Active Shooters: Not Mentally Healthy, But Not Mentally Ill

A new FBI study challenges the idea that most shooters have a mental disorder.

Posted Jun 21, 2018

Public domain
Despair, Edvard Munch (1894)
Source: Public domain

This week, the FBI released the sequel to its 2014 study of the 160 “active shooting incidents” occurring in the US between 2000 and 2013. While Phase I of that study focused on circumstances (e.g., location, duration, outcome) of the active shooter incidents, the just-published Phase II part of the study focuses on the pre-attack behaviors of a smaller sample of 63 shooters (based on cases where background information was available and excluding spontaneous instances of violence such as fights that escalated), trying to answer questions about how the shooters behaved before the attacks and why they did what they did.

The FBI defines an “active shooter” as an “individual actively engaged in killing or attempting to kill people in a confined and populated area.” The term is used to describe a situation in which “a shooting is in progress” and “inherently implies that both law enforcement personnel and citizens have the potential to affect the outcome of the event based upon their responses.” Active shootings may or may not be mass shootings, defined as “four or more murders [by gun] during the same incident, with no distinctive time period between the murders."

A number of important findings have come out of this new study. For example, shooters were 94% male, but comprised a variety of age groups and ethnicities (63% were white). Most active shootings were premeditated, with time—often weeks to months—taken to plan and prepare for the attack. And most active shooters demonstrated “concerning behaviors” and experienced a variety of stressors (e.g. financial strain, problems at work, marital difficulties, conflicts with family, etc.) observed or known by others in the time leading up to the shooting. While the most common stressor was classified under “mental health,” a crucial distinction is that most active shooters did not have a confirmed diagnosis of mental illness:

“It is exceedingly important to highlight that the FBI could only verify that 25% (n=16) of the active shooters in Phase II were known to have been diagnosed by a mental health professional with a mental illness of any kind prior to the offense. The FBI could not determine if a diagnosis had been given in 37% (n=23) of cases.”

The report further clarifies the difference between having a stressor classified under the heading of “mental health” and actually having a mental disorder:

“There are important and complex considerations regarding mental health, both because it is the most prevalent stressor and because of the common but erroneous inclination to assume that anyone who commits an active shooting must de facto be mentally ill. First, the stressor “mental health” is not synonymous with a diagnosis of mental illness. The stressor “mental health” indicates that the active shooter appeared to be struggling with (most commonly) depression, anxiety, paranoia, etc. in their daily life in the year before the attack. There may be complex interactions with other stressors that give rise to what may ultimately be transient manifestations of behaviors and moods that would not be sufficient to warrant a formal diagnosis of mental illness.”

In fact, this new finding isn’t really new at all—it’s an enduring finding across a number of studies and comes as little surprise to those studying active and mass shootings. I’ve been writing about mass shootings for the past few years now, starting with the article “Running Amok” in Aeon magazine, in which I noted the lack of evidence supporting a clear link between mass shootings and mental illness.

“Efforts to profile mass shooters don’t support mental illness as a root cause. For instance, a 1999 publication by the US Federal Bureau of Investigation (FBI) suggested a wide variety of risk factors for school shooters, including depression, alienation, narcissism, poor coping skills, low frustration tolerance, lack of trust, fascination with violence-filled entertainment, negative role models, low self-esteem, access to weapons, and the tendency to manipulate others. Such wide-ranging warning signs result in a profile that has reasonable sensitivity (mass shooters often do have multiple risk factors), but very poor specificity (the overwhelming majority of people who have those same risk factors do not become mass shooters). This sets up the problem of ‘false positives’ in which widespread screening would lead to the inappropriate identification of large proportions of the population. While some might find that reasonable, they might also feel very different if they or their child was among those identified at risk.”

I echoed this conclusion in a follow-up blogpost here at Psych Unseen called “Mass Shootings in America: Crisis and Opportunity”:

“While a few mass shooters in history have indeed had serious mental illnesses, the more typical shooter has experienced the kind of milder difficulties with mood, anxiety, and social interactions with which most of us have some personal familiarity. That’s not to say that nothing was “wrong” or that they mass shooters are “normal,” but rather that they aren’t the distinct “others” that we make them out to be, particularly in the years or months leading up to murder where interventions might be most helpful.”

The new FBI report notes that among the 25 percent minority of shooters studied in Phase II who had a confirmed diagnosed mental illness, 12 had a diagnosed mood disorder; four had an anxiety disorder; three had a psychotic disorder; two were diagnosed with a personality disorder; one with autism spectrum disorder; one with a developmental disorder; and one was classified as "other." (A few shooters had more than one diagnosis.)

Note also that the FBI report includes no information about active shooters taking psychiatric medications. Although the FBI report does not say that active shooters weren’t taking psychiatric medications, the fact that so many of the shooters had no diagnosed mental illness suggests it’s unlikely in most cases (see my previous blogpost “Mass Shootings, Psychiatric Medications, and Rick Perry” for a brief discussion of this topic).

"In short," the FBI report concludes, "declarations that all active shooters must simply be mentally ill are misleading and unhelpful.” But once again, the lack of a diagnosis of mental illness doesn’t mean that active and mass shooters are mentally healthy. In most cases, they’re not. The same could be said for a substantial part of the “normal” population (if that strikes you as illogical, ask yourself whether most of the population is physically healthy). It’s also possible that some active shooters did actually have a mental disorder, but were undiagnosed and untreated. Either way, these shooters may not appear that different from you and me or our family members and friends, and there seems to be a window of time in which intervention might be possible.

So, while proposals for gun control are one popular response to the problem of mass shootings, let’s not neglect seeking answers to these questions:

► How can we promote mental health in a way that might deter the risk of active and mass shootings?

► How can we change a culture (or subculture) that glorifies gun violence?


To read more about the psychology of the gun control debate and about mass shooters, see:

The Psychology of Guns
Guns in America: What's Freud and Sex Got to Do With It?
Worshipping the AR-15: Cult, Church, or the American Way?
Mass Shootings in America: Crisis and Opportunity
Mass Shootings, Psychiatric Medications, and Rick Perry
When Racism Motivates Violence