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Amy Barnhorst MD
Amy Barnhorst MD

Hate Is Not a Mental Illness

To prevent mass shootings, focus on gun laws — not mental health.

This past month, 11 Jewish people were shot at a synagogue by a man who had posted anti-Semitic comments online. Two African-American people were murdered at a grocery store by a gunman who had just tried and failed to enter a black church. Twelve people were shot and killed at a Thousand Oaks nightclub. Like clockwork, public speculation about the presumed mental illness of the shooters unfolded soon thereafter. As the events of each man’s past were slowly unearthed, they started to ring familiar bells: run-ins with the police, domestic violence, involvement with online hate groups, bar fights, brief psychological interventions for threats of suicide or violence. Many of these mass shooters had previous diagnoses of things like depression, autism spectrum disorders, or anxiety. But even if these diagnoses were accurate, did they cause the shootings?

When someone robs a liquor store or assaults their girlfriend, we don’t automatically assume they are mentally ill. Even people who murder neighbors, rivals, or family members don’t garner such diagnostic speculation. So why is it different after a mass shooting? It’s as though once the body count exceeds a certain number, we can no longer explain it with plain old criminal behavior. Or maybe on some level, we all understand the desire for people we know to be dead, but killing a group of total strangers for no obvious gain or motive seems inconceivable. It defies logic, so we call it “mental illness,” and pretend that is reason enough.

Most mass shooters, though, didn’t have a diagnosis of a serious mental illness before their attack. Having ”mental health issues” like getting in fights at school, beating your spouse, or being a loner who spends too much time on Internet hate sites is different from having a mental illness like schizophrenia or bipolar disorder. Consider a medical corollary: a man in his mid-40s who lives a sedentary lifestyle. He eats a lot of fast food and takeout, usually in front of his television, and washes it down with a few beers until he falls asleep on the couch. He’s a good 50 pounds overweight, and his only source of exercise is walking outside for his regular smoke breaks.

You don’t have to go to medical school to know that this guy is never going to make the cover of a Men’s Health magazine. But when he goes to his doctor for a checkup, she doesn’t find any evidence of diabetes, emphysema, high blood pressure, or other diseases. She doesn’t see the need to start any medications or admit him to a hospital, because he is not medically ill (not yet, anyway). He’s just really unhealthy.

This distinction applies to mental health, too. There are lots of angry and embittered people in the world who have it out for others. They get fired from jobs, fight with their partners, perpetrate road rage, harbor grudges, and plot revenge. We certainly wouldn’t describe them as psychologically healthy, but, like the couch-dweller, they don’t necessarily have a diagnosable illness. And unless they are motivated to make a lot of changes in their own lives, they are very difficult for mental health professionals to treat.

These entitled, rage-filled people can be extremely dangerous. Imagine what happens when you take someone with those personality traits and immerse them in an online culture that provides validation and fuel for their hatred, and steers it towards a specific target: African-Americans, women, immigrants, Jews. Throw in access to assault weapons, and you have a uniquely American tragedy waiting to happen.

Photo by Max LaRochelle on Unsplash
Mental illness isn't a major factor in most mass shootings. But guns are.
Source: Photo by Max LaRochelle on Unsplash

To be fair, there have been a few instances of horrific public violence committed by people whose mental illness altered their perception of reality and contributed to their crimes. Consider the case of the young woman who, in 1999, opened fire inside a Utah television station, because she believed the news anchors had been broadcasting videos of her sex life. Or the civilian contractor for the military who, in 2013, killed 12 people in the DC Navy Yard, because he was hearing voices and believed that an “ultra-low frequency attack” of radio waves was being sent through his walls to prevent him from sleeping. But these cases are the rare exceptions.

Most of the time, mass shooters aren’t driven by delusions or voices in their head. They are driven by a need to wield their power over another group. They are angry at the perceived injustices that have befallen them at the hands of others — women who wouldn’t sleep with them, fellow students who didn’t appreciate their talents, minorities enjoying rights that were once only the privilege of white men like them. It’s not an altered perception of reality that drives them; it’s entitlement, insecurity, and hatred. Maybe some of them also have depression, ADHD, or anxiety, but that is not why they opened fire on a group of strangers.

To prevent mass shootings, we need to stop focusing on mental illness as the culprit. We need to redirect our efforts towards enacting legislation that directly targets dangerous people and restricts their access to guns. The first step in this is closing the holes in the federal background check system. This means running all gun sales through the background check database to see if the buyer is prohibited, not just sales by licensed dealers. It also means requiring state agencies to submit their records of prohibited persons to the federal government, a process which is currently voluntary and woefully incomplete. It means passing and utilizing legislation like extreme risk laws (or gun violence restraining orders), which allow law enforcement to remove guns from people who are at imminent risk of suicide or violence. If instead we continue to hope that every angry, entitled male with a grudge and an arsenal can be cured by the mental health system, we doom ourselves to watching these tragedies unfold again and again.

Facebook image: Eddies Images/Shutterstock

About the Author
Amy Barnhorst MD

Amy Barnhorst, MD, is Vice Chair for Community Mental Health in the Department of Psychiatry at the University of California, Davis.

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