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Severe Depression Can Trigger a Manic Urge to Kill

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Kerby Trevelus decapitated one of his sisters, stabbed another to death, and injured a third. Robert Stewart slaughtered eight people in a nursing home, and wounded another three. In the days leading up to the massacre of four police officers, Lovelle Mixon told relatives that he felt depressed and angry, an uncle noticing that he was emotionally withdrawn. Michael McLendon killed five family members and five other people before shooting himself. In the days leading up to the massacre, he told a friend that he was depressed.

Tim Kretschmer murdered fifteen people before shooting himself. Between April and September of 2008, Kretschmer had five outpatient "therapy" sessions for depression. Devan Kalathat shot to death six family members, wounded his wife, and committed suicide, Jiverly Voong gunning down fourteen people at an immigrant's center.

These, and the massacres at Fort Hood, Tucson, and New York City, had the markings of amok.

In the sixteenth century, Portuguese travelers observed Javanese who would go out in the street and kill as many persons as they met, before others subdued or killed them, or they committed suicide.

Malaysians called these people Amuco, amok meaning murderous frenzy or rage. Amok is traditionally attributed to loss of face, shame, humiliation, jealousy, or provocation. That amok is an expression of manic-depressive disorder is suggested by the preliminary symptoms: before the attack, the killer is typically preoccupied, withdrawn, brooding and apathetic - in other words, depressed. Following an amok, the perpetrator is often confused and amnesic, and if not apprehended or killed, may commit suicide.

In his "In Manic Depressive Insanity and Paranoia" (1921) Emil Kraepelin, suggested that amok is an expression of enraged mania, others referring to the attack as the outcome of switching from depression into manic agitation.

Dictionary com deftly defines amok as "a psychic disturbance characterized by depression followed by a manic urge to murder." While the motives are always investigated, an amok is indiscriminate, and biologically programmed to kill as many people as possible, as in battle. In "A Brotherhood of Tyrants: Manic Depression and Absolute Power," D Jablow Hershman and I suggested that natural selection may have preserved mania, because of the advantages it bestows in battle.

At the battle of Austerlitz, Napoleon displayed a cluster of manic symptoms advantageous for a military leader: excellent humor, optimism, enthusiasm, aggressiveness, confidence, daring, rapidity of thought and action, endless energy, little need for sleep, and insensitivity to hunger and physical discomfort. He saw opportunities to take the enemy by surprise, and then marched his troops huge distances, his forces appearing when and where they were not expected.

"My troops," he said, "move as rapidly as my thoughts." At Austerlitz Napoleon rode five horses to death, and went for five nights without sleep. Mania made him one of the most brilliant, and effective generals in history. At Borodino, early setbacks had the Emperor downcast and in his chair by midday, too disinterested to deploy his Imperial Guard, when it could have won him the day, and en route to his depressive fragmentation in Moscow.

Using humor to "disarm" others, grimacing, gesticulating, finger pointing, swearing, insulting, threatening, road rage, and police brutality, are variations of amok, and programmed to keep a potential aggressor at bay. The Maoris are past masters at using body language as a warning to keep one's distance, which the world has come to know in the form of the "HAKKA, "designed to send shivers down the spines of its foes.

Manic-depressive disorder has many variations, to the extreme of paradox. While gifting us with creative geniuses, it has, paradoxically, inflicted destroyers.

According to a widely published study at the Karolinska Institute, more than ninety percent of murderers are mentally ill, among them many with the violence-prone variant of manic depressive disorder.

Prevention starts by educating the public, physicians, law enforcement, the judiciary, and lay and medical media of amok in its rightful context. According to the medical literature accumulated over hundreds of years, amok it is, and not rampage, as invented by the New York Times and other media.

Stigmatization of manic-depressive disorder will subside when society comes to grips with the ubiquity, variations and advantages of it, and when stigmatization is placed firmly at the door of professionals, poorly equipped to recognize its signs and symptoms, and effectively treat them.

Julian Lieb, M.D is a retired Yale medical school professor, and author or coauthor of forty-eight articles and nine books. With D Jablow Hershman, Lieb coauthored: "Manic Depression and Creativity" and "A Brotherhood of Tyrants: Manic-Depression and Absolute Power." In these volumes, the authors showed that manic depressive disorder is paradoxical, in gifting society with creative geniuses, and great destroyers.

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