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In Wake of Texas Massacre, Calls For Closer Look At Link Between Mass Shootings, Suicide

Getty Images | NPR

After mass shootings, mental health professionals find themselves at pains to explain that people with mental illness are more likely to be victims of violence than aggressors.

And they’re more likely to die by suicide than to harm others.

That’s again been part of the conversation after the Texas church shooting in which 26 people died, and the shooter, by several accounts, dealt with some form of mental illness or instability, including erratic, violent behavior.

The debate after such incidents often seems to divide into two camps: those who say mental illness accounts for such violence and those who deny that link. 

The truth lies somewhere in the middle ground, and not in such blanket statements, according to Dr. Dan Potenza, psychiatric medical director for the N.H. Dept. of Corrections and chairman of the N.H. Suicide Prevention Council.   (Listen here for the full Exchange conversation: Mental Illness and Mass Shootings: A Misplaced Connection?)

“We have to look at the logic of the situation,” said Potenza.  “A mindset for violence does not equate to mental illness, but it often gets transformed into that.”

Still, Potenza said, the fact that many of these mass shooters end up taking their own lives suggests there’s a real need to scrutinize a possible link between suicide and mass homicide. 

“There is a component about folks who may have some inherent suicidality, where most of these folks expect to die in these mass shootings,” Potenza said. “And is there an element of their intent to die, their suicide intent, that we should also examine?”  

The American Association of Suicidology recently called for more scrutiny of the apparent link between suicide and mass shootings.

“It is imperative that more research is funded and conducted to help us determine who is at most risk of suicide and killing others as part of their suicidal act,” said Julie Cerel, PhD, President of the American Association of Suicidology.

Our family has had a lot of mental illness from both sides of the gene pool and the combination has been catastrophic on many levels. We’ve had physical violence. Some of it is suicide, but some of us think that it's okay if we kill somebody because we can bring them back to life. I beg mental health professionals: Please stop debating and triaging what’s mental illness versus mental state in this manner. Instead reopen a sane mental health system so that people have a place to go. My bipolar brother, bless his heart, fights to stay on his meds, but he has to fight tooth and nail to get access to treatment, to see somebody, to find out is he acting weird or not acting weird because he doesn't know. -- Martha

Some research finds that a subset of people with mental illness – men who struggle with schizophrenia  -- are more likely to commit violent acts, particularly if substance abuse is involved. These are generally not mass shooters, however, said Potenza.

In fact, said Dr. Nicole Sawyer, people with schizophrenia who are exhibiting  paranoid and violent behavior are more likely to harm those closest to them rather than attack random strangers.  

“Family members, supporters, caregivers --  those are going to be the recipients of that violence more often than not. These are not people going out into their communities and getting on top of buildings with AR 15s. That is highly unlikely.”

Other Comments

Nicole Sawyer: I feel very protective of the people that I treat because I know that stigma has a deep impact on people's willingness to seek help, on people's willingness to be open about the help that they need. When you have a person who is maybe just on the cusp of stepping up and reaching out for help and they hear a statement like:  ‘Oh well, my gosh, you said you're not feeling well. Are you dangerous or should we be concerned about you or your safety with others?’  they immediately retreat into the darkness; they disappear again into the cracks, waiting for the next opportunity to present themselves.

Peter Evers, CEO of Riverbend Community Mental Health:  Last year, there were 30,000 gun deaths in America I believe. Two-thirds of that number were suicides. So, yes, there is a link between an individual who is suffering greatly, in psychic pain, and self-inflicted violence. And when people have guns, that’s the most lethal means of taking a life. It's much more lethal than a knife or a bottle of pills.

Sawyer: We all from time to time have irrational paranoid thoughts. We can all probably relate to the hurt or rejection that results from social or emotional rejection --   a relationship breaks up; you have a sudden job loss or are rejected from a job.  For most of us who are well and have relationships, we rely on our family and friends to support us and tell us, It's going to be okay; we're going to get through this. But for isolated individuals, for angry individuals, for people who are feeling marginalized or people who are feeling persecuted, if they don't have that support system bringing them back to that rational state of mind..then we're talking about that unwellness possibly drifting into a place of unchecked irrational behavior.

Dan Potenza:  We will treat people who have violent history and violent tendencies. That does not mean they have a mental illness…It's very important that we can contribute as mental health professionals to our society, to helping identify and decrease violence, without necessarily calling it a mental health problem.

Sawyer:  Violence from a cultural standpoint is perceived as being a more acceptable outlet for men than women in general.  I think that recently there's a growing perception of men feeling more marginalized and more persecuted. There are people feeling less access to jobs and less access to healthcare. That is making people feel less empowered. So for men when this begins to happen and they're feeling as though they aren't employable and they're not able to support their families and there's a rhetoric that's going on in the media that's supporting their idea of being marginalized and  persecuted, if they're a person who is prone to irrational thinking and if they're a person who's prone to violent fantasy, that could potentially be paving a way for acting out behavior. 

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