HARVARD GAZETTE ARCHIVES
Jack was walking down the street enjoying a snack he had just bought at a convenience store. Feeling good, he smiled at the stranger coming toward him while continuing to eat. The stranger suddenly pulled out a knife and began stabbing Jack. Bystanders pulled the knife away, but too late.
After the killing, the attacker said that he was deeply sorry. He had sensed a strange aura, then experienced a flashback of having been bitten and of having a hernia operation under local anesthesia. That was followed by hallucinations about Jack cutting off his flesh, testicles, and heart to eat them.
That story was one of several reports of inexplicable violence
related by Anneliese Pontius during the Medical School's psychiatric research day on March 14. An associate clinical professor of psychiatry, Pontius has identified 18 such people -- 14 murderers, 3 arsonists, and a monk who robbed a bank.
Pontius attributes these crimes to a previously unrecognized mental illness she calls limbic psychotic trigger reaction. The cases she describes are real and have been reported in scientific journals. However, her theory that they represent a new type of psychiatric disorder remains controversial because there is no direct physical proof of it.
"The syndrome is characterized by repeated moderate or mild stress, which social people might ignore or quickly forget," Pontius explains. "But in shy loners, the memories stay alive in the brain's limbic system, a center of memory and emotion."
One day, a match comes along in the form of a sight or sound that revives such memories and sets off, or "kindles," a brain seizure. This blaze of activity is intense enough to override normal control mechanisms and cause a firestorm of violence. Previously nonviolent, these people attack the source of the trigger without plan, motive, or feelings.
As a child, one man repeatedly heard his mother crying and choking when his father hit her. At these times, he would come to her defense by punching his father. On the day after his mother died, the man, a devoted father, fatally hit his own crying and choking child.
Loners Who Lose It
The massacre of 16 children and their teacher in Scotland last week does not fit this pattern. Thomas Hamilton arrived on the scene with motive and committed the murders with rage. The people that Pontius studied killed without premeditation, reason, or rage.
"They are like pet dogs who suddenly kill unexpectedly," she said. "But when the seizure subsides, they show horrified remorse and quickly turn themselves over to the police."
There is one common characteristic between Hamilton and Pontius' part-time psychotics: they were all white, male loners. Those she classifies as limbic psychotics are shy loners who never forget a hurt or share their feelings.
"Social contact is very important," Pontius insists. "The more isolated an individual is, the more likely he will become aggressive,
be he a lab rat, a caged monkey, or a human. One way to prevent eruption of this kind of violence may be to identify shy, isolated children and provide them with opportunities to have companions and participate in social activities."
Pontius speculates that women are less likely to engage in this type of violence because they socialize and share their feelings more readily. "The same is probably true for black men," she says. "They take part in communal rap sessions where they talk about their stresses, share their feelings."
Lights, Sound, Action
Another preventive measure might involve the strange feelings and sensations these people experience just before they commit their deadly acts.
When they encounter a trigger, there is often a brief time (about five minutes) of puzzlement, as if their brains suddenly disconnected from reality. "This stage often includes an aura, such as sounds, flashing light, or strange body sensations," Pontius explains. Patients might be taught to recognize such alarms and, possibly, seek help.
The next phase includes hallucinations, delusions of grandeur, and out-of-character acts.
The bank-robbing monk, for example, grew up poor and took a vow of poverty. He became a pious monk with an exemplary record. But in his 50s, suddenly finding himself penniless during a visit to a city, he robbed a bank. Then he went into a topless club and started fondling the performers. He also believed he was superior to Thomas Merton, the famous Catholic monk and writer, and that he was a painter as compelling as Rembrandt.
The seizures last up to about 20 minutes, and may include nausea, dizziness, sweating, the feeling of being ice cold, and uncontrolled urination, erection, or ejaculation. These symptoms, along with the homicide itself, occur without emotion, but they are well-remembered.
When the reasoning part of the brain resumes control, the offenders are horrified, contrite, and blame only themselves. The monk, for example, went straight to the police who, at first, thought he was kidding them.
"About half of the brain scans and other tests done on these people were abnormal in various ways," Pontius reports. However, the tests did not reveal any common physical anomaly that might explain the seizures. She notes that the limbic structures thought to be involved are deep in the brain, making them difficult to study.
"Also, kindled seizures can occur without visible brain damage," Pontius says. "And, there is no common stimulus for the kindling. Each patient has very individualized experiences and each trigger is very specific. This also accounts for its rarity." She found only 18 cases in 15 years of conducting court-appointed psychiatric examinations of some 200 men charged with homicide and other felonies.
Pontius described her work and conclusions to a meeting of the American Association for the Advancement of Science last month. Others who spoke at the same session, which she organized, described the result of implanting electrodes in the limbic system of patients prior to brain surgery.
"When stimulated with weak electric pulses [sent through the electrodes], these patients reported strange experiences very similar to the seizures described by my patients," Pontius maintains. She cites this as indirect evidence for her seizure theory.
Also, innocuous sights and sounds can sometimes evoke intrusive memories of war, rape, or other traumas. The smell of a man's cologne, for example, might cause a woman to have flashbacks of a sexual attack. Or a traffic helicopter might send a Vietnam veteran scurrying for cover. However, such incidents do not involve seizures.
All of the evidence for limbic psychotic trigger reaction, therefore, is indirect. This lack of absolute neurological or physiological evidence leads some psychiatrists to doubt that the syndrome exists.
"It's an interesting interpretation of a complicated clinical situation," commented Joseph Coyle, chairman of the Department of Psychiatry at the Medical School. "But I don't know if [limbic psychotic trigger reaction] is real and verifiable or not."
"I cannot prove my theory conclusively," Pontius admits, "but
I am open to any theory that better fits the repeated pattern of the symptoms I've documented. In order to increase confidence in the correctness of my theory, it will be necessary for my observations to be confirmed by other researchers and by additional cases."
That may happen. Pontius says she has been contacted by lawyers about some 50 cases of apparently motiveless, unplanned murders, committed by previously nonviolent people during sudden psychosis. Many of these people are now on death row.
Copyright 1998 President and Fellows of Harvard College