GUN CRIMES AND MENTAL HEALTH
COMPILATION AND COMMENTARY
BY LUCY WARNER
FEBRUARY 7, 2019

I CAN’T HELP WONDERING WHAT A “LAW ABIDING CITIZEN” MEANS TO DO WITH A LOADED GUN ANYWHERE EXCEPT AT THE FIRING RANGE. WHAT IS GOING ON IN THEIR MINDS? SELF-DEFENSE? WHY ARE THEY SO FRIGHTENED? ONE OF MY DEVELOPING CONCLUSIONS FROM READING SO MUCH NEWS IS THAT MENTAL CONDITIONS WHICH ARE POTENTIALLY UNHEALTHY, AT LEAST TO SOME DEGREE, INCLUDING EXTENSIONS OF A NORMAL INSTINCT, ARE PRESENT BEFORE THE CRIME IS COMMITTED, AND ESPECIALLY IN CASES OF VIOLENCE. THEY ARE ALSO FAR MORE COMMON AND HARDER TO DETECT THAN I WOULD LIKE TO BELIEVE. THAT DOESN’T MEAN THAT WE SHOULD NOT TAKE AS MANY GUNS AS POSSIBLE OUT OF THE HANDS OF THE MENTALLY ILL, AND OFF THE STREETS IN GENERAL. MANY A TRAGEDY HAS OCCURRED FROM A FIREARM BEING LEFT OUT IN THE OPEN FOR A CHILD TO FIND.

OF COURSE, THERE WILL STILL BE VIOLENCE WITHOUT FIREARMS, BUT NOT 50 PEOPLE BEING GUNNED DOWN FROM THE TOP OF A BUILDING, AS OCCURRED A YEAR OR TWO AGO IN LAS VEGAS. THIS ARTICLE DOESN’T MENTION THE ISSUE OF RELIGION AND POLITICS IN REGARD TO GUNS. THE RELIGIOUS TEND TO THINK THAT IF THEY FRIGHTEN THE POPULATION ENOUGH ABOUT A FIERY HELL, THE SIN WILL STOP; AND THE PARANOID BELIEVE THAT THE CONSTITUTION GIVES THEM THE RIGHT TO CARRY A GUN ANYTIME AND ANYWHERE THEY WANT TO, SO THEY CAN BE THE HEROIC DEFENDER AGAINST A GUN-CARRYING VILLAIN.

IT’S ALL INTELLECTUAL AND PSYCHOLOGICAL NONSENSE, OF COURSE, AND IN THE MEANTIME THE NATIONAL RIFLE ASSOCIATION CONTINUES TO BRIBE CONGRESSMEN AND SENATORS TO VOTE THEIR WAY, AND THREATEN THEM IF THEY PUT UP TOO MUCH OPPOSITION. WE NEED TO “GET SERIOUS” ABOUT THE KIND OF SOCIETY WE ARE WILLING TO LIVE IN. PERSONALLY, I WANT TO BE SANE, MORAL AND INTELLIGENT FIRST. IF I FEEL THAT MY NEIGHBORHOOD IS UNSAFE, I’LL CARRY A LESS LETHAL WEAPON SUCH AS A KNIFE. THEY’RE DANGEROUS ALSO, BUT MORE CONTROLLABLE THAN A GUN.

THE SECOND WRITING BELOW IS AN ARTICLE FROM psychiatrictimes.com, SO IT IS MORE PROFESSIONALLY RELIABLE ON THE ISSUE OF INSANITY AND CRIME, THAN IS THE AVERAGE NEWS REPORT. IT, HOWEVER, IS A VERITABLE TANGLE OF FACTORS THAT ARE 1) TIGHTLY INTERRELATED AND 2) INSUFFICIENTLY SPECIFIC IN THEIR MEANING AND STATISTICAL PREDICTABILITY TO ALLOW A PSYCHIATRIC WORKER TO “PREDICT” ACCURATELY WHO WILL COMMIT ANY KIND OF VIOLENCE, AND ESPECIALLY GUN VIOLENCE IN PARTICULAR. 3, I WOULD LIKE MORE ATTENTION PAID TO THE FACT THAT MENTAL ILLNESS IS TOO OFTEN “UNDIAGNOSED,” SO THE UNPREDICTABILITY FACTOR IS A MAJOR CAUSE OF PROBLEMS. IT INTERESTS ME THAT THE ARTICLE IS SPECIFICALLY ABOUT GUN VIOLENCE. GIVEN THE EASY AVAILABILITY OF FISTS, STICKS, CUTTING OBJECTS AND ROCKS, THE LIKELIHOOD OF A MURDER OCCURRING IN ANGER BY ONE OF THOSE METHODS IS MUCH GREATER. WE NEED TO FOCUS MORE ON VIOLENCE ITSELF.

MY BROTHER-IN-LAW, A “CONSERVATIVE” SOUTHERNER, DID TAKE A SAFETY RAZOR WITH THE BLADE IN IT ONTO AIRPORT PROPERTY WITH THE INTENTION OF TAKING IT ON THE PLANE. HE ISN’T DANGEROUS OR “INSANE,” BUT HE IS A BIT OF A SMART-ALECK. HE MAINLY WANTED TO GET AWAY WITH IT. HE DIDN’T LIKE THE LIST OF RESTRICTIONS ON WHAT CAN GO INTO THE CARRY-ON BAG, SO HE PACKED IT INTO THE TOE OF A SHOE WITH WADDED PAPER STUFFED IN BEHIND IT. THE LUGGAGE EXAMINERS FOUND IT, AND I ASSUME HE WAS AT LEAST EMBARRASSED. MY SISTER DIDN’T TELL ME WHAT HAPPENED TO HIM, BUT ACCORDING TO THIS ARTICLE, PEOPLE CAN BE FINED UP TO $13,333 FOR ONE OFFENSE. IT JUST ISN’T WORTH IT.

WATCH THE VIDEO THAT GOES WITH THIS ARTICLE. SEE ALSO THE SECOND, VERY INTERESTING ARTICLE ON FREQUENCY AND PREDICTION OF A DIAGNOSED MENTAL ILLNESS IN PUBLICIZED CASES OF VIOLENCE: “psychiatrictimes.com.”

https://www.usatoday.com/story/travel/flights/todayinthesky/2019/02/07/guns-airports-tsa-record-2018/2799757002/
TSA found a record-setting number of guns at airports in 2018
TODAY IN THE SKY
Harriet Baskas, Special to USA TODAY Published 9:39 a.m. ET Feb. 7, 2019 | Updated 2:00 p.m. ET Feb. 7, 2019

VIDEO -- In 2018, TSA screeners detected a record number of guns in airline passenger carry-on bags. Buzz60

It’s no secret that it is illegal for passengers to bring firearms, loaded or not, to airport security checkpoints.

Yet, in 2018, the Transportation Security Administration found a record-setting 4,239 firearms in carry-on bags at 249 airport checkpoints around the country.

That’s more than a 7 percent increase over the 3,957 firearms discovered at airport checkpoints in 2017, averaging out to 81.6 firearms a week and 11.6 firearms a day, according to the TSA’s Year in Review, which was released today.

Perhaps more alarming, of the 4,255 firearms found last year, more than 86 percent (3,656) were loaded (another record) and almost 34 percent (1,432) had a round chambered.

The TSA's 2018 Year in Review. (Photo: TSA)

The TSA’s Year in Review also lists the top 10 airports for firearm discoveries in 2018.

Hartsfield-Jackson Atlanta International Airport (ATL), tops that list, with 298 firearms (253 loaded), an increase of 53 compared to 2017.

ATL, which regularly sets records for the busiest airport (in terms of passenger count), also set a record for the airport with the most firearms discovered in one month: In August 2018, 32 firearms were found at ATL checkpoints.

Some of the firearms found at airport checkpoints in 2018.Some of the firearms found at airport checkpoints in 2018. (Photo: TSA)

Here’s the rest of the TSA’s top 10 list of airports for firearms discoveries in 2018:

.... Dallas/Fort Worth International Airport: 219 (193 loaded)
.... Phoenix Sky Harbor International Airport: 129 (120 loaded)
.... Denver International Airport: 126 (95 loaded)
.... Orlando International Airport: 123 (112 loaded)
.... George Bush Intercontinental Airport: 117 (115 loaded). Some good news here: this is a decrease of 25 compared to 2017.
.... Fort Lauderdale-Hollywood International Airport: 96 (80 loaded)
.... Austin-Bergstrom International Airport: 93 (76 loaded)
.... Dallas Love Field Airport: 89 (83 loaded)
.... Nashville International Airport: 86 (80 loaded)

While the laws regarding firearm possession vary by state and locality, TSA is able to, and regularly does, impose civil penalties of up to $13,333 per violation, per person for prohibited items violations and violations of other TSA regulations.

In a year when the TSA also screened a record number of travelers (813.8 million; a 5.5 percent increase over 2017), the agency’s officers also found a wide variety of prohibited items and "artfully concealed" objects other than firearms in carry-on bags, including inert grenades, a bottle of lighter fluid, fireworks and knife combs*.

The TSA’s week in review also notes the loss of Curtis “Blogger Bob” Burns, the charmingly corny employee who chronicled the agency’s odd finds on the TSA blog, on Twitter and on Instagram. Burns is featured in quirky videos highlighting the TSA’s most unusual finds for 2016 and 2017 and the TSA’s Year in Review promises that a video highlighting 2018’s most unusual finds will be released soon.

TODAY IN THE SKY: 'Blogger Bob' Burns, TSA’s surprise social media star, dies

PHOTOGRAPH -- Some of the prohibited items found at airport checkpoints in 2018. (Photo: TSA)


https://www.psychiatrictimes.com/special-reports/gun-violence-stigma-and-mental-illness-clinical-implications
Gun Violence, Stigma, and Mental Illness: Clinical Implications
Jonathan M. Metzl, MD, PhD
Mar 25, 2015
Volume: 32, Issue: 3

Special Reports, Trauma And Violence

New legislation in a number of states requires mental health professionals to assess their patients for the potential to commit gun crimes. For instance, New York state law mandates that mental health professionals report anyone who “is likely to engage in conduct that would result in serious harm to self or others” to the state’s Division of Criminal Justice Services, which then alerts local authorities to revoke the person’s firearms license and confiscate his or her weapons. Similarly, a recently passed bill in Tennessee requires mental health professionals to report “threatening patients” to local law enforcement.

Supporters of these types of laws argue that they provide important tools for law enforcement officials to identify potentially violent persons—and understandably so. US policymakers and the general public look to psychiatry, psychology, neuroscience, and related disciplines as sources of certainty in the face of the often incomprehensible terror and loss that gun violence inevitably produces. And to be sure, persons with mental illness who have shown violent tendencies should not have access to weapons that could be used to harm themselves or others.

However, the notion that psychiatric attention might prevent gun crime is more complicated than it might seem. New research undertaken by me and my colleague, Professor Ken MacLeish, warns of the potential pitfalls of such laws if they are unaccompanied by other community-based or antistigma interventions.1 We systematically reviewed the key psychiatry, psychol- ogy, public health, and sociology literature that addressed connections between mental illness and gun violence between 1960 and 2014. We also used our own primary source historical research on violence and mental illness, and American gun culture.2-4

Our review critically addresses 4 central assumptions that underlie many US political and popular associations between gun violence and mental illness:

• That mental illness causes gun violence

• That psychiatric diagnosis can predict gun crime before it happens

• That US mass shootings teach us to fear mentally ill loners

• That because of the complex psychiatric histories of mass shooters, gun control “won’t prevent” another Tucson, Aurora, Newtown, or Navy Yard

Each of these statements is certainly true in particular instances. At the same time, our research shows how these seemingly self-evident assumptions are replete with complicated and at times contradictory assumptions. At the aggregate level, the notion that mental illness causes gun violence stereotypes a diverse population of persons with psychiatric conditions and oversimplifies links between violence and mental illness. Moreover, notions of mental illness that emerge in relation to gun violence frequently reflect larger cultural issues that become obscured when mass shootings come to stand for all gun crime and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat.

Our research also shows how anxieties about insanity and gun violence are imbued with often unspoken anxieties about race, politics, and the unequal distribution of violence in American society. In the current American landscape, these tensions play out most clearly in differing cultural responses to, for instance, high-profile shootings in places like Newtown (where headlines located pathology in the perpetrator’s brain) and New York City (where news commentators wondered whether murderous actions were motivated by “black politics.”5)

Our analysis suggests that similar, if less overt, tensions suffuse discourses linking guns and mental illness more broadly, in ways that subtly connect “insane” gun crimes with often unspoken assumptions about “white” individualism or “black” communal aggression.

Ultimately, our research challenges psychiatry to think deeply about potentially untenable situations in which mental health practitioners become the persons most empowered to make decisions about gun ownership—and most liable for failures to predict gun violence—if these situations are not accompanied by larger reforms that address the social, structural, and indeed psychological implications of gun violence in the US.

Our findings appear in the February 2015 issue of the American Journal of Public Health.1 By way of a summary, the following 4 assumptions are examined.

Assumption 1: mental illness causes gun violence

The focus on mental illness in the wake of recent mass shootings in the US reflects a decades-long history of psychiatric and legal debates about guns, gun violence, and mental competence. Psychiatric articles in the 1960s deliberated ways to assess whether mental patients were “of sound mind enough” to possess firearms.6 Following the 1999 mass shooting at Columbine High School, psychiatrist Peter Breggin decried the toxic combination of mental illness, guns, and psychotropic medications that contributed to the perpetrators’ actions. After the 2012 shooting at Sandy Hook Elementary School in Newtown, psychiatrist E. Fuller Torrey claimed that “about half of . . . mass killings are being done by people with severe mental illness, mostly schizophrenia, and if they were being treated they would have been preventable.”7

Gun Violence, Stigma, and Mental Illness: Clinical Implications: Page 2 of 4

Yet surprisingly little population-level evidence supports the notion that individuals with mental illness are more likely than anyone else to commit gun crimes. According to psychiatrist Paul Appelbaum,8 fewer than 3% to 5% of American crimes involve people with mental illness, and the percentages of crimes that involve guns are lower than the national average for persons without a diagnosis of mental illness. Databases that track gun homicides, such as the National Center for Health Statistics, similarly show that fewer than 5% of the 120,000 gun-related killings in the US between 2001 and 2010 were perpetrated by people with mental illness.9

Moreover, a growing body of research suggests that mass shootings represent anecdotal distortions of, rather than representations of, the actions of “mentally ill” people as an aggregate group. By most estimates, there were fewer than 100 mass shootings reported in the US—defined as crimes “when four or more people are shot in an event, or related series of events”—between 1982 and 2012.10 Rates of reported mass shootings rose in 2013 and 2014.

Scholars who study violence prevention contend that mass shootings occur far too infrequently to allow for statistical modeling and predictability—factors that lie at the heart of effective public health interventions. Psychologist Jeffrey Swanson11 argues that mass shootings denote “rare acts of violence” that have little predictive or preventive validity in relation to the bigger picture of the 32,000 fatalities and 74,000 injuries caused on average by gun violence and gun suicide each year in the US.

Links between mental illness and other types of violence are similarly contentious among researchers who study such trends. Study findings suggest that subgroups of persons with severe or untreated mental illness might be at increased risk for violence during periods surrounding psychotic episodes or psychiatric hospitalizations.12 At the same time, a number of seminal studies asserting links between violence and mental illness have been critiqued for overstating connections between serious mental illness and violent acts.13

Media reports often assume a binary between mild and severe mental illness, and they connect the latter form to unpredictability and lack of self-control. However, this distinction is called into question by mental health research. To be sure, a number of the most common psychiatric diagnoses, including depressive, anxiety, and attention-deficit disorders, have no correlation with violence whatsoever. Community studies find that serious mental illness without substance abuse is also “statistically unrelated” to community violence. At the aggregate level, the vast majority of people with psychiatric disorders do not commit violent acts—only about 4% of violence in the US is attributable to persons with mental illness.14

This is not to suggest that researchers know nothing about predictive factors for gun violence. However, credible studies suggest that a number of risk factors more strongly correlate with gun violence than mental illness alone. For instance, alcohol and drug use increase the risk of violent crime by as much as 7-fold, even among persons with no history of mental illness—a concerning statistic in the face of recent legislation that allows persons in certain states to bring loaded handguns into bars and nightclubs. According to Van Dorn and colleagues,15 male sex and a history of childhood abuse and binge drinking are all predictive risk factors for serious violence. Belying Lott’s16 argument that “more guns” lead to “less crime,” Miller and colleagues17 found that homicide was more common in areas in which household firearms ownership was higher. The rate of interpersonal conflicts resolved by fatal shootings jumped by 200% after Florida passed “stand your ground” in 2005.18 The availability of guns is also considered a more predictive factor than is psychiatric diagnosis in many of the 19,000 completed suicides by gun each year in the US.

Some persons with mental illness undoubtedly commit violent acts. Yet growing evidence suggests that mass shootings on which gun legislation is often based represent statistical aberrations that reveal more about particularly horrible instances than they do about population-level events. To use Swanson’s11 phrasing, basing gun-crime prevention efforts on the mental health histories of mass shooters risks building “common evidence” from “uncommon things.” This type of approach loses the opportunity to build common evidence from common things—such as the types of evidence that clinicians of many medical specialties might catalogue, in alliance with communities, about substance abuse, domestic violence, availability of firearms, suicidality, social networks, economic stress, and other factors.

Assumption 2: psychiatric diagnosis can predict gun crime before it happens

Legislation in a number of states mandates that psychiatrists assess their patients for the potential to commit violent gun crime. History suggests, however, that psychiatrists are inefficient gatekeepers in this regard. Data that support the predictive value of psychiatric diagnosis in matters of gun violence are thin at best. Psychiatric diagnosis is largely an observational tool, not an extrapolative one. Largely for this reason, research dating back to the 1970s suggests that psychiatrists using clinical judgment have difficulty in predicting which patients will commit a violent crime.

The lack of prognostic specificity is in large part a matter of simple math. Psychiatric diagnosis is in and of itself not predictive of violence, and the overwhelming majority of psychiatric patients do not commit crimes.

In this sense, population-based literature on guns and mental illness suggests that legislatures risk drawing the wrong lessons from gun crimes and mass shootings if their responses focus on asking psychiatrists to predict future events. Although rooted in valid concerns about public safety, legislation that expands mental health criteria for revoking gun rights puts psychiatrists in potentially untenable positions, not because they are poor judges of character, but because the urgent political and social conditions psychiatrists are asked to diagnose are at times at odds with the capabilities of their diagnostic tools and prognostic technologies.

Assumption 3: look out for dangerous loners

Mass shootings in the US are often framed as the work of loners—unstable, angry white men who never should have had access to firearms.19 “Gunman a Loner Who Felt No Pain” read a headline in the wake of the Newtown shooting. And to be sure, a number of other recent shooters undoubtedly led troubled, solitary lives.

It is important to note, however, that the seemingly self-evident images of the mentally disturbed, gun-obsessed, white male loner are relatively recent phenomena. In the 1960s and 1970s, by contrast, many of the men labeled as violent and mentally ill were also, it turned out, African American. And, when the potential assailants were black, American psychiatric and popular culture frequently blamed “black culture” or black activist politics—not individual, lone shooters—for the threats such men were imagined to pose.2

For instance, anxieties about race and politics shaped many 1960s-era American political associations between schizophrenia and gun violence. FBI profilers spuriously gave diagnoses of militant forms of schizophrenia to many “pro-gun” black political leaders as a way of highlighting the insanity of their political activism. According to declassified documents, the FBI diagnosed “pre-psychotic paranoid schizophrenia” in Malcolm X while highlighting his attempts to obtain firearms and his “plots” to overthrow the government.2 The FBI also gave Robert Williams, the head of the Monroe, North Carolina, chapter of the NAACP, the diagnosis of “schizophrenic, armed, and dangerous” during his flight from trumped-up gun charges in the early 1960s.20 Malcolm X, Robert Williams, and other leaders of African American political groups were far from schizophrenic. But fears about their political sentiments, guns, and sanity mobilized substantial response.

During this era, US psychiatry also spoke out in favor of gun control—articles in the American Journal of Psychiatry urged psychiatrists to address “the urgent social issue” of firearms in response to “the threat of civil disorder”—while Congress began serious debate about gun control legislation leading to the Gun Control Act of 1968.6

Recent history suggests that cultural politics underlie anxieties about whether guns and mental illness represent individual or communal etiologies. In the 1960s and 1970s, widespread concerns about black “cultural” and political violence fomented calls for widespread reforms in gun ownership. As this played out, politicians, FBI profilers, and psychiatric authors argued for the right to use mental health criteria to limit gun access. However, in the present day, the actions of “lone” white male shooters go hand in hand with calls to expand gun rights, or limit gun rights only for the severely mentally ill. Indeed it would seem political suicide for a legislator or doctor to hint at restricting the gun rights of white Americans, private citizens, or men, although these groups are frequently linked to high-profile mass shootings.21

Assumption 4: gun control “won’t prevent” another Tucson, Aurora, Newtown, or Navy Yard

The mantra that gun control “would not have prevented Newtown” is frequently cited by opponents of such efforts. This contention generally assumes that because none of the recent mass shooters in Tucson, Aurora, Newtown, or Isla Vista used weapons purchased through unregulated private sale or gun shows, gun control in itself would be ineffective in stopping gun crime, and that gun purchase restrictions or background checks are in any case rendered moot when shooters have mental illness.

No one wants another tragedy like Newtown—on this point all sides of the gun debate agree. Moreover, it is widely acknowledged by persons on all sides of that debate that there is no guarantee that the types of restrictions voted down by the US Senate in April 2013, based largely on background checks, would prevent the next mass crime. Yet, as discussed above, many scholars who study violence prevention hold that mass shootings occur too infrequently to allow for statistical modeling, and as such serve as poor jumping off points for effective public health interventions.

The focus on individual crimes or the psychologies of individual shooters obfuscates attention to community-level everyday violence and the widespread symptoms produced by living in an environment engulfed by fear of guns and shootings. Far from the national glare, this everyday violence disproportionally affects lower-income areas and communities of color, and is held to be the cause of widespread anxiety disorders and traumatic stress symptoms as a result.22

Given this terrain, it is increasingly the case that when violence prevention experts talk about ebbing gun crime linked to mental illness, they do not mean that mental health practitioners will avert the next random act of violence such as Newtown, although of course stopping mass crime remains a vital goal. Instead, they contend that the insanity of urban gun violence all too often reflects the larger madness of not investing more resources to support social and economic infrastructures and support systems.

Conclusion: implications for clinicians

Questioning the associations between guns and mental illness in no way detracts from the dire need to stem gun crime. Yet as the fractious US debate about gun rights plays out in ever-more divisive ways, it seems incumbent to find common ground beyond assumptions about whether particular assailants meet criteria for specific mental illnesses, or whether mental health experts can predict violence before it occurs. Of course, understanding a person’s mental state is vital to understanding his actions. At the same time, our research suggests that focusing legislative policy and popular discourse so centrally on mental illness is rife with potential problems if, as seems increasingly the case, those policies are not embedded in larger societal strategies and structural-level interventions.

Research also suggests that agendas that hold mental health workers accountable for identifying dangerous assailants puts these workers in potentially untenable positions because the legal duties they are asked to perform misalign with the predictive value of their expertise. In this sense, instead of accepting the expanded authority provided by current gun legislation, mental health workers and organizations might be bet-ter served by identifying and promoting areas of common cause between clinic and community, or between the social/community and psychological/individual dimensions of gun violence.23

Connections between loaded handguns and alcohol; the mental health effects of gun violence in low-income communities; or the relationships between gun violence and family, social, or socioeconomic net- works are but a few of the topics in which mental health expertise might productively join community and legislative discourses to promote more effective medical and moral arguments for sensible gun policy than currently arise amongst the partisan rancor.

Put another way, perhaps psychiatric expertise might be put to better use by enhancing understanding of the complex anxieties, social and economic formations, and blind assumptions that make people fear each other in the first place. Psychiatry could help society interrogate what guns mean to everyday people, and why people feel they need guns or reject guns out of hand. By addressing gun discord as symptomatic of deeper concerns, psychiatry could, ideally, promote more meaningful public conversations about the impact of guns on civic life. And, it could join with public health researchers, community activists, law enforcement officers, or business leaders to identify, promote meaningful conversation about, and empathically address the underlying structural and infrastructural issues that foster real or imagined notions of mortal fear in our minds, our streets, and our society.

Disclosures:
Dr Metzl is Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society; Director of the Center for Medicine, Health, and Society; and Professor of Psychiatry at Vanderbilt University in Nashville, Tenn. He reports no conflicts of interest concerning the subject matter of this article.


References:
1. Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. 2015;105:240-249.

2. Metzl JM. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press; 2011.

3. MacLeish KT. Making War at Fort Hood: Life and Uncertainty in a Military Community. Princeton, NJ: Princeton University Press; 2013.

4. Metzl JM, MacLeish KT. Triggering the debate: faulty associations between violence and mental illness underlie US gun control efforts. Risk Regul. 2013;25:8-10.

5. North A. When officers die and protesters get the blame. New York Times. December 23, 2014. http://op-talk.blogs.nytimes.com/2014/12/23/when- officers-die-and-protests-get-the-blame/?smid= tw-share. Accessed February 10, 2015.

6. Rotenberg LA, Sadoff RL. Who should have a gun? Some preliminary psychiatric thoughts. Am J Psychiatry. 1968:125:841-843.

7. CBS News. Preview: Imminent Danger. 60 Minutes. September 27, 2013. http://www.cbsnews.com/videos/preview-imminent-danger. Accessed July 23, 2014.

8. Appelbaum PS. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006;163: 1319-1321.

9. Centers for Disease Control and Prevention. Leading Causes of Death Reports, National and Regional 1999-2010. February 19, 2013. http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html. Accessed February 3, 2015.

10. Follman M, Aronsen G, Pan D. A guide to mass shootings in America. Mother Jones. May 24, 2014. http://www.motherjones.com/politics/2012/07/mass-shootings-map?page=2. Accessed February 3, 2015.

11. Swanson JW. Explaining rare acts of violence: the limits of evidence from population research. Psychiatr Serv. 2011;62:1369-1371.

12. Keers R, Ullrich S, Destavola BL, Coid JW. Association of violence with emergence of persecutory delusions in untreated schizophrenia. Am J Psychiatry. 2014;171:332-339.

13. Grohol JM. Violence and mental illness: simplifying complex data relationships. Psych Central. http://psychcentral.com/blog/archives/2007/05/02/ violence-and-mental-illness-simplifying-complex-data-relationships. Accessed July 1, 2014.

14. Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006;163:1397-1403.

15. Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012;47:487-503.

16. Lott JR Jr. More Guns, Less Crime: Understanding Crime and Gun Control Laws. 3rd ed. Chicago: University of Chicago Press; 2010.

17. Miller M, Azrael D, Hemenway D. Rates of household firearm ownership and homicide across US regions and states, 1988-1997. Am J Public Health. 2002;92:1988-1993.

18. The Editorial Board. Craven statehouse behavior. New York Times. March 14, 2014. http://www. nytimes.com/2014/03/15/opinion/craven-statehouse- behavior.html. Accessed February 3, 2015.

19. Metzl JM. When shootings happen, gender has to be part of the conversation. MSNBC. June 9, 2014. http://on.msnbc.com/TmbHlK. Accessed February 3, 2015.

20. FBI Hunts NAACP Leader. NY Amsterdam News. September 23, 1961.

21. Peters JW. Senate balks at Obama pick for surgeon general. New York Times. March 14, 2014. http://www.nytimes.com/2014/03/15/us/senate-balks-at-obama-pick-for-surg.... Accessed February 3, 2015.

22. Ruiz R. Life, death, and PTSD in Oakland: how violence and poverty are traumatizing the city’s youth. East Bay Express. December 11, 2013. http://www.eastbayexpress.com/oakland/life-death-and-ptsd-in-oakland/Con.... Accessed February 3, 2015.

23. Hiday VA. The social context of mental illness and violence. J Health Soc Behav. 1995;36:122-137.



WHY DID THIS PERSON SHOOT A DOZEN INNOCENT STRANGERS? I NOTE THAT NONE OF THESE ARTICLES GOES INTO THE MORBID LOVE OF DEADLY WEAPONS THAT I HAVE SEEN IN SOME PEOPLE, MEN ALL. THAT, TO ME, SHOULD BE ON ANY LIST OF PREDICTIONS OF WHO WILL DO ONE OF THESE ACTS OF MAYHEM.

https://www.psychiatrictimes.com/couch-crisis/moving-beyond-motives-mass-shootings
Moving Beyond “Motives” in Mass Shootings
James L. Knoll IV, MDRonald W. Pies, MD
Jan 14, 2019
Volume: 36 Issue: 1

PHOTOGRAPH – A HAND HOLDING A PISTOL

Couch in Crisis, Forensic Psychiatry, Trauma And Violence
COMMENTARY

Dr Knoll is Director of Forensic Psychiatry and Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, NY. He is Editor in Chief Emeritus of Psychiatric Times (2010 to 2014). Dr Pies is Professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY and Tufts University School of Medicine, Boston. He is Editor in Chief Emeritus of Psychiatric Times (2007 to 2010).

As psychiatrists, our stock-in-trade is understanding our patients’ motives—and in general, understanding what makes people “tick.” So, it may seem surprising that when it comes to mass shootings, such as the horrific Thousand Oaks bar massacre, we feel frustrated by the media’s obsession with the shooter’s “motives.” The same goes for investigators of such attacks, who seem fixated on determining the shooter’s “motive.”

To be sure: after such tragedies, it’s simply human nature to ask, “Why did the shooter do it?” And even in the most heinous and difficult to fathom crimes, there is motive. The popular myth that the perpetrator of a mass shooting “just snapped” has been debunked.1 Furthermore, the determination of “motive” is often important in criminal law. Essentially, motive (from the Latin word motivum, meaning “moving cause”) is what moves a person to commit a certain act. In US criminal law, there is no requirement to prove motive to reach a verdict. However, motive may be shown by the prosecution in order to prove that a defendant had a plausible reason to commit the crime.

Technically, motive is distinct from intent, although the two are often intertwined. (Motive has been defined as “the reason that nudges the will and prods the mind to indulge the criminal intent.”2) Thus, a person who knowingly puts a loaded gun to someone’s temple and fires it clearly had the intent to kill or grievously wound the person, but may have done so for a number of motives (eg, revenge, jealousy, racial animus).3 Motive becomes critical in, for example, the prosecution of hate crimes and acts of terrorism.4

Notwithstanding the legitimate role of “motive,” we believe that the ritualized hunt for the shooter’s motive is usually an exercise in fruitless speculation and wasted resources. When pursued by the media, this quest almost always lacks the necessary data to reach a sound determination. Moreover, these exercises rarely yield any useful or actionable information that would help reduce the likelihood of future mass shootings. Almost invariably, we learn little more than what we have known for many years—that mass shooters are typically (though not always) angry, aggrieved, emotionally unstable, or socially isolated males who are seeking retribution or revenge for perceived mistreatment, rejection, or humiliation.5

AS A SOCIETY, we must do better than this. We need to focus on:

1 Recognizing the major risk factors that raise the risk of violence in general;

2 Identifying and reporting observable “red flag” behaviors that point toward imminent, directed violence;

3 Reducing the likelihood that would-be killers can easily get hold of lethal weapons.


PAGE 2 OF 4

Is there a “profile” for mass shooters?


The most important risk factor for future violence in general is a previous history of violence.

Other prominent risk factors include, but are not limited to6,7:

• A history of substance abuse

• A history of having been abused or bullied

• Witnessing violence between parents

• A preoccupation with weapons or death; poor control of anger

• Social isolation


Unfortunately, these risk factors are far too prevalent in the general population to be of practical use in identifying would-be shooters and may not apply to mass shooters. For example, there is often no history of serious past violence in these individuals. Furthermore, neither the Secret Service nor the FBI has found a specific psychological profile or checklist of personality traits that can be used to predict who will become a mass shooter.8

And yet, almost invariably, there is uninformed speculation in the media regarding the role of “mental illness” in mass shootings. First, it bears repeating that there is only a weak correlation between violence and mental illness per se.9 However, untreated mental illness is a significant risk factor for violence; ie, “. . . a small number of seriously mentally ill individuals do become violent when they are not treated . . .”10 With regard to mass shooters specifically, there is little documented clinical evidence linking these perpetrators to major mental illnesses like schizophrenia or bipolar disorder. Indeed, no research has reliably established that most mass murderers and shooters are psychotic or suffering from a serious mental illness.5

In fact, a recent FBI report on 63 active shooters (2000-2013) found that only 25% (n = 16) of subjects had ever had a mental illness diagnosis; and of those, only 3 had a diagnosis of a psychotic disorder.11 The FBI report pointedly notes that, “. . . formally diagnosed mental illness is not a very specific predictor of violence of any type, let alone targeted violence;” and, further, that “declarations that all active shooters must simply be mentally ill are misleading and unhelpful.” On the other hand, some evidence suggests that many mass shooters have been preoccupied with feelings of social persecution and fantasies of revenge for some type of perceived injustice.11,12

While the FBI report did not directly assess the shooters’ motives, it did identify various grievances in 79% of the active shooters, mainly in the realm of interpersonal or employment actions perceived to be directed against the shooter (total of 49%). The report also identified “precipitating events” in 44% of the shooters who had an identifiable grievance (eg, an adverse ruling in a legal matter, a “romantic rejection,” job loss). However, the report implied that while these precipitants may have accelerated the timing of the shooting, they did not “set the course.” In any case, neither the identified grievances nor the putative precipitants are specific enough to be useful predictors of a shooting; after all, millions of people probably experience the sort of grievances, rejections, and losses noted in the report.

One important limitation of the FBI report was the absence of formal psychological autopsies. These involve collecting all available information on the deceased via structured interviews of family members, relatives, or friends, and attending health care personnel, as well as collecting data from psychiatric records and other documents.

Page 3 of 4

Watching for worrisome behaviors

Rather than speculating on the shooters’ motives, the FBI report emphasizes the observable, pre-attack behaviors of would-be shooters, and how alert citizens can communicate their concerns to appropriate authorities. Warning signs include, among others, “leakage of violent intent” to others; making threats; and acting aggressively. (“Leakage” occurs when a person intentionally or unintentionally reveals clues to a third-party about thoughts, attitudes or intentions suggesting the intent to commit a violent act.11)

The FBI found that, over time, the majority of perpetrators demonstrated at least 4 to 5 concerning behaviors that were observable to others, such as problematic interpersonal interactions, or communicating their violent intent (leakage)—either through verbal or physical behavior. Those under age 18 demonstrated such behaviors to school peers or teachers, while those over 18 demonstrated the behaviors to spouses or domestic partners. This phenomenon of leaking violent intent is consistent with findings by the US Secret Service that found that over three-quarters of perpetrators made concerning communications and/or elicited concern from others before carrying out their attacks.13

It is in the area of paying attention to warning signs and appropriate reporting to authorities that we may make the biggest gains in preventing mass shootings. Indeed, the FBI report suggests that by means of recognizing such red flags we may be able to head off potential shootings. Specifically, in 13 states, initiating an “extreme risk protection order” allows a judge to temporarily restrict a dangerous individual’s access to firearms, possibly preventing an imminent shooting.14

The following Case Vignette is an example of “what went right” in averting a potential mass shooting. It involves a 22-year-old international student, here on a temporary visa.

CASE VIGNETTE

Mr Z had attempted to buy an AR-15—the semiautomatic weapon of choice for most mass shooters—at a local gun shop. For several reasons—including Mr Z’s inquiring about high-capacity shotguns for hunting—the gun shop owner became suspicious and contacted the sheriff’s office. In doing so, the gun store owner became the hero who appropriately alerted law enforcement. A series of discoveries uncovered Mr Z’s history of alcohol abuse, depression, suicidal thinking, anger problems, and feeling that he might lose control or act violently. This led authorities at the University to fill out the paperwork for New York’s SAFE Act, which bans the sale of most semi-automatic weapons, and prevents people from buying a gun if a mental health professional determines that individuals might harm themselves or others.

Subsequently, fellow students shared screenshots of messages they had seen Mr Z post in a social media group. These revealed that Mr Z felt compelled to buy a gun and a bulletproof vest, and to practice shooting. Police obtained a search warrant for Mr Z’s apartment, where they found high-powered optics, scopes, ammunition, targets from shooting ranges, receipts from shooting ranges, and similar equipment. Ultimately, Mr Z’s visa was revoked, and he was deported. Further investigation uncovered a series of texts between Mr Z and his girlfriend, in which he openly talked about wanting to shoot people.


Moving Beyond “Motives” in Mass Shootings: Page 4 of 4

Moving away from motives to preemption and prevention


We hope that cases such as this, in concert with the FBI’s recommendations, will shift the focus of the press and other parties from sensationalizing motives to observing and reporting ominous behaviors. We would include suicidal threats or behaviors in this category, since almost half of the shooters in the FBI study had suicidal ideation or engaged in suicide-related behaviors at some time prior to the attack.11

Through collaboration between the public and responsible authorities, we stand a chance of preempting at least some planned shootings. Indeed, one study of thwarted mass homicide plots found that friends, family members, and acquaintances of threateners—as well as the general public—all played an important role in discovering and thwarting homicidal plots.15 To be sure, there is a great deal of room for improvement in this area. For example, the FBI report found that only about 41% of persons reported their concerns about potential shooters to law enforcement authorities.

While solid, evidence-based methods of preventing mass shootings are still lacking, we believe that progress will come through work on a number of fronts. First, better reporting of ominous behaviors and careful use of extreme risk protection orders may avert at least some mass shootings. Second, the use of Threat Assessment and Management (TAM) teams in our schools may also help preempt planned attacks. TAM teams are interdisciplinary groups of professionals that include law enforcement, mental health providers, and other security stakeholders, collaborating in a structured effort to accurately assess and mitigate the risk of violence.16

Finally, we believe—albeit speculatively—that the media can contribute to a reduction in mass shootings by refusing to publicize and sensationalize mass shooters by dwelling on their supremely resentful, narcissistic motives. There is reason to believe that such notoriety may encourage copy-cat killers, bent on outdoing the previous shooter.17,18 Surely, proactively uncovering homicidal plots and removing the lethal means of carrying them out makes far more sense than retroactively speculating on a shooter’s motives.

This article was originally published on 11/16/18 and has since been updated.

Disclosures:
The authors report no conflicts of interest concerning the subject matter of this article.