Another mass shooting has just happened.
The staggering chaos and unimaginable loss of life heightens the nation’s attention once again. As the images begin saturating the airwaves, the picture of a mentally unstable man starts to take shape.
The story becomes a subject that we’ve heard before – violence and mental illness.
While we ask the question, “Why has this happened again?” it's important to know that the answer isn’t a simplistic one.
Though statistics have shown that mass shootings of late have been done by young men with a history of mental illness, it’s not the entire story. In fact, it’s dangerously reductive.
Because it implies that all people with mental illness are violent.
While evidenced based research shows us that many who commit violent acts DO indeed have mental illness, there is more to this diagnostic picture. The 4% of individuals who are violent have very serious problems dealing with strong emotional thoughts and feelings, struggle with drugs and/or alcohol abuse, experience environmental stressors, school/job difficulties, financial issues, and social disturbances. The other 96% living with mental illness are not violent, nor are likely to be prone to violence.
It can be easy for media and the general public to be misinformed about violence and mental health. There is a long history of stigma and ignorance surrounding mental illness. Even as research has grounded mental illness in science, data in news broadcasts, newspapers and internet reporting about mental illness are often misquoted, misused or factually reported wrong.
What is known about mental illness and violence is that it’s strongly linked to emotional regulation, the ability to inhibit or appropriately deal with strong emotions. When aggressive impulses are experienced, they move through the structures of our brain for processing. For those who don’t have regulation issues, these negative feelings find a healthy expression in the form of sarcasm, talking issues through, or going for a run, for example.
In individuals who have poor emotional regulation, these brain operations fail to mediate provocative feelings like frustration, anger or rage. As a result, these enormously powerful feelings are not filtered, examined or contained – and transform into violent behavior. Not everyone who has mental illness has emotional dysregulation. But it can certainly be said that those who commit violent acts have significant dsyregulation problems, in what is often clinically called “top down” control systems.
Emotional regulation difficulties are a combination of genetic predispositions and learned behaviors that occur over life. Those with dysregulation issues have a high sensitivity and vulnerability to emotional events, a significantly amplified emotional response to such events, and return very slowly back to a baseline from their reactive state. Individuals with emotional dysregulation often experience chronic stress, rejection and victimization. These experiences refuel frustration and anger and cycles the person back into an emotional dysregulation state.. This vicious circle loops endlessly, often leading to violent outcomes.
It’s clear that there is still so much more to do to detect those at risk for violent acts. To address this challenge, we need to:
 Elbogen, E. & Johnson, S. (2009). The intricate link between violence and mental disorder: Results from the National Epidemiologic Survey on alcohol and related conditions. Archives of General Psychiatry, 66(2):152-161.
 Lidz, C.W., Mulvey, E.P. & Gardner, W.P. (1993). The accuracy of predictions of violence to others. Journal of the American Medical Association, 269: 1007–1011.
 Wahl, O. (1997). Media Madness. Public Images of Mental Illness. New Brunswick, Rutgers University Press.
 Siever, L. (2008). The neurobiology of aggression and violence. American Journal of Psychiatry. 169:429-442.
 Herts, K. et. al. (2012). Emotional dysregulation as a mechanism linking stress exposure to adolescent aggressive behavior. Journal of Abnormal Child Psychology, 40(7):111-1122.
Dr. Deborah Serani's award winning books are Depression and Your Child: A Guide for Parents and Caregivers and Living with Depression by Rowman & Littlefield.