Cho Sueng-Hui: Asperger’s Disorder with Psychotic Features

Amateur armchair mental health sleuths within both the mainstream and blogging media have been quick to cast their mental illness fishing nets at Cho Seung-Hui, hoping to snare some understanding of him. One reporter recently wrote, “This man will turn out to have been the classic “outsider” brand of mass killer — paranoid, egotistical, maybe delusional, passive-aggressive, with pronounced antisocial characteristics.” Instead, reflect upon this brief and less-inflamed hypothesis:

Consider this:

From the beginning, he did not talk. Not to other children, not to his own family. Everyone saw this. In Seoul, South Korea, where Seung-Hui Cho grew up, his mother agonized over his sullen, brooding behavior and empty face. Talk, she just wanted him to talk.

When I told his mother that he was a good boy, quiet but well behaved, she said she would rather have him respond to her when talked to than be good and meek,” said Kim Yang-Soon, Mr. Cho’s 84-year-old great-aunt.

When his parents announced when he was 8 that they were going to America, their relatives were gladdened. “We thought that it would help the boy gain confidence if he moved to the United States’ open society,” said an uncle who asked to be identified only by his last name, Kim.

And yet when he and others heard from Mr. Cho’s mother, it was the same dismal story, a buried life of silence. In church, she told them, she prayed for God to transform her son.

By now, the world knows what Seung-Hui Cho became, how on a gusty, snowy morning last Monday at Virginia Tech in Blacksburg, Va., he massacred 27 students and 5 teachers before killing himself.

No one could understand why. On Friday, his sister issued a statement of apology and sorrow that revealed the family’s own bewilderment. “This is someone that I grew up with and loved,” she said. “Now I feel like I didn’t know this person.”

Interviews with investigators, relatives, classmates and teachers offer inklings of how he progressed from silence to murderous rage, and show how he meticulously prepared for his final hours.

In Seoul, there was never much money, never enough time. The Cho family occupied a shabby two-room basement apartment, living frugally on the slender proceeds of a used-book shop. According to relatives, the father, Seung-Tae Cho, had worked in oil fields and on construction sites in Saudi Arabia. In an arranged marriage, he wed Kim Hwang-Im, the daughter of a farming family that had fled North Korea during the Korean War.

Their son was well behaved, all right, but his pronounced bashfulness deeply worried his parents. Relatives thought he might be a mute. Or mentally ill. “The kid didn’t say much and didn’t mix with other children,” his uncle said. “ ‘Yes sir’ was about all you could get from him.

And then this:

In his junior year, Mr. Cho told his then-roommates that he had a girlfriend. Her name was Jelly. She was a supermodel who lived in outer space and traveled by spaceship, and she existed only in the dimension of his imagination.

When Andy Koch, one of his roommates, returned to their suite one day, Mr. Cho shooed him away. He told him Jelly was there. He said she called him Spanky. SpankyJelly became his instant-message screen name.

With this:

His junior-year roommates mostly ignored him because he was so withdrawn. If he said something, it was weird. During Thanksgiving break, Mr. Koch [a dormitory roommate] recalled, Mr. Cho called him to report that he was vacationing in North Carolina with Vladimir Putin, the Russian president; Mr. Cho said he had grown up with him in Moscow.

In class, some students thought he might be a deaf-mute. A classmate once offered him $10 just to say hello but got nothing. He hunched there in sunglasses, a baseball cap yanked tight over his head. Sometimes Mr. Cho introduced himself as “Question Mark,” saying it was the persona of a man who lived on Mars and journeyed to Jupiter. On the sign-in sheet of a literature class, he simply scribbled a question mark instead of his name.”

And then this:

In a previous encounter with mental health services:

“…the physician who proclaimed Cho a danger to himself in 2005 found him quite lucid, writing, “His insight and judgment are sound,” according to court papers.”

However, upon what were that physician’s conclusions about Cho’s state of mind based. Was it the relatively simplistic Oriented X3 mental status exam? What I am suggesting is that there are important unanswered questions here. For example, what was the nature of that insight? Was it in the nature of a psychologically growth promoting form of introspection, or was it more likely associated with a more painful, perhaps even obsessive and ruminative pre-occupation with searing internal difficulties (such as his admitted life-long, mutilated sense of worth would suggest).

By what clinical measure or measures was Cho’s adequacy or impairment of reality testing assessed? Further, were any standardized measures of a formal thought disorder administered? This would have been important, of course, since impaired reality testing (related to the interpretation of information about the outside world) and evidence of either a transient or formal thought disorder (impaired quality of one’s thinking) represent two relatively separate areas of cognitive functioning (although one can certainly interpenetrate the other).

Nevertheless, even if one does accept the conclusions of that physician’s 2005 mental health assessment (which I am inclined not to do), it seems relatively clear just from the brief anecdotal materials presented here that there were other instances of interpersonal interactions in 2005 that provided strong indications that Cho’s level of cognitive functioning was, seen from an intrapsychic perspective, already in a seriously deteriorated state.

Taking all of the above into account, one quite probably could consider this: Asperger’s Syndrome with Psychotic Features.

This would open up, of course, a new avenue for clinical investigation and dialogue about this horrible tragedy.

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9 Responses to “Cho Sueng-Hui: Asperger’s Disorder with Psychotic Features”

  1. Dr X Says:

    Well, what do you know!

  2. raincoaster Says:

    That’s an interesting insight. I’ll read up on that. Asperger’s Syndrome itself is relatively controversial, but it does seem to account for a great deal, not only in this case but in the scope of human history.

  3. timethief Says:

    You’ve written yet another powerful, sensitive and insightful post. Well done.

  4. mysticgal Says:

    I completely agree. Thought the same thing myself when I heard his former roommates say that he would listen to the same song over and over. Then I heard his great-aunt say he didn’t talk. others who knew him said he didn’t make eye contact. He had no social interaction at all. He didn’t speak to other students or faculty when spoken to. In his dorm suite he was prone to staring at TV or obsessively typing on his laptop. A few things I’d like to know:

    1) How did he get into Virginia Tech in the first place? What were his HS transcripts like? SAT scores? Application for admissions essay? Are English majors not held to the same academic standards as the “hard” sciences? Or did he have the qualifications, on paper at least? Was there an admissions interview? What was the evaluation of that? I picture a completely mute Cho and an utterly flummoxed interviewer. How did that translate to granting admission?
    2) One of the Salon commenters said her brother was just like Cho but got help when he was 17. She didn’t mention what her cultural or economic background was, but there are some cultures that do not place great stock in the helping professions (counseling, psychiatry, inpatient mental health). That somehow this would bring shame upon their families. Is this the case in Cho’s family? Were recommendations that he get help rebuffed by his parents?
    3) What was he typing anyway? I think we will start to learn a lot more about his inner disturbance when his laptop is scoured and other papers reviewed. Unless he obsessively destroyed this evidence ahead of time, which might be unlikely given his desire to make his murderous intentions known by sending video tape to a major news outlet. It would be inconsistent of him to wipe his hard drive clean.
    I predict lots more interesting forensic psychological analysis to come.

  5. Joyce Says:

    As a sufferer of Aspergers, I can tell you that not all of us reach for a gun to solve our problems. Mr. Cho fell prey to his psychosis. But many Aspergers kids are bullied throughout their school years, and this can be very tough. The following links gives some insight into Asperger kids that have support and guidance, and the courage to face aspergers head-on.
    http://abcnews.go.com/Nightline/print?id=3006889

    http://abcnews.go.com/Video/playerIndex?id=3010139

  6. disembedded Says:

    Hi Joyce,

    I wholeheartedly agree with you! Thanks very much for your comments.

  7. "School Shooting": Suche nach einer psychiatrischen Diagnose in den USA « PsychoNeuro Says:

    […] weiterer Experte interpretiert einen ausführlichen New York Times-Artikel über die Kindheit Chos in Südkorea dahingehend, […]

  8. Josh Says:

    If it’s true that Cho fell into an autism-spectrum range of functioning, then this condition could have served as a background factor in shaping his rage. But I am also struck by a set of clues in his writings and utterances that seem to revolve around the theme of sexual abuse. I worked as a mental health counselor a number of years ago and knew individuals who had been molested by family members or relatives. Cho’s two plays from his creative writing class, which were published online, sound a lot like the feelings of sexual abuse victims. They are filled with tremendous rage as well as fear. In both plays a male authority figure perpetrates rape on an innocent kid. Graphic language depicting the abuse is repeated over and over, with the rest of the plot clearly revolving around it. Note also that Cho, in his MSNBC harangue, said Virginia Tech students had ‘raped and sodomized’ him. I want to be careful here not to accuse any of Cho’s family members, I’m just articulating a strong impression I get. Other mental health workers who have had experience with child victims of incest, especially young children, might see the similarities between the content of Cho’s plays and the shame, paranoia and rage that are commonly experienced by incest survivors. Couple this with the isolation that an autistic person experiences in NT (neurotypical) social environments, and you end up with a potentially explosive mix. I know this is just one way to look at it; yes, maybe the rape themes in his written and spoken comments come from schizo-like delusions, but imagine that his two plays, ‘Mr Brownstone’ and ‘Richard McBeef’, were his way of trying to get out a message to anyone who might care, without giving away too much to his family or teachers or other students. Sexual abuse victims are extremely distrustful of others and guarded about their ‘secret’. Without some form of therapy, their hatred and terror of the one who committed the abuse can become generalized: from the perpetrator to other adult authority figures, like ‘Mr. Brownstone’ the teacher, and beyond that to other students.

  9. hymes Says:

    As we now know, the independent evaluation of Cho in 2005 only lasted 15 minutes, which is sadly typical of all independent evaluations in Virginia for commitment since evaluators are paid practically nothing to do them outside of a few counties that pay the going rate. His stay in the hospital was only 14 hours because this particular hospital has/had? a strange schedule of holding commitment hearings only 3 days a week.

    I thought Aspergers right off, and if he was taking anti-depressants or anti-psychotics on top of Aspergers, which we may never know, that could make him a lot worse off.
    His family has given his mental health records from Virginia Tech. to the Governor’s panel, no word yet on toxicology results being given to or supoenaed by the panel before the July 1 deadline when Virginia law changes and prohibits the release of autopsy results.


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