Mass Shootings and Mental Health

A Personal Review of the Issues

Seth Underwood
Invisible Illness
Published in
9 min readSep 11, 2023


Image by mybaitshop, Sourced and Licensed by writer from Adobe Stock.

“We have blood-soaked films out there, like ‘American Psycho,’ ‘Natural Born Killers’ that are aired like propaganda loops on splatter days.” — Wayne LaPierre, NRA’s executive vice president.

Autistic Self Advocacy Network (ASAN) in an online statement “Make Real Change on Gun Violence: Stop Scapegoating People with Mental Health Disabilities” notes “Research shows that there is no direct link between gun violence (excluding suicide) and mental health.” Adding “The police are also more likely to use deadly force against people with disabilities.”

The problem with ASAN’s statement concerning research is that the American Psychological Association (APA), in a statement entitled “Resolution on Firearm Violence Research and Prevention,” states that “no methods currently exist for reliably predicting whether or not specific individuals will behave violently, nor the specific time, place or manner in which they will behave violently.”

But further qualifies this with, “On the other hand, science-based risk assessment and management strategies using empirically-derived assessment tools for individuals with histories of violence have developed as the standard for preventing targeted violence in many settings.”

There’s no way to predict who with a mental health issue will become violent, but previous cases of actual people provide insight, which suggests to me that some cases of gun violence could be attributed to those with mental health problems contrary to ASAN’s assertion.

Making the Case for the Mentally Ill Mass Shooter

On the political and news media perception of things, there appears to be an anecdotal reality that a mass shooter more than likely has a mental illness. When dealing with something as senseless as a mass shooting, blaming the cause on mental illness sounds plausible. No one really wants to admit that there could be purely evil people hell bent on killing others.

A Pew Report from 2021 showed that most Republicans (85%) and Democrats (90%) support policies that restrict people with mental illnesses from buying guns.

A good deal of news outlets have reported cases of mass shootings over the years citing mental illness.

CNN recently reported on the person who killed three people in Jacksonville, Florida. He had been the subject of a 2017 law enforcement call under the Baker Act, which allows people to be involuntarily detained and subject to an examination for up to 72 hours during a mental health crisis. He then took his own life after killing the three people.

The Baker Act is a common law across many states, but even if it results in removal of gun rights, those rights can be restored typically if the individual petitions with certification that the problem is resolved. In Switzerland, restoring gun rights might require an annual mental health exam, unlike the U.S.

As we study these anecdotal claims scientifically, we see they may be based on facts rather than stereotypes or casual observations.

According to a report by the U.S. Secret Service, reported by NPR, on mass-shootings, noted 96% were male, 57% were white, 64% had a prior criminal history (excluding minor traffic violations), the majority had an online presence, and nearly all had “at least one significant stressor’ within five years of the attack with family and romantic relationships.” With 72% having financial troubles before the attack. “Outside of personal delusions” representing a symptom of mental illness (as shown in examples in the study), 26% believed in a “conspiratorial, topic-specific, or hate-focused belief system.

I’d like to note here that the U.S. Department of Justice would classify a “hate-focused belief system” as hate bias, but for it to be a hate crime, this belief system has to be connected to a “violent crime, such as assault, murder, arson, vandalism, or threats to commit such crimes.” And technically, a “hate-focused belief system” is protected by the First Amendment as “hate speech” per Matal v. Tam until it crosses that line into violence.

Last, the National Institute of Justice reports that “suicidality was found to be a strong predictor of perpetration of mass shootings.” But also notes, “but the research indicates the role of mental illness in mass shootings is complicated, not clear-cut.” Concluding, “that nearly all persons who engage in mass shootings were in a state of crisis in the days or weeks preceding the shooting.”

The APA states that while mass shooters have common psychological traits, predicting their actions is too complex. There are just too many variables involved that need to come together to set a person down this road.

Besides, then there are ideologies that promote violence as a solution and if they have influenced the person. We can’t limit such things to just the extreme right, like the KKK or Neo-Nazi organizations. But in the book, Antifa: The anti-fascist handbook by Mark Bray, he speaks about the concept of using violence as a potential step to achieve its goals against fascism.

How to Prevent All This…

To prevent things in advance, we could give psychological exams to all men, like Switzerland does during conscription. This reminds me of how Robert Heinlein viewed citizenship through military service to build a better society.

Swiss Military conscripts men aged 19–34 undergo psychological exams which identify those with certain psychological traits, including personality disorders like antisocial. Or if they are autistic and have a comorbidity with a personality disorder, as per the 2021 study entitled, “Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis.

This study found 2% of high functioning ASD subjects to have “avoidant and paranoid PD diagnoses” with 15% having this life long. This reminds me of the autistic person who was charged in the January 6th U.S. Capitol riot. Autism, PD diagnosis, and obsession with Trump’s election could lead to an attack on the US Capitol. I’m not saying that the specific person had all this, but such things make it plausible.

Stamping Out Evil Content

What I’m not suggesting is the banning in the U.S. of all violent and hate-filled content. The main reason I don’t think we can do such a banning is that it would be un-constitutional. And Germany has already tried this with everything that’s Nazi, and they still have a problem with Neo-Nazis in Germany. With too many enemies against America, it would be necessary to eliminate this content from the internet, print media, and elsewhere globally.

This is Germany’s problem as content keeps getting to their people from outside their nation. Even massive information controlled societies like China have difficulty keeping out stuff it doesn’t like. Thus, it’s an unrealistic goal, and it’s far better for society to deal with the mental illness aspects than trying to stamp out evil content on a global scale.

Is This All Stigmatizing to Those with Mental Illness?

According to an article on Mental Health, a social or public stigma for mental health would be “when society or the general public share negative thoughts or beliefs about a person or group of people with a mental health condition.”

In a 2014 study published in Psychiatric Services found that “promotion of policies to prevent persons with serious mental illness from having guns does not seem to exacerbate negative public attitudes toward this group.”

Meanwhile, a 2022 study published in the open access system, Cureus, showed that “the number of homicides related to severe mental illnesses can be prevented by earlier and more effective treatment and follow-up, as well as the implementation of ways to reduce the stigma and discrimination toward mental illness in the public eye.”

I don’t know if saying mass shooters are mostly mentally ill is truly stigmatizing to those suffering from mental illness in the U.S. I can only answer this stigma question for myself, as must all individuals with mental illness. And I don’t feel stigmatized having a mental health condition. I’m treated as if I’m “normal” most of the time unless you talk to my wife. But the fact is, I would welcome a law which would allow me to request to put me on the list to block me from owning or purchasing any guns in the U.S.

Do I think I’m a danger to myself and others? Not right now, but I don’t know about the future. I’ve already had one mental breakdown episode in my life, and if I had another, I do not know what I would do. As it stands now, only other parties like my wife or a therapist can block my access to guns.

Wrapping Up

So, ASAN is correct that the majority of those with mental illness will not end up being a mass shooter by numbers alone. The fact is the odds and science do not support the claim that all with mental illness will end up being a violent mass shooter.

Will there be some? Yes, but that number is tiny indeed.

The problem is a mass shooter kills many more people than a person who simply commits suicide or robs a convenience store. But for mass shootings, we need specific circumstances for them to happen, which may include having certain psychological conditions present. Psychological conditions such as a personality disorder, which doesn’t have any known medicinal treatments. Even autism has two FDA-approved drugs for treatment.

The problem is, according to Pew Research, active shooter incidents have been increasing over the years. For example, in 2021, that figure was only 61 and only 40 the year before that.

According to the U.S. Department of Justice, a review showed the number of mass shootings was small in comparison to other shootings. They also noted that many in their study, which only covered 2009 to 2013, had no mental illness reported. The more than likely cause is a life stressor event and the person not seeking or being unable to seek proper help. Thus, “those with mental illness make up a small proportion of violent offenders.

Most mass shooters have suicidal tendencies, making it a crisis extension of gun-related suicide. According to the Pew Research, mentioned above, suicides accounted for 54% of gun deaths in 2021 and is something ASAN excludes from its statement.

When I recently re-entered therapy, I noted my suicide ideation issues. This triggered my therapist to ask a series of questions by state law to see if I was a danger to myself, my family, or others. I happen to be one of these odd ball autistics who’s fascinated by death, even my own, but never carries it out. But there are types of gun related suicides where whole families are killed, or others who seek suicide by cop.

To prevent mass shootings, society needs to view the problem as a symptom of depression and suicidal tendencies.

The first thing is we are going to need to deal with our mental health system here in the U.S. by providing universal mental health care to allow easier access.

The restriction of gun access for people with mental health disorders can only happen after we set this up. The way we have it now is backwards. It waits for someone to be diagnosed first, and even then, people can still get access to guns in some manner.

A lot of shooters who had mental health issues did not receive treatment because our nation is not pro-mental health. And I’m not talking about a stigmatizing mental health idea here, but a positive view of mental health as in it is okay to seek treatment when needed. That’s why free access is important.

And even when their gun rights are restored, such individuals may need to be subjected to annual screenings. Recidivism with major depressive disorders with or without a personality disorder is not uncommon.

I know all this sounds draconian and it may cause a social stigma for those with depression, but it only takes one bullet to kill. I know because I’ve researched how to kill oneself with a gun before and used it in some of my writings.

This problem is something people like me will have to live with, and I have no problem with that if it means a safer world for all.

Personal Note about ASAN statement- Some of the cited research is questionable. One study cited wasn’t even done in the U.S. but Sweden, and many of the others had questionable methodologies such as a low number of subjects or self-reporting. The problem is there can be no public research in the U.S. on this topic because funding has been blocked for years, and it’s too costly for large-scale private research.



Seth Underwood
Invisible Illness

54+ autistic, undiagnosed dyslexic, sufferer of chronic migraines, writer of dark science fiction, player of video games and Mike Pondsmith Fan. Race- Human.