[ANALYSIS] Will court orders requiring mental illness treatments help prevent mass attacks?

Cho Seon, center, the perpetrator of a stabbing rampage near Sillim Station in Seoul, is surrounded by reporters in front of Gwanak Police Station before he was taken to the prosecution, July 28. Korea Times file

Forensic psychologists say there is little link between mental illness and violence

By Kang Hyun-kyung

Prosecutors indicted Cho Seon, the 33-year-old perpetrator of the July 21 stabbing rampage near Sillim Station, Seoul, on four counts ― murder, attempted murder, burglary and defamation.

A 22-year-old male died from the attack, while three other victims in their 30s were severely wounded.

According to the Seoul Central Prosecutors' Office, Cho has a video game addiction and suffers from an inferiority complex.

He bore grudges against society and his pent-up frustration developed into hatred and anger when he received a subpoena from the police in July after a YouTuber sued Cho for defamation. He had posted a comment claiming that the YouTuber was gay.

In the stabbing rampage, prosecutors said Cho appeared to be emulating a video game character.

"He acted like a character in a first-person shooting game," Kim Soo-min, the chief prosecutor in charge of the case, told reporters during a briefing on Friday. "He ran around the streets looking for targets. After spotting a target, he attacked the vital spots from behind or the side. He then quickly changed his position to find another target, just like how a game character shifts to a new spot."

The briefing confirms that grudges and an inferiority complex, which developed into anger, were the direct causes of the stabbing rampage, refuting the popular belief that Cho's mental state seemed to have triggered the violent attacks. Cho was assessed to have psychopathic traits in a Hare Psychopathy Checklist-Revised (PCL-R) test conducted shortly after he was arrested.

"There is little link between mental illness and mass attacks," Craig Jackson, professor of occupational health psychology at Birmingham City University in the United Kingdom, said in an email interview with The Korea Times.

"Most mass shootings are traced back to the attackers being extremely angry, disaffected and even having extreme personalities. Most research that looks into mass casualty attackers finds that extreme mental health problems (for example, psychosis) were active factors in only 15 to 25 percent of attackers at most. Although some mass casualty attackers do have low levels of mental health problems, these mental health problems are not the cause of their attacks."

Peter Langman, a forensic psychologist who has studied many mass killers in the United States, concurred with Jackson.

"The question about mental illness is frequently asked, but the term mental illness is rarely defined in this context," he told The Korea Times. "If people mean schizophrenia, then we can say that the overwhelming majority of people with schizophrenia are not violent, but that some people who become violent do have schizophrenia―- usually with many other factors that contribute to their violence."

Langman said schizophrenia is simply one factor among many that can contribute to the risk of violence.

Choi Won-jong, center, the suspect of a stabbing rampage near Seohyeon Station, answers questions from reporters at a police station in Seongnam, Gyeonggi Province, Aug. 10. Yonhap

Court order for mental illness treatment

Another deadly mass attack shocked the nation two weeks after the stabbing rampage near Sillim Station.

Choi Won-jong, a 22-year-old delivery worker, drove onto a sidewalk near Seohyeon Station in Seongnam, Gyeonggi Province on Aug. 3 and stabbed shoppers in a mall next to the subway station.

One victim in her 60s was killed in that attack, while 13 others were wounded.

Choi claimed he was a victim of stalking by unspecified people for years.

"Long story short, I have been a victim of an organized stalking crime. I suffered from harassment from them even on the day when I committed the mass attack," he told reporters on Thursday when he was taken by the police to a detention center. "I concluded there were plenty of stalkers living near my place, so I decided to kill them."

The 22-year-old is known to have been diagnosed with a schizoid personality disorder in 2020, but had not received medical treatment.

The two deadly mass attacks raised the red flag on patients with mental disorders who did not receive proper medical treatment.

Calls are growing to introduce a court order for mental illness treatment to prevent such deadly attacks in the future.

An online survey by JoongAng Ilbo showed 89 percent of respondents want the government to introduce a law requiring patients with mental disorders to receive medical treatment.

In an editorial published on Aug. 9, Chosun Ilbo, one of the major newspapers in Korea, called on Korean courts of law to make sure such individuals receive treatment.

"The recent two stabbing rampages have one thing in common: the perpetrators have records of mental health problems but they didn't receive medical treatment or stopped seeing doctors for years until they committed the crime," it reads. "These tragic incidents would have been preventable if the perpetrators had received medical treatment."

The Ministry of Justice responded favorably to the calls, saying it is consulting with the Ministry of Health and Welfare regarding a court order for mental health treatment.

But it remains uncertain whether the government will end up implementing the measure or not.

Even if such a law is introduced, a court order for mental health treatment is unlikely to be helpful in preventing mass attacks, considering the fact that such disorders are not the root cause of the deadly incidents.

Flowers are laid near Seohyeon Station in Seongnam, Gyeonggi Province, Aug. 7, to pay tribute to the victims of the Aug. 3 stabbing rampage. The deadly incident killed a 64-year-old woman and wounded 13 others. Korea Times file

Under-achiever

Forensic psychologists said the government needs to focus on the real causes, other than mental health problems, advising authorities to invest financial resources to find solutions based on the results.

Langman observed that psychological dynamics could be the reason.

"Mass attackers are never happy, well-adjusted people," he said. "Thus, there are always psychological issues involved, though these are often not what people consider to be mental illnesses. For example, personality disorders often play a role in mass attackers."

He said envy could be a possible factor.

"I've studied a number of mass killers who experienced what I call a dramatic gap between aspiration and achievement. Related to this is the role of envy. Envy is often overlooked as a motivation for murder but in some cases, it appears to play a significant role," he said.

"This does not mean that being an under-achiever by itself is a risk factor for violence. It can combine with other factors, however, such as various personality disorder traits, to contribute to violence."

Choi's upbringing and his past remarks can be interpreted to mean that he is an underachiever. Excelling in math and sciences, he was known to be a smart kid and an aspiring computer programmer. Like his older brother, he hoped to go to a magnet high school. But he failed to get in. He went to a public high school as a second choice and then dropped out.

"I failed because I didn't get into an elite high school that my older brother attended," he was quoted as saying.

An unidentified member of his family said in a media interview that Choi became a loner and a troublemaker around the time he failed to gain admission into the elite high school.

After dropping out of high school, Choi made a living as a delivery worker. He was quoted as telling police that he felt some of his customers were rude to him and did not show him the respect he deserved.

If anger or hatred fueled by an inferiority complex were the causes of the rampage, a policy remedy should contain measures that can help teens cultivate self-esteem and self-respect, regardless of their academic accomplishments.

Jackson viewed that a feeling of inferiority or jealousy could be a trigger point that cause people to attack others.

"Most mass casualty attackers feel they are not doing as well in life as others and they tend to blame someone or something for this other than themselves, so many mass casualty attackers bear grudges against schools, teachers, workplaces or even wider society in general," he said.