Mass Shooters Are Not Mentally Ill

There’s an awful stigma around mental illness. From depression to bipolar disorder to schizophrenia. Headcase. Looney. Crazy. Insane. Psycho. These are just common insults, even the last one has no medical weight, used to question the way someone acts if it’s out of line with expectations. When applied to some who is sick they can be particularly hurtful. There’s even evolutionary advantage to question unpredictable people who threaten the group in a way that doesn’t exist with many other prejudices. But the mentally ill are victims of diseases as cruel or more than any other. Diseases that can rob people of their personality.

Every time someone commits an act of mass violence, questions arise about the mental health of the perpetrator. But with few exceptions, these acts are not committed by people with a mental illness. These people are simply unstable. These are seemingly normal people whose expectations of reality, when not met, cause them to commit extreme acts. An ex husband who throws all of his wife’s belongings in a dumpster when she won’t behave as he expects. A man who slashes the tires of a person over a minor personal property dispute that isn’t working as he expects. Any number of violent acts from punches and beatings to mass shootings.

On the subject of the last example, after every one of these too common events the media begins look for explanations other than the prevalence of and ease of access to guns in America. And the mental health of the shooter always comes into question. I could be wrong but I don’t believe there are many DSM-V diagnoses that include violent, catastrophic outburst as a potential result. (Intermittent explosive disorder and a few personality disorders are the exceptions that come to mind.) I don’t believe these people are mentally ill in that they suffer from a persistent disturbance in thinking and behavior such as a person with schizophrenia does. They are simply unbalanced individuals. Shooters and any number of other people who can potentially react to life events with extreme violence or punitive hatred or criminal spite are people who live their lives close to the edge of extreme behavior and can be pushed over that edge for any number of reasons, situations events or realities that they cannot cope with any other way than by hurting someone.

The mentally ill in the truest sense, those with day-to-day dysfunction of thinking or handling emotions, are not often the perpetrators of violence. They are more often the victims of violence. Mass shootings and crimes of passion and criminal acts of selfish vindication are not examples of the failure of the mental health system to help these people. I don’t believe that Dylan Roof would have been much helped by going to the therapist. Could a therapist deescalate murderous racism? Seung-Hui Cho may have had major depression, but how could that possibly predict the murder of 32 of his peers? How could the mental health community have stopped these or any other mass shooter? Saying this is not a failure of the mental health system isn’t a very hard statement for me to make, and given its state in this country it’s full of failures, but psychiatrists and counselors are there to help people suffering. They aren’t thought police. And unless a patient makes a threat in a session, they can’t possibly do anything because a person determined to commit a violent act or prone to them on an impulse probably won’t mention it to a doctor unless they find their thoughts discomforting.

The scary thought, the uncertain reality, is that there is no predictor to screen for people who are just off enough to do unthinkable things to their loved ones or the public at large. There’s no failed mechanism to scapegoat. These people are sane enough to carefully prepare and execute a plan or just unhinged enough to snap when life gives them an outcome they can’t accept.

There will always be people who snap and do horrible things or who build a hatred for years and let it stewed into an explosion. But the least we can do on the subject of the shooters is make it hard or impossible for them to inflict the kind of destruction that we saw in Las Vegas.

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