RICHMOND, Va., Aug. 30 -- The Virginia Tech massacre might have been prevented if university authorities had heeded "clear warnings of mental instability" from the shooter, found a state review panel report issued today.
The summary of the report, by a panel appointed by Virginia Governor Tim Kaine, began with a stark statement of the facts:
"On April 16, 2007, Seung Hui Cho, an angry and disturbed student, shot to death 32 students and faculty of Virginia Tech, wounded 17 more, and then killed himself."
Action Points
- Explain to patients that selective mutism, with which Virginia Tech shooter Seung Hui Cho was diagnosed, is a near-paralyzing inability to speak in certain social situations.
- Explain that despite its name, selective mutism is non-voluntary and is a symptom of severe social anxiety disorder, but is not typically associated with violent behaviors.
The report goes on to document in exhaustive and painstaking detail Cho's history of mental health problems, which were recognized in childhood. He received psychiatric treatment and counseling for depression and selective mutism, a symptom of a larger severe social anxiety disorder.
"His middle and high schools responded well to these signs and, with his parents' involvement, provided services to address these issues," the panel found.
But confusion about state and federal privacy laws, gaps in mental health services within Virginia Tech and at the local and state level, and gaping holes in gun laws all conspired to allow a dangerous and deranged student to go on a killing rampage in a dormitory and classroom building.
"No one knew all the information, and no one connected the dots," the panel members wrote, regarding the university's response to "troubling incidents" that occurred during Cho's junior year.
The report noted that in interviews conducted for the panel's investigation, various Virginia Tech officials -- including those from the counseling center, office of judicial affairs, campus police and the dean of students -- reported that they didn't share information with one another or with Cho's parents in the belief that they were barred from doing so by privacy laws.
But "in reality, federal laws and their state counterparts afford ample leeway to share information in potentially dangerous situations," the panel members found.
The panelists also noted that while Virginia is one of only 22 states reporting any mental health data to a federal database, which is used to do background checks on people who try to buy guns, Virginia law is fuzzy about the need to report information on people ordered into outpatient care, as Cho was, but who were not committed to an inpatient facility.
"Cho purchased two guns in violation of federal law," the panelists wrote. "The fact that in 2005 Cho had been judged to be a danger to himself and ordered to outpatient treatment made him ineligible to purchase a gun under federal law."
After his assault, Cho took his own life, leaving behind grieving families and friends, a rambling videotaped screed, and a multitude of unanswered questions.
One of these concerns the failure of Virginia Tech to spot a deeply troubled young man. According to the panelists, Virginia Tech, unlike most schools, does not require letters of recommendation or essays in freshman applications, and does not conduct personal interviews.
“Incidents such as these are rare to begin with, but they could be made rarer,†said William S. Pollack, Ph.D., director of the Centers for Men and Young Men at the Harvard-affiliated McLean Hospital in Belmont Mass., in an interview.
Dr. Pollack was a contributor to the U.S. Secret Service task force report on school shootings. That report found that while all of the documented shootings have been carried out by boys or young men, there is no typical, easily identifiable profile of a likely shooter.
Still, there are common signs, and someone at Virginia Tech should have been able to read them, he said.
“Obviously, he was acting strangely, appeared to be in a depressive state, and didn’t talk to people for long periods of time,†he said.
Judging from publicly available information, Dr. Pollack said that Cho appeared to be like many others who engage in targeted violence -- violence involving at least some planning. In Cho’s case the violence seems to have grown out of depression and rage engendered by some aspect of his life at school.
“The hate turns to a depressive sense of lassitude and a feeling that there’s no other way, and they move onto a path of violence. This fellow moved onto a path of violence a long time before the event occurred,†he said.
Cho's Virginia Tech classmates remembered a silent young man who rarely if ever spoke in class, even when directly called on, a classic hallmark of selective mutism. In fact, Cho's lack of communication with his parents and other family members was a cause for great concerns in his childhood, the investigative panel found.
"Over the years, Cho spoke very little to his parents and avoided eye contact," they wrote. "If called upon to speak when a visitor came to the home, he would develop sweaty palms, become pale, freeze, and sometimes cry. Frequently, he would only nod yes or no."
In 1999, when he was in eighth grade, a psychiatrist diagnosed Cho with selective mutism and single episode major depression. Selective mutism falls under the broad ICD-9 diagnostic category of disturbances of emotions specific to childhood and adolescence.
Diagnostic criteria for selective mutism, according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), include "a consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations."
To meet the criteria, the disturbance must interfere with school, work, or social interaction, last at least one month, not be due to lack of knowledge or comfort with the language requited in the social situation, and not be explained by other conditions such as communication disorders, pervasive developmental disorder (including autism spectrum disorders), or psychotic disorders.
Selective mutism, a component of the severe social anxiety disorder that Cho was diagnosed with in eighth grade, is not associated per se with violent personalities, but may be a source of ridicule by others, and may prompt bullying. A history of being taunted and bullied in school often underlies deadly incidents such as the Columbine High School killings in 1999, authorities on violent behavior in adolescents say.
Although there are no confirmed reports of Cho being a target, "it would be reasonable…to assume that Cho was a victim of some bullying, though to what extent and how much above the norm is not known," the panelists wrote.
That Cho thought of himself as a victim was made clear by a videotaped rant that he mailed to NBC News in the two hours between murders at the West Ambler Johnson dormitory and a killing spree in Norris Hall.
"You had a hundred billion chances and ways to have avoided today, but you decided to spill my blood," Cho told the camera in an almost robotic monotone. "You forced me into a corner and gave me only one option. The decision was yours. Now you have blood on you hands that will never wash off."
As early as April 1999, following the Columbine shootings, there were signs that Cho was capable of violent thoughts, if not actions. He wrote a paper in English class that expressed thoughts of suicide and homicide, and a desire to "repeat Columbine," although he did not mention specific individuals or targets.
The incident prompted the school to urge Cho's parents to have a psychiatric evaluation for their son, which led to the diagnosis of mutism and depression, for which he was started on a short course of paroxetine (Paxil).
But information about Cho's medical history was never passed up the chain to Virginia Tech. And during his time there, repeated "red flags" were not recognized as symptoms of a larger problem the panelists said.
Some of the signs of trouble looming included Cho's playing with knives, uncooperative and disruptive behavior in the classroom, students who skipped classes to avoid being near him because they were afraid of him, disturbing or bizarre text messages sent to female students, and an involuntary commitment to a hospital for expressed thoughts of suicide.
The panelists also questioned why Virginia Tech authorities did not receive information about Cho's mental health status at the time of his admission.
"It is common practice to require students entering a new school, college, or university to present records of immunization. Why not records of serious emotional or mental problem too?," the panelists asked. "For that matter, why not records of all communicable diseases? The answer is obvious: personal privacy."
"His mental health records might be sealed, but his behavior was overt. There’s not a law in the United States that says if a student engages in strange behaviors that the university can’t respond to those behaviors, “ Dr. Pollack said.
In the section of the report devoted to Cho's mental health history, the panelists recommended that universities "have a system that links troubled students to appropriate medical and counseling services either on or off campus, and to balance the individual's rights with the rights of all others for safety."
They recommended that "incidents of aberrant, dangerous, or threatening behavior must be documented and reported immediately to a college's threat assessment group, and must be acted upon in a prompt and effective manner to protect the safety of the campus community."
The panelists also recommended the following steps at the state level:
- Amendment of laws to extend time periods for temporary detention for mental health evaluations, and to give magistrates authority to issue temporary detention orders on the basis of the recommendations of emergency physicians trained in psychiatric evaluations.
- Revising criteria for involuntary commitment to promote more consistent application of the standard and allow involuntary treatment for a broader range of cases involving severe mental illness
- Increased capacity of secure crisis stabilization units.
- Clearer definition of the role of independent mental health evaluators and better access to medical and mental health records.
- Amending health privacy laws to include a "safe harbor" provision that would protect health providers from liability or funding loss when they disclosed information in connection with mental health evaluations and commitment hearings.
The full report of the Virginia Tech Review panel is available free of charge at the .