Taiwan has become a diverse society and we need to take active steps to prevent incidents of social violence.
The FBI defines “mass rampage killing” as the killing of four or more people in a short period of time, without a break, in a single location. Mass killing incidents of this kind — that have no political motivations, are not carried out by terrorist organizations and are not genocidal — are most commonly seen in the US, where it is legal to possess firearms. The killers in such incidents generally end up killing themselves or being shot dead by the police, so the killer’s motive and mental condition are often unclear.
To my knowledge, only one such killer has been arrested in the US, and, after three years of litigation, was found guilty by a jury and sentenced to life imprisonment without possibility of parole.
The murderer, James Eagan Holmes, was born into a middle-class family in California in 1987. At the time of the incident, he was 25 years old, unmarried and studying for a doctorate.
On July 20, 2012, during a midnight showing of The Dark Knight Rises at a movie theater in Aurora, Colorado, he threw tear gas canisters into the audience, pulled out his firearms and started shooting at random, killing 12 people and wounding another 70. Following the attack, he did not utter a word.
The judge who presided over his trial agreed to the use of narcoanalysis — questioning with the aid of a “truth drug” — to determine his mental condition.
Eventually Holmes was examined by two psychiatrists from different institutions, one of whom diagnosed him with schizotypal personality disorder, while the other diagnosed him with schizoaffective disorder. The two psychiatrists were both of the opinion that he was psychologically abnormal, but had to bear criminal responsibility for his actions, but they still did not understand his motive for killing.
Although the reasons for mass killings remain unclear, as far as Taiwan is concerned, there are some risk factors that are worthy of attention. These include: long-term unemployment among young men; use of addictive substances, notably ketamine, amphetamines and the relatively new narcotic MDPV, commonly known as “bath salts”; the lack of a family support system; and personality disorders such as compulsiveness, callousness, narcissism and antisocial behavior.
However, the most important thing to note about personality disorders is that they are very hard to distinguish and that those who suffer from them might not think they are sick and might not seek treatment.
Taiwan is nowhere near as big as the US, and it has a household registration system that has been in use since the days of Japanese rule. Actually, as long as they do their job and do not focus all their attention on political affairs, borough wardens and neighborhood chiefs are the people who know who in their communities are outsiders, which people have only recently moved into the area, and which people have personality disorders, use illegal addictive substances or are disadvantaged and have insufficient support systems.
Taipei’s district health centers and their forerunners — which were called public health centers — have in the past seven decades played the role of promoting public health with considerable success, especially in regard to disease prevention.
They have been very helpful in promoting the quality of care for people with chronic and psychiatric illnesses. As time goes by, their duties should be adjusted to reflect scientific and technological developments and the demands of changing social and economic conditions.
It would be a good idea for the Taipei City Government to use health centers as a platform that, in combination with policy departments governing civil and social affairs, policing and healthcare, would form a social and psychiatric prevention and security network. By setting up a notification mechanism and arranging home visits, health centers might be able to detect some problematic cases at an early stage and then employ psychiatric counseling or other kinds of treatment to prevent violent incidents.
With regard to forming a social and psychiatric prevention and security network, there is another kind of information that is severely lacking, namely epidemiological data about psychiatric illnesses.
Taipei does not have figures for the prevalence of drug and alcohol addiction, nor does it have epidemiological data on people who suffer from personality disorders. Without data on psychiatric illnesses as a basis from which to work, it would not be easy to allocate personnel, form strategies or decide what measures should be taken.
Because of its low birth rate, Taiwan is facing some problems associated with small families. Children who grow up in small families might be so doted upon that it becomes hard to regulate their behavior.
Another problem is the popularity of online games, many of which contain scenes of killing, violence and sex.
Adolescents and young people who become engrossed in these games might suffer from a lack of social exposure, become distanced in their interpersonal relationships, have difficulty expressing their emotions or become emotionally immature.
When they grow up, if they run into difficulties and do not have enough self-control, they might project imaginary images into their real life and think that violence and aggressive acts can solve their problems or relieve their tension. This might lead them to commit grievous mistakes that they are not even aware of.
These are psychologically abnormal forms of expression, but not psychiatric illnesses, so the perpetrators must bear full criminal responsibility for their actions. Incidents such as these are more likely to happen in densely populated urban areas. As society develops in diverse ways, it is foreseeable that incidents of mass rampage killings could happen in Taiwan, so we cannot afford to be off our guard.
By means of mutual-help preventative networks and alert mechanisms, it might be possible to reduce the likelihood of this kind of serious social safety incident occurring.
Chen Chiao-chicy is a professor of psychiatry at the Mackay Memorial Hospital and Taipei Medical University.
Translated by Julian Clegg
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