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.

Facebook
Twitter
LinkedIn

H. Steven Moffic, MD

H. Steven Moffic, MD, is an award-winning author whose fifth book, “The Ethical Way: Challenges & Solutions for Managed Behavioral Health,” is considered a seminal study on healthcare ethics. Always in demand as a writer, Dr. Moffic has attracted a national audience with his three blogs— Psychiatry Times, Behavior Healthcare, and Over 65.H. Dr. Moffic, who is also a popular guest on Talk-Ten-Tuesdays, recently received the Administrative Psychiatry Award from the American Psychiatric Association (APA) and the American Association of Psychiatrist Administrators (AAPA).

Related Stories

New OIG Report on Health Risk Assessments

New OIG Report on Health Risk Assessments

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued a report titled “Medicare Advantage: Questionable Use of Health

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Trending News

Featured Webcasts

Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!