By Joel Dvoskin, PhD, ABPP (Chair, Nevada Behavioral Health and Wellness Council)
Too often, even the most well-intentioned among us believe that most mass shootings are carried out by those with untreated mental illness. As a forensic and clinical psychologist with extensive experience treating individuals with serious mental illness, and as a member of APA’s Policy Review Task Force on the Prediction and Prevention of Gun Violence, I believe this to be unfounded and incorrect for the following four reasons:
1. We often base our belief that mental illness is a characteristic of mass shooters on retrospective or circular logic.
In other words, people say, “You’d have to be crazy (sic) to do something like that.” Further, in the aftermath of a heinous crime, even minor quirks and eccentricities are often incorrectly labeled as evidence of mental illness through the stigmatizing lens of retrospective analysis.
2. Many mass shootings are connected to organized crime and many others are connected to domestic violence.
Even though many of us believe that one would have to have a personality disorder to be in a criminal gang, that myth ignores the sad truth that in some parts of America, joining a gang is a survival tactic for adolescents. And sadly in the case of domestic violence, which is all too common, it can become fatal when a firearm is used.
3. Our media tends to overhype mass shootings committed by individuals who appear to be mentally ill.
There is typically saturation publicity when a mass homicide appears to have been committed by someone with psychiatric problems, leading the public (and, sadly, many mental health professionals) to overgeneralize from these few vivid cases. Professor Michael Perlin has referred to this as “the vividness heuristic.” And make no mistake of it; vividness and extreme statements sell TV advertising much more successfully than truthful reporting of the news.
4. Crisis is the culprit, not mental illness.
I have studied many of these seemingly irrational mass homicides, and in my opinion, many of them are perpetrated by people without serious mental illnesses (the way that term is appropriately used). What the perpetrators seem to have in common is the experience of extreme situational crisis. This often includes rage and despair, sometimes fueled by alcohol or stimulants. For more information on this, see APA’s Resolution on Firearm Violence Research and Prevention. While a situational emotional crisis could be characterized as an adjustment disorder or acute depression, terms such as “serious mental illness,” “the mentally ill”, etc. typically refer to people with serious and persistent emotional and cognitive conditions that have pervasively made their lives more difficult over time. Referring to situational crises as evidence linking mental illness to mass homicide is, once again, circular reasoning that creates misleading discourse.
Strengthening the public mental health system will help those in crisis
Most perpetrators of random mass shootings either commit suicide, manage to get killed by police, or spend the rest of their lives locked up. In any case, they have given up on life as they know it. Thus, it is useful to understand that mass shootings, in addition to being homicides, are typically acts of suicide or its metaphorical equivalent.
While it is virtually impossible to know which of the millions of people in emotional crisis will commit acts of murder and suicide, we do know how to prevent suicides. By using simple public health approaches to suicide prevention, American jails have managed to dramatically reduce the number of jail suicides. (Read anything by Lindsay Hayes of the National Center for Institutions and Alternatives for data on this).
I have spoken often over the past few years about ways in which the public mental health system can and must help to prevent mass homicides. This is not because of its important role in treating persons with serious mental illness. Rather I see the public mental health system as equivalent to other first responders such as Fire and Rescue, Police, and EMT’s. And like those vital services, mental health care should receive adequate funding to provide timely and competent services to people in extreme crisis and despair, whether or not they happen to have a psychiatric diagnosis.
Crisis workers need to be adequately compensated and trained in enough numbers to respond to crises with skill and speed. The U.S. public mental health system has been ravaged by budget cuts, to the tune of tens of billions of dollars, during the past 15 years. If America would meaningfully invest in suicide prevention, I believe that we would prevent some mass homicides.
Policy changes and funding can help
Violence and its origins are currently at the forefront of political debate in the U.S. It’s heartening to see and take part in the robust national dialogue about mental illness, violence, and criminal justice that is happening at the federal level. Congress is working on legislation to overhaul both the public mental health system and the criminal justice system. APA supports their efforts to ensure that individuals with serious mental illness get access to care. We also are encouraged by the push to provide federal funding for research into the causes and prevention of violence without unnecessary restrictions.
Helping people in emotional crisis can not only prevent suicide and mass homicides. It can prevent deeper involvement in the criminal justice system as well. APA strongly supports diversion from deeper levels of justice system involvement, when public safety allows, so that individuals with mental illness can obtain the care they need. Law enforcement officers who serve on crisis intervention teams can divert individuals pre-arrest and connect them with public mental health resources. Diversion also allows criminal justice agencies to focus on those individuals for whom jail time is deemed necessary.
Emotional crises are an equal opportunity phenomenon. They can happen to anyone experiencing enough distress whether or not they have a serious mental illness. The public mental health system should be able to help them see a less horrifying way to alleviate their psychological pain.
For more information on preventing gun violence, read APA’s seminal report – Gun Violence: Prevention, Prediction and Policy.
Joel Dvoskin, PhD is a clinical psychologist, licensed in the State of Arizona since 1981 and the State of New Mexico since 2005. He is a Diplomate in Forensic Psychology of the American Board of Professional Psychology, a Fellow of the American Psychological Association (APA) and the American Psychology-Law Society. Dr. Dvoskin is past President of Division 18 of the American Psychological Association, Psychologists in Public Service, (2000-2001), past President of the American Psychology-Law Society, Division 41 of the APA. He is the former Acting Commissioner of Mental Health for the State of NY and the former Chair of the (Nevada) Governor’s Advisory Council on Behavioral Health and Wellness. Dr. Dvoskin holds a Certificate of Professional Qualification in Psychology from the Association of State and Provincial Psychology Boards. He is also author of numerous articles and chapters in professional journals and texts, including a number of articles that deal with treatment of persons with serious mental illness and co-occurring substance use disorders. He has been qualified as an expert witness on these and related issues in numerous state and federal courts throughout the United States. Dr. Dvoskin also served as a member of APA’s Policy Review Task Force on the Prediction and Prevention of Gun Violence.
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