The following is the transcript of a video presentation by Jeffrey A. Lieberman, MD, which was published in MedScape on August 6, 2019:

COMMENTARY

Stop Scapegoating Mental Illness for Mass Violence

This transcript has been edited for clarity.

This past weekend, in a little over 24 hours, gun violence claimed the lives of 30 people and injured dozens more. Almost as tragic as the incidents themselves is the fact that mass shootings have become a routine part of life in America. It no longer feels unusual to turn on the news and see the mugshot of another angry young man who has committed another act of violence targeting multiple innocent victims, leaving behind nothing but an angry manifesto, a trail of dead and wounded bodies, and a host of unanswered questions.

In the aftermath of these incidents, an all-too-familiar scenario unfolded. The media and public erupted in outrage and emitted cries of “never again.” After the chest-thumping died down, the soul-searching began and the requisite question of “why” was asked, along with calls for action to prevent such events in the future. Politicians and pundits then solemnly weigh in with sanctimonious platitudes, and eventually the argument devolves into the familiar refrain of name-calling and partisan bickering, where no consensus is ever reached and nothing is done to prevent these shootings from happening in the future.

In this political theater, mental illness too often becomes the convenient scapegoat that is used to deflect attention from other causes, such as the NRA, ineffective gun control laws, a culture of hate, and the lack of respect for morals and laws. However, the data expose the mendacity of this claim. In 2019 alone, there have been 255 reported and verified mass shootings in the United States. These happen in the places we visit in our communities every single day, from schools and religious institutions to shopping malls and movie theaters.

The perpetrators of these crimes are uniformly male and can be categorized by their motivations: ideology, disgruntled at work, disaffected loners, and untreated persons with mental illness. A recent white paper by an expert group of mental health providers, law enforcement officials, and educators, commissioned by the National Council on Behavioral Health, found that approximately 25% of the perpetrators were mentally ill and their symptoms appeared to be a motivating factor. They suffered from a relatively small number of disorders, including psychotic, mood, and PTSD. Thus 75% of mass murders were caused by people doing so for reasons other than mental illness. Moreover, the main diagnoses of those mentally ill perpetrators have comparable frequencies of males and females being affected, yet almost 100% of the culprits were male. This clearly implicates other factors in prompting people to commit these heinous crimes, such as ready access to weapons, a permissive culture with relaxed restrictions that encourages individual expression, the Internet, ubiquitous exposure to violence in the entertainment media, and the prevalence of recreational intoxicants.

Another analysis, reported in The New York Times, “What Explains U.S. Mass Shootings? International Comparisons Suggest an Answer,” disentangled the variables of mental illness, treatment, and violence. It found that the rates of severe mental illness and crime in the United States are comparable to those seen in other wealthy countries. Yet crime in America was found to be more lethal due to the greater availability of guns.

I find it ironic that psychiatrists should have to caution people not to falsely pathologize objectionable behavior when we are so often accused of broadening the DSM boundaries by doing the same. It’s also reminiscent of the slippery slope of using mental illness as a scapegoat for politically dissident or potentially dangerous behaviors.

In America we pay a price for our cultural openness and individual freedoms of beliefs and expression. We are the engine of the world’s innovation and creativity. However, there is a dark side to this unless we do something to stop it.