What was Wrong with the Las Vegas Mass Murderer?

Mental health diagnoses offer possible insight into the mind of suspected Las Vegas mass murdered Stephen Paddock.

EDITOR’S NOTE: The following are remarks by nationally renowned psychiatrist H. Steven Moffic, MD during a recent broadcast of Talk Ten Tuesdays.

For reasons of understanding and possibly prevention, the question of what was wrong with Stephen Paddock is taxing people’s minds, including mine. There have been plenty of speculations over the last week, and here’s how a psychiatrist might think about them, other than (labeling Paddock) such colloquial terms as “monster,” “miscreant,” and “madman,” which are actually very stigmatizing.

One is by President Trump (was) “pure evil.”

He didn’t say why he made that conclusion, but it is a religious, not political, conclusion. Psychiatry usually doesn’t talk about “evil.” I only started to do so when I worked in a prison. For a couple of patients, no other explanation seemed to fit the (prisoners’) longstanding actions. However, Paddock’s horrendous action was one time only.

“Psychopath” – so concluded the Las Vegas Sheriff. To a psychiatrist, a “psychopath” is like a sociopath – or, in diagnostic terms, an antisocial personality disorder. It includes a lifetime of harmful behavior without remorse, which is not yet apparent in this man. We (did) find out that his father seemed to have more of such a history in his robberies and escape from prison, and there also seems to be some genetic predisposition. Consciously or not, he outdid his father.

“Mentally ill” concluded many, but the usual suspects didn’t get mentioned, such as schizophrenia. He was prescribed Valium, suggesting a concern with anxiety.

“Gambler:” yes, there is an addiction called a gambling disorder, but it requires gambling that is out of control, whereas the perpetrator’s gambling did not seem to be.

“Not psychotic” – so said a neighbor, who also said that “he was just a cold loner fish” and “a little bit weird.” Sounds a bit Aspergerish?

“Brain tumor?” His (Paddock’s) girlfriend apparently told the FBI that “he would lie in bed, just moaning and screaming ‘oh my God.’” If true, this is suggestive of being in intermittent psychological and/or physical pain. (This) makes me wonder about the admonition that when we psychiatrists can’t seem to make a psychiatric diagnosis, then perhaps there is a hidden, hard-to-diagnose, medical one. Like a rare, slow-growing brain tumor, which would compromise his judgment, I wonder? There are copycat resemblances to the (University of) Texas Tower sniper, Charles Whitman, of over 50 years ago, who had a brain tumor discovered on autopsy. However, Mr. Paddock blew up his brain.

Many, in the meanwhile, concluded that he “didn’t fit the profile of a mass killer,” either.

“A meticulous, controlling nature” – so said the subtitle of the front-page New York Times article titled “I wish I could tell you he was a miserable bastard.” That suggests some obsessive-compulsive characteristics.

“Biggest” – CNN reported on his own words in a 2013 deposition. He claimed he was the “biggest video poker player in the world.” Whether true, he did become the biggest mass murderer (in modern U.S. history). Whenever we hear someone claim they are the “biggest” in anything, we think of excessive narcissism.

Today, maybe we just have to conclude that what we know is not yet consistent with any common diagnosis, but rather take some comfort that this may fortunately be a rare individual of mixed characteristics that turned out to be lethally combustible.