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Adolescent violence: What school shooters feel, and how psychiatrists can help

Shooters share psychological traits that are also found in youths who commit more common acts, from taunting to physical assault.

Vol. 4, No. 6 / June 2005

Few films have achieved cult status as quickly as “The Matrix.” The lead character—a passive, unassuming young man—discovers that a malevolent system controls him and almost everyone else. He learns martial arts, then attacks and destroys the system and its allies.

Not surprisingly, “The Matrix” has a particular grip on adolescent and young adult males. For most, the film’s themes and special effects are simply entertainment. Others are drawn—and their concerns perhaps affirmed—by questions the film raises about reality and control over destiny. For a few, the film speaks to overpowering psychic pain.

“A movie doesn’t make anyone do anything,” says John C. Kennedy, MD, assistant professor of psychiatry at the University of Cincinnati. Even so, he thinks it’s of interest that 19-year-old Josh Cooke of Oakton, VA, who murdered his parents with a 12-gauge shot gun, “wore out his first copy of ‘The Matrix’ and got a second one.”

The movie’s graphically depicted alienation and despair resonate with what he calls “marginalized” adolescents. “These teens aren’t connected to anyone or anything, and this lack of empathy allows them to dehumanize those around them. It lowers the threshold for a violent attack; it reduces the taboo.”

Adolescent violence made headlines March 21, when a 16-year-old at Red Lake High School in Minnesota shot and killed a security guard, five classmates, a teacher, and himself. The Columbine High School shootings in 1999—in which two teens killed 12 students, a teacher, and themselves—prompted the U.S. Department of Education and Secret Service to study youth violence, particularly in schools. The Safe Schools Initiative (SSI)1 was published in 2002 and analyzed 37 school shootings between 1974 and 2000 (Box).

William S. Pollack, PhD, assistant clinical professor, Harvard Medical School department of psychiatry, co-authored the SSI supplementary report on threat assessment in schools.2 He told Current Psychiatry that the boys who shot their classmates and teachers “felt disconnected from both their peers and adults. They had been bullied at school or otherwise humiliated.”

The SSI found that school shooters differed in many ways—in ethnic and socioeconomic backgrounds, family situations, and academic performances. Yet they shared some psychological traits that are also found in youth who commit less-dramatic but far more common violence, from taunting to physical assault.

Although few shooters met criteria for mental illness, “many had suffered significant losses, had symptoms of depression, and had thought a great deal about suicide,” Dr. Pollack says. “Adolescents who commit violent acts often feel hurt and despair behind their more obvious anger. They believe no one understands them and they have no one to turn to.”

Like “The Matrix” protagonist, destroying the system—and themselves—begins to seem like their only option. Add access to weapons, and you have a recipe for disaster.


Safe School Initiative: Shooters felt bullied and depressed

The Safe School Initiative (SSI), undertaken by the U.S. Secret Service and Department of Education after the 1999 Columbine High School killings, found many school shooters:

  • felt bullied and depressed, without any adult response
  • had talked with someone—usually other students—about their plans, but no one prevented the attacks.

“These were not impulsive acts but a response to events that had been going on for some time,” said William S. Pollack, PhD, who analyzed the 2002 SSI report.

The SSI study of 37 school shootings between 1974 and 2000 yielded no psychological profile for predicting which students might attack. Many of the shooters, however, were coping with personal losses or failures and had considered or attempted suicide.

Psychiatrists can help teens who are at risk to commit violence by providing support to those referred for treatment, educating parents about the need to connect with their teenagers, and advocating for antibullying programs in local schools, according to Dr. Pollack.

“Adolescents who have a positive connection with an adult are less likely to become violent and to commit extreme acts,” he said.

Source: Safe School Initiative, references 1 and 2.


Any discussion of youth violence must address the fact that most of it is done by boys. Nearly all school shooters have been boys, and more than 90% of juvenile homicides—gang-related and otherwise—are committed by boys.3

Biology is undeniably at play, Dr. Kennedy says, but he is convinced that parents and society hold boys to a behavior code that affirms the inclination for violence. “A ‘real’ man hangs tough; when he’s feeling vulnerable or in distress, he doesn’t ask for help,” Dr. Kennedy says.

Dr. Pollack agrees. He said his research as director of the Centers for Men and Young Men at McLean Hospital, Belmont, MA, indicates that “the way we bring up boys hasn’t changed in 100 years. The ‘boy code’ demands that to prove their masculinity they have to prove that they’re bigger and tougher than someone else. ‘Big boys don’t cry,’ and when anger is the one feeling they’re allowed to express, you’re going to see male violence.”

Youth violence, of course, is not the sole purview of boys. Girls do plenty of it and appear to engage in physical fighting more than they used to, Dr. Pollack notes. But girls are not generally as violent as boys, and both Drs. Pollack and Kennedy believe the critical difference is that girls ask for help when they hurt.

“For girls, relating is a solution; for boys, it’s anathema,” Dr. Kennedy says. The “girl code” allows—even encourages—girls who are feeling miserable to seek help from their friends. That help can come in many forms, including beating up someone. Nonetheless, the fact that girls do not feel that they must handle problems on their own may stop them from resorting to extreme violence.


Media coverage of the Columbine and Red Lake school shootings and the unforgettable televised images can give the impression that these events are common and may be happening more often. But, as Dr. Kennedy points out, “such events are rare and have been going on for a long time.”

Compared with earlier attacks, the Columbine and Red Lake attacks claimed more victims, and the perpetrators brought more weapons and used them more indiscriminately. But even though these two events were extremely violent, the SSI found no increase in the incidence of school shootings since 1974. Youth violence in general has decreased somewhat in recent years, according to the U.S. Department of Justice.4 Moreover, the phenomenon of young males shooting each other is not new.

“Although we don’t have hard epidemiologic data,” Dr. Pollack says, “history indicates that in the 19th century young males on the frontier were a violent group, and they were likely to shoot other young males.”

School shootings are the “tip of the iceberg” of adolescent violence, Dr. Pollack says. Fighting, bullying, and taunting are pervasive, and these actions—troublesome in themselves—appear to foster more-lethal varieties. And text messaging, email, and cell phones are part of the bully’s arsenal.

“It’s easier to bully someone,” says Dr. Kennedy, “when you don’t have to see their face.” He has heard of more than one instance in which a girl who was bullying another “called her victim’s house and left a message for the parents to hear, saying: ‘This is Planned Parenthood. We have the results of your pregnancy test. Call us back’.”


Dr. Pollack believes psychiatrists can help prevent adolescent violence by addressing its risk factors in their communities and when treating teens and their parents (Table). The risk factors —as identified by the Safe School Initiative—include a history of bullying and being bullied, feelings of humiliation, depression, suicidal thoughts, and failed attempts to get help.1,2

“Most important is the absence of a connection to a caring adult,” said Dr. Pollack. “These kids yearn for an alliance, and they respond to efforts to form one.”

Many young men who commit violent acts suffer from atypical depression, he notes.1,2 “They don’t complain of classic depressive symptoms—sadness, anhedonia, decreased appetite and libido—rather, they engage in antisocial and other negativistic behavior and feel more angry than sad.”

Clinical experience derived from the revised Structured Guide for the Assessment of Violence Risk (HCR-20, version 2)5 indicates that “the younger an adolescent is when he commits his first violent act, the greater the probability of violence,” Dr. Kennedy adds.

An adolescent’s capacity for empathy is another prognostic sign.6 “Kids who cannot grasp that when they bully someone they hurt his feelings are likely to continue and perhaps escalate their violent behavior,” Dr. Pollack says.

Unfortunately, these risk factors have limited predictive value, according to Dr. Kennedy. Although adolescents who commit extreme violence embody most of these risk factors, only a small minority who possess these risk factors commit such acts. “But these risk factors do identify kids who are in trouble and need help,” he says.

Sometimes that help should include treatment —such as antidepressant medication. But more than anything else, Dr. Pollack stresses, these youths need “connection, connection, connection” to protect them and their potential victims.

“Kids who have one person at home who cares about them are two times more likely to be protected from harm and from causing harm; if they feel an adult loves them, they are four times more likely to be protected,” he said.7

Psychiatrists can educate parents of adolescents—both in family counseling sessions and in the community—about the importance of being emotionally available and of telling teens they love and care about them. Coaching in listening skills is helpful, and Dr. Kennedy suggests that “psychiatrists also help parents develop strategies for supervising kids—including access to weapons —in a respectful, nonpunitive manner.”

“Schools don’t like to hear this,” Dr. Pollack says, “but the boys who did the shootings targeted the school for destruction because school was the source of their hurt and humiliation.” Before more than half the shootings the SSI examined, “some kids knew something bad or dangerous was in the offing. They didn’t tell anyone in authority because they feared being made fun of, punished, or not supported.”1,2

Some school administrators have acknowledged the connection between the school environment and violence and have instituted programs to reduce taunting, bullying, and fighting.8 These include efforts to increase empathy and respect for others to create a climate of civility. Dr. Kennedy feels psychiatrists and other mental health professionals have “a role, if not a duty” to help shape school policies and culture. He said psychiatrists need to advocate for antibullying and mentoring programs in their communities.

“Few people champion these programs,” Dr. Kennedy says. “We need to be among them.”


Protective measures to manage risk factors for youth violence

Risk factor

Suggested protective measures

No connection to an adult

Consider referral to Big Brothers/Big Sisters mentoring programs

Bullying or being bullied

Advocate for safe school programs that discourage bullying and encourage civil behavior

Depression, suicidal thoughts

Educate parents about atypical symptoms of adolescent depression, including anger

Assess adolescents for violence risk factors

Consider medication for depression

Significant losses

Form and maintain therapeutic alliance with kids at risk

Access to weapons

Help parents develop strategies for limiting youths’ access to weapons

Lack of empathy

Consider having the adolescent help care for pets, with supervision

Source: William S. Pollack, PhD, and John C. Kennedy, MD

Related resources


1. Vossekuil B, Fein RA, Reedy M, et al. Final report and findings of the Safe School Initiative. Implications for the prevention of school attacks in the United States. Washington, DC: United States Secret Service and United States Department of Education, 2002. Available at: Accessed May 16, 2005.

2. Fein RA, Vossekuil B, Pollack WS, et al. Threat assessment in schools. A guide to managing threatening situations and creating safe school climates. Washington, DC: United States Secret Service and United States Department of Education, 2002. Available at: Accessed May 16, 2005.

3. Office of Juvenile Justice and Deliquency Prevention. Supplementary homicide reports, 1980 to 1997. Washington, DC: Federal Bureau of Investigation, 1999. Available at: Accessed May 16, 2005

4. Office of Juvenile Justice and Delinquency Prevention. National Crime Victimization Report Bureau of Justice Statistics, 1973-1997. Washington, DC: U.S. Department of Justice, 1999:62. Available at: Accessed May 16, 2005.

5. Webster C, Douglas K, Eaves D, Hart S. Structured guide for the assessment of violence risk (Historical, Clinical, Risk-20). Burnaby, BC, Canada: Mental Health, Law and Policy Institute, Simon Fraser University, 1997.

6. Borum R. Assessing violence risk among youth. J Clin Psychol 2000;56:1263-88.

7. Resnick M, Blum P, Bearman R, et al. Protecting adolescents from harm. Findings of the National Longitudinal Study on Adolescent Health. JAMA 1997;278(10):823-32.

8. Safe Schools - Safe Communities (SCSS) model. Boulder, CO: University of Colorado Center for the Study and Prevention of Violence. Available at: Accessed May 16, 2005.

John C. Kennedy, MD, is director, Center for Threat Assessment, University of Cincinnati (UC) College of Medicine, assistant professor of psychiatry, and director of the UC forensic psychiatry fellowship. His research interests include how clinicians use data to assess risk, workplace violence, and false confessions.

William S. Pollack, PhD, is director, Centers for Men and Young Men, McLean Hospital, Belmont, MA, and assistant clinical professor, Harvard Medical School. The author of ‘Real Boys’ and ‘Real Boys’ Voices,’ he studies male development, gender and violence, normal parenting, and the effects of gender on depression.

Walter A. Brown, MD, who interviewed Drs. Kennedy and Pollack and wrote this Current Events article, is clinical professor of psychiatry, Brown Medical School, and Tufts University School of Medicine. His research interests include psychopharmacology, the placebo response, and the neurophysiology of emotion.

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