Analyzing the video and photographs that Cho Seung-Hui, who killed 32 people and then himself at Virginia Tech Monday, sent to NBC in the middle of his shooting spree leads me to conclude he craved being "seen," being visible, being attended to. Why? Because he had a profoundly fragile sense of who he was. He did not know who he was - and what he did know, he hated. Whether this might have stemmed from severe psychosis or major affective disorder, which impedes the establishment of the self-concept, or from a serious personality disorder, in which such a self-concept develops over the years, frequently as a function of childhood maltreatment, we do not yet know. NBC said the package sent by Cho Seung-Hui, apparently during the two-hour gap between shooting attacks, contained a rambling and often incoherent 23-page written statement, 28 video clips and 43 photos. Several of the photos showed him aiming handguns at the camera. My speculation, and it is only a speculation, is that prior to, during, and subsequent to the attack, the perpetrator was conducting an intensive inner dialogue with "internalized" - real or imaginary - others, in an attempt to justify to them the nature of his horrendous act. I see the videotape as the perpetrator's externalized attempt to vindicate himself in the face of those he cares about - again, real or imagined. I watched the videotape and related pieces by the various news channels. In line with other viewers, I was shocked and stunned by what I saw, as well as, obviously, by the enormity of the crime committed and the scope of the resultant tragedy. The information that I have thus far is scant and sparse, and, although it does permit some speculations on the perpetrator's mental health and state of mind, this analysis should be treated as highly provisional and be read with caution. It is quite clear that this was a seriously disturbed, practically ill, adolescent. Whether he suffered from psychosis, a major affective disorder, a very severe personality disorder, or a combination of these psychiatric conditions - I cannot tell. From the information I have I understand that the perpetrator has a documented history of mental illness, as well as stalking. In the tape, his thought processes are clearly disorganized and he appears extremely agitated. This, however, does not constitute sufficient information for a determination of a diagnosis. I am not privy to the information that will allow drawing conclusions about his mental status. I am quite confident, however, that the investigators, assisted by behavioral science experts, are currently launching a "psychological autopsy" of the perpetrator, and are collecting information that will be conducive to the determination of pre-morbid psychiatric diagnosis. The term "psychological autopsy" refers to a set of assessment techniques aimed at deciphering people's mental health and personality structure prior to their death. These techniques include, but are not limited to, extensive interviews with significant others of the perpetrator, analysis of his or her documents, and a close scrutiny of medical records. Admittedly, it is a controversial, but to my mind, potentially useful, technique. It is important for me to stress that, while I believe that the perpetrator's psychiatric condition is a major contributor to his crime, this should not be taken to mean that people with mental illness are dangerous. The vast majority of people with mental illness and psychiatric disorders are not dangerous, and those who are, usually engage in drug or alcohol abuse, which accounts for their violent behavior. This horrible case should be closely looked into, but should not be used in order to stigmatize mental illness. The author is associate professor and director of The Risk/Resilience Lab, Department of Behavioral Sciences, Ben-Gurion University of the Negev and a visiting associate professor of psychiatry at Yale University's School of Medicine.