Don’t Blame Mental Illness
Dear Leading Ladies,
“There wouldn’t be a gun violence problem in the United States if we could just keep people with mental illness from having guns.”
Have you heard that familiar trope?
We sure have.
But the problem isn’t people with serious mental illness.
“The reality is that people with mental illness account for a very small proportion of perpetrators of mass shootings in the U.S., says Ragy Girgis, MD, associate professor of clinical psychiatry in the Columbia University Department of Psychiatry and the New York State Psychiatric Institute, in a recent issue of the Columbia Psychiatry News.
“The public tends to link serious mental illnesses, like schizophrenia or psychotic disorders, with violence and mass shootings. But serious mental illness—specifically psychosis—is not a key factor in most mass shootings or other types of mass murder,” according to Girgis. “Approximately 5% of mass shootings are related to severe mental illness. And although a much larger number of mass shootings (about 25%) are associated with non-psychotic psychiatric or neurological illnesses, including depression, and an estimated 23% with substance use, in most cases these conditions are incidental.”
Although Dr. Girgis maintains that it is important to identify individuals with mental illness and substance abuse disorders who are at high risk for violence, he believes it is more important to look at other risk factors “such as a history of legal problems, challenges coping with severe and acute life stressors, and the epidemic of the combination of nihilism, emptiness, anger, and a desire for notoriety among young men” as a more useful focus for prevention and policy.
Chart credit: efsgv.org
Bad behavior is not mental illness
“A lot of people who aren’t experts in mental illness tend to equate bad behavior, and often immorality, with mental illness,” says Girgiis. “These are a false equivalence. I think it's incumbent on us, especially when we're talking about something as horrible as mass shootings, to make sure other people understand that all bad behavior, and certainly not evil and pure psychopathy, is not the same as mental illness.”
Girgis and other researchers at the New York State Psychiatric Institute and the Columbia University Irving Medical Center have compiled a database at Columbia, which is the largest catalog of mass shootings and mass murder in the world. An analysis of their findings concluded, not only that the vast majority of mass shootings and mass murder are committed by people without serious mental illness, but also that half of all mass shootings are associated with no red flags—no diagnosed mental illness, no substance use, no history of criminality, nothing. In addition, these crimes are generally committed by middle-aged men who are responding to a severe and acute stressor. Because the crimes are not planned, they are even more difficult to prevent. The most glaring correlation found is the rise in the incidence of mass shootings between 1970 and 2019 and increase in the availability of guns in general and automatic weapons in particular.
Some commonalities among shooters
Psychologist Jillian Peterson, Ph.D., was the principal investigator of a study funded by a three-year grant from the U.S. Department of Justice to understand the life histories of mass shooters. With students from Hamline University, Peterson built a different database of every mass shooter since 1966.
Peterson agrees with Girgis that most mass shooters do not display serious mental illness, but she does see some commonalities among them. “So we see this common pathway and of course it's a little different for each person, but this pathway seems to start with really significant early childhood trauma. So things like physical abuse, sexual abuse, suicide of a parent, domestic violence in the home. Over time, that individual becomes angry, becomes isolated, becomes hopeless, there's a lot of self-loathing there. Many of them are suicidal and attempt suicide before doing a mass shooting. Then that self-loathing kind of turns outward and it becomes whose fault is this? Who do I blame for the fact that I feel this way? So school shooters blame their school. Workplace shooters blame their workplace. Other people blame religious groups, or racial groups, or women.”
Dr. Christine Glenn, a psychotherapist in Portland, Oregon, who treats many survivors of trauma and PTSD, says, “Mass shooters are always highly unhappy, traumatized people. But most traumatized people never shoot anyone or even act out significantly.” In fact, she says, “Many are highly moral. And what traumatizes one person may not traumatize another. So trauma cannot be used as a screening tool. A formal diagnosis of PTSD could be used as one criteria for concern but there would have to be something else, e.g., threats, violence, stalking.”
Likewise, where Girgis seems to question any attempt at predicting who will commit a mass shooting, Peterson believes it may be possible, in some cases, to identify potential mass shooters. “Perpetrators tend to be radicalized through studying other shooters before them. Many of them spend time on the internet in kind of these dark chat rooms where violence is really celebrated and validated. And then they go into this act knowing it's their final act. So they're kind of actively suicidal, planning to die in the act. They have access to the firearms that they need. And many of them leak their plans. Many of them tell other people they're thinking about violence before they do it. And then they go out and they choose a location that's symbolic of their grievance with the world because they're looking for this fame and notoriety in their death that they didn't have in their life.”
Clearly, like Girgis, Peterson does not see serious mental illness in most mass shooters. They both fear the stigmatization of those with serious mental illness because of the assumption that mass shooters are among them. The fact is that most diagnosed with psychosis are no more likely to be violent than anyone else. “Only 3%–5% of violent acts can be attributed to individuals living with a serious mental illness, according to the US Substance Abuse and Mental Health Services Administration. In fact, people with severe mental illnesses are over 10 times more likely to be victims of a violent crime than the general population.”
In sum, this is not to say that those who commit mass shootings are not troubled or without serious problems. They are clearly very poorly adjusted individuals, but they do not meet the criteria for severe mental illness.
Suicides by firearms
But what about suicides by guns?
The annual number of deaths by suicide in the US is 48,183, with 26,328 of those being achieved by firearms, according to the Center for for Disease Control. By contrast, suffocation is responsible for 12,431 suicides, and poisoning for 5,568. That means, by the way, that suicides by firearms account for more than half of all deaths by guns.
“Firearms (including handguns, rifles, shotguns or other large firearms, or other unspecified firearms) have consistently been used more frequently than any other methods among men,” according to the National Library of Medicine. “Firearms have also been the leading method of suicide for rural females, but use of firearms among women in general also increased significantly since 2008, and they became the leading method for all female decedents in 2020 (1.9 per 100,000).”
Once again, however, most people who commit suicide were not diagnosed with serious mental illness. They may have been sad and desperate but the vast majority were not psychotic, and certainly not violent towards others.
Those at risk for suicide can sometimes be identified, if people are watching carefully. Primary care physicians have access to a rapid diagnostic tool called The Patient Health Questionnaire to help them assess a patient’s mental state, including if they are at risk of suicide. This tool is available to all physicians for free. A pilot program in Montana is screening high school students for depression in hopes of identifying children in need of intervention. Their program may become a model for other schools in the country for early identification of psycho-social needs of adolescents.
So who should NOT have guns?
So when we are talking about limiting access to guns, who should be left out?
If serious mental illness is off the table as a reliable indicator of someone with the propensity to carry out a mass shooting, who is left? A background check can’t exclude every applicant because he had a childhood trauma or got thrown out of high school. If most mass shooters don’t even have criminal records, that won’t help. Screening for past offenses does come in handy when you are dealing with individuals who have had restraining orders against them for domestic abuse or been incarcerated for aggravated assault, but should every felon released from prison be prevented from owning a gun? Even those who committed white collar crimes? Petty thieves who committed burglaries without weapons?
And, again, if we are not using a diagnosis of severe mental illness, and we agree it is not part of the picture, what other criteria are useful? Age seems like a good one. If all the research shows that the adolescent brain is still developing and the amygdala that regulates impulse control and judgment is a gelatinous mess during the late teen years (some experts say it isn’t working at full tilt in boys until 27), doesn’t it make sense to keep guns away from these hormone-driven teens?
What else can help?
Preventing people with histories of violent behavior from buying and owning guns is a worthy goal. We certainly hope that the federal Brady Law requiring background checks will extend to more states and include sales from unlicensed sellers, online or at gun shows. Red and Yellow Flag laws that allow people to bring concerns about witnessed behavior to the attention of authorities can also aid in prevention. Laws against semi-automatic rifles; gun safety training; and screenings for depression and suicidal ideation at high schools and colleges can all help.
What will also help is to get rid of so many guns. The United States does not have more people with serious mental illness or who have suffered trauma than other countries with far fewer gun-related deaths. What we have are more guns. We need to get rid of the AR-15 style semi-automatic killers for everyone but the military. Instead, help our communities reach out to people young and old who may feel isolated, lonely, angry, and distraught. Increase support services for teens and adults of all ages.
What will NOT help is further stigmatizing those with serious mental illness by incorrectly blaming them for the plague of gun violence in our country.
That’s just too easy. And just plain wrong.
Therese (she/her/hers)
Judy (she/her/hers)
Didi (she/her/hers)
Leading Ladies Executive Team