VA Tech Massacre: Mentally Ill or Monster? A Story of System Failure

Snapshot from one of several videos Cho Seung-Hui sent to NBC News NBC News / MSNBC

 Elizabeth Hall February 9, 2010

 April 16, 2007 is a day that the college of Virginia Polytechnic Institute and the rest of America will not soon forget. A lone gunman performed a double murder, then opened fire and killed 30 people at the college and wounded over half as many more faculty, and students then turned the gun on himself. Was Seung Hui Cho mentally ill or a monster?
He had several instances on the campus the year before the shooting. In all actuality, his mental problems appeared in middle school. Research indicates that there was a breakdown in the system of mental health reporting, officers responsible for dealing with the incident, school officials, and nuances of our country’s privacy laws. Could the worst school shooting in our great nation have been prevented with a better system of communication for troubled students?

 The Virginia Tech Review Panel, created after the massacre, found several items in the application of national, state, and collegiate laws that prevented officials from responding to the red flags exhibited by Cho in his junior year at the college. Thus, causing the panel to suggest some changes be made to existing polices to prevent this sort of catastrophe from repeating itself (Panel, 2009). No one in Virginia or the rest of America will forget the incident on April 6, 2007 when Seung Hui Cho killed two people in the West Ambler Johnson Hall, then, two and a half hours later opened fire in Norris Hall killing 30 people and wounding 17 more students and faculty of the college before turning the gun on himself. In order to understand the events of the worst school shooting incident in our history, Governor Tim Kaine appointed a panel of nine experts from the various fields associated with the tragedy, such as
'Always by Himself'
'Always by Himself' (Photo credit: Tidewater Muse)
university administration and law, the Dept of Public Safety and Security, Virginian law enforcement, and Virginian experts on mental health.

 This panel was given a direct executive order from the Governor to find the answers to these questions: How did Cho manage to attain firearms and carry out the killing of 32 people and the wounding, of 17 more? Investigate the mental history of Cho from childhood to the time of the crime, and determine if there were warning signs missed by the school and or mental health services, that might have prevented this tragedy. The commitment hearing would be included in this investigation. Review the timelines of the incident beginning when he went into West Ambler Johnson dorms to the end of the incident at Norris Hall. Review and assess all of the States services and agencies involved in the incident for the recommendations on improving any State responses to any future incidents of this kind. Investigate anything else that the panel sees a need to in order to improve responses to any other incidents such as this. After all investigations and reviews, they were to make appropriate recommendations to the governor about changes that need to me made to improve “laws, policies, procedures, systems, and institutions of the Commonwealth and the
Screenshot from the MSNBC coverage of several ...
Screenshot from the MSNBC coverage of several videos Seung-Hui Cho sent to NBC News (Photo credit: Wikipedia)
operation of public safety agencies, medical facilities, local agencies, private providers, universities, and mental health services delivery system.” (Panel, 2009).

 The review panel conducted over 200 interviews, and asked for documentation from institutions and offices involved including but not limited to VA Tech Staff, families of victims, Cho’s family, medical examiners, and law enforcement. They also researched literature, held public meetings, maintained a website and post office box, conducted numerous telephone inquiries and sent out countless e-mails What they found was a definite breakdown of the systems involved, due to campus policies, law enforcement policies, and the various privacy laws such as HIPPA, and FERPA that govern the medical and educational institutions right to share information. (Panel, 2009)

 Cho’s early years began in Korea on January 18, 1984. He was born the second child of his family following a daughter three years earlier. The troubles began when he was just 9 months old with a bout of whooping cough complicated by pneumonia. During the course of treatments for this, doctors discovered that he had a heart murmur. When he was three, they ran tests on his cardiac system to examine the extent of the problem. The examination included a procedure that caused considerable discomfort to the infant and from that time on, he had a definite aversion to being touched, and was considered frail, fussy, and sick most of the time. He was noticeably quiet, however he did have a few friends that would come over his house and spend time with him. Even though being quiet and calm is considered desirable qualities in Korea, Cho was already concerning his parents. (Panel, 2009)

 When Cho was eight, his parents moved to the United States to pursue a better life. This was a very difficult transition for all of them, but most of all for Cho. Along with moving to a foreign country with a new language, customs, and people, both of his parents were forced to work long hours outside of the home to make ends meet. Because they worked for dry cleaners, learning English was never a priority for them since it was not required for their jobs. When he was nine, they moved to Virginia. At this time, his family thought he was improving; he took Tae Kwon Do, played video games, and collected figurines much like any normal kid. The only things standing out at this time were the facts that getting Cho back and forth to activities proved to be a problem due to his parent’s long working hours, and Cho’s introverted nature. At this time, he would only speak to his sister Sun, and even that was sparse. At school, his introverted nature was noticed, and he was referred to the educational screening committee because of it. (Panel, 2009)

All of this caused considerable stress to the family. Cho’s mother and sister tried to help him join groups and have extracurricular activities, but his father remains distant, obviously favoring his sister Sun. His problems with introversion followed him all through middle school and high school with an actual diagnosis being rendered as selective mutism. His writings begin to reflect suicide along with homicide, which raises some red flags with teachers. He is given antidepressants by the Multicultural Center for Human Services where he received a psychiatric evaluation during this time. (Panel, 2009)

Cho was on medication for roughly a year, and seemed to be improving. Because he responded so well, doctors took him off the antidepressants at that time. When he started Westfield High School, he was diagnosed with an “emotional disability”, and because of his refusal to communicate was enrolled in a special Individual Educational Program and is enrolled in art therapy through the Multicultural Center for Human Services. For the rest of his high school years, Cho conforms relatively to his program requirements, poses no threats, and has no behavioral problems outside of his shyness. He graduates with a 3.5 GPA, and enrolls in VA Tech. While his parents are opposed to this, because they believe the school is too large for him to handle, Cho goes anyway. He is given a number to contact a person at the local high school if he feels like he needs help, but Cho never calls the number. (Panel, 2009)

Nothing remarkable happened in his freshman year, aside from changing rooms
Glock 19 Pistol,
Glock 19 Pistol, (Photo credit: Wikipedia)
 because of a messy roommate. He majored in Business Information Systems major, sees his parents weekly, and gets good grades. It was in his second year at VA Tech that the old issues started creeping back in. He moves off campus into an apartment. He had a roommate, but the roommate was rarely home, and Cho was there alone most of the time. (Panel, 2009)

 During this time, he cultivated an interest in writing. When his grades fall, he considers changing majors to English the following year. He also submits a book idea to a publishing house. When the spring semester arrives in 2005, Cho requests a change of major to English, even though his book idea was rejected. This appears to depress him, but there are no problems, and he seeks no counseling or help of that nature. The only outward signs are his continued silence. In the fall of 2005, junior year starts with him moving back to the dorms. It wasn’t long after this that problems of a more serious nature emerged. (Panel, 2009)

 In the beginning of the semester, Cho attempted to socialize by attending a couple of parties with his suitemates. That was short lived because he was soon labeled as a little strange because he spent one of those parties stabbing the carpet with a knife in the presence of Margaret Bowman and his suit
emates. Shortly after this, trouble arises in his English class with Professor Nikki Giovanni when she confronted him in a letter, concerned about the violence in his writing, and the behavior he was exhibiting in class. She tells him that she will help him get into a different teacher’s class. She then requests that Dr. Roy (English Dept Chair) remove him from her class. Dr Roy, then informs the Associate Dean of Liberal Arts and Human Sciences, Mary Ann Lewis of the problem of the violent poem, and adds that students have reported that Cho is hanging around taking unwanted pictures of them. She also contacted the Dean and Vice Presidents of Student Affairs, and the VA Tech police department along with the Cook County Counseling Center, attempting to gain advice on the matter. (Panel, 2009)

Virginia Polytechnic Institute and State Unive...
Virginia Polytechnic Institute and State University (Photo credit: Wikipedia)
 Student affairs advises her that Cho may be moved from Professor Giovanni’s class if there was somewhere else for him to go, and the CCC advises her that even though they agree that the poem is violent in nature, there really is no particular direct warning or intimidation mentioned in the prose. They do agree that Cho should have a referral made so that they could treat him. The Director of Judicial Affairs and the Dean of Student affairs both concur with Dr. Roy on this plan of action and tell Dr. Roy to inform Cho that any more problems of this nature will be handled by Judicial Affairs. When Dr. Roy accompanied by Cheryl Ruggiero talk with him about this the next day, Cho replies with the notion that his poems are satirical, and promises not to take any more pictures of his classmates. In this meeting, and followed with an e-mail, Cho is advised to seek counseling services and of the study options available to him. This turned out to be private tutoring by Dr. Roy, and another professor. Cho would not accept any counseling at this time, so Dr. Roy informed the following agencies and Departments of this: Student Affairs, VA Tech police department, CCC, Schiffert Health Center, the Virginia Tech Care Center, and the College of Liberal Arts and Human Sciences. (Panel, 2009)

 The Virginia Tech Care Center had a meeting to discuss the arrangement made to remove Cho from Professor Giovanni’s class, it was decided that the arrangement of Dr. Roy and colleague tutoring the boy was agreeable, and the subject was closed. This was only the beginning of the problems to come during the school year. (Panel, 2009) In November of 2005 Cho was accused of setting fires, and by Jennifer Nelson of making “”annoying” contact with her on the Internet, by phone, and in person” (Panel, 2009). She decided not to file charges, even though Cho had been questioned by the Virginia Tech Police Department. The officers investigating the case turned it over to the Office of Judiciary Affairs. They informed Nelson that in order to go further with this, she would have to file a written grievance. She never went to do this, so the matter was dropped without a hearing. Three days later the CCC was called by Cho in the follow up after the questioning by VA Tech Police department. They conducted a triage on the phone, but didn’t see Cho in person. (Panel, 2009)

 December of the same year, besides beginning with the RA’s discussions about the previous month’s activity with the activities regarding Cho and Nelson, there were three more girls complaining about the same sort of behavior directed at them, by the troubled young man and that he had possession of knives. One RA contacted Rohsaan Settle from the Resident Life Staff, e-mailing a detailed list of grievances against Cho. He advises her that they should discuss the situation with the knives. (Panel, 2009) The third student to complain about the aggravating behavior is Margaret Bowman, who was one of the people who witnessed Cho at a party stabbing the carpet with a knife. In this encounter, he Im’s her, and leaves a message on the whiteboard outside her dorm room. Two days later, he quotes Shakespeare on the board. The next day, he leaves more messages, and she finally files a grievance with the VA Tech police. They question Cho, and he replies, “Shakespeare did it” VA Tech Police attempt to find Cho at his room, but only find his roommate so they leave a message.

 On this same day, December 12, 2005 Cho cancels his appointment at the CCC, however phones in and is triaged at that time. The next day, VA Tech Police inform Cho that there is to be no more contact with Bowman. He then IM’s his roommate indicating that he might want to commit suicide. This causes the roommate to alert VA Tech Police who pick him up and take him to the station. There he is prescreened by someone from the New River Valley Community Services Board. They decide that he is a high risk of harming either himself or others, and gets the magistrate to sign an order to detain Cho. They take him to Carilion St Albans Psychiatric Hospital where he is kept overnight and evaluated. During this time, Cho’s parents are not notified of this. (Panel, 2009)

In the morning, Cho is evaluated by Roy Crouse and considered to be in no danger of harming himself. He is evaluated again by a staff psychiatrist from the hospital and recommended that he be treated on an outpatient basis. Special Justice Barrett then conducts the commitment hearing and rules that he must have outpatient treatment as recommended. When the hearing was over, Cho arranged to be seen at CCC and leaves upon released. In the report from the staff psychiatrist, it is indicated that Cho is appearing normal in insight and judgment. The CCC is notified of the judgment and is given copies of the evaluations from St Albans. When Cho goes to his appointment, they triage him again. This has happened three times in two weeks. (Panel, 2009)

 The CCC receives a summary of the psychiatric evaluation from St. Albans in January of 2006, but does not, nor does anyone else, follow up on Cho. In February, Dr Miller, the CCC Director is let go and accidently packs Cho’s file when vacating his office. In April Cho is again asked by a professor to drop a class. This time it is his technical writing professor, Carl Bean. He has talked to Cho on several occasions about his writing subjects being inappropriate for his class, and refusal to communicate. Cho then proceeds to follow him to his office, and yells heatedly at him. The professor asks him to leave, but does not report this to anyone. (Panel, 2009)

In the fall of 2006, Cho wrote a play about a student who cannot stand his classmates and decides to kill both his classmates and after himself. The professor Ed Falco talks with Cho’s former teachers Norris and Roy. They filled him in on the previous events of 2005. Norris talks to Dean Mary Ann Lewis, but is informed that there are not any psychological or police reports on Cho. She then tries with no avail to convince Cho to try counseling. Cho goes on to write a few more aggressive assignments English class. (Panel, 2009)

Unbeknownst to anyone, Cho orders a .22 caliber gun online, and picks the gun up in February 2007. In March, he rents a van that he videotapes some of the content delivered to NBC. He also buys a 9mm Glock 19 and ammunition. Since Cho had waited the required 30 days between gun purchases, and there were no mental health records on file, he had absolutely no trouble purchasing these weapons. He also purchases another gun and ammunition on e-bay, and at local chain stores ammunition, magazines, chains, and other supplies he used. He continued these purchases in April as well as finishing videotaping his rant that ended up at NBC a couple of days after the massacre, and practiced chaining the doors in Norris Hall. There were a few bomb threats made in April to various buildings on campus that month, and while some speculate that Cho made these threats to test campus police response to major situations. (Panel, 2009)

 The day before the massacre, April 15, 2007 passed without incident, with Cho completing his weekly call to his parents with no indication of any trouble to come. On the fateful day, Cho was noticed by his roommates to be at his computer early at 5:00 am, and to be gone by 5:30. The rest of the events are as follows:
 6:45 am Cho seen in the lobby of West Ambler Johnston Hall
BLACKSBURG, VA - APRIL 16: Students and visito...
BLACKSBURG, VA - APRIL 16: Students and visitors attend a candlelight vigil on campus at Virginia Tech April 16, 2012 in Blacksburg, Virginia. Virginia Tech is marking the fifth anniversary of the killing of 32 students and faculty by Seung Hui Cho in 2007, the deadliest mass shooting in modern U.S. history. This is the first year the university has not suspended classes on April 16. (Image credit: Getty Images via @daylife)
 7:02 am, Emily Hirscher, dropped off by her boyfriend, enters West Ambler Johnston Hall followed by Cho
 7:15 am she is shot in her room by Cho along with RA Ryan Clark 7:17 am Cho cancels accounts and changes clothes in his room.
 7:20 am Va Tech Police receive a call from a student about a secondhand report of a student in  Hirscher’s room falling off a loft bed.
 By 7:24 am, VA Tech Police are aware of the double shooting, and are on scene asking for more staff and crime scene technicians.
 By 7:30 am, the investigation is underway, and police interview witnesses, no one was able to give a description of anyone leaving the dorm after shots were heard.
 7:40 am VA Tech police chief is notified. He tries to notify the Office of the Executive Vice President, and notifies the Blacksburg Police Dept. asking for detectives and evidence technicians.
 7:55 am Dr. Spencer arrives from Burruss Hall after being told by a housekeeper that an RA was shot in West Ambler Johnston Hall.
 7:57 am VA Tech Police Chief finally reaches the Office of the Executive Vice President to inform him of the events in West Ambler Johnston.
 8:00 am classes begin as scheduled. The Tech Center for Continuing Education is locked down without orders to do so. President Steiger finds out about the shootings at approximately 8:10 am
Between 8:10 and 8:40 am, police from all agencies involved continue to investigate the shooting, interview Emily’s roommate who informed them that Kevin Thornhill her boyfriend, always drops her off on Monday mornings before class. He is then named a “person of interest” and police begin looking for him. They put his house under scrutiny until he could be found. Two Virginia Tech Senior officials have talked to people one about the shooting, and the other to arrange for a babysitter. The Emergency Response Team is called to handle the possible arrest of a suspect. Some students who are able to leave West Ambler Johnston go to class at Norris Hall. Chief Flinchum and President Steiger are in communication with each other. One student is in critical condition, and the other is dead. This is a domestic incident as far as all are concerned at this point. More police from both the Blacksburg and the VA Tech departments are added to the investigation. Someone with Cho’s general description was observed around the area known as the Duck Pond around 8:20 am. Bank deposits scheduled for daily pick up are cancelled, and the Policy Team meets to discuss what the plans are to inform students of the incident at West Ambler Johnston. (Panel, 2009)

Walther P22 semi-automatic pistol, another mod...
Walther P22 semi-automatic pistol, another model of handgun used by Cho (Photo credit: Wikipedia)
From 8:40-9:00 am, President Steiger is updated that the female victim’s boyfriend is being searched for as a person of interest, and the Governor’s Office is notified by the Policy Team of the incident. Police are making phone calls to each other’s officers and alerting the Montgomery County Sheriff’s office advising them to watch out for Kevin Thornhill’s vehicle. A member of the Policy Team leaks an e-mail to a colleague in Richmond, telling them that a student had been killed, and another wounded and saying that the colleague should not tell anyone about this. With the first class ending, the Policy Team comprises a notification to be sent out via e-mail to the university, advising students of the incident at West Ambler Johnston. The message was delayed at first as technical difficulties arise. The public school in Blacksburg is locked down until further notice, and the College of
Veterinary Medicine is locked down. No one is expecting the horrors yet to come later in the morning. (Panel, 2009)

 Between 9:00 am and 9:40 am, Cho goes to the Blacksburg Post Office, where he sends a package to NBC, which contains his videotapes ranting about wanting to even the score with everyone who has oppressed him, an 1800 word tirade, and photos depicting himself with various weapons. He hints at the events to follow, in the contents of the package. He mails a letter to the English Department as well, criticizing Carl Bean. The second class of the day convenes on campus, and the college decides to postpone sanitation services for the day. People see Cho both outside and inside Norris Hall, but he has a class in this building. No one notices him chain three entrance doors. A bomb threat is found and the faculty member passes it to the cleaning staff to deliver to the Dean. Meanwhile a traffic stop produces Kevin Thornhill, who was headed back to the campus to locate the female victim, as she was not responding to his calls. A VA Tech Police captain is appointed as liaison on the Policy Team. The management of the college sends out messages via e-mail informing the entire campus of the morning incident. The Policy Team is updated to the police opinion that Thornhill does not seem to be the gunman although residue test results are forthcoming. (Panel, 2009)

Norris Hall, Virginia Polytechnic Institute an...
Norris Hall, Virginia Polytechnic Institute and State University (Virginia Tech). (Photo credit: Wikipedia)
 Roughly 9:40 am, gunfire breaks out in Norris Hall as Cho begins shooting. The unlucky group of 13 Engineering students were in room 206, where he murders 9 students and the professor and wounds 3 more students. He moves across to room 207 and after shooting the teacher turns the gun on the students moving up and down the aisles. In room 205, hearing the noise down the hall, they manage to barricade the door keeping Cho out. Further away in room 211, a student is asked by the teacher to dial 911. Despite putting a desk in front of the entrance, Cho manages his way through the door to room 211, and begins to shoot the occupants of this room as well. During this time, 911 is on the line of Colin Goddard who called them. He is shot in the leg, dropping th
e phone, which is then picked up by Emily Haas, another student in the French Class. She is heard by Cho as she begs police to arrive. He fires at her and two bullets graze her head. She appears dead, but she is hiding the phone, keeping the connection with the 911 operator. There are two other students feigning death, and all three survive. Cho has been silent during the whole incident. (Panel, 2009)

For the next ten minutes, as Cho continues with his rampage, the Blacksburg Police Department receives a call concerning the shooting, has trouble understanding the caller, and finally realizing that the problem was on campus, transfers the call to the VA Tech Police Department. When the message reaches them, they call for the EMS personnel in the county to react to the situation at the campus. Police are arriving on the scene at Norris Hall, and attempt to shoot the locks open, which doesn’t work. President Steiger notices police activity around Norris Hall. While all of this is happening, Cho tries to reenter room 207 unsuccessfully, finally making his way back to room 211. He returns to walking up the aisles and shooting people again. Goddard is hit a couple more times. A janitor runs into Cho, but manages to escape to another floor. Cho then attempts to get into room 204 where the professor uses his body to keep the door shut while 10 students manage to escape from the window. Cho pushes his way in, shooting the professor and two additional students who were attempting escape out of the window. Moving on, he goes back to room 206, shooting more people. (Panel, 2009)

 9:50 am, police gain entry into Norris Hall, and following the sound of gunfire make their way to the second floor of the building, beginning the task of rescue and assessment of the wounded. Just as police start on the second floor, Cho commits suicide, by gunshot wound to the head. The whole massacre in Norris Hall only lasted 11 minutes; however, Cho managed to squeeze off 174 shots, kill 30 victims, himself included, and wound 17 additional people during that small window of time. (Panel, 2009) Due to a lack of communication at the college level, the seriousness of Cho’s problems were never addressed, as they were in the elementary, grade school, and high school levels. His parents were not included in the situations concerning their son at school, so they could not intervene, and help Cho during these stressful years. While the review panel found many faults in the system, including but not limited to: a lack of interdepartmental sharing of information, a lack of communication between medical facilities, and a failure of the system in general in regards to the way commitment to a mental facility is conducted, they did not fail to recognize that the biggest impediment to Cho was himself, in hiding his mental history when questioned. (Panel, 2009)

In conclusion, this incident was the largest school shooting in the history of our country. It drew national attention as well as local. The way this incident was handled, and the red flags missed by VA Tech and the Virginia Medical Professionals was studied extensively by a review panel of experts in order to recommend changes in the law to prevent this sort of incident from repeating itself. Had anyone looked more closely at the warning signs, or connected the dots in this case, informed his parents, or insisted that more action be taken as early as 2005, 32 people may still have been alive today. Privacy laws such as HIPPA and FERPA may have been put into place with good intentions, however this country needs to make sure that those laws are completely understood by the professionals charged with keeping them, and there should be instances where in the interest of public safety, troubled students should be taken more seriously. More precautions must be taken to identify and treat these students, and mental history information should have a special category of privacy laws, allowing institutions a way to track these records.
Virginia Tech massacre memorial on the campus ...
Virginia Tech massacre memorial on the campus of Virginia Tech, photographed at the 2007 Ohio game (Photo credit: Wikipedia)

 References: NBC/MSNBC. (n.d.). Seung-Hui Cho. Retrieved February 08, 2010, from http://www.bing.com/reference/semhtml/Virginia_Tech_massacre?fwd=1&qpvt=va+tech+massacre&src=abop&q=va+tech+massacre
 Panel, V. T. (2009, November 15). Mass Shootings at Virginia Tech Addendum to the report of the review panel,presented to Governor Timothy M. Kaine, Commonwealth of Virginia. Retrieved February 11, 2010 Pumroy, D. K. (2007). What Caused the Tragedy at Virginia Tech? (J. Wyatt, Ed.) Behavior Analysis Digest International , 19 (2), pp. 5-7.

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