Extended Interview: Virginia Tech Review Panel Member Discusses Cho Case

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• SUSAN DENTZER:

  Let's start by talking a bit about what we know that is in the public domain about what happened to Seung-Hui Cho. From what is in the public domain, what do we believe was going on with him, from a mental health standpoint?

• BELA SOOD:

  Well, as far as the mental health standpoint, I don't think we have delved enough to know exactly what was going on with him, but we do know that he did have a history of some mental health problems which led him to be committed into a psychiatry facility within that area in 2005.

  And so we clearly know that there was some interaction with the mental health system, which one then assumes there was something going on with him as far as an illness is concerned, by virtue of which he was committed into that setting. And soon after that he was allowed to leave because it was felt he did not meet criteria for inpatient admission, and then was probably sent for outpatient treatment, and then there's practically no record of what exactly transpired.

• SUSAN DENTZER:

  Now his mother apparently, when he was much younger, made reference to relatives back in South Korea that he was "autistic." What, if any, validity do we assign to that brief reference? We don't even know if it was a diagnosis or a description or what, but what would we take away from that?

• BELA SOOD:

  Yes, I think in this day and age, especially with the Internet and the part that media plays, and the information that the lay public has access to, it's a very different era than it was about 50 years ago, where if you heard that kind of a label, you would pretty much be sure that this was something that was given to them by a professional.

  It could very well be that someone had just made that statement, and the parents picked that up, and that seemed to be something that they expressed their concerns to a family member. But to say that that probably was going on is probably a stretch. And so I would take that with a grain of salt.

  I guess what the parents were probably referring to was that someone had figured out there was something going on with this child, and that he'd been identified with having some sort of a problem which needed addressing, and that is what they were referring to.

• SUSAN DENTZER:

  There has been a lot written about his social isolation, the fact that he lacked a lot of social interaction skills, or apparently even capacity.

• BELA SOOD:

  Certainly the media talks about this young man being very withdrawn, very isolated, extremely and painfully shy as he was growing up.

  Shyness by itself, what we call introversion, is not a sign of mental illness. People can be introverted. There are some people who are very gregarious and very people seeking, and there are some people who draw their energy from within themselves. And that by itself is not a sign of mental illness.

  It is really a combination of that, along with other symptoms, which come together as a constellation of mental illness. So, you know, I think there are lots of people out there who would identify with that and be highly, highly shy, but there's nothing wrong with them. […] Introverts can be very good with family members, and they can be very good with a few select peers. They may not be the life of the party, but they can make those connections.

  It's when there's a complete lack of connectiveness with the rest of the world which then, along with other functionally impairing symptoms such as things that come out in creative writing which are very dark, which are very gloomy, where there is a threat which is posed which indicates that the person either intends to self-harm or harm someone else, or that you are beginning to see cruelty to animals, or you begin to see a real cruel sort of interaction with others, that all of those begin to sort of come together, and then that poses a threat.

• SUSAN DENTZER:

  And indeed some of the creative writings of Cho were precisely what gave many of his professors a good deal of alarm.

• BELA SOOD:

  Absolutely. And that is always an area of confusion. You know, what poses a threat, and what is an actual imminent threat? How do you go about making a decision that what your students are writing creatively — and how much do you aid and abet that process because it's creative — is really posing a threat where there are absolute threats made in the content of the information, which then raises red flags to say something needs to be done.

  I think that is one of the fears that this tragedy has brought, at least to the larger, wiser mental health community, is that you don't throw the baby out with the bath water. Any time that violence is connected with behavior, the assumption is that it must be driven by mental health problems, which then criminalizes the notion of mental health.

  Because mental health is just like any other physical illness. It may be very much confined to the person — they're very distressed, but that doesn't mean that there's a propensity for violence.

  In fact, the literature and the research indicate that a lot of violent crimes are unconnected to mental health issues. So one really wants to be very worried about that aspect of the Virginia Tech tragedy, and to make sure that at the time of the commission of the crime, that indeed it was the mental status that was driving that or not. A lot of things go into that, looking at the premeditative nature, looking at what amount of thinking went into it, and that it was not an impulsive, explosive, rageful crime which just occurred at the spur of the moment.

  Having said that, when you talk about making armchair diagnoses, that is a tendency for many people. You begin to speculate. And as you begin to speculate, it's not then based on data. You are just extrapolating based upon the little pieces of information. That's very dangerous because even the evaluations that I do at this stage of my career, which is 25 years into being a psychiatrist, I rarely ever make a diagnosis of anyone in the first ten minutes. Even though I know where I'm going, I take a good hour and a half in order to gather all the bits of information that can allow me to formulate the case, because unlike what people think about mental health, mental health is a much more complex and complicated arena of health than even physical diagnosis.

  When you look at problems of the heart, problems of the liver, problems of physical aspects of the body, those, I think, are much easier to diagnose. I'm a physician by training, and I know that.

  On the other hand, when you're looking at behavior, it really requires a very high cognitive science to pull together all of the symptoms and say 'how do I understand this? Can this be understood merely by the parsimonious explanation of environmental factors like stressors, or is it really neurobiological?' How can I understand this person? Because people's behaviors are very complicated, and it really requires a great deal of training, a great deal of experience to really hang your hat on what's going on.

  So I would strongly caution against the idea of making armchair diagnoses based upon finite amounts of data, and I think that's going to be one of the biggest challenges for this panel.

  […]So we can talk in generalities, but until we get the specifics, it's very hard for me, and I think any good card-carrying psychiatrist, to make a diagnosis based upon the finite amounts of data we have at this point.