Can We Predict Teen Violence?

Patrice Pascual
April 28, 1999


Interview with Barry L. Siegel, M.D., Clinical Associate Professor of Psychiatry at Georgetown Medical School.

Q: Help us understand the boys who attacked Columbine High School.
A: There's no indication that these boys were monsters as some claim, but these boys were seriously mentally ill. [They] suffered from a psychosis, which means that their thinking was disordered and rendered them unable to distinguish reality from their violent fantasies. They thought that people were against them and that people were making fun of them. In addition to the wish to destroy their enemies, they had a grandiose view of themselves that they could wreak all this destruction, even beyond their school.

Considering the bizarre quality of these acts and ideas, you don't have to be a psychoanalyst to think these kids were crazy.


Q: Then shouldn't it have been easy to predict their violence?
A: Not necessarily. When adolescents-or for that matter anyone-become psychotic, they don't necessarily manifest crazy behavior until they explode. A psychiatrist or a mental health professional might [pick up this psychosis], but I think it's unfair to expect the parents to do so.

There are really three factors, all of which must be present, for this kind of violence to occur: a serious mental illness, the presence of violent fantasies and access to destructive weapons. The absence of any of these would result in no action.


Q: How does this level of mental illness remain hidden?
A: Teens might become moody or withdrawn or wear peculiar clothes or manifest some other kind of strange behavior, but many behave this way for a period of time and are perfectly normal adolescents.

When an adolescent becomes psychotic, it's not uncommon for it to be temporary. It may come and go depending on the degree of stress and his capacity to deal with that stress in an adaptive fashion. I am talking here about adolescents that are already ill and vulnerable to regression to a psychotic state.

The immediate causative factor is often a particular stress-when the stress disappears, if they haven't reacted, they can continue to function. When you look back in the boys' histories, they were doing well in school. They had some peculiarities, but I think something happened. Some stress must have occurred in their lives or in the life of one of them.

I have no proof of this, but the fact that these [school killings] seem to occur in the spring, it seems to me that the impending separation from the school makes them anxious. [Editor's note: Six of the eight recent school shootings occurred in the months of March, April or May.]


Q: If their psychosis was intermittent, why did they plan the attack for so long?
A: You can have an elaborate fantasy and have no intention to carry it out. It is after one loses contact with reality that the fantasy suddenly becomes a delusion and actionable.

Suppose a guy is fired from his job. He might be really upset and may even have a fantasy for six months or a year that he's going to kill his former boss or blow up his house in order to get even. That doesn't mean he is going to do it. But if he becomes psychotic and loses his ability to tell what is real and what is only a fantasy, he may very well carry it into action. I would not say he had been planning to act for all that time.


Q: So how does one know when to take the fantasies seriously? For instance the video the Littleton boys made about guns.
A: The kids should have been brought to the attention of a mental health professional-it was enough of an indication for someone to evaluate their thinking, their impulse control, their mental state in general, to see if there was a danger that they were or might become psychotic.

There are hundreds, if not thousands of disaffected kids who have fantasies like these who never do anything because they are in good enough mental health. The problem is that a few are seriously ill and if one begins to talk about violence and becomes so involved in it that he makes a video, a thorough psychological evaluation done by someone who regularly deals with this age group is a good idea.


Q: But people are reluctant to read too much into early threats?
A: To report [a concern] is not an attack or an accusation against anyone. It's a way of helping the children, helping the family and helping the community.

There's a reluctance for parents to take action because if there's something wrong with their child mentally, they always blame themselves. They are afraid that to recognize that something is wrong is to point their finger at themselves. But [mental illness] is not a consequence, in most cases, of parental abuse or neglect. It's very important to send a message to parents that if they think there is something wrong with their kids, that is not evidence that the parents are to blame.

If people in the community are going to cast stones, they can't expect anyone to be helped. No one is going to stand up and say stone me. They will hide in the attic, they will hide in the closet, and they will wait until the bomb goes off. It's time to really do something in the area of increasing awareness and funding for mental health diagnosis and treatment.


Q: Anything else?
A: Going back to the three factors that create this violence, we also need to diminish the availability of guns, and of violent images. Parents can deny their kids access to these images and put pressure on the purveyors of these images to stop. Too many parents in this country haven't a clue about what violent media and video games do to their kids-it desensitizes kids to the humanity of other human beings and it puts great stress on them at a time when they are already dealing with the stress of growing up. In my view, the violence America's kids are being bombarded with is as injurious to them as are drugs, alcohol and tobacco. And while violent images are potentially injurious to all children and adolescents, they are particularly noxious to those that are vulnerable to mental illness or are already mentally ill.