Stop Blaming Mental Illness

The number of mass shootings continues to increase with horrifying frequency. Media outlets report that in the first 216 days of this year alone, there were a total of 251 mass shootings in the United States – more shootings than days.

Coverage of these tragedies is widespread and emotional, yet also polarizing. It has become routine. On network and cable television, public figures and experts in a variety of fields provide statistics and contemplate solutions. Reports of “yet another” shooting are followed by footage of the crime scene, interviews with traumatized witnesses, and statements from officials.

Speculation about the shooter begins.

Were there warning signs?

Was there a motive?

People interpret the events through the lens of their own cultural experience and opinion. Initial empathy for victims devolves into a morass of fractured and adversarial ideology. Vigorous calls for legislative action are met with equally forceful admonitions not to politicize.

Then it happens again.

Pundits seek scarce common ground by taking positions they believe to be universally acceptable. Some insist law enforcement needs more tools to monitor suspicious online activity. Others suggest the need for more research in order to better understand our growing societal propensity for violence.

But many steer the conversation toward mental health. While perhaps well-intentioned, physicians, nurses, and therapists cringe as commentators routinely pathologize the shooter by labeling them as “crazy” or “sick.” Whether they use these terms colloquially or attach genuine clinical significance to them remains unclear. Either way, invoking mental illness is at best misguided and at worst potentially dangerous.

Even in light of rapidly expanding scientific understanding of diseases afflicting the brain, psychiatric illness still carries inordinate stigma compared to pathologies of the heart, lungs, or gastrointestinal system. The brain is complex, its functions are often difficult to explain, and neuroscience, for all its advances, leaves much to be discovered. Old, well-entrenched prejudices of “weakness” or “moral failing” abound and create a chilling effect on the provision of treatment. Who wants to be viewed in such a way? Moreover, some verbalize an understanding that they are not at fault for their depression or anxiety, but at their core harbor even the smallest belief that they should be able to just shake it off, pull themselves up by their proverbial boot straps.

In any event, reflexively attributing a shooter’s behavior to mental illness generally happens for one of two reasons:

1.    An effort to avoid a controversial conversation about gun laws

2.    Erroneously held beliefs about mental health

A comprehensive discussion of the former is beyond the scope of this writing and would, in any event, split readers along lines of closely held and fixed political positions. Attention to the latter, however, is crucial. Propagating a false narrative about psychiatric illness has the effect, albeit perhaps unintended, of further stigmatizing people who require care but are reluctant to seek it due to shame, fear, or concerns of adverse social consequences.

Certainly, there are instances of diagnosable thought disorders leading to violence. They are exceedingly rare, however, and given the broadcast dialogue many might find the statistics surprising. One need only consider how infrequently the legal defense of “not guilty by reason of insanity” is employed and even then, how rarely with success. According to statistics published by the American Academy of Psychiatry and the Law, the “insanity defense” is only proffered in about 1% of cases and is unsuccessful 75% of the time it’s tried. Following the math, statistically only 0.6 of the 251 shooters could be exculpated under the law due to mental defect.

The fact is that all violence is not due to psychopathology.

The irony is that, in actuality, the majority of people suffering from mental illness are not violent toward others. In fact, the National Institute of Mental Health reports that suicide is twice as common as homicide among those who are suffering from mental illness. Suicide is also the second-leading cause of death among individuals between the ages of 10 and 34. Notably, law enforcement officers are more likely to die by suicide than in the line of duty. The police who are dealing with an active shooter pose more of a statistical danger to themselves than do the well-armed individuals they’re trying to stop.

The treatment necessary to prevent death by suicide is already stifled by stigma, more so when people fear perceived public affiliation with perpetrators of mass shootings and others whom television and the internet have diagnosed with unsubstantiated mental illness. As it stands, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 60% of people requiring psychiatric treatment do not receive it and cite stigma as a major obstacle.

One or more of the shooters involved in mass killings may eventually be shown to have a diagnosable disease that affects their thoughts and judgment so severely that it is deemed causally related to and responsible for their violent behavior. While no thoughtful individual denies the potential danger to self or others attendant to some burdened by certain diagnoses, blanket assertions that evil acts flow solely and specifically from mental illness are misinformed, inappropriate, and wrong.

Individuals who have a public voice, who are capable of influencing others, must wield that power carefully lest they unwittingly contribute to the toll of avoidable deaths. Opportunity exists to educate rather than stigmatize, treat rather than shame, and to seek real solutions instead of misdirecting blame.

Let’s take that opportunity.