Scientists, doctors disagree with politicians over causes


WASHINGTON, D.C. >> 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. The oversimplication, experts say, is perpetuated by the gun industry and a society that assumes that the mentally ill are the only ones capable of vicious killing sprees.

"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. "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 distinct categories. 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. And 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 two in every 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.

"The whole notion of mental illness and mass shootings is so poorly understood," said Liza Gold, a forensic psychiatrist at Georgetown University. "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 recent 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."

President Obama proposed spending $500 million to expand mental-health treatment.

"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 (R-Wis.) said earlier this year.

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-Connecticut, also has proposed a reform package. Sen. Murphy's bill is competing with legislation sponsored by Sen. John Cornyn, R-Texas, 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 (NRA) 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 will 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 mental-health 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."

Underlying the disconnect between the legislative ideas and the scientific reality are, experts say, 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 mentally ill 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."


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