Those who want to know why Charles C. Roberts IV went on a killing rampage in an Amish schoolhouse will be tempted to find answers in the suicide note he left behind and in his final conversation with his wife.

But psychiatrists say they haven't heard anything so far that explains why the milk truck driver would shoot 10 girls -- at least five of them fatally -- before taking his own life.

They didn't find it in his account of being tormented by the death of his infant daughter -- or in his claim that he molested two young relatives when he was about 12 and was tormented by dreams of doing it again.

"There's a tremendous amount of rage, just a total disregard for human beings, for life," Dr. Steven Sharfstein, president of the Sheppard Pratt Health System, said yesterday. "But the fact that he molested or may have molested, and the .... death of a premature baby doesn't at all add up to that.

"At least for me, it doesn't compute."

"It sounds like we have tidbits of history, and those tidbits are significant," said Dr. Douglas Jacobs, a Harvard psychiatrist who has written extensively on murder-suicides. "But there's probably a lot more. All child molesters don't end up doing this -- in fact, most don't."

Murder-suicides occur 300 to 600 times a year, said Jacobs, representing 1 percent to 2 percent of the 30,000 suicides that take place annually in the United States. And though it's difficult to identify patterns for a behavior that's so rare, a few situations do occur more frequently than others.

One involves a person, usually a man, who flies into a paranoid rage over a lover's infidelity and kills all concerned. Another involves a woman in the throes of a postpartum depression who kills her child and then herself. In a third, an elderly couple become distraught over growing infirmity, and one spouse decides to end it for both of them.

But the Amish schoolhouse murder doesn't fit any pattern Jacobs has seen.

"The implication here is -- on one hand -- he killed himself to avoid molesting, but on the other hand, he killed these victims who have no apparent relationship to himself," Jacobs said.

He said it is possible that Roberts murdered the Amish children as "the ultimate act of molestation." It's important to remember, Jacobs said, that molestation, like rape, is more an act of violence than of sex. So killing the children may have satisfied an urge that was not fundamentally carnal.

But he added, "Is there a continuum between child molestation and this kind of act? I really don't know the answer to that, and I wouldn't want to be quoted as saying this is a natural outcome."

Dr. Fred Berlin, an associate professor of psychiatry at the Johns Hopkins School of Medicine and an expert on sexual disorders, also cautioned against drawing conclusions.

"Sometimes, when people become profoundly depressed, they ruminate about things in the past they feel guilty about" -- such as sexual molestation, Berlin said. "Sometimes, this is associated with thoughts of self-hate and suicide."

"That still leaves this tremendous gap of how this leads to the mass killing of a number of children," Berlin said. "You could say he perhaps, to some extent and in some twisted way, is blaming the children for the fact that he feels attracted to them. But that's purely speculative."

The psychiatrists all said they would need more information to complete the picture of what went through Roberts' mind -- questions they typically ask in cases of extreme violence.

"I'd be interested if he has a pattern of cruelty and a disregard for human life, human pain," Sharfstein said. "Was he cruel to animals? And what's his history in terms of firearms? Has he been abusive at home with his kids and with his wife?"

Sharfstein said he would also like to know if Roberts suffered delusions or hallucinations brought on by a psychotic disorder. For example, did he hear voices that commanded him to commit terrible acts?

Dr. Robert T.M. Phillips, a forensic psychiatrist in Annapolis, specifically cautioned against assuming that the events described in Roberts' suicide note really happened.

"We don't know the accuracy of what he was saying, the extent to which it was embellished, altered by whatever was going on in his mind," Phillips said.

But in taking his own life, Roberts may have destroyed any chance that others will understand what drove him to such a desperate act. "Unfortunately, absent the ability to examine him, we may never know," Phillips said. "Speculation is all we're going to be left with."

jonathan.bor@baltsun.com