Most mass shoot­ers aren’t men­tally ill

Ex­perts fault psy­chi­atric so­lu­tions pur­sued by White House, Congress

The Washington Post - - FRONT PAGE - BY MICHAEL S. ROSENWALD

When it comes to mass shoot­ings, Pres­i­dent Obama and House Speaker Paul D. Ryan are in rare ac­cord on a lead­ing cul­prit.

Both point fin­gers at men­tal ill­ness. And in poll af­ter poll, most Amer­i­cans agree.

But crim­i­nol­o­gists and foren­sic psy­chi­a­trists say there is a crit­i­cal flaw in that view: It doesn’t re­flect re­al­ity.

While ac­knowl­edg­ing that some of the coun­try’s worst mass shoot­ers were psy­chotic — the Colorado theater gun­man, James Holmes, with his or­angedyed hair; the Vir­ginia Tech shooter, Se­ung Hui Cho, whom a judge or­dered to get treat­ment — ex­perts say the vast ma­jor­ity of such killers did not have any clas­sic form of se­ri­ous men­tal ill­ness, such as schizophre­nia.

In­stead, they were more of­ten ruth­less so­ciopaths whose be­hav­ior, while un­fath­omable, can’t typ­i­cally be treated as men­tal ill­ness.

The over­sim­pli­fi­ca­tion, ex-

perts say, is per­pet­u­ated by the gun in­dus­try and a so­ci­ety that as­sumes that the men­tally ill are the only ones ca­pa­ble of deadly ram­pages. Now, with the White House and Congress pri­or­i­tiz­ing an over­haul of the men­tal-health sys­tem to try to cur­tail mass shoot­ings and gun vi­o­lence, crit­ics say the coun­try is chas­ing an ex­pen­sive and po­ten­tially coun­ter­pro­duc­tive cure on the ba­sis of the wrong diagnosis.

“It would be ridicu­lous to hope that do­ing some­thing about the men­tal-health sys­tem will stop these mass mur­ders,” said Michael Stone, a foren­sic psy­chi­a­trist at the Columbia Col­lege of Physi­cians and Sur­geons and au­thor of “The Anatomy of Evil,” which ex­am­ines the per­son­al­i­ties of bru­tal killers. “It’s re­ally folly.”

Stone main­tains a data­base of more than 300 killers, most of them shoot­ers of four or more peo­ple. He es­sen­tially breaks men­tal ill­ness into two categories. In the first cat­e­gory are those with schizophre­nia, delu­sions and other psy­choses that sep­a­rate them from re­al­ity and who are suf­fer­ing from se­ri­ous men­tal ill­ness and could be helped with med­i­cal treat­ment. In the sec­ond are those with per­son­al­ity, an­ti­so­cial or so­cio­pathic dis­or­ders who may exhibit para­noia, cal­lous­ness or a se­vere lack of em­pa­thy but know ex­actly what they are do­ing.

In a paper pub­lished last year, Stone found that just about 2 out of 10 mass killers were suf­fer­ing from se­ri­ous men­tal ill­ness. The rest had per­son­al­ity or an­ti­so­cial dis­or­ders or were dis­grun­tled, jilted, hu­mil­i­ated or full of in­tense rage. They were un­likely to be iden­ti­fied or helped by the men­tal-health sys­tem, re­formed or not.

These traits, by Stone’s anal­y­sis and def­i­ni­tion, de­scribe Eric Har­ris, the ring­leader of the Columbine High School shoot­ings in 1999; Michael McDermott, a soft­ware tech­ni­cian who killed seven co-work­ers in 2000; Ni­dal Hasan, an Army cap­tain who killed 14 peo­ple at Fort Hood, Tex., in 2009; Dy­lann Roof, who is charged with killing eight wor­shipers in a church in Charleston, S.C., last year; and many more.

“The whole no­tion of men­tal ill­ness and mass shoot­ings is so poorly un­der­stood,” said Liza Gold, a foren­sic psy­chi­a­trist at Ge­orge­town Univer­sity and ed­i­tor of a re­cent col­lec­tion of schol­arly papers on gun vi­o­lence and men­tal ill­ness. “To ad­dress the re­al­ity of it, it’s like deal­ing with peo­ple in a par­al­lel di­men­sion.”

Around the coun­try, at the fed­eral and state lev­els, law­mak­ers have pro­posed or passed leg­is­la­tion link­ing men­tal ill­ness to gun vi­o­lence, say­ing the mea­sures were needed to stop mass shoot­ings. Some states, in­clud­ing New York, now re­quire men­tal-health work­ers to re­port any­one they think is danger­ous to a data­base used for firearms back­ground checks. Af­ter the Vir­ginia Tech shoot­ings in 2007, Vir­ginia passed mea­sures to lower the cri­te­ria for com­mit­ment.

Al­most ev­ery high-pro­file mass shoot­ing in re­cent years has prompted plans and prom­ises to re­form the men­tal-health sys­tem.

Jonathan Metzl, a Van­der­bilt Univer­sity pro­fes­sor who stud­ies the his­tory of men­tal ill­ness, has writ­ten that “in­san­ity be­comes the only po­lit­i­cally sane place to dis­cuss gun con­trol.”

Ear­lier this year, in a tear­ful an­nounce­ment of mea­sures to stem the Amer­i­can phe­nom­e­non of mass shoot­ings and gun vi­o­lence, Pres­i­dent Obama said, “We’re go­ing to do more to help those suf­fer­ing from men­tal ill­ness get the help that they need.”

He pro­posed spending $500 mil­lion to ex­pand men­tal­health treat­ment. His fre­quent leg­isla­tive spar­ring part­ner on the Hill — the House speaker — is in­sist­ing that some­thing be done to pro­tect Amer­i­cans from ran­domly be­ing shot.

“We have seen con­sis­tently that an un­der­ly­ing cause of these at­tacks has been men­tal ill­ness, and we should look at ways to ad­dress this prob­lem,” Ryan (RWis.) said ear­lier this year. The ques­tion is how. In 2013, in re­sponse to the shoot­ings at Sandy Hook El­e­men­tary School in New­town, Conn., that killed 20 first-graders, Rep. Tim Mur­phy (R-Pa.), a child psy­chol­o­gist, pro­posed a far-reach­ing men­tal-health re­form pack­age to ex­pand in­pa­tient psy­chi­atric care and re­lax pri­vacy rules so fam­ily mem­bers of the men­tally ill are able to ac­cess their health records. States would have lost fed­eral grant money if they didn’t pass laws forc­ing peo­ple to get out­pa­tient treat­ment. The bill, which had Demo­cratic co-spon­sors, stalled amid con­cerns about pa­tients’ pri­vacy and the in­vol­un­tary-treat­ment pro­vi­sion.

Mur­phy re­vised and rein­tro­duced the bill last year, back­ing off the in­vol­un­tary treat­ment re­quire­ment. Sen. Chris Mur­phy (D-Conn.) also has pro­posed a re­form pack­age, although he has not linked it to mass shoot­ings, say­ing he was “un­com­fort­able hav­ing men­tal health framed as a re­sponse to gun vi­o­lence be­cause it risks draw­ing an in­her­ent con­nec­tion be­tween men­tal ill­ness and vi­o­lence, which doesn’t ex­ist.”

Sen. Mur­phy’s bill is com­pet­ing with leg­is­la­tion spon­sored by Sen. John Cornyn (R-Tex.) that would re­quire courts, not men­tal-health pro­fes­sion­als, to de­ter­mine whether some­one should be pro­hib­ited from buy­ing guns. Democrats say that would make it tougher to seize firearms, but the Na­tional Ri­fle As­so­ci­a­tion sup­ports Cornyn’s mea­sure.

There may not be much chance of any mean­ing­ful re­form pass­ing in an elec­tion year. Still, both par­ties seem de­ter­mined to get some­thing done.

“The re­al­ity is, so many of these mass shoot­ings could have been pre­vented,” Rep. Mur­phy said in an in­ter­view. “The is­sue is iden­ti­fy­ing these peo­ple sooner and get­ting them the help they need.”

But psy­chi­a­trists and crim­i­nol­o­gists who spe­cial­ize in mass killings say these cum­ber­some and ex­pen­sive ef­forts would have lit­tle ef­fect in stop­ping mass shoot­ings. They fear that the coun­try will be given a false sense of se­cu­rity and that when the shoot­ings per­sist, the men­tal­health sys­tem will be blamed again.

Crit­ics are es­pe­cially con­cerned about in­creased stigma­ti­za­tion of the men­tally ill, fear­ing that they will avoid treat­ment so their med­i­cal records aren’t en­tered into data­bases, some of which have deroga­tory cat­e­gory ti­tles such as “the men­tally de­fec­tive file.”

‘So de­ranged, so evil’

Un­der­ly­ing the dis­con­nect be­tween the leg­isla­tive ideas and the sci­en­tific re­al­ity, ex­perts say, are fun­da­men­tal mis­con­cep­tions about the con­nec­tion be­tween se­ri­ous men­tal ill­ness and vi­o­lence.

Stud­ies show that the men­tally ill do present a higher risk for vi­o­lence than oth­ers, but over­all they ac­count for just 3 to 5 per­cent of vi­o­lence in the coun­try — and only 1 per­cent of gun vi­o­lence against strangers. They are far more likely to be vic­tims of crime.

There are many groups per­pet­u­at­ing the myth of the men­tally ill mass shooter, ex­perts say.

One is the news me­dia, which looks for and raises the men­talill­ness story line af­ter ma­jor in­ci­dents, some­times with­out con­fir­ma­tion but with pro­found ef­fects. Read­ers of news ar­ti­cles link­ing men­tal ill­ness to a mass shoot­ing “re­ported sig­nif­i­cantly higher per­ceived dan­ger­ous­ness of, and de­sired so­cial dis­tance from, peo­ple with se­ri­ous men­tal ill­ness in gen­eral,” ac­cord­ing to a paper by re­searchers at Duke and Johns Hop­kins uni­ver­si­ties.

An­other is the NRA, whose of­fi­cials, in fight­ing off tighter gun-con­trol poli­cies, have called mass shoot­ers “so de­ranged, so evil, so pos­sessed by voices and driven by de­mons that no sane per­son can even pos­si­bly com­pre­hend them.”

And most Amer­i­cans agree, with 63 per­cent blam­ing mass shoot­ings on the fail­ures of the men­tal-health sys­tem to iden­tify sick peo­ple be­fore they act, ac­cord­ing to a Wash­ing­ton PostABC News sur­vey last year.

“I think it’s the hu­man in­cli­na­tion to ex­plain be­hav­ior that is fright­en­ing and tragic as the re­sult of men­tal ill­ness, be­cause it’s very hard to un­der­stand that in­di­vid­u­als do not have to be men­tally ill to do some­thing fright­en­ing and tragic,” said J. Reid Meloy, a pro­fes­sor of foren­sic psy­chi­a­try at the Univer­sity of Cal­i­for­nia at San Diego who stud­ies mass killings and con­sults with the FBI.

Mass shoot­ers come in dif­fer­ent forms. Some are de­pressed about their lot in life. Some are en­raged by per­sonal slights and seek re­venge. Oth­ers are para­noid, in­clud­ing Roof, who voiced deep ha­tred of blacks and other mi­nori­ties in a man­i­festo on his web­site and al­legedly told his African Amer­i­can vic­tims: “You rape our women, and you’re tak­ing over our coun­try. And you have to go.”

But that doesn’t mean they have a “sig­nif­i­cant im­pair­ment in re­al­ity test­ing,” as Stone put it in his anal­y­sis of mass killers. They plot me­thod­i­cally. They know what they are do­ing.

“Con­se­quently, they of­ten have not had sig­nif­i­cant in­ter­ac­tion with ei­ther the men­tal-health or law en­force­ment com­mu­nity,” the Con­gres­sional Re­search Ser­vice said in a long re­port on mass shoot­ings that raised ques­tions about the con­nec­tion to men­tal ill­ness. “Nonethe­less, fol­low­ing mass shoot­ings, pol­i­cy­mak­ers of­ten pro­pose pro­vid­ing in­creased fund­ing to bol­ster” the back­ground-check data­base.

It’s a dead end, re­searchers ar­gue.

The book on men­tal health and gun vi­o­lence that Gold edited in­cluded a paper on mass shoot­ings with this con­clu­sion: “Re­ac­tive at­tempts to re­duce gun vi­o­lence by fo­cus­ing on peo­ple with men­tal ill­ness rep­re­sent an in­ter­ven­tion with no sup­port­ive ev­i­dence of prac­ti­cal ef­fi­cacy.”

‘Peo­ple in crises’

What might work? A first-of-its-kind law in Con­necti­cut of­fers some lessons — and ob­sta­cles.

In 1998, a dis­grun­tled state lot­tery ac­coun­tant fa­tally shot four em­ploy­ees at the agency’s head­quar­ters. A year later, the state passed a law that al­lowed po­lice to seize guns from peo­ple deemed im­mi­nently danger­ous to them­selves or oth­ers, based on tips of­ten pro­vided by fam­ily mem­bers or friends. More than 2,000 guns were seized in the first 10 years af­ter the law took ef­fect, ac­cord­ing to a state leg­isla­tive re­search re­port.

A 2014 anal­y­sis of the seizures in the Con­necti­cut Law Re­view found that 80 per­cent of those who had guns taken away — most were men — had no his­tory of men­tal ill­ness. “The pro­file that emerges from Con­necti­cut’s ex­pe­ri­ence is that of peo­ple in crises,” the anal­y­sis said.

Mar­i­tal con­flicts. Fi­nan­cial prob­lems. Grief. Dis­putes with co-work­ers.

“The risk fac­tors are the cir­cum­stances,” the ar­ti­cle con­cluded, “not the per­son and not a diagnosis.”

Two other states — Cal­i­for­nia and In­di­ana — have passed sim­i­lar laws, which al­low for both seizures and a tem­po­rary pro­hi­bi­tion on pur­chases. Pub­lic health ex­perts say these mea­sures, if adopted widely, could have a sig­nif­i­cant ef­fect on gun vi­o­lence and mass shoot­ings, par­tic­u­larly be­cause shoot­ers of­ten drop hints about their plans to fam­ily mem­bers and friends, who could then re­port them.

The NRA op­poses such mea­sures. And men­tal-health ex­perts also ques­tion them. Peo­ple with fail­ing mar­riages, fi­nan­cial trou­bles and prob­lems with co­work­ers are ev­ery­where. So are peo­ple with per­son­al­ity dis­or­ders.

How could a sys­tem be de­vised to tri­an­gu­late the risk and iden­tify real threats? Not eas­ily. Or ever.

“From a psy­chi­atric per­spec­tive,” Gold said, “I don’t think you can de­sign an in­ter­ven­tion to pre­vent mass shoot­ings.”

But some of the men­tal­health re­forms be­ing pro­moted to re­duce gun vi­o­lence — in­creas­ing the num­ber of in­pa­tient beds, rais­ing fund­ing for schizophre­nia re­search, im­prov­ing com­mu­nity men­tal-health ser­vices — may de­serve sup­port any­way.

“If the re­sult is bet­ter fund­ing and treat­ment for men­tal health, is that a wor­thy out­come?” said Meloy, the foren­sicpsy­chi­a­try pro­fes­sor who con­sults with the FBI. “I think so, even if the means to get there were some­what du­plic­i­tous.”

BELL COUNTY SHER­IFF’S OF­FICE VIA REUTERS

James Holmes, left, the Colorado theater shooter, and Se­ung Hui Cho, cen­ter, the Vir­ginia Tech gun­man, were de­ter­mined to be men­tally ill, but an anal­y­sis of mass shoot­ings shows that they are in the mi­nor­ity. About 80 per­cent of mass killers had per­son­al­ity or an­ti­so­cial dis­or­ders or were dis­grun­tled, jilted, hu­mil­i­ated or full of in­tense rage. These traits de­scribe Ni­dal Hasan, right, an Army cap­tain who killed 14 peo­ple at Fort Hood, Tex., and other high-pro­file killers, in­clud­ing Eric Har­ris and Dy­lann Roof.

WIN MCNAMEE/GETTY IM­AGES

Pres­i­dent Obama sings “Amaz­ing Grace” at a fu­neral for one of the vic­tims of the mass shoot­ing in Charleston, S.C. Go to wapo.st/massshoot­ing for “What ‘374 mass shoot­ings in 365 days’ ” looks and sounds like.

POOL PHOTO BY RJ SANGOSTI/DEN­VER POST VIA AS­SO­CI­ATED PRESS

VIR­GINIA STATE PO­LICE VIA REUTERS

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