Understanding Mental Illness and Violence

In Blacksburg, Virginia, one college student at Virginia Polytechnic Institute and State University shot and killed 32 people and wounded 25 others in 2007. The shooting took place in two separate attacks, approximately two hours apart. This mass murder finally ended when he turned the gun and shot himself in the head. He was known to have struggled with mental illness for many years. The attack is now known as the deadliest shooting incident by a single gunman in U.S. history and recorded as one of the biggest massacres by a single gunman worldwide. The horrendousness of this shooting raised several pressing questions: Are the mentally ill violent? Are the mentally ill at risk of public violence?

According to American Psychiatric Association, the vast majority of people with mental illness are not violent. The absolute risk of violence among the mental ill as a group is very small.¹ In other words, only a small portion of the violence in our society can be attributed to persons who are mentally ill. However, the studies that have examined the antecedents of aggressive incidents reveal that “the majority of incidents have important social/structural antecedents such as ward atmosphere, lack of clinical leadership, overcrowding, ward restrictions, lack of activities, or poorly structured activity transitions.”² These studies indicate that it is not actually the symptoms of mental illness that cause violence, but the overall personal and social surroundings that play important roles in causing violence. Then, in the case study of Virginia Tech Massacre, it is important to carefully examine the shooter’s back story in order to fully understand how his personal experiences of oppression, marginalization, and inequality related to mental illness affected his act of violence.

The Korean American Back Story

In April, 2007, while the nation was in complete shock, the Korean American community was stunned to learn that the gunman responsible for the worst mass shooting in American history was a Korean immigrant—Cho Seung Hui, a 23-year-old student. At that time, the Korean American community felt ashamed of Cho because they feared that this tragic shooting event might touch off racial prejudice against Koreans. The entire nation was also shocked to find out that the shooter was an American of Asian decent. Often times, Asian immigrants are perceived as “model minorities” who have achieved the status as the highest-income, best-educated and fastest-growing racial group in the country by their exceptional work ethic and collective effort.³ In the American imagination, they do not seem to share the challenges faced by other immigrant groups In fact, this shooting was one of those rare events that in fact shattered the myth of the model minority. As the entire nation was trying to make sense of this great tragedy, the Korean American communities throughout various parts of the United States had some time of soul-searching occasion, critically and honestly reflecting on this event and the story of Cho. At that time, many were ashamed of Cho. But, at the same time, they felt empathetically connected to Cho, whose underlying major depressive disorder (MDD) was never fully noticed because of the stigma of mental illness in the Asian American community.

Troubling Signs of Mental Illness

Cho had been diagnosed with selective mutism. Selective Mutism (SM) is an anxiety disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people.⁴ Selective mutism usually co-exists with shyness or social anxiety.⁵ This diagnosis in the spring of Cho’s eighth-grade year, and his parents sought treatment for him through medication and therapy. In high school, Cho was placed in special education under the “emotional disturbance” classification. He continued receiving mental health therapy as well until his junior year, when Cho rejected further therapy. These reports on Cho’s medical treatment history strongly indicate that he struggled with various form of illness, such as social anxiety, depression, speech disability and more.

When Cho was about 8 years old, he and his family came to the country from South Korea. They eventually settled in Centreville, Virginia, where they ran a dry-cleaning business. Because his parents were very busy as immigrants to run a dry-cleaning business, his parents did not spend much time with him when he was young. Cho was known as a shy child who liked basketball and did well in math. However, Cho was also constantly bullied by other children in school and church especially by wealthy members of his church because he was “a weird kid.”⁶ In high school, Cho was described as sullen and aloof. In college, as a English major Cho often stood out as a near-silent loner who wrote gruesome poems, stories and plays. In classroom, he referred to himself as “the Question Mark.”⁷

Not Only a Perpetrator, But Also a Victim

Cho killed 32 people and wounded 25 others by using gun. That is the hard facts. He is the perpetrator of this one of the deadliest crimes. According to the criminal justice system, Cho must be given punishment for his act of violence. However, before putting him into the category of “retributive justice,” as part of ethical judgment of Cho’s action, we must take into careful and critical consideration that Cho had struggled with various of forms of severe mental illness for many years. We must carefully investigate and think about what kind of lifestyle Cho was forced to have due to his state of selective mutism and major depressive disorder. As an ethnic minority living in the United States, Cho had been already living in the margin of the society. Further, due to his mental illness and related issues, he was constantly bullied by his friends in school, neglected by his parents who were “too busy” to survive a life of immigrants and even constantly mistreated by his church members as well. In Cho’s case, it is critical to note the presence of stigma of mental illness in Asian American community. Due to cultural perceptions, Asian Americans may feel shame or embarrassment in experiencing a mental illness, and prefer not to seek care, for fear of shaming their family. Also, expression of one’s feelings is an admittance of weakness. Under the weight of his contextual and cultural conditions, it’s likely that Cho was not given appropriate care and proper support to deal with his mental issues throughout his childhood and adolescence. When he became a college student, he often identified himself, “the Question Mark” in classrooms. What does it mean for a person to identify himself or herself as “the question mark?” It implies that Cho did not have a sense of self; he was a non-person. Cho’s identity as “the question mark” denotes that Cho did not know who he claims himself to be and how to make sense of his painful life. In other words, he was a victim. He became a victim not only due to his mental illness, but also a serious lack of appropriate care for him to be even “a human.” Thus once again, we must first be concerned with conditions of vulnerability and inequality of Cho and understand how that state of vulnerability and inequality may have led to act of violence. Cho’s vulnerability and inequality could be clearly recognized in “his absence of self-identity” and “his constant experience of marginalization and mistreatment” in his communities including his family, school, church and more.

The Doctrine of Imago Dei

The shooter is not only a perpetrator of violence, but also a victim. He was the victim of his intense form of mental illness and lack of care from others around him. In fact, it is known that people with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. The shooter was the victim and the one who was vulnerable and defenseless because he did not have an identity of himself. He saw himself as “the question mark,” and “a non-person.” In fact, the scripture explains that everyone human is given an inborn identity: a person made in the image of God. Every human being was carefully and fearfully made in the image of God. However, what we see from the shooter’s back story is that he did not have any sense of “who he is as a person.” The shooter had completely lost the fact that he was made in God’s image. How does the doctrine of Imago Dei that features prominently in moral discernment of this issue of personal and social identity crisis?

James M. Gustafson explains that the use of Scripture in Christian ethics first “involves the determination of the theological and ethical principles which will be used to bring coherence to the ‘meaning’ of Scripture’s witness.”⁸ Gustafson provides the two primary views of Scripture in Christian ethics: (1) Scripture as the revelation of morality and (2) Scripture as the revelation of action of God. Gustafson contends that a view of Scripture as the revelation of a morality that is authoritative for the judgments of Christian from a view of it as a revelation of theological principles that are used to interpret what “God is doing,” and therefore in turn, can give clues to what man as a moral agent is to do in particular circumstances.⁹ Then, how do we understand the biblical concept of Imago Dei and apply it as a tool to understand the given situation? In fact, there are several passages in the Bible that talk about the divine image in human beings. Most prominently, in Genesis 1:26-27 (NRSV) says:

Then God said, “Let us make humankind in our image, according to our likeness; and let them have dominion over the fish of the sea, and over the birds of the air, and over the cattle, and over all the wild animals of the earth, and over every creeping thing that creeps upon the earth.” So God created humankind in his image, in the image of God he created them; male and female he created them.¹⁰

Genesis 1 account explains that God made humans in God’s image because God wanted humans to be set apart from other creatures by having divine qualities. It was God’s own choice to create humans in God’s image so that God’s quality, character and value can be shined through human beings.

Before he was labeled with the inhumane titles of “the deadliest shooter,” “a loner,” “a mentally ill patient,” “a weird kid,” and even more, he was a human. He was a human who was made in the image of God. Also with the fact that he was a Christian, his fundamental identity should have been a child of God who has divine characteristics and value. However, over the course of years in his life, he had lost his identity due to mental illness and its related struggles in large part. And the people in his life had failed to treat him with appropriate care and proper treatment in how people should treat each other in light of the fact that we are all made in God’s image. He clearly had lost his godly image in him and claimed himself to be “the question mark.” Therefore in ethical implication, before we quickly jump into judging his act of violence and label him with the deadliest shooter in history, we must look at the tragic fact that the shooter as a human being had lost his own identity. For many years of his life struggling with mental illness, he had grown to deny the image of God in him and had given up to be simply a human. His family members, teachers/professors, church members and friends failed to protect and nurture his human dignity by not giving careful attention to his state of vulnerability and self-denial.

The Ethics of Care

Thus what the biblical conception of Imago Dei informs us that it is very important to acknowledge that all human being are made in the image of God. And we must look and pay attention to each individual who may have lost his or her sense of identity as a bearer of God’s image. In order to restore and revitalize one’s personhood and human dignity from Christian ethics perspective, ethics of care as an approach can be very helpful to in responding to one’s needs. Virginia Held explains, “The central focus of the ethics of care is on the compelling moral salience of attending to and meeting the needs of the particular others for whom we take responsibility.”¹¹ For instance, caring for one’s child may well and defensibly be at the forefront of a person’s moral concerns. The ethics of care recognizes that human beings are dependent on us for the care they need is pressing and that there are highly important moral aspects in developing the relations of caring that enable human beings to live and progress.¹² Held emphasizes that all persons need care for at least their early years because “prospects for human progress and flourishing hinge fundamentally on the care that those needing it receive, and the ethics of care stresses the moral force of the responsibility to respond to the needs of the dependent.”¹³ Held argues that ethics of care is essentially about what it means for people to be “human beings.” Many people will become ill and dependent for some periods of their later lives and some people who are permanently disabled will need care the whole of their lives. Moralities built on the image of the independent, autonomous, rational individual largely overlook the reality of human dependence and the morality for which it calls. Thus, the ethics of care attends to this central concern of human life and delineates the moral values involved.

Therefore, one of the key ethical elements in this particular approach to ethics is responsiveness. Joan Tronto argues that responsiveness signals an important moral problem within care: by its nature, care is concerned with conditions of vulnerability and inequality.¹⁴ Tronto explains that responsiveness and reciprocity are not equivalent. Rather, it is one important method to understand vulnerability and inequality by understanding what has been expressed by those in the vulnerable position, as opposed to re-imagining oneself in a similar situation.¹⁵ Returning to the case study and the moral question, in the process of moral judgment on person with mental illness who caused act of violence, we must foremost be concerned with “conditions of vulnerability and inequality” of a person with mental illness and understand how that state of vulnerability and inequality may have led to act of violence. The shooter was left in the vulnerable position for many years without anyone to depend on. In fact, he was not given any fundamental form of care in early years of his age, which allowed his mental illness to take deeper roots in his personhood and ultimately affect his violent and abnormal behaviors. In the end of the shooting, Cho killed himself. So how do we morally judge him? How do we respond to this situation? The scripture tells us that every human being is created in the image of God. From the perspective of Christian ethics, before we label him as the perpetrator of violent crime, we are responsible to restore his human dignity and shine the image of God that was in him by recognizing his human struggles of mental illness, social isolation, lack of dependence and searching for his human identity.

Conclusion: Challenges Left Behind

Then what are some challenges of the doctrine of Imago Dei and the perspective of ethics of care? What are some possible critical responses? We must acknowledge that the biblical conception of Imago Dei is in fact one of many ways to understand human’s personhood. It has been views as the Christian doctrine of human being. So for those who do not come from the Christian tradition may have difficult time understanding this concept of Imago Dei. And in the case study’s context, if you do not believe in Imago Dei, you may not be able to locate the image of God in the shooter’s act of violence because often times, violence is not perceived as God’s or divine feature. If I were to defend the shooter’s shattered personal identity of bearer of God’s image, what about the victims of the shooting? If we believe that the shooter was made in God’s image, how do we defend and care for those who were killed by the shooter? How do we explain this to those who were brutally killed by the one who is believed to have God’s image? Moreover, in private sense, it may make sense to understand that the shooter was also a victim of mental illness. However, in public realm, the shooter is still the perpetrator of violence who killed and wounded over 50 college students. This brings up a challenge in using ethics of care as the main approach in moral discernment. The strength of ethics of care is that it recognizes the moral value and priority of personal relationships. It also affirms relational knowledge, emotion, and loyalties as parts of the process of moral discernment by responding to individual’s human need. However, these moral values of personal relationship based approach do not carry equal significant in the public realm as these do in the private realm. The shooter’s background story, the condition of vulnerability due to mental illness is very heartbreaking, yet the facts that he still went against the rules (justice orientation) by killing people intentionally and also violated other people’s human dignity never change. But in the end, what ethics of care challenges us is to be attentive to individual’s needs in the public realm. It challenges us to gain and use attentiveness in the public realm where individual human dignity is often ignored and crushed in the name of justice for all. In essence, care requires recognition of others’ needs in order to respond to them. Those who are in support of ethics of care suggest that care must become the social responsibility, not only the personal, individual responsibility. So that act of care could be performed and caregivers could be valued in both public and private spheres.

Eunil David Cho, PhD Candidate

Emory University

Categories: (T) Article