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Mental Illness and Mass Shootings — An Automatic Connection?

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While the aftermath of a mass shooting has historically been a window of opportunity to garner support for policies to reduce gun violence – such as greater screening of those who wish to purchase guns – how the mass shooter is presented in the media also plays a major role in how we perceive him, especially when mental illness is involved.


In a new report by the Johns Hopkins Bloomberg School of Public Health, Emma (Beth) E. McGinty, MS, a PhD candidate with the Johns Hopkins Center for Gun Policy and Research, part of the Johns Hopkins Bloomberg School of Public Health and her and colleagues used a national online sample of 1,797 adults in the U.S., and randomly assigned respondents to four groups: a control group which did not read any news story, a group which read a news story describing a mass shooting by a person with a serious mental illness, a group which read a news story describing the same mass shooting that also described a proposal for gun restrictions for persons with serious mental illness, and a group which read a story describing the same mass shooting that also described a proposal to ban large-capacity magazines.


What McGinty and her team found was that when stories described a mass shooting perpetrated by a person with mental illness, not only were negative attitudes toward persons with serious mental illness heightened – 54% of respondents who read a news story of a mass shooting thought persons with serious mental illness were likely to be dangerous, compared to 40% in the control group – but respondents were also more likely to support gun policy measures with restrictions for the mentally ill – 79% compared to 71% in the control group (Swanson, et al. 2016).


“We found that the public’s negative attitudes toward persons with serious mental illness are exacerbated by news media accounts of mass shootings involving a shooter with mental illness” (McGinty, 2016).


The problem of course, is that our negative attitudes toward people with mental illness, whether exacerbated by media reporting or not, are not well founded. Previous research has found that most persons with serious mental illness are not violent, and the relationship between serious mental illness and gun violence is complex and influenced by factors such as substance use. Perhaps even more concerning is that the stigmatization of people with mental illness may lead to a reluctance to seek treatment or raise other barriers to care.


Daniel Webster, ScD, MPH, director of the Johns Hopkins Center for Gun Policy and Research cautions, “As states across the U.S. consider restrictions on gun access among those with serious mental illness, future research should examine whether such policies deter people with mental illness from seeking treatment” (Webster, 2016).


Further, a public opinion survey conducted by the same researchers found a large degree of ambivalence among Americans on the topic of mental illness and guns: Almost half of respondents believed that people with serious mental illness are more dangerous than members of the general population, but less than a third believed that locating a group residence for people with mental illness in a residential neighborhood would endanger area residents. Two-thirds (61%) of respondents supported increased government spending on mental health care as a strategy for reducing gun violence (Swanson, et al. 2016).



However, as the pervasiveness of media reports on public shootings increase, the way in which the media cover these violent stories can have broad social implications, including the creation and perpetuation of racial and mental health stereotypes.


Examining 170 stories about public shootings published in five major national newspapers from 2008-2016 – which included shootings by police officers, those acting in self-defense, and criminal shootings – Cynthia Frisby, an associate professor of strategic communication at Mizzou, found four primary adjectives used to describe public shooters: hero, terrorist, thug and mentally ill.


Frisby also found the following trends throughout the 170 stories:

  • the word “hero” was used 32 times to describe public shooters, 75 percent of whom were white, while only 16 percent were black and 9 percent were Hispanic.
  • “terrorist” was used 35 times, describing Muslim shooters 37 percent of the time, black shooters 34 percent of the time and white shooters 17 percent of the time.
  • “thug” was used 57 times in the stories, 53 percent of which described black shooters, 28 percent described Hispanic shooters and 16 percent described white shooters.
  • “mental illness” was used 46 times in the stories, 80 percent of which described white shooters, 16 percent described black shooters and 4 percent described Muslim shooters.

Frisby’s conclusion is that we are not without our biases, even if they are implicit. She explains, “Black and Hispanic shooters are more likely to be labeled as thugs, while many white public shooters seem to be given some measure of leniency by attributing their actions to mental illness. This trend not only perpetuates negative racial stereotypes, but also creates damaging stigmas around mental illness, despite the fact that the vast majority of people with mental illness are non-violent” (Frisby, 2017).


Further, Frisby found that stories about white shooters were much more likely to only include objective facts, such as the time, date and place of the shooting, while stories about shooters of color were much more likely to include subjective facts, such as aggravating circumstances that might have caused the shooting.


“News media serve as a powerful mode of communication and have incredible power in influencing public opinion on controversial topics, especially those topics that involve race, gun violence, shootings, killings and injuring innocent victims. If social change is to occur, media outlets need to start facilitating conversations about race and crime in the 21st century. Hopefully journalists, like all of us, can face their personal biases and understand that words have meaning before making decisions about how to write headlines” (Frisby, 2017).


And yet while the way mass shooting are reported ignites many biases, around race, gender, stereotype and mental illness, many experts continue to question whether or not we are allowing mental illness to simply become a scapegoat for mass shootings.


It seems that there is a familiar narrative that follows mass shootings: the mass shooter was a lone ranger who suffered from untreated mental illness that became the primary cause for the terrifying act. However, Vanderbilt University researchers, Dr. Jonathan Metzl and Kenneth T. MacLeish are not convinced. Conducting an extensive review, Metzl and MacLeish analyzed data and literature linking guns and mental illness over the past 40 years.


What emerged were four central myths that arise after mass shootings. They are:

  • Mental illness causes gun violence
  • Psychiatric diagnosis can predict gun crime before it happens
  • U.S. mass-shootings “prove” that we should fear mentally ill loners
  • Because of the complex psychiatric histories of mass-shooters, gun control “won’t prevent” mass shootings.

Metzl summarizes, “Our research finds that across the board the mentally ill are 60 to120 percent more likely than the average person to be the victims of violent crime rather than the perpetrators” (Metzl, 2016).


And while our assumptions, say Metzl and MacLeish, are understandable, they are also incorrect. The reality is that most mentally ill people are not violent. “Fewer than 5 percent of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness,” they write (Metzl & MacLeish, 2016).


“Gun discourse after mass shootings often perpetuates the fear that ‘some crazy person’ is going to come shoot me. But if you look at the research, it’s not the ‘crazy’ person you have to fear” (Metzl, 2016).


One outcome of this isolated focus on mental illness, say Metzl and MacLeish, is that it misdirects us from the bigger issues tied to preventing gun deaths in the U.S. Metzl explains, “There are 32,000 gun deaths in the United States on average every year and people are far more likely to be shot by relatives, friends or acquaintances than they are by lone violent psychopaths” (Metzl, 2016).


And while the presumed link between mental illness and gun violence has led to calls for mental health screening for gun owners, psychiatric diagnosis is in and of itself not predictive of violence. “Even the overwhelming majority of psychiatric patients who fit the profile of recent U.S. mass shooters – gun-owning, angry, paranoid white men – do not commit crimes,” explain Metzl and MacLeish (Metzl & MacLeish, 2016).


“Basing gun crime-prevention efforts on the mental health histories of mass shooters risks building ‘common evidence’ from ‘uncommon things,’ all while giving mental health providers the untenable responsibility of preventing the next

massacre” (Metzl, 2016).


Further, focusing solely on mental illness ignores those factors that do predict gun violence more broadly, such as drug and alcohol use, a history of violence, access to firearms, and personal relationship stress. Instead, argue Metzl and MacLeish, more attention should be paid to mental health systems such as access to mental health care, medication and health insurance.



Media reporting of mass shootings also seemed to perpetuate the fear of the “unknown stranger”,

who is often a person of a different race or culture. The rhetoric – ‘Somebody could come attack me or my family, so we need to protect ourselves’ – is a prominent historical them that Metzl and MacLeish found, drives the desire to own and carry guns. Metzl explains, “Reading the gun rights statements of the Black Panthers and other black power groups in the 1960’s is almost exactly the same as the Tea Party today. Both groups argued that they’re protecting themselves from government tyranny and have a constitutional right as individuals to bear arms” (Metzl, 2016).


As one study suggests, it may be that we make a fundamental miscalculation – we misinterpret

mental illness for what might actually be extreme beliefs.


When Andres Breivik, a Norwegian terrorist, killed 77 people on July 22, 2011, in a car bombing in Oslo and a mass shooting at a youth camp on the island of Utøya in Norway, he claimed to be a “Knights Templar” and a “savior of Christianity,” whose violent attacks were acts to save Europe from multiculturalism.



Two teams of court-appointed forensic psychiatrists later examined Breivik. The first psychiatric team diagnosed him with paranoid schizophrenia. However, after widespread criticism, a second team concluded that Breivik was not psychotic and diagnosed him with narcissistic personality disorder.


“Breivik believed that killing innocent people was justifiable, which seems irrational and psychotic,” explains Tahir Rahman, M.D., an assistant professor of psychiatry at the University Of Missouri School Of Medicine who studied Breivek’s case as a way to open a larger discussion about the societal implications of extreme beliefs (Rahman, 2016).


The term that Rahman proposes to better define behavior such as Breivek’s is one that is currently not found in current clinical guides, such as the Diagnostic and Statistical Manual of Mental Disorders is “extreme overvalued belief” (Rahman, 2016).


Extreme overvalued beliefs, Rahman explains, are beliefs that are shared by others and often relished, amplified, and defended by the accused. These beliefs incur as intense emotional commitment, which may lead to violence. Further, although the individual may suffer from other forms of mental illness, the belief applies only when the diagnosis of psychosis has been ruled out – as was the case for Breivek (Rahman, 2016).


“Sometimes people think that violent actions must be the byproduct of psychotic mental illness, but this is not always the case. Our study of the Breivik case was meant to explain how extreme beliefs can be mistaken for psychosis, and to suggest a new legal term that clearly defines this behavior” (Rahman, 2016).


Understanding mass shootings as acts driven by extreme overvalued beliefs could improve our legal response to such violent acts, particularly when the defendant’s sanity is questioned, and it could also help identify those at risk. As Rahman explains, “Certain psychological factors may make people more vulnerable to developing dominating and amplified beliefs. However, amplification of beliefs about issues such as immigration, religion, abortion or politics also may occur through the internet, group dynamics or obedience to charismatic authority figures. We already warn our youth about the dangers of alcohol, drugs, teen pregnancy, and smoking. We need to add the risk of developing extreme overvalued beliefs to that list as we work toward reducing the violence often associated with them” (Rahman, 2016).


So what is the answer? Should mental illness be a preclusion to owning a firearm?


Asking just this question, a group of international scholars, including co-author Vickie Mays, a professor of psychology and health services who directs the Center for Research, Education, Training and Strategic Communication on Minority Health Disparities in the UCLA College, analyzed dozens of epidemiological studies on gun violence and mental illness and compared the results to media-fueled public perceptions about the dangerousness of mentally ill individuals.


The conclusion, says Mays, is that we are missing the point – or in this case the clear risk factors for gun violence.


A history of violent behavior, especially with criminal justice involvement, and other behavioral indicators of risk are much stronger predictors of future gun violence than having a serious mental health diagnosis. This sentiment echoes the findings of the Consortium for Risk-Based Firearm Policy, a group of national experts on gun-violence prevention and mental illness that released a set of federal and state policy recommendations in December 2013 (Swanson et al., 2016).


Other risk indicators, the report found, include being subject to a temporary domestic violence restraining order, having been convicted of a violent misdemeanor, having two or more driving-under-the-influence convictions in a five-year period, and having two or more controlled-substance convictions in five years.


“Mental illness is not the main cause of violence in society. Policies should focus more on limiting access to firearms for people with behavioral risk factors for violence during specific times when there is evidence that risk is elevated” (Mays, 2016).


Some of this limited access would include the development of state mechanisms allowing law enforcement officers to confiscate guns from individuals who pose an immediate threat to themselves or others, and to request a warrant for the removal of guns when the risk of harm is “credible,” if not immediate. In addition, the report suggests that family members and intimate partners be able to petition the court to temporarily authorize gun removal and prohibit gun purchases by individuals who pose a credible risk of harm to themselves or others (Swanson et al., 2016).


However, we don’t only need more evidence-based policies to effectively prevent gun violence, we also need to expand mental health services and improve access to treatment. In Mays words, “Some people are slipping through the cracks” (Mays, 2016).


“An estimated 3.5 million people with serious mental illnesses are going without treatment every year” says Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the study. Moreover, mental health disorders are much more strongly linked to self-harm or suicide than to violence against others. A very small proportion of people with serious mental illness pose a threat to others, and gun violence and mental illness intersect only on their margins” (Swanson et al., 2016).



“Even if schizophrenia, bipolar disorder and depression were cured, our society’s problem of violence would diminish by only about 4 percent. A person with serious mental illness is far more likely to be a victim of violent crime than a perpetrator” (Swanson, 2015).


Approximately six of every 10 gun deaths in the U.S. are suicides, which points to failures in both the mental health care system and firearms regulation, according to the report. However, there are also failures in our ability to predict violence. Citing a 2012 review of 73 studies on the accuracy of psychiatrists’ predictions of violent behavior in their patients, the report found that prospective risk-assessment by mental health professionals is only slightly more accurate than flipping a coin (Swanson et al., 2016).


“The public mental health system in most states is woefully inadequate – fragmented, overburdened and underfunded. It shouldn’t be harder for a person in a suicidal mental health crisis to get treatment than to get a handgun” (Swanson, 2016).


What the report calls for is that we step back, look past our biases, assumptions, stereotypes, and the myths perpetuated by slanted media coverage of mass shootings and consider the evidence based research. Mental illness alone does not accurately capture the motives that drive mass shootings. Further, over-focusing on mental illness as a driver of violence acts often leads us to miss other predicative signs, such as extreme overvalued beliefs, a history of violence, a criminal record, and substance abuse.

Photo by Mike Licht,

Mental Illness and Mass Shootings — An Automatic Connection?

Claire Dorotik-Nana, LMFT

Claire Dorotik-Nana LMFT is a licensed marriage and family therapist specializing in post-traumatic growth, leveraging adversity, and other epic human achievements. Claire has written multiple continuing education courses for Professional Development Resources, Zur Institute, and International Sport Science Association. Claire has also authored multiple books, including:
Leverage: The Science of Turning Setbacks into Springboards and On The Back Of A Horse: Harnessing The Healing Power Of The Human-Equine Bond. For more information about Leveraging Adversity or Claire, visit

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APA Reference
Dorotik-Nana, C. (2018). Mental Illness and Mass Shootings — An Automatic Connection?. Psych Central. Retrieved on July 15, 2020, from


Last updated: 6 Apr 2018
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