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With recent mass shootings in Dayton Ohio and El Paso Texas still near the top of the US news cycle, one article summarizes the typical profile of the killers:

Most studies of mass shooters have found that no more than a quarter of them have diagnosed mental illness. Researchers have noted that more commonly shared attributes include a strong sense of resentment, desire for notoriety, obsessions with other shooters, a history of domestic violence, narcissism, and access to firearms.

Studies have found that violent behavior by persons with a major mental disorder who do not abuse substances is about the same as the general population who do not abuse substances. However, when someone with a mental illness also abuses a substance, the risk of violence doubles.

In spite of these facts, the president of the United States has been using his bully pulpit in recent days not only to finger mental illness as a cause of mass shootings, but even to advocate for the reopening of mental institutions as a way to prevent future such incidents. This assertion is foolish and dangerous.

As the United States chief law enforcement officer, the president’s decision to link mental illness to mass shootings steers local, state, and federal law makers and law enforcement officials away from proven personality traits of likely mass shooters and reduces law makers’ and enforcement officers’ ability to act on these proven factors to prevent these horrors.

Just as bad, the president’s assertion heaps more stigma on the heads of people living with mental health conditions. His assertion could drive people showing symptoms of mental illness away from seeking treatment, especially among gun owners. It’s not hard to hear someone thinking, “I know I’m not well, but there is no way I’m going admit to dealing with a mental illness if it might mean that someone will take away my guns.”

According to research curated by the National Alliance on Mental Illness (NAMI), one in five of us have a mental illness. We must not reopen mental institutions which were ineffective in treating mental illness and often resulted in abuse of residents. Instead, Americans need to engage in a national conversation on how we can help people with mental health challenges find and pay for treatments which are proven effective. The same NAMI research finds that three quarters of all chronic mental illness begins by age 24. Although effective treatments are available, long delays—sometimes decades—divide the first appearance of symptoms and when people get help.

The human toll of untreated mental illness can be devastating. When people with mental health conditions engage in violent behaviors, they usually direct that behavior against themselves with suicide being the second leading cause of death among people aged 10 to 34, and with more than 90 percent of people who die by suicide showing symptoms of a mental health condition. People with serious mental illnesses die on average 25 years earlier than others, largely due to treatable medical conditions. Serious mental illness costs America nearly $200 billion in lost earnings per year.

In a previous blog, I cited research that indicated one other potential factor in mass shootings—the lack of strong social bonds. My conclusion to that blog is a good way to end this one too. The last thing we want to do is further stigmatize people with mental health challenges. Instead, we can work to prevent mass shootings by reducing the social isolation of “the loners” among us, by loving as Christ first loved us. “One thing every one of us can do is love one another, including the neighbor who wants to be left alone. Maybe especially the neighbor who just wants to be left alone.”

Update, September 10, 2019: The president is consistent in his analysis of mass shootings. After another mass shooting in Odessa TX on August 31, President Trump once again said that the issue is a "mental problem". Since then, according to the Washington Post, “The White House is considering a controversial proposal to study whether mass shootings could be prevented by monitoring mentally ill people for small changes that might foretell violence.” If this legislation passed, it would be ineffective in preventing mass shootings, and it would allow the government to spy on one fifth of US citizens who have various mental health diagnoses. 


Mark - while your statistics about the co-ocurrence of mental illness and mass shootings is true, it ignores the fact that the other underlying characteristics - obsession, narcissism, domestic abuse, etc. - are hallmarks of personality disorders and other decreased mental functioning. They may not have classic mental illness - bipolar, depression, schizophrenia - but mass shooters are not in a healthy frame of mind. Personality disorders are notoriously difficult to diagnose and treat, but that does not mean that the president is incorrect. Virtually all mass shooters have some type of mental state for which medical or counseling treatment would be beneficial. Reading the literature closely is important. One must note how people write about mental illness vs. mental conditions. The former is exclusive to bipolar, schizophrenia, depression, while the latter includes anxiety disorders and personality disorders.

Further, the discussion about the necessity of mental institutions must consider the needs of the chronically homeless, for which mental illness co-occurrence is significant. In fact, the increase in the number of mentally ill homeless on the street coincides with the closure of mental institutions in the 1980's. You and I agree that the institutions that were closed were rife with abuse. But that does not negate the need for institutional treatment and support for so many people who currently do not receive it. If community-based, voluntary care has not been effective, then perhaps it is important to consider again mandatory, institutional-based care.

The point of the de-institutionalization was that community support resources were supposed to follow the discharge of psychiatric patients into the community, but those resources never followed the patients. That's why so many of them are homeless. Another problem, especially in the U.S.A. is that access to healthcare is expensive unless you have insurance. I understand that Medicaid is supposed to provide that for those who cannot afford to buy insurance, but I saw a program years ago in which a pregnant young woman looking for an ob/gyn was turned down when she mentioned that she was on Medicaid, so apparently its not that easy for poor people to get treatment for their mental illness, and most people who have mental illnesses are poor.
In Canada the issues are different, and access to doctors and medications varies from one province the next, so its very difficult to generalize.

Jeremy Oosterhouse makes a very good point. A lack of an official, clinical diagnosis does not necessarily mean all is well.

Mark, are you saying that people who commit mass murder are mentally stable? I would say the very fact that a person is willing to randomly maim and murder other human beings, as many as possible, indicates that the person is very troubled spiritually, mentally, and emotionally, correct?

Jeremy and Dan, thanks for your comments. I couldn't agree more that "mass shooters are not in a healthy frame of mind." However, society has given us a particular understanding of "mental illness" today that results in only 25 percent of mass shooters having a diagnosable mental illness. So tying mass shootings to "mental illness" does not help the larger purpose of preventing mass shootings. In addition, using such language needlessly and cruelly implies that people with mental illnesses may well be violent, which in nearly all cases is not true. 

Yes, I've read as well that the population of homeless people increased when the institutions closed in the '70's. I'm drawing on old memories here, but as I recall, all the funding that went to those institutions was supposed to go to assist people living in those institutions to get the supports they needed for life in communities. Instead, federal, state, and local governments spent the money elsewhere, and many in institutions ended up on the streets. The president's suggestion about resurrecting mental institutions in this context does not have a ring of compassionate care for homeless people who are struggling with a serious mental illness but implies that if we just lock up enough people (in this case, people with mental illnesses) we'll reduce the incidence of mass shootings. Again, considering that only 25 percent of mass shooters have been diagnosed as having a mental illness, that reasoning does not hold water. 

Mark, with all due respect: if any of the recent mass shooters (any mass shooter, really) stated their desire to engage in a mass shooting and their reasoning behind it, all of them would have been committable to a psychiatric ward for inpatient observation/medication/therapy on the spot. Just because only 25% have been diagnosed with a mental illness before the shooting, it does not change the fact that post-shooting virtually all are diagnosed (whether alive or living) with the kind of behavior and traits indicative of mental illness, esp. schizoid breaks with reality. In fact, the kind of mental break with reality that causes someone to think, "it's okay if I go kill 5, 10, 20, 40 people" is an evaluative factor in diagnosing someone with mental illness! By definition, mass shooters are mentally ill.

The president is correct to say that mass shooters need help and that our current system is not helping them.

Jeremy, I'd like to see the research backing your claim that "post-shooting virtually all are diagnosed (whether alive or living) with the kind of behavior and traits indicative of mental illness". I see plenty of news reports that claim a mass shooter had mental illness, but these are not trustworthy. And I disagree with your statement, "the kind of mental break with reality that causes someone to think, "it's okay if I go kill 5, 10, 20, 40 people" is an evaluative factor in diagnosing someone with mental illness." There are many people today and throughout history who would say "It's okay to kill a bunch of people" who would not be diagnosed with a mental illness - heads of organized crime, drug lords, many other people with immense power and unquestioned authority (such as King Herod, as Ken Libolt mentions), and many others. Given the wrong conditions, a whole lot of us would be mass murderers. So once again, I firmly believe that instead of talking about "mental illness" it would be much more helpful for law makers and people in law enforcement to identify those wrong conditions, those behavior traits, societal mores, that have caused us to raise up so many mass shooters in American society today so that we can make new laws and law enforcement can watch for the "tells" that would suggest someone is about to commit mass murder. In addition, we need to engage in thinking and preparation for what any of us need to do to protect ourselves and our loved ones in the event of a mass shooting. (Many schools still practice fire drills, even though school children in the US are more likely to be injured or killed by a mass shooter than a fire.) Here's an example of the kind of thinking I have in mind. Notice that "mental illness" is not mentioned once in the article:

Mark, your comment that news reports are not trustworthy indicates your position on this issue. When I read that I hear you saying, "I don't trust news reports that report information that contradicts with my preferred narrative". I have no reason to not trust that media validly report on the issues surrounding these catastrophic events. It's going to be difficult to continue this line of dialogue if you are not open to the possibility that others have different - and valid - perspectives from you.


Keeping in mind the community guidelines, let us agree to disagree and cease this line of discussion. Please receive this in love. I share your desire to provide loving, appropriate care for those with mental health needs (which includes those who have a psychotic break with reality that causes them to inflict harm on others). But having worked in the field, I recognize the need for institutional care - up to and including the ability of the government to commit those who refuse to seek help voluntarily if they present a danger to others.

Hi Jeremy,
Once again, current analysis shows that only 25 percent of mass shooters have been diagnosed with mental illness. That's the reason I asserted that the news media are jumping on a band wagon that does not square with this fact.

Indeed, we need to agree to disagree with regard to attributing mass shootings to mental illness. However, as I responded to another, it may be most helpful if we cease talking about "mental illness" in the case of wanton destruction of human life and instead talk about "moral illness".  

Hi Jeremy, I agree with Mark. There isn’t the data or studies they state most are mentally ill. In fact the opposite is true with only a small percentage have a diagnosis of mental illness! Lake of any moral or social constraints is more common! Thx, I hope you read the information that is available.

I disagree. I think the president is using simplistic answers to complex problems to avoid addressing the real issue which is restricting access to firearms, especially assault rifles, which are not necessary for civilians to either protect themselves or hunt. The president has made a habit of singling our groups as scapegoats, and I think he's doing it again. It's a lot easier and cheaper than standing up to the NRA which provides him with a lot of financing for his campaign and that of the Republican Party. Making people with mental illnesses disappear by putting them away in institutions is not going to make the problem of mass shootings go away, because other people are going to do it. For one thing it would not be that easy to round up all psychiatric patients since they would not volunteer for it, and you have to know who has an illness and who doesn't. It's not written on their foreheads.

If we refer back to the Bible, there are numerous occasions of mass murder by people that would be considered of sound mind and lacking any concern for there actions. Like killing all the firstborns that Herod did to find Jesus! Ideologies and society norms are a bigger factor in mass killings. I have read modern studies that bear out the same thing. Thx

I thought we were talking about RANDOM mass murders...the ones in the headlines recently. The ones that the President was referring to. I didn't think we were talking about mass murderers who are robbing people (like Bonnie and Clyde), or protecting their political turf (like Herod).

But even in the case of Herod (or murderous bank robbers), I would make the case that there is CLEARLY something that is wrong mentally. Would you say that Hitler, Stalin, etc. were of sound mind?

I guess we had better have a better definition of mental illness vrs abnormal mental behavior! Of course some of the people you mentioned had a definable mental illness or physical illness that caused the behavior. But most mentally ill are not violent without the ideology for violence being present! For that matter, “Normal” people are capable of mass murder if they have enough angry and hate! The act of murder whether mass or individual doesn’t require a illness. We had better expand our definition for mental illness if all were mentally ill being the reason  for killing! Thx, and have a good day!

Ken, I think you might be speaking sarcastically. But I agree with you that it would be prudent to expand our definitions of mental illness, in order to include people who randomly murder and injure other human beings. As the author of this article stated, we don't know all the factors involved, so it is wise to keep an open mind. One thing I think is blatantly obvious is that anyone who would commit such heinous crimes is suffering from extreme spiritual, mental, and social problems. Not all people who are mentally ill are mass murderers. But all mass murderers are mentally (and spiritually) ill.

Hi Dan, I wasn’t speaking sarcasticly, I just read up from a multitude of resources the reasons people commit mass murders! The research supports what I saying! I don’t treat people with sarcasm but make my points simple. I am sorry if you thought that! Thx 

Ken, thanks for the clarification. And more importantly, thanks for engaging in this discussion in a meaningful way. I think it's important for us CRC members to be able to disagree with each other and talk about it. I sincerely appreciate the folks at The Network creating a place for that to happen!

Also, thank you Mark for sharing this article. I think we all have more areas of agreement than disagreement, and it's important to remember that. While I have no issue with the President identifying metal illness as a key factor, I understand your perspective and I respect it.

In the end, I think we can all agree that all of us have various strengths and limitations. And those of us with strength in one area need to be mindful of those with limitations, treat them with dignity, and facilitate each others abilities wherever we can. Our greatest limitation is shared by all of humanity: our sinful nature. To deal with that we can only rely on the strength of Jesus Christ our Savior. The good news of His Gospel is the greatest thing we can share with anyone, regardless of "ability."

Dan, we're searching for language to describe horrors that people commit, so I understand your desire to stick with the word "illness". I suggested several years ago that instead of trying to use the term "mental illness" maybe we need to start talking about a continuum of "moral illness". People with severe moral illness do things like commit mass murders and lead nations into genocide. I wrote: "I think of moral illness as a condition of the soul in which one has so abused his concept of right and wrong for so long, that his choices descend further and further from common mores into a dark world where people can commit mass murder or sexually abuse young boys." If you'd like to read the rest of that blog, it's called Mental Illness or Moral Illness

Mark, can you tell me whether the comments written with authorship of Disability Concerns are only you or are these responses part of a team?

Jenny, your question is excellent. I have two ways to post to the Network, and when I wrote that reply, I should have posted as "Mark Stephenson". The comment was not the work of a team, but mine alone. I'm hoping the Network team will be able to correct my mistake, and I've asked them to do so. 

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