In just under six weeks, the United States has had to grapple with two mass shootings in Las Vegas and Texas that left a total of 85 people dead.
As investigations continue, the notion that the shooters had to be mentally ill has been brought up by many people, including President Donald Trump during a press conference last week.
Just one day after the mass shooting at a Texas church, the president called the massacre the result of “a mental health problem at the highest level.”
But experts in psychology and mental health say the president’s statement isn’t only wrong — it could also be dangerously stigmatizing.
Past research has found people with mental illness are 10 times more likely to be the victim of a crime than to perpetrate one.
Additionally, the American Psychological Association (APA) found in one study that just 7.5 percent of crime was related to mental illness symptoms.
Experts say that while it’s understandable questions arise about a shooter’s mental health and sanity after a mass shooting, these acts can and often are perpetrated by people who are sane.
What is mental illness?
Mental illness is defined by the APA as “health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”
Joel Dvoskin, PhD, a clinical psychologist based in Arizona, explained that the president’s statement could be harmful by equating violence with mental illness.
Dvoskin told Healthline that the president defined mental illness by linking it to violence by saying, “You’d have to be ‘crazy’ to do something like that.”
“If that’s true, then everyone who does it by definition is mentally ill, but that’s not the definition of mental illness,” he said.
Dvoskin said people with severe mental illness are generally less likely to commit gun violence against others.
“If you think about it, in order to have a gun you have to be organized, you have to have money,” he explained. “You have to get a license, you have to buy one. If people [have severe mental illness], they’re less likely to do that.”
Dr. Ramani Durvasula, professor of psychology at California State University, Los Angeles, explains that despite the headlines, mental illness and mass homicide haven’t been proven to be related.
“Committing a horrible act and mental illness, they’re two independent issues,” she told Healthline. “Is it possible that someone with mental illness could commit a terrible act? Yes… But the one implying the other is a completely incorrect assertion and is a potentially dangerous assertion.”
Instead, Durvasula said people who have a hard time regulating emotion may not reach a threshold to be considered mentally ill. But they may be more likely to commit violence.
She points out that a history of perpetrating domestic violence or acting out of anger would likely be better predictors of future violent episodes, rather than a diagnosis of depression or bipolar disorder, for example.
There have been some studies that found people with substance use disorders, schizophrenia, or bipolar disorder are increasingly likely to commit a violent act. But this risk is also related to multiple other factors, including family history, personal stressors, and socioeconomic factors.
Antonio E. Puente, PhD, president of the APA, said in a statement that while there are risk factors associated with gun violence, mental illness isn’t one of them.
“The vast majority of people with mental illness are not violent,” Puente said. “A complex combination of risk factors, including a history of domestic violence, violent misdemeanor crimes and substance use disorders, increases the likelihood of people using a firearm against themselves or others.”
Who will become violent?
The increasing rate of mass shootings has put pressure on mental health experts and law enforcement officials to identify and stop those likely to commit these acts early.
However, Dvoskin and Puente explained the signs that someone may commit a mass shooting is often too vague to pinpoint.
“For every lonely, angry, disconnected person who commits a crime, there are tens of thousands that don’t commit that crime,” Dvoskin said.
He added there’s one clear red flag that should always be taken seriously: a threat.
“The red flag is when somebody says, ‘I’m going to kill myself or kill a bunch of people.’ That’s the red flag, and it must never be ignored,” he said.
However, Puente said there’s little scientific evidence in identifying mass murderers that can help authorities before a shooting.
“If we look at the science of mass murders... it’s really next to impossible to predict this behavior,” he said. “The science of violence, whether it’s terrorism or mass shootings, is very, very poorly understood.”
Durvasula said that past violence, especially domestic violence, is a warning signal that someone can’t regulate their emotions properly. As a result, it could be thought of as a serious sign of future violence.
“I think domestic violence is a really important canary in a coal mine,” she said. “It’s a really important marker variable for somebody who is incapable of regulating emotion, rage, violence — even in the relationship in which they need to feel the most safe.”
Stigmatizing mental illness
All three experts interviewed by Healthline expressed concern that officials publicly linking mental illness and a mass shooting, without good evidence, are likely to hurt those with actual mental illness.
“If you have mental illness and you hear comments on the national and international level” about these shootings, said Puente, “one may feel uncomfortable in admitting and acknowledging and seeking out the necessary intervention.”
Puente also pointed out that federal funding for mental illness treatment has been slashed under the past three presidential administrations.
“On the one hand we’re being stigmatized, and on the other hand we’re not given the opportunity to take care of those individuals, so it’s a double jeopardy situation,” he said.
Durvasula said that the more people blame mass shootings on some version of “mental illness” without any evidence, the more likely people may avoid getting treatment.
“I can see how it might keep people in the shadows, not only for themselves, but for family members who are unwilling to say, ‘You know what, you need help,’” she said. “In our society, if we’re conflating mental illness with mass shooting, that is an incredibly adverse association.”