Over the next few days to weeks, we will try to piece together what could have caused Jared Lee Loughner to attempt to assassinate Congresswoman Gabrielle Giffords, kill six and wound fourteen others.

We will learn of a long trail of "red flags," and questions as to why there was not some earlier intervention will arise. We will hopefully nail down whether this was the act of a lone individual or part of some conspiracy. Forensic and other psychiatrists will weigh in on this being the act of an untreated, mentally disturbed and psychotic individual. Political extremist groups will be -- if you pardon the bad taste -- targeted as contributing to what may have triggered Loughner.

And, of course, we will have the benefit this time of a living perpetrator, so we will no doubt learn a number of answers from Loughner himself. However, even when he opens up, we may learn little more than that we are dealing with a psychotic, paranoid if not schizophrenic person.

This situation and the information coming out about Loughner has caused me to try to understand what could have caused his action, drawing on my 30 years as a clinical psychiatrist and behavioral analyst.

From listening to many suicidal and rageful/violent people and hearing information similar to what we are beginning to learn about Loughner, I believe that four factors may have contributed to his actions. (This is not in any way to excuse his heinous acts, but to gain a better understanding of his psyche so that we might prevent such tragedies in the future).

Prisoner of his own imagination*: When someone is a loner and not regularly in conversation with others, they run the risk of their imagination obscuring their contact with reality. In fact, most people have experienced their imaginations taking over when under stress and lying awake at 3 a.m., unable to fall to asleep or shut their mind off. Furthermore what if someone's imagination caused them to feel as if the world (both real and on the Internet) was continually trying to either control them (with rules), reject them (as we know from his attempt to enlist in the armed services) or laugh at them (more likely a nervous laugh from people feeling anxious around them)? What effect might that have on someone's psyche?

Reality-based persecutory fantasies: Much of Loughner's paranoia about government control, etc. is likely delusional, but there is one area where his persecutory beliefs are grounded in reality. When someone acts bizarre and rants and raves in public, they do trigger fearfulness and avoidance in those around them. And if that someone has no awareness or insight that they are triggering such reactions, they will come to perceive that those people who are acting awkwardly are out to get them, when in reality they are out to avoid them.

Loss of executive function: The less one is able to use the reasoning part of their mind and upper brain to do a reality check on their perception and their runaway imagination, the more they become prey to being controlled by their emotional middle brain and "fight or flight" lower brain. A person's lowest and most primitive brain works more according to reflex than to reason, and there is also a tendency to react back at the world at an equal, "eye for an eye" level of intensity to the way they perceive the world has treated them. Therefore, the more Loughner perceived that the world was after him (because in fact the world was indeed trying to avoid him when he acted crazy), the more he felt the need to get back at it in a more massive way than a single, focused murder.

Revenge of the "nobody": In this world, many people suffer from "somebody envy." To many people, being "anybody" can feel like being "nobody." That may explain some of the massive appeal of shows like "American Idol," "Dancing with the Stars," "The Biggest Loser," etc. where "anybodies" get to become "somebodies."

Worse than being a "nobody" is feeling put down and pushed away, as Loughner may have experienced with the multiple rejections in his life. And when people with a disturbed mind such as Loughner feel put down and pushed away, they often find a way to get back in and get even.

*Many mental health professionals and others will say, "This is much more than a wayward imagination; this is delusional and psychotic thinking that requires treatment, including medication." That is all true, but the challenge is how to gain cooperation and with it, the willingness to comply with and then continue treatment and medication. Unfortunately, establishing sufficient trust with a paranoid individual to cause them to be williing to cooperate with treatment, especially when there will be many uncomfortable side effects, is often a painstakingly long and frustrating process. Much of psychopharmacologic research is aimed at finding medications that have fewer of those side effects so that there might be greater cooperation and compliance. My aim in laying out the four factors above is that they may enable a conversation to take place with these individuals that is sufficiently empathic to tip the scale towards cooperation. One of my mentors once told me, "When you get where people are coming from and care and understand them when you're there, they're more likely to cooperate with where you'd like them to go."