In recent years, American society has seen what seems to be a troubling increase in the number of high profile violent incidents. When we think about these, our minds usually drift to events at Columbine High School (1999), Virginia Tech University (2007), Fort Hood (2009), Sandy Hook Elementary School (2012), Cinemark Century Theater in Aurora, Colorado (2012), the Orlando nightclub (2016), Las Vegas (2017) or Majory Stoneman Douglas High School in Parkland, Florida (2018). Although each of these was a tragedy, history contains many more that we are not as aware of (see gunviolencearchive.org/reports as an example).
Mass shootings happen more often and have been occurring for much longer than we realize. One of the primary reasons the high profile shootings noted above are so easy to remember is that they have been highly publicized by the media. However, most people are not aware of the 49th Street Elementary School shooting in Los Angeles (1984), the Cokeville Elementary School hostage situation in Cokeville, Wyoming (1986), or the Oakland Elementary School shooting in Greenwood, South Carolina (1988) – all of which occurred long before Columbine. Further, few know of recent events like the 16 people killed in San Bernadino, California in December 2015 or the 450+ murders that have occurred in East Saint Louis, Illinois (population 26,000) in the last 20 years, most of which remain unsolved (see this article). These situations are no less tragic, nor the lives less valuable. However, it seems that the Columbine High School shooting captured the attention of the media and there has been a laser focus on some – far from all – mass shootings since.
Media Bias and the Cascading Impact
In addition to the disturbing bias involved in deciding which shootings are publicized, the media is guilty of a much greater and destructive error. In most of the aforementioned shootings, the mental health of the alleged shooter became a central component of the reporting. In each of the aforementioned high profile incidents, questions about mental illness were quickly raised and repeated frequently. Often, within hours of the shooting, authorities were seeking mental health records, asking questions about the mental stability of the shooter and implying that one must be ‘crazy’ to engage in such behavior. In the weeks, months and years that followed these tragedies, there were numerous advocacy groups clamoring for mental health reform and greater access to services, implying that if needed resources were available, such tragedies may have been prevented. Even as recently as September 2019, mental illness is being linked with the horror of Columbine (see this article).
Images like these only reinforce a flawed message.
The clear implication in the reporting and associated responses, of course, is that mentally ill people are dangerous and that only a ‘crazy’ person is capable of actions like these. Thus, we equate violence with mental illness. The logical extension for most laypeople is that mentally people are – or at least have great potential to be – unpredictably violent. The ultimate impact is that mentally ill people are to be feared – or worse.
In mid 2019, after mass shootings in Ohio and Texas, President Trump perpetuated this message with his call for more regulations to assure mentally ill people could not access guns and even argued to involuntarily hospitalize more mentally ill people. The President is far from the first politician to make this argument. As but one example, Illinois has a longstanding law requiring gun owners to apply for the right to own a firearm. In addition to other requirements, if a person has ever been in a psychiatric hospital, they are restricted from buying or owning a gun – regardless of any specific details related to their treatment. Other states have similar statutes. Again, the implication in the President’s statements and laws such as Illinois’ is clearly that if mentally ill people cannot access guns, fewer violent crimes and mass shootings will occur.
Is Mental Illness a Risk Factor for Violence?
Unfortunately, these implications are horribly wrong and the associated statutes misguided. Decades worth of research has clearly shown us the most common risk factors for crime and violence, among which are:
- A history of violent behavior
- Male gender
- Substance abuse/intoxication
- Childhood abuse, neglect, exploitation and poor parental monitoring
- Impulsivity or poor behavioral control
- Low IQ
- Early exposure to violence and violent lifestyles
- Parents engaged in antisocial/criminal lifestyles
Notice what is not the list: mental illness. To be fair, mental illness can, at times, be a risk factor for violence. Specifically, a person who suffers from Schizophrenia and has the particular symptoms of either persecutory delusions (i.e. someone is after me, wants to hurt me) or command hallucinations (i.e. voices that command me to do something like hurt someone) may be at higher risk to commit a violent action. However, these unique circumstances are the exception to the exception to the rule.
First, Schizophrenia is exceptionally rare, affecting fewer than 1% of people over the course of their lifetime (the number of people who have this disorder in any given year is much smaller: about 1 in 300). Second, although it is not clear how many of these have persecutory delusions or command hallucinations, most do not. Third, of that small fraction that do have these specific symptoms, many do not act upon them. Put another way, many Schizophrenia sufferers who believe they are being followed or at risk to be harmed, to not harm others in response, and many who hear voices telling them to harm others do not comply.
In conclusion, although mental illness may be a risk factor for violence in an infinitesimally small number of people, the number of violent actions perpetrated by this very small group is also incredibly small. Although mental illness should not be ignored, the likelihood of violence perpetrated by a mentally ill person is so small, it is low on the list of priorities in a discussion about violence risk. The factors listed above should garner much more concern and attention if we are truly interested in reducing violence.
Even worse, having a mental illness actually makes a person far more likely to be the victim of a crime than the perpetrator of one. However, when is the last time we saw the news media or advocacy group demanding recompense for these crime victims?
Who Are Violent Criminals?
If it’s not mental illness, then why do these horrible tragedies happen? If they are not crazy, then what kind of person would do this? While it’s not difficult to demonstrate how one factor (like mental illness) is not the reason, it’s more complicated to account the many factors that contribute to how and why violence of this magnitude occurs.
A major part of understanding who engages in violence goes back to the list of risk factors above. The overwhelming majority of crime, including violent crime, in the US occurs at the hands of an identifiable and fairly predictable group of people. While there are always exceptions, most criminals possess many of the risk factors noted. It’s very common to find them having come from abusive homes in which corporal punishment was routine, drug and alcohol abuse were normal and there was little structure, support or nurturing. These same kids often get involved in violent and/or criminal activity at a young age, have educational problems and are frequently rejected by their peers and have interpersonal problems. As a result of this combination of factors, these kids often end up migrating toward social groups that share in those struggles (i.e. other antisocial, peer rejected kids). As one would expect, when a group of people with similar values and behaviors gets together, they reinforce each other and perpetuate those behaviors.
There is no guarantee these types of youth will turn into violent criminals or mass shooters in adulthood. But given these various risk factors, the likelihood increases. There is a small percentage of these who will continue their antisocial, criminal tendencies into adulthood and throughout their life’s course. Unsurprisingly, many of these will end up incarcerated for a variety of reasons. This type of lifestyle is often associated with Antisocial Personality Disorder (ASPD) – a clinical condition that can be diagnosed by a qualified mental health professional and is common among incarcerated offenders.
A separate construct that bears some similarities to ASPD is called psychopathy (or some use the term sociopathy), for which there is no formal diagnosis. The psychopath (sociopath) is much rarer than the antisocial personality, but can be much scarier. While both are capable of violence and carnage, it is the psychopath who is terrifyingly calm, skilled, patient, well-studied and rehearsed in their criminal acts. The psychopath is more likely to spend a great deal of time planning each detail of what they intend to do, hiding weapons where they can be easily accessed, planning for contingencies, knowing where the best entrances and exits are, anticipating when law enforcement will arrive and knowing how long they have to inflict the most deaths possible. They are organized, thoughtful and thorough. The psychopath lacks emotion, empathy or conscience, which makes them an efficient and remorseless killing machine who is not subject to anxiety, fear or second-guessing themselves.
While it would be irresponsible to claim that any or all of the above-named mass/school shooters are psychopaths, one must recognize that the manner in which they approached their crimes have many well-planned, cold and calculated traits.
ASPD & Psychopathy: Mental Illness or Not?
While it may be tempting to conclude that both ASPD and psychopathy are mental illnesses – thus undermining the very argument being made here – this conclusion has some substantive problems. ASPD is a psychiatric diagnosis that can be found in the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM 5). However, it is classified as a personality disorder, which is a quite different classification than mental illnesses like Schizophrenia or depression.
A thorough compare-and-contrast would be extensive and time-intensive, but here is the short version: major mental illnesses (e.g. Schizophrenia) are akin to diseases a person has; a personality is better understood as a disease the person is. The personality disordered individual has some fundamental aspects of themselves (i.e. their personality) that are extremely chaotic, broken and disordered. This, in turn, affects every part of their life, especially their relationships with others. While the schizophrenic person may experience symptoms or similar-looking disruptions, their core personality remains unchanged. Thus, if their symptoms are brought under control, their underlying, unaffected personality will emerge.
As such, the antisocial person’s personality is organized as being against (anti) society (social). This personality orientation leads them to direct their life and behaviors accordingly by angrily and defiantly acting against social norms, breaking laws and committing crimes. Thus, prisons are full of antisocial personalities. Unlike the schizophrenic, the symptoms of ASPD are manifestations of the person themselves – not simply some disease that afflicts them.
As noted above, the psychopath is similar to the antisocial in that they both disregard the rights and wishes of others and they are both oriented against society. Where they diverge is that the psychopath’s antisocial acts are not angry or disorganized. They are cold, calculated and remorseless, showing heartless sadism and vicious cruelty. The psychopath is often very intelligent, smooth, charismatic and seamlessly weaves his way into and out of the lives of those he victimizes before they ever know what hit them.
Since it is the core of the person that is disordered, ASPD and psychopathy are not mental illnesses like depression, anxiety or Schizophrenia, where one’s mood, thinking or behavior deviates substantially from normal expectations because of factors acting outside their control. The antisocial, psychopath and others like them, while twisted and evil, are acting with volition in accordance with their deeply held anti-society values and their behaviors are consistent with these beliefs. By contrast, when the schizophrenic person commits their (rare) crime, they are not acting in accordance with values they hold, but in response to an uncontrollable outside influence (e.g. a voice telling them to act).
While there are many additional legal and psychological nuances that can be fleshed out, this illustrates some of the fundamental differences between the groups and why antisocial and psychopathic characters should not be equated with the truly mentally ill. Even more pointedly, it is a gross mischaracterization to claim that mass shootings and other such violent acts occur due to failures in the mental health system or due to the erratic effects of someone’s mental illness. In truth, it is these antisocial and psychopathic actors who are guilty of most of these atrocities and the American justice system already accounts for how to handle anti-society, violent criminals – they are prosecuted and incarcerated in accordance with their crimes.
Although the mental health system in America has many significant problems, even if it was demonstrably perfect, it would have no useful response for the antisocial or the criminal psychopath who engage in mass murder.