Response to Shameful scapegoating of the mentally ill

by Joel Dvoskin, PhD, ABPP

I appreciate the sentiments expressed by Sheriff Dart, but I do want to take issue with one small but important part of his article. Sheriff Dart wrote: "Yes, the majority of mass shootings are carried out by those with untreated mental illness...." I believe this statement to be at least unfounded and more likely incorrect. I am aware of no evidence whatsoever to support the notion that "the majority of mass shootings are carried out by those with untreated mental illness." Further, I don't believe it to be true, for the following reasons:

1. Many of the allegations regarding mental illness as a characteristic of mass shooters is retrospective, and based upon circular logic. In other words, people say, "You'd have to be crazy (sic) to do something like that." Further, in the aftermath of a heinous crime, even minor quirks and eccentricities are likely to be incorrectly labeled as evidence of mental illness through the stigmatizing lens of retrospective analysis.

2. Many mass shootings are carried out in regard to organized crime, especially including street gangs. Again, there is a circular myth that one would have to have a personality disorder to be in a street gang, but that myth ignores the sad truth that in some parts of America, joining a gang is viewed as a necessary evil, or a way to remain safe.

3. There is typically saturation publicity when a mass homicide appears to have been committed by a person with psychiatric problems, leading the public (and, sadly, many mental health professionals) to overgeneralize from these few vivid cases. Professor Michael Perlin has referred to this as "the vividness heuristic." And make no mistake out it; vividness and extreme statements sell TV advertising much more successfully than truthful reporting of the news.

4. Sadly, I have studied many of these seemingly irrational mass homicides, and in my opinion, many of them are perpetrated by people without serious mental illnesses (the way that term is appropriately used.) What the perpetrators seem to have in common are the experience of extreme situational crisis, often including rage and despair, sometimes fueled by alcohol or stimulants. While a situational emotional crisis could be characterized as an adjustment disorder or acute depression, terms such as "serious mental illness," "the mentally ill" (sic), etc. are typically used to refer to people with serious and persistent emotional and cognitive conditions that have pervasively made their lives more difficult over time. Referring to situational crises as evidence linking mental illness to mass homicide is, once again, circular, tautological reasoning that creates misleading discourse.

5. The majority of perpetrators of random mass shootings either commit suicide, manage to get killed by police, or spend the rest of their lives locked up. In any case, they have given up on life as they know it. Thus, it is useful to understand that in addition to being homicides, these are typically acts of suicide or its metaphorical equivalent. While it is virtually impossible to know which of the millions of people in emotional crisis will commit acts of murder and suicide, it is also true that we know how to prevent suicides. By using simple public health approaches to suicide prevention, American jails have manage to dramatically reduce the number of jails suicides. (Read anything by Lindsay Hayes of the National Center for Institutions and Alternatives for data supporting this statement.) However, preventing suicides costs money, so that crisis workers can be adequately compensated and in adequate numbers to respond to crises with skill, and quickly. As everyone on this list is aware, the public mental health system in the US has been ravaged by budget cuts, to the tune of tens of billions of dollars, during the past 15 years. If America would meaningfully invest in suicide prevention, I believe that we would undoubtedly prevent some mass homicides, but we would never know it, because the percentage of suicidal people who commit mass homicide is literally infinitesimal. Consider that there are nearly twice as many gun suicides each year as gun homicides, and mass shootings account for less than 1% of all gun deaths annually.
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I have spoken often over the past few years about ways in which the public mental health system can and must help to prevent mass homicides, but it is not primarily due to its important role in treating persons with serious mental illness. It is important to remember that the public mental health system, along with other first responders such as Fire and Rescue, Police, and EMT's, must receive adequate funding to provide timely and competent services to people in extreme crisis and despair, whether or not they happen to have a psychiatric diagnosis. Emotional crises are an equal opportunity phenomenon, which can happen to anyone (with or without SMI) who is experiencing enough distress, and the public mental health system ought to be there to help them see a less horrifying way to alleviate their psychological pain.

Again, I mean no criticism of Sheriff Dart, whose heart was definitely in the right place, and who has been a positive force in advocating for the rights of people with mental illnesses who are detained or imprisoned. But I do think it's important to correct stigmatizing myths, even when they come from people of genuinely good will and intentions.