The Amok of Lovelle Mixon, Michael McLendon, Tim Krestchmer, Robert Stewart, Kerby Revelus and Travis the Chimp

Following an amok, the perpetrator is often confused and amnesic, and if not apprehended or killed, may commit suicide.

Clockwise from top left; McLendon, Mixon, Revelus, Stewart, Travis the Chimp and Kreschmer.

(BURLINGTON, Vt.) - Kerby Revelus decapitated one of his sisters, stabbed another to death, and injured a third. Robert Stewart slaughtered eight people in a nursing home, and wounded another three.

In the days leading up to the massacre of four police officers, Lovelle Mixon told relatives that he felt depressed and angry, an uncle noticing that he was emotionally withdrawn.

Michael McLendon killed five family members and five other people before shooting himself. In the days leading up to the massacre, he told a friend that he was depressed.

Tim Kretschmer murdered fifteen people before shooting himself. Between April and September of 2008, Kretschmer had five outpatient “therapy” sessions for depression. In the sixteenth century Portuguese travelers observed Javanese who would go out in the street and kill as many persons as they met, before others subdued or killed them, or they committed suicide. Malaysians called these people Amuco, amok meaning murderous frenzy or rage.

Amok was traditionally attributed to loss of face, shame, humiliation, jealousy, or provocation. That amok is an expression of manic-depressive disorder is suggested by the preliminary symptoms: before the attack, the killer is typically preoccupied, withdrawn, brooding and apathetic - in other words, depressed.

Following an amok, the perpetrator is often confused and amnesic, and if not apprehended or killed, may commit suicide.

In (1921) Emil Kraepelin, suggested that “amok is an expression of enraged mania,” others referring to the attack as the outcome of switching from depression into manic agitation.

Dictionary.com deftly defines amok as “a psychic disturbance characterized by depression followed by a manic urge to murder.” While the motive and targets of amok are always investigated, an amok is indiscriminate, and biologically programmed to kill as many people as possible, as in battle.

Amok is remarkable not only for the numbers, but for the savagery, when the victims are raped, mutilated, cannibalized or beheaded. It explains the atrocities that soldiers often inflict on civilians during and following battle. Mood cycles have been observed in many species of domestic and wild animals, the vicious attack of chimp Travis having all the markings of amok.

The biological basis of amok must be recognized, and society educated so as to be sensitive to its warning signs. In referring to these attacks as “rampage” media are at odds with the medical literature, which for hundreds of years has used the word “amok.”

If the clinician who treated Kretschmer used psychotherapy, in preference to an antidepressant or lithium or both, the fifteen people he killed may have been the victims of negligent care.

Jeffrey Dahmer’s probation officer frequently noted his depression, but nothing was done about it.

In adolescence, John Hinckley was diagnosed as “emotionally immature” but while in the throes of a delusional erotomania almost assassinated a President.

A psychiatric post mortem on Mr. Dixon might be more revealing than a physical one. Was he ever evaluated by a mental health professional, if so, was it by a Board Certified psychiatrist? Were the diagnosis and treatment accurate?

Bipolar individuals that are offended when the disorder is linked to violence may not be aware that a Swedish study has shown that 90% of murderers have one or another form of mental illness, and often bipolar disorder.

They also tend to overlook the paradox that the disorder has gifted society with most of our creative geniuses. Bipolars are in excellent company with, among many others, Beethoven, Mozart, Schuman, Berlioz, Chopin, Mingus, Parker, van Gogh, Newton, Dickens, Faraday, Byron, Michelangelo, Abraham Lincoln, and Winston Churchill. Sigmund Freud and Emil Kraepelin, lifelong rivals, were born in 1856.

And it isn't just human animals.

"Chimp Travis" attacked a friend of his suburban keeper in Westport, CT, and literally ripped most of her face off. Nose, lips, eyelids, facial skin, penetrating her skull, and causing considerable brain damage. She was transferred to the Cleveland Clinic, where the first US facial transplantation was done.

She may be permanently brain damaged, and blind. It all fits the criteria of an amok attack, and mood fluctuations have been observed in many animal species. Natural selection may have preserved mania for the advantages it confers in battle.

Freud seduced America with his psychosexual theories, while Kraepelin’s precise descriptions of hospitalized manic depressives in their acute phases were confined to a minority of medical schools. Freud won, but America lost.

Julian Lieb, M.D is a retired Yale medical school professor, and author or coauthor of forty -five articles and nine books. With D Jablow Hershman as first author, Dr Lieb coauthored: “Manic Depression and Creativity” and “A Brotherhood of Tyrants: Manic Depression and Absolute Power.” In these volumes, the authors showed that manic- depressive disorder is paradoxical, in gifting society with most of its creative geniuses, and inflicting many of its great destroyers.

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This is not an academic exercise or thesis. One cannot prevent a problem without knowing its cause. Manic depressive disorder has many variations and a complex phenomenology, and society must become aware of the dangers of not recognizing warning signs, of misdiagnosis, and of not treating it correctly.