Table of Contents

Introduction
The Virginia Tech Killings
Prevention of Apocalyptic Mass Murder/Suicide
Author Bio
Cho Seung-Hui
The Virginia Tech Shootings
The Shootings Begin
Norris Hall
The Manifesto
Who was Cho Seung-Hui?
Cho’s Childhood
Cho’s Problems Worsen
The Middle School Years
High School
College
Cho’s Psychosis Worsens
The Fatal Spring Semester, 2007
What We Have Learned from the Virginia Tech Massacre
Emergency Medicine in America
Prediction of Violence: Who Is Dangerous to Whom, Why, and What Can Be Done about It?
Predicting Future Behavior
The Neuropsychiatric Assessment of Violence
Principles of Triage
The Gathering Storm
No Exit, Not Even for Doctors
Medical Receptionists as Gatekeepers
Validity of Diagnosis for Service Optimization
Innovation for Service Optimization via Progressive Computer-Assisted Screening
Computer Software Can Model the Clinician’s Triage Decision Process
Diagnostic Specificity Necessary for Documentation and Service Optimization
Emergency
Med-Surg
States of Mental Disorganization Impairment
Emergency Screens
Violence toward Staff
Assessing Dangerousness
Other Violent Crime Statistics
Assessing Suicide Intent
Medical Screens
Neuropsychiatric Screen
Med-Surg Screen
Screens for States of Mental Disorganization
Psychosis
Substance Abuse
Traumatic Stress Disorders
Psychiatric Impairment
Dysphoria and DSM IV Screen
Psychosocial Maladjustment
The Virginia Panel and Campus Safety
Treatment Advocacy
Kurt Entsminger
An Epidemic of Campus and Workplace Suicidal Mass Murder
The Psychotic
Modern Psychiatry and the Psychotic
Cho Seung-Hui, Attachment Disorders, and Pathological Narcissism
The Paul Keller Case
Origins of Rage in Pathological Narcissism
Best Clinical Practices
First Encounter: Clinical Assessment in the New Millennium
The 9/11 Anthrax Case
Potential Signs for Dangerous Behavior and Best Practice Solutions
Prevalence of Violence
Sodini’s Videos
Warning Signs of Violence
Ideations of Violence and Violent Fantasies
Actual Warnings of Impending Violence
Auditory Hallucinations
Bullies and Victims of Bullying
Previous Acts of Violence or Sexual Violence
Chronic Drug or Alcohol Abuse
Cumulative Rage
Dramatic Mood Swings
Violent Sexual Fantasies and Insatiable Sex Drives
Abnormal Fascination or Obsession with Blood, Gore, and Death
Indifference to Life, to Suffering, and to Pain of Other Creatures
History of Arson and Fire Starting
History of Homicidal Behavior or Manifested Homicidal Intent as a Child
Gathering and Possession of Weapons
Best Practice Solutions
Education
Warnings to Individuals
Enabling Violent Behavior
Community Education
Municipal and State Child Services and Juvenile Services
Emergency Room Training
Telemedicine
Telepsychiatry
Change Makers
Emergency
Med-Surg
States of Mental Disorganization
Impairment
Appendix A
Appendix B: Richard McBeef
Appendix C: The Sodini Transcript

About the Author

John Liebert, M.D., is a Diplomat of the American Board of Psychiatry and Neurology and is in the private practice of neuropsychiatry, with special interests in both psychopharmacology and forensic problems of children, adults, and the elderly. His career has been focused on the association of trauma and human destructiveness, about which he has extensively lectured and written. He served as special forensic psychiatry consultant to the Ted Bundy, Green River, Atlanta Child Murders, and Charmer cases. William J. Birnes, J.D., Ph.D. is a New York Times bestselling author. With Robert D. Keppel, he co-authored the CRC Press book Serial Violence: Analysis of Modus Operandi and Signature Characteristics of Killers. He is currently the Chairman of Sunrise Community Counseling Center in Los Angeles.

Reviews

! the definitive book on mass murderers, written by the man who knows more about interviewing and profiling violent offenders than anyone else in his field.a Dr. Liebert's work in forensic psychiatry is second to none.a -- Robert D. Keppel, Ph.D., author of The Riverman and Serial Violence No better person could have been chosen ! than John Liebert, America's psychiatric expert on serial killings and mass murder, who is frequently called to assist the law enforcement in such cases as Green River, the Atlanta Child Murders, and the Ted Bundy cases. -- Steven Hirsch, M.D., Forensic Psychiatrist and leading international researcher in the field of schizophrenia ! an excellent presentation of the Virginia Tech incident, definitely some lessons to be learned. --Marvin Skeen, Chief Criminal Investigator, Criminal Justice Division, HITS Unit, Washington State Office of the Attorney General Dr. John Liebert, a well-known and highly respected psychiatrist, has written an eye-opening, timely andaimportant bookaabout a dramatic and tragic subject, with which we are all-too-familiar: It is aboutaindividuals in our midst who have perpetrated mass murders and then committed suicide. His astute thesis is that theseaadult killersawere showing clues early in their development that we in the education, corrections and mental health professions should have, and indeed could have, picked up. Dr. Liebert is veryapersuasive when he shows that early sensitivity to aberrant behaviors,afollowed byatimely corrective interventions, could have staved off the tragic outcomes which befell the victims, and affected all of us.aThis significantawork should serve as a resource for those who areainvestigating these terrible occurrences, as well as for those who are interested in preventing such tragedies in the future. --Dr. Saul Levine, Professor of Clinical Psychiatry, University of California, San Diego, international expert on factors reducing the risk of adolescent violence Dr. Liebert is a nationally known and respected psychiatrist. His expertise assessing human behavior and dangerousness have contributed to our understanding of those individuals who perpetuate mass homicide and suicide. Dr. Liebert's discussion of these individuals, and their actions, offer insights to help identify and deter future tragedies. --Dr Robert Johnson, Clinical Psychologist, FORCCOM, US Army, Baghdad, Iraq When I was in charge of the Missing and Murdered Children case in Atlanta, Georgia during the late 70s and early 80s, John Liebert was one of my psychiatric advisers. He provided valuable insight into the possible motives of the person or persons responsible for the killing of Atlanta's children. Now he has written a book that explains to the reader why mass murderers kill. By examining actual cases, he provides the reader with a clear insight into the phenomenon of mass violence. It is a must read for anyone associated with criminal justice education as well criminal justice and medical practitioners. --Dr. Lee P. Brown, Chairman and CEO, Brown Group International ... Chapter 2, which I think is excellent ! [the book raises] many interesting issues. I never knew where least restrictive alternative came from, so I learned something. --Dr Bill Holliday, Police Psychiatrist of Washington State I was eager to read Dr. Liebert's Suicidal Mass Murderers -- A Criminological Study of Why They Kill and found the chapters on "Prediction of Violence" and "Potential Signs for Dangerous Behavior" to be the most useful, from a law enforcement point of view. If we can identify and interdict a mass murderer BEFORE a massacre occurs, we will have provided an extremely valuable service. I can assure the reader that every murder victim would have preferred the PREVENTION of that murder to a detailed police investigation AFTER the fact! Dr. Liebert's splendid contribution toward that goal will be welcomed by all concerned and will help to save lives that might otherwise be lost. -- D.P. Van Blaricom, MPA, Chief of Police (Retired), Bellevue, Washington