Mental Health and Mass Shooters

April 29th, 2016

After a mass shooting, the response is fairly predictable (even cyclical). Those who favor gun control advocate for stricter gun control  measures. Those who oppose gun control advocate for keeping guns out the hands out of people with mental health problems. However, in light of the nature of mass shooters, neither approach is designed to eliminate these high-profile, but extremely rare, mass killings. (It is worth stressing that attempting to reduce the number of single-person gun homicides differs wildly from reducing suicides or mass shootings, where four or more people are killed in a single incident).

The New York Times–in a piece that does not even mention gun control–discusses how difficult it is to predict the psychological profile of a mass killer.

These lone killers usually don’t fit into an existing category of mental illness, and there’s usually little evidence that early treatment would have helped . . . .

In fact, the sort of young, troubled males who seem to psychiatrists most likely to open fire in a school — identified because they have made credible threats — often don’t fit any diagnosis, experts say. They might have elements of paranoia, deep resentment or narcissism that are noticeable but don’t add up to a specific disorder, according to strict criteria. And there’s no good evidence that mental health treatment would have made a meaningful difference.

It is really easy to use 20/20 hindsight goggles, but making these diagnoses in advance is tougher than the media would let on.

The college student who killed six people before shooting himself in Isla Vista, Calif., in May 2014 saw multiple therapists; they disagreed whether he had emotional problems or high-functioning autism. TheSandy Hook shooter, who killed 26 people in an elementary school in Newtown, Conn. in 2012, had seen numerous psychiatrists and psychologists for years before his mass murder, including therapists at Yale’s renowned Child Study Center. After details of the young man’s childhood and home life emerged, some experts saw evidence of earlypsychosis or obsessive compulsive tendencies. But the only official diagnosis Adam Lanza, the shooter, had received was Asperger’s syndrome, a mild form of autism that by itself does not dispose people to violent acts.

It is simply not the case that these sick individuals–even with proper screening–can be identified in advance for heightened gun control with any degree of accuracy.

Intervening early to address the resentments and fantasies of this group — an approach called threat assessment — is thought to reduce the risk that the boys will act out. But spree killings are rare enough that it has been difficult to know how well such preventive measures work.

The consequence of these findings is that most gun-control laws premised on “mental health” conditions–as a means to halt mass shootings–will primarily generate false positives. Such a regime assumes people with depression, or other similar condition, are dangerous, so the state denies them the right to acquire an arm–even though their condition is unlikely to drive them to commit such horrific crimes.

I’ve written before how doctors in New York have explained that the state’s new mental-health registry may actually be counterproductive because it chills patients from seeking treatment, out of a fear of losing a constitutional right. This is compelled by New York’s imposition of liability on doctors who fail to report patients who go on to do bad things.This creates a perverse incentive to further increase the number of false negatives.