Targeting Those with Mental Illness Will Not Prevent Mass Shootings

So now, according to the Washington Post, the Trump Administration is “…considering a controversial proposal to study whether mass shootings could be prevented by monitoring mentally ill people for small changes that might foretell violence.”¹ As a psychiatrist, I keep wondering how many times the White House will scapegoat those with psychiatric illnesses rather than looking at the scientific data on mass shooters. To understand the problem, consider the case of “Tyler” (a composite of many mass shooter profiles).

Tyler is a 19-year-old, single, unemployed high school dropout. He was working as a short-order cook and doing other odd jobs, but he was recently fired for showing up intoxicated at work. Tyler has always felt like “the odd man out” and that he’s always gotten “the short end of the stick.” He posts angry rants regularly on social media, arguing that “the whole damn system is stacked against me,” and complaining that “it’s always the minorities that get the goodies, even though they shouldn’t even be in this country.” Tyler has long held a grudge against the high school he attended, accusing the administration of “specifically targeting me for oppression and exploitation” and fantasizing about “a revolution born in blood to overthrow the elites.” He adds, “I’m the only true-born leader who can purify this world of its filthy elements.” Tyler has made a careful study of mass shootings in the U.S. and expresses admiration for the shooters, writing, “These are the soldiers of the revolution.”

I’ll wager that most readers will find Tyler’s feelings and beliefs frightening and disturbing. Yet there is a very good chance that, examined clinically, Tyler would not be diagnosed with a mental illness. It’s also obvious that Tyler is not a model of mental health. On the contrary, he is what many psychiatrists would call “emotionally disturbed” — but not “mentally ill.” His world view is one of rage, resentment, victimization, and narcissistic grandiosity. But Tyler is likely not psychotic, or suffering from what psychiatrists call “serious mental illness”, such as schizophrenia, bipolar disorder, or major depression.

While, in theory, people like Tyler might benefit from psychotherapy or supportive counseling, few individuals with Tyler’s psychological profile show any interest in “talk therapy.” Their world view is such that they do not perceive anything in themselves that needs “treatment.” The problem, as they see it, is with the cruel, unfair, persecuting world, which needs to be cleansed, overthrown, or shot to pieces.

And what does the best available evidence tell us about most mass shooters? A major FBI study found that only 25% of mass shooters ever had a mental illness diagnosis, and only 3 of these individuals had a diagnosis of a psychotic disorder. ² Similarly, forensic psychiatrist Dr. Michael Stone, who maintains a database of 350 mass killers going back more than a century, concludes that “The majority of the killers were disgruntled workers or jilted lovers who were acting on a deep sense of injustice,” and were not mentally ill. Specifically, Dr. Stone found that about 65 percent of mass killers exhibited no evidence of a severe mental disorder; 22 percent likely had psychosis; and the rest likely had depressive or antisocial traits. ³

And, in a recent editorial, Dr. John Grohol has offered a detailed rebuttal of the alleged link between mental illness and mass shootings.

To be clear: it is true that when serious mental illness goes untreated, the affected individual is at a significantly higher risk of violence than someone in the general population, though people with mental illness are more likely to be victims than perpetrators of violence. And, to be sure, the lack of adequate resources devoted to treating mental illness is a serious problem in this country. But that is a separate issue from how best to prevent mass shootings. That problem will not be solved, as the White House seems to believe, with “phones and smartwatches… used to detect when mentally ill people are about to turn violent.” ¹

There are no quick and easy solutions to our mass shooting problem. But, as my colleague, Dr. James L. Knoll and I have argued, the best hope may lie in the public’s vigilance in detecting behavioral signs of impending violence and reporting these to the appropriate authorities. ⁴ Often, the would-be shooter discloses his intention to friends, family, or social media. Timely reporting of this “leakage of violent intent” can sometimes lead to rapid interventions that can avert a mass shooting, such as instituting an “ERPO” — an extreme risk protection order that allows law enforcement officers to temporarily remove a person’s access to firearms.

There are far too many “Tylers” out there to monitor with smartwatches. And while people like Tyler may need professional help, few of them suffer from a diagnosable mental illness.

Sources:

1. Wan, W. (2019, September 9). White House weighs controversial plan on mental illness and mass shootings. Washington Post. Retrieved from https://ift.tt/2Q2quUR
2. Silver, J., Simons, A., & Craun, S. (2018). A study of the pre-attack behaviors of active shooters in the United States between 2000 and 2013. US Department of Justice: Federal Bureau of Investigation. Retreived from https://ift.tt/2yw6sct.
3. Carey, B. (2017, November 8). Are mass murderers insane? Usually not, researchers say. New York Times. Retrieved from https://ift.tt/31AG2AA
4. Knoll, J.L. & Pies, R.W. (2019 January 14). Moving beyond “motives” in mass shootings. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/couch-crisis/moving-beyond-motives-mass-shootings

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