Florida shooter may not be insane, but nation’s gun policies are senseless, experts say

With the heartbreaking loss of young lives in another school shooting, we yet again debate the causes of this epidemic in the United States, where we have an average of one school shooting per month. The assumption that the perpetrator must have a serious mental illness has led many commentators to suggest that expanding access to mental health care is the solution.

As a forensic and a child psychiatrist, we certainly champion expanded access to mental health care for the one in every 4 to 5 Americans between the ages of 13 and 18 who have a mental disorder with severe impairment. But it is not the prescription for preventing school shootings.

It is worth noting that the prototypical school shooter is a young white male who is socially isolated, bullied by others, preoccupied with guns and violence, and likely abuses alcohol and drugs. He is likely to have a history of behavior problems, and although 23 percent of adolescent mass murders had a documented psychiatric history, only 6 percent had psychosis at the time of the tragedy. As a group, mass murderers are not characterized by significant neurocognitive impairment. Their crimes are premeditated and they have better language, processing speed, reasoning, and verbal memory abilities on average than single victim murderers. It's easy to call a school shooter “mentally disturbed” and a “savage sicko” as President Trump did, but these are convenient and misleading labels.

To be sure, rare exceptions to this profile occur wherein the individual has chronic psychosis, such as schizophrenia, with delusional thought and auditory hallucinations driving the violent behavior. Individuals whose thinking and actions were so distorted by serious mental illness that they could not understand their actions qualify for the insanity defense. Justice requires that punishment is reserved for those who are morally culpable for their misdeeds.

Once the rate of state firearm ownership has been taken into account, no significant association between the incidence of these events and prevalence of mental illness, or the strength of firearm legislation in that state, remains. 

The profile of the typical school shooter does not meet criteria for an insanity defense. While there is no national standard, an insanity defense requires that an individual’s actions be directly related to severe symptoms of a mental illness or mental defect to qualify for an insanity defense. In the typical insanity statute, evidence of a severe mental illness alone is not sufficient. The individual must either lack the ability to understand the wrongfulness of his actions or fail to understand the nature and consequences of his actions. This is a higher bar than mental illness alone.

The reflexive assumption that mass shooters are mentally ill reflects the societal stigma against Americans who suffer from mental illness. But there is an even more disturbing angle--focusing on mental illness is a convenient means to divert attention away from solutions that are deeply unpopular with gun manufacturers and the politicians financed by them. We cannot accept the temptation to explain away deviant behavior, even deeply disturbing behavior, as being evidence of mental illness. Curtailing access to automatic firearms is a solution to reducing deaths from mass shootings that preserves second amendment liberties. It has worked elsewhere. In 1996, Australia banned semiautomatic rifles and bought back nearly 700,000 rapid-fire guns from its citizens. In the 16 years prior to the ban, there were 13 mass shootings. In the 20 years following the ban, no mass shootings have occurred. We owe the same action to our citizens.

Limiting access to potentially dangerous hazards has effectively reduced harms from a number of public health threats. For example, raising the minimum drinking age to 21 has reduced youth motor vehicle fatalities. Robust gun control is supported by the American Psychiatric Association, American Psychological Association, American Academy of Pediatrics, American Academy of Emergency Physicians, American Medical Association, American Nursing Association, and American Public Health Association.

The rate of firearm ownership in a state is significantly associated with its incidence of mass killings with firearms, school shootings, and mass shootings. Once the rate of state firearm ownership has been taken into account, no significant association between the incidence of these events and prevalence of mental illness, or the strength of firearm legislation in that state, remains. 

The devastating injuries resulting from mass shootings with rapid fire weapons are beyond the trauma care capacity of our hospitals. And despite prompt law enforcement responses, most attacks are not stopped by law enforcement officers, but by school personnel or by the perpetrator stopping on his own.  And yet our federal government will not follow the successful action of Australia, and it will not fund research into gun violence.

Expanding access to mental health treatment for the many Americans who are suffering from mental illness, the vast majority of whom are not violent, is an important public health goal. Young adults aged 18-25 had the highest prevalence of any mental illness (22 percent) compared to adults 26-49 (21 percent) and 50 and older (nearly 15 percent). However, treatment rates are low. Only 35 percent of youth 18-25 received treatment, compared to 43 percent of adults 26-49 and nearly 47 percent of adults 50 and older.

State rates of federal aid for mental health services are strongly associated with reduced suicide rates. But to pretend that this will have a major impact on stopping school shootings will again delay effective intervention. Only confronting the underlying public health problem — the ready availability of guns and particularly rapid-fire weapons — will address this plague affecting American school children. 

Cara Angelotta, M.D., is a forensic and perinatal psychiatrist at Northwestern University. Katherine L. Wisner, M.D., M.S., is a child and perinatal psychiatrist and the Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology at Northwestern University, and a Public Voices Fellow.