Mental Health and Mass Shootings

How is mental health related to the epidemic of mass shootings in recent years? Mass shooting, stabbing, clubbing, etc. is defined as victims of three or more not counting the perpetrator that are committed at random but usually premeditated.

What are not considered mass shootings?

• Serial killings
• Terrorist acts either secular, ethnic or religious
• Botched home invasions
• Driving while on alcohol or drugs in which there are one or more injuries or deaths both inside or outside of the vehicle
• Bank robberies that end up in deaths
• Assaults with grave bodily injuries

Another term for mass shooting could be mass mayhem.There seems to be a pattern after mass mayhem in the press describing the perpetrator as “a loner” or having “mental illness” otherwise not specified. In the literature studying mass shootings there seems to be a consensus that in half the cases the perpetrator has a mental health condition and in particular; schizophrenia.

What Other Mental Health Conditions Could Be Involved with Mass Shooters?

Not discussed is the mental issues of the other half of persons involved in mass mayhem. A pattern is emerging that the other half have schizophrenia and a coexisting personality disorder, a personality disorder alone, or mixed-autism-spectrum-disorders such as Asperger’s syndrome. There is a conspicuous absence of psychopathy which will discussed separately.

Approximately 1% of the American population has schizophrenia so about three million persons. In all the literature about this three million it must be emphasized that these folks are more likely to be the victim of violence then they are to be the perpetrators of violence.

Symptoms of schizophrenia include delusions meaning false ideas such as feeling unduly observed or thoughts of superiority as feeling being a famous personage. The other hallmark of schizophrenia is hallucinations which can be seeing, smelling or tasting something that does not exist. Also, thinking can be disordered such as moving from one subject to another in a way that makes no sense. Sometimes the individual makes up words known as confabulating. People with schizophrenia generally are socially withdrawn and with blunted emotions.

The four types of schizophrenia are:

1. Paranoid schizophrenia,
2. Disorganized schizophrenia (incoherent speech without delusions)
3. Catatonic schizophrenia (withdrawn to the point of being mute), simple or residual schizophrenia (no delusions or hallucinations but no motivation in life)
4. Schizoaffective disorder (a mixture of schizophrenia and a mood disorder such as major depression or bipolar disease).

More recent research into mass mayhem suggests that the other fifty per cent of attacks are due to schizophrenia when combined with one of several personality disorders or a personality disorder alone.

There are ten personality disorders:

1. Borderline personality disorder (impulsive, difficulty with relationships, self-image, feeling abandoned and self-harm.)
2. Schizoid personality disorder (introverted and socially withdrawn),
3. Paranoid personality disorder (perceiving actions of others as threatening.)
4. Schizotypal personality disorder (need for social isolation, anxiety in social situations.)
5. Anti-social personality disorder (ignore normal rules of social behavior.)
6. Narcissistic personality disorder (increased sense of self-importance and non-accepting failure or criticism.)
7. Avoidant personality disorder (sensitive to rejection, needing reassurance of being liked.)
8. Dependent personality disorder (submissive and unable to make decisions.)
9. Obsessive-compulsive disorder (striving for perfection, highly conscientious, orderly, methodical and detail oriented.)
10. Histrionic personality disorder (needing to be the center of attention and dramatic.)

The personality disorders that may be co-existent with schizophrenia are likely the schizoid, schizotypal and anti-social ones.

Autism is now felt to be a spectrum called autism spectrum disorder (ASD) characterized as persistent deficits in social interaction; repetitive behavior; early onset and impairment of occupational or functioning. Asperger’s syndrome is included in ASD. Its symptoms are less severe.

Children with Asperger’s have above average vocabulary and want to interact with others but have difficulty doing so. They have a problem understanding social rules, may use inappropriate gestures and avoid eye contact. IQ is average to advanced but learning requirements may be different than people without autism. Although there are clues in infancy such as clumsiness the diagnosis is more likely to be made when entering school. Males predominate the diagnosis and in later life major depression is common.

Although psychopathy is generally not associated with mass mayhem I will discuss it here as it is so commonly used in the wrong context. Most psychiatrists do not see psychopathy as one of the personality disorders although there is some overlap with sociopathic personality disorder. It is a stand-alone diagnosis. Features include: callous, lack of empathy or emotions, lack of feelings of disgust, lacking shame or guilt, lack of fear, lack of responsibility, lying, selfishness to the point of using others, increased sense of self-worth, impulsiveness, failure to have a plan for life, rage and aggression.

Psychopaths have some overlap with sociopathic personality disorder but differ in the ability to form emotional attachments, may be charming, are manipulative of others to their own ends, may be well educated and hold steady jobs. Psychopaths ae meticulous and calm while planning their crimes leaving few clues. Psychopathic persons are the most damaging members of society. They are able to dissociate emotionally from their actions. These are the people who are serial killers and are unremorseful regarding their victims as inhuman or playthings.

I researched mass shootings going back to Charles Whitman of the Texas tower shootings at the University of Texas (Austin) in 1966 for my book “An Insider’s View of Bipolar Disease.” Other than a short chapter on schizophrenia I did not include the other diagnoses above or the review of mass mayhem as they do not generally relate to bipolar disease. Nevertheless I researched the subject because of the volatility of our society to an extent that hearing of the almost weekly occurrence of mass mayhem has left us numb. Also, the media coverage is so expansive as to generate copycat crimes. And yet the media does not seem to have any grasp of the mental conditions involved.

I studied case by case from that incident and twelve of the most infamous since then. Some glaring examples include: Patrick Purdy in Stockton, CA, Adam Lanza in Newtown, CONN, James Huberty in San Ysidro, CA, Mark Orrin Barton in Atlanta, GA, Scott Evans Dekraai in Seal Beach, CA., Larry Gene Ashbrook in Fort Worth, TX., James Eagan Holmes in Aurora, CO., Jiverly Antares Wong in Binghamton, NY, Jared Lee Loughner in Tucson, AZ, Eric Harris and Dylan Klebold in Columbine, CO, Seung-Hui Cho in Blacksburg, VA (Virginia Tech) and Elliot Rodger in Isla Vista, CA.

Of these, eight had paranoid schizophrenia. One had paranoid personality disorder. One had a combination of Asperger’s, obsessive-Compulsive disorder and simple schizophrenia. One had dysmorphic mania (a subcategory of bipolar disease with depression and mania occurring at the same time). One was psychopathic and whose partner had anti-social personality disorder (sociopathic).

I have written this article because lumping these shootings into a single mental illness basket is misleading. As far as the recent Oregon shooter, not included in the above, his mother said he had Asperger’s syndrome. It is questionable that he only had this aberration.