majority of the more rigorous studies,” especially in those individuals with an underlying propensity toward anxiety and hostility (6). In addition, a prospective cohort study of nearly one thousand Finnish subjects published in the journal World Psychiatry demonstrated that current use of benzodiazepines elevated risk of homicide by 45% compared to controls (7).
Data compiled from the U.S.
Food and Drug Administration (FDA) adverse event reporting system
similarly highlights that use of some antidepressant medications is
disproportionately related to an increased number of violent events (8).
The authors report that, “Varenicline, which increases the availability
of dopamine, and antidepressants with serotonergic effects were the
most strongly and consistently implicated drugs” in case reports of
“homicide, homicidal ideation, physical assault, physical abuse or
violence related symptoms” (8).
Psychotropic Drugs and The Absence of Informed Consent
At the epitome of this
discussion is that deleterious side effects of psychotropic drugs are
ill-publicized and patient do not receive sufficient information about
the devastating sequelae that can result from their use. Little of the
public knows that in 2004, the Food and Drug Administration (FDA) issued
a black-box warning for antidepressants,
advertising that they are associated with suicidal ideation and
behavior in two to three children out of every hundred who are
administered these drugs (9, 10). In fact, a meta-analysis of 372
randomized clinical trials entailing nearly 100,000 subjects elucidated
that the rate of suicidal thoughts and action was double in those
patients assigned to receive an antidepressant compared to placebo (11).
Notwithstanding the
tendency of psychotropic drugs to predispose individuals to homicidal
and suicidal ideation is the evidence that antidepressants elevate risk
of death and cardiovascular disease,
which is often not shared when a physician dispenses a slip from their
prescription pad. A meta-analysis of 17 studies published in the journal
of Psychotherapy and Psychosomatics found that in the general
population, antidepressant medications increase all-cause mortality
(death from any cause) by 33% and the risk of cardiovascular incidents
(heart attacks and strokes, for example) by 13% (12). According to
researchers, “The results support the hypothesis that ADs
[antidepressants] are harmful in the general population” (12).
Also rarely discussed with patients is the potential of psychotropic drugs to distort emotional affect. Selective serotonin reuptake inhibitors (SSRIs) have
mind-numbing effects, as demonstrated by their ability to blunt
emotions and produce apathy, disinhibition, and amotivation similar to a
frontal lobe lobotomy, all of which would be consistent with a mindset
that might predispose an individual to homicidal behavior (13). As a
corollary, SSRIs are known to induce serious movement disorders,
including akathisia, dyskinesia, tardive dyskinesia, dystonia, and
parkinsonism (14). Pertinent to this discussion is akathisia, a form of
severe agitation also induced by antipsychotic drugs, which can cause
suicide and violence (15). Further, almost one in ten admissions to
hospital psychiatric units have been attributed to antidepressant-induced mania or psychosis (16).
Moreover, it is often not
disclosed that antidepressant therapy can exacerbate the severity and
chronic nature of depression and lead to poorer outcomes. For instance,
one retrospective study of nearly 12,000 patients in the Netherlands
revealed that 72 to 79 percent of those who were treated with
antidepressants during their first depressive episode experienced
relapses (17). It is telling that despite record high rates of
antidepressant use, prevalence of depression continues to soar.
Lastly, meta-analyses,
which compile data from placebo-controlled trials, indicate that the
differences in levels of symptoms resulting from SSRI use “were so small
that the effects were deemed unlikely to be clinically important” (18).
Further, a meta-analysis involving 6,944 patients participating in 38 studies underwritten
by drug manufacturers found that “Antidepressants demonstrated a
clinically negligible advantage over inert placebo” (19). This is all
the more shocking, since the efficacy of the drug was likely
artificially inflated. Researchers state, “This analysis probably
overestimates the antidepressant effect because placebo washout
strategies, penetration of the blind, reliance on clinician ratings,
use of sedative medication, and replacement of nonresponders may
penalize the placebo condition or boost the drug condition” (19).
It is incumbent upon
physicians to provide patients with true informed consent as to the
potential disastrous consequences of consuming mind-altering
psychotropic drugs, to identify at-risk individuals and mobilize
support, and to provide alternatives where applicable. For instance,
luminary Dr. Kelly Brogan, who has been a pioneer in debunking
mythologies of conventional psychiatry, recently published the success
of her holistic protocol incorporating mind-body techniques, dietary and
lifestyle interventions, detoxification modalities,
and targeted supplementation in producing dramatic clinical remission
in a patient with bipolar disorder with psychotic features, panic
disorder, and premenstrual dysphoric disorder (20).
Other Risk Factors for Amok and Mass Shootings
Compounding the effect of
skyrocketing prescription rates for violence-promoting psychotropic
drugs is the unprecedented social isolation that accompanies the digital
age. The common thread uniting amok and contemporary mass shootings is
what is branded mental illness, which is often inextricably intertwined
with social alienation in a chicken-or-egg scenario.
In the anthropological
curiosity known as amok, dimensions such as grief, acute loss, and
interpersonal stress are intimated to be contributing factors (1). For
instance, an 1846 Malay incident was concluded to be caused by an
elderly man’s bereavement of his wife and child,
while the offender in a 1998 Los Angeles incident suffered financial
bankruptcy (21). Furthermore, individual characteristics, such as
predilection to aggression, and recurring cognitive themes such as persecution and revenge are speculated to constitute instigating elements (1).
Undoubtedly at play in
mental illness is that we are divorced from our nuclear families,
proverbial islands adrift from the quintessential tribe and support
system to which we are evolutionarily adapted. Social ostracism was
historically the ultimate ancestral punishment, as an individual was
ill-equipped to survive when banished from a community. Moreover,
admissions of psychiatric disorders are met with derision and social
stigmatization, and the mobilization of social and professional support
needed to contend with mental illness is radically deficient. Therefore,
many individuals are deterred from seeking professional help.
Initial narratives by amok witnesses chronicled two forms characterized by differential causative factors: “The
more common form, beramok, was associated with a personal loss and
preceded by a period of depressed mood and brooding; while the
infrequent form, amok, was associated with rage, a perceived insult, or
vendetta preceding the attack” (1). Many of these traits can be
reconciled with the diagnostic criteria for modern psychiatric disorders
such as depressive,
mood, psychotic, dissociative and personality disorders, as well as
paranoid schizophrenia (1). Some argue that psychiatric classifications
are not reproducible or diagnosable with objective biomarkers, and
therefore do not constitute objectively delineated and non-overlapping
categories, but they do have utility in their ability to describe and
operationalize behavior in recognizable terms.
According to Saint Martin,
“Viewing amok from this new perspective dispels the commonly held
perception that episodes of mass violence are random and unpredictable,
and thus not preventable” (1). However, the modern medical
infrastructure has failed to support these individuals with anything
other than pill-for-an-ill psychotropic cocktails and psychotherapy,
rather than undertaking a holistic, root-cause resolution approach
consistent with the precepts of personalized medicine. Instead of
deferring to this standard of care, which has proven inadequate, we
would be wise to use these societal tragedies as impetus for
revolutionary reform and the heralding of evidence-based natural
approaches that address the underlying causes of mental illness rather
than applying symptom-suppressive chemical band-aids.
Going Forward: Making Sense of Devastation
In summary, the behavior
exhibited in modern mass shootings bears uncanny resemblance to amok,
indicating that indiscriminate violence has long been intrinsic to the
human psyche. It is fundamental to recognize, when drawing parallels
between the two constructs, the role that social isolation, collective
disillusionment, violent proclivities, and mental instability play in
precipitating this behavior in order to generate effective solutions.
More recently, the widespread use of psychotropic drugs no doubt
contributes to the rising incidence of mass shootings, yet it is a topic
mainstream media outlets fail to broach.
However, the prescribing of
these pharmaceuticals is only symptomatic of more upstream causes of
psychological imbalance, many of which remain to be elucidated.
Fundamental, though, is the profound disparity between the circumstances
to which we are evolutionarily accustomed and the modern-day stressors
we encounter, such as micronutrient deficiency, toxicant burdens, a
genetically engineered and irradiated food supply, and a
deeply-entrenched sense of dissatisfaction and loss of social
connection.
This is not meant to
catalogue excuses for such egregious and monstrous behavior, or to
rationalize the very worst in humanity. Nor is it meant to represent an
exhaustive survey of all the multifaceted socioeconomic, psychosocial,
and geopolitical variables that contribute to acts of mass violence. But
rather, this article serves as a commentary on some of those
little-discussed instigating variables and the pharmaceutical
industry-promulgated predecessors to such tragic events. It also
attempts to paint a portrait of how massacres are not isolated to the
modern era, and that by using critical analysis of the historical
patterns of amok we can garner insight into shared risk factors such as
detachment of an individual from the fabric of society and lack of
supportive resources or constructive coping mechanisms.
By finding common
psychological threads, and exploring their physiological origins, as
well as unearthing novel variables such as psychotropic drugs which
contribute to the never-before-witnessed frequency of fatal massacres,
we can take productive action to prevent their recurrence. We can
transform our righteous indignation into meaningful change. Although it
is tempting to abdicate all blame and to employ the bad apple narrative,
this does nothing to prevent the recurrence of these home-grown acts of
terrorism, but rather, represents a society-wide coping mechanism and
means of distancing oneself from some of the sources of these ultimate
acts of unimaginable aggression.
References
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About the Author
Ali Le Vere holds dual Bachelor of
Science degrees in Human Biology and Psychology, minors in Health
Promotion and in Bioethics, Humanities, and Society, and is a Master of
Science in Human Nutrition and Functional Medicine candidate. Having
contended with chronic illness, her mission is to educate the public
about the transformative potential of therapeutic nutrition and to
disseminate information on evidence-based, empirically rooted holistic
healing modalities. Read more at @empoweredautoimmune on Instagram and at www.EmpoweredAutoimmune.com: Science-based natural remedies for autoimmune disease, dysautonomia, Lyme disease, and other chronic, inflammatory illnesses.
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