The murder count, like the spring temperature, continues to rise in America, this as a 45-year-old gunman walked into a rural North Carolina nursing home at 10 AM Sunday morning with multiple firearms and began shooting. Before he was shot by a police officer he had fired dozens of rounds, killing 8 and wounding 3, to include the police officer who traded shots with him in the halls of the nursing home. This latest incident of mass murder (3 or more victims at the same location at the same time) follows the March 8 church shooting in Maryville, IL where the popular pastor was murdered before his congregation, and the March 10 shooting that spanned two Alabama communities in which 10 were killed, to include the shooter. The next day a teenager entered his former high school in Germany and killed 12, so this kind of crime is not simply a byproduct of America's old west as some suggest. All of these shootings took place where the shooter likely believed he would be the only person with a gun and would have all the time he needed to complete his terrible act.

For many, though, the home is also their workplace, especially for stay-at-home mothers. Such appeared to be the case, unfortunately, on Sunday night in a Santa Clara, CA home when an Indian man using two handguns shot and killed 5 people. The victims included three children, a man and a woman. A woman believed to be the shooter's wife sustained multiple gun shot wounds, and then the shooter took his own life. Police described the tragic event as "a family on family, murder suicide." What personal demons must have possessed the shooter in this case?

What the latest N.C. nursing home workplace shooting and so many similar situations seem to have in common is that the shooter appeared to have great anger and rage, and may well have believed that he was going to die, going out in a blaze that would somehow even the score in life, one in which such shooters may believe themselves far behind. The former wife of the North Carolina killer, Robert Stewart, indicated he was angry and violent at times. While they had not spoken since their divorce 8 years ago, he had tried reaching out to her this past week through relatives, indicating that he had cancer and was preparing to "go away." It has been reported that the gunman's ex-wife was working at the site of the murders, The Pinelake Health and Rehab Center, and had barricaded herself in a room while the shootings were taking place. Her presence suggests that this was not a random act of violence and the gunman's likely target was his former spouse, with his anger acted out against nursing home residents. This is, unfortunately, not atypical for acts of domestic violence that far too often are carried out in the workplace.

Some shooters go into a workplace as it is one location where they can be assured that they can find their current/former significant other or another target of their wrath, this while others may want to make a "statement" that will forever impact on their former associate or loved one. What remains clear through the acid-like smoke of gunfire in these terrible incidents is that anyone who gets in the way of the gunman and his intended target becomes a secondary target. Someone like Jerry Avant, a male nurse at the facility who was allegedly shot 27 times by Stewart (perhaps suggesting a 12 gauge shotgun firing 00 buckshot with nine .33 caliber pellets in each shell) as he tried to protect his patients, noting the dead, other than Avant, were between 78 and 98 years of age. These victims were hardly able to stand between the gunman and his intended target(s), and, in fact, became the innocent victims of his uncontrollable rage, as they were simply in the wrong place at the wrong time.

We have learned many lessons since the April 1999 shooting at Colorado's Columbine HS in which two students murdered 12, wounded 23 and committed suicide. We saw these terrible lessons put into action when authorities, unlike the Columbine massacre, quickly entered a classroom building on the Virginia Tech campus in April 2007 to stop a raging student gunman who was still able to murder 32 and wound 23 before committing suicide, this representing the greatest single act of mass murder by one person with a firearm in U.S. history. Police now understand "the active shooter" and know they simply do not have the time to put together a dedicated assault plan when people are actively being shot and killed. They must enter the affected facility and go directly for the gunman, engaging him to force him to place his attention and his firepower on them, thereby saving lives. This is what 25-year-old police officer Justin Garner did as he engaged Stewart in a gun battle, wounding the shooter with one .40 cal shot to his chest, stopping his murderous rampage. Officer Garner, who was hit 3 times in the leg by Stewart, probably never imagined being involved in such a situation while working for the small town of Carthage, population 1,800. We need true heros in this country and what this 4 1/2 year veteran police officer and nurse Jerry Avant did to save the lives of others was surely heroic! In war time they might both be awarded the Medal of Honor.

My experience is that there are always people sitting on the edge of their own personal psychological abyss, waiting for the right time to jump, perhaps taking others with them on their mission from hell. For some shooters, though, the murder and mayhem they create may be their answer to their own personal problem, their way to say something, and, perhaps, to end something; like their life. While many will say of the Robert Stewarts of the world, "he just cracked," "there was no indication that he would act out in this manner," I believe differently. I think there are always signs, outward manifestations of the rage that is boiling just below such a person's psychological surface. These clues, these cracks in their personalities and their changes in behavior can be subtle at times, and can be overlooked, ignored, or simply missed by those around the shooter-to-be. And, in the case of each of these shooters over the years, someone like Cho at Virginia Tech, why not the week before, the month before, or the following month; why did he choose to act out on that particular day?

I believe that there is always order in what we otherwise describe as chaos, or in the case of humans, chaotic behavior. This in regard to the random, senseless, and chaotic behavior that we see in a person who commits a mass murder in a school, church or nursing home; we just need to find what the individual cares about and how he goes about resolving his own personal conflicts. The cracks and fissures in our own personalities can weaken us to the point where any of us could be capable of committing a terrible act, but we choose to control that impulse; this, as we tell ourselves, because we are socialized. Some, however, due to a number of different reasons either lose control of their impulsive behavior, or are able to justify their acts as they blame others for what they are about to unleash on them.

A mass murder may take his own lives as such completes the personal destruction he may already believe has taken place, while others may simply not want to be subjected to the questions of an ordered society. Robert Stewart will likely have some reason to explain, to justify why he gunned down so many senior citizens who were simply living out the last days of their life in peace; something that may have eluded him. There will be some order to what he did, but for the rest of us, we are continually challenged to understand what to most in the unexplainable; man's inhumanity to man.