Mass Killing and Mental Illness

By Dr David Laing Dawson

Two serious online Psychiatric journals recently implored us to not “equate mass killing with mental illness.”

While the impulse to avoid further stigmatizing mental illness with the burden of mass murder is admirable, simply labeling these killers as bad, evil, amoral, racist, or, as one of the authors called them, “terrorists”, is not in the least helpful.

The information I have on the mass killings of the past 30 years is limited to that which is eventually revealed in the public media, but it is enough, I think, to make these judgements:

For the older men (40’s, 50’s, 60’s) the pattern is often one of a psychotic depression. Failure, a loss of relationship/job, long standing grievances and obsessions, blaming, nihilism, depression, despair, anger and suicide. They shoot up the doctor’s office, the emergency room, the post office, the place of recent employment, the extended family, the perceived cause of their pain and failure, and then themselves.

For the younger men (late teens, early twenties) the pattern is one of a developing psychotic illness like schizophrenia: social isolation, imposed by personality, disability, or illness, failures, grievances, seeking meaning and explanation in the wrong places, finding one, a simple satisfying explanation for all that is wrong, one that also provides a cause or source.

Plus that moment of slipping from obsession to delusion, a delusion in which the young man developing a psychotic illness now believes he is a major player, that he must act to ….., that he has been chosen for……., that he must die in a grand gesture for…..and then be remembered for….

I have been there many times in the past 50 years when young men reached that point. Fortunately not one had access to handguns or AR 15’s. And usually, almost always, the organizing principles, the delusions they arrive at, are only harmful to themselves and their families.

One decided he was Hitler’s illegitimate son. One stabbed his father who was “possessed by evil”. One decided to don the robes of Christ and preach to the masses as he wandered the continent. One did decide to borrow his uncle’s hunting rifle to kill the kids at school who had bullied him, but his right arm froze. Another unfurled a flag on the roof of the police station. Another jumped off a school roof, commanded to do this, to save the world. Another sought the home address of his nurse counselor so that he might kill her and rid the world of evil. Another stopped talking, went mute, lest his words cause more floods and famine. More than a few have come to the conclusion that the police and/or the government are controlling them, have implanted chips in them, listen to them, watch them day and night. Some have wondered if I am part of this evil cabal. And many, in the last 15 years, have fallen down the rabbit hole of internet conspiracy theories.

But none had easy access to weapons of mass killing.

So yes, in both those age groups, at the expected age of onset, mental illness is often a factor, along with easily attainable weapons. And of these two factors the latter is far more amenable to prevention.

3 thoughts on “Mass Killing and Mental Illness

  1. It would be wiser if the journals in question stopped playing a game that cannot be won . Political correctness serves absolutely no purpose, if it avoids the truth . Clearly better outcomes come about by facing the obvious, that delusional illnesses can lead to some very painful tragedies. Available appropriate safe health care for such ailing individuals ( and better mental health legislation would help) to reduce the number of deaths. In the U.S guns are multipliers to such events .
    Many people in a psychotic episode can frequently fool the Emergency Department . The family who usually know the extent of the delusions, but are often ignored, have ended up dead.

    I once asked a very nice young man ” What could have been done to save the tragedy from happening ” ? This university student had killed his parents before his illness was stabilized. He pondered and said he believed that nothing could have been done. But clearly the family should have been listened to. A safe secure space was required until his delusions were culled.

    On another occasion in the 1960s at a hospital in Cambridge U.K a postpartum woman was transferred with her newborn(second child) to the local psych hospital where I was a staff nurse. The highly intelligent woman had had a psychotic episode after she gave birth to her then 4 year old. He had grown into a lovely little boy and she would proudly bring him to her appointments . SO there was a past history as a warning.

    Anyhow a somewhat senior nurse to me, said the day old newborn should be in the room with the mother for BONDING ! The bonding business was fashionable at the time. I ask you… where truth and common sense was in the nurses head. I lost the argument. Within a few hours, the baby was thrown hard across the the room into a nurses arms . There were three gobsmacked nurses in the room ! Sometimes the reality principle needs to win the day. Often it does not.
    That was then in 1960or so. In 2022 There is even less health care for very real situations which ensue from untreated mental illness. What can be done?


    1. I have cast out the ridiculous term “mental illness” from my lexicon to the extent that is possible and still be understood. However, I would answer your question to say that there needs to be a massive public re-education campaign for Brain Health Awareness. Cerebral illness is just not something can be understood intuitively, and some people may not have the metacognitive powers to every understand. It took me over 10 years of calling myself an advocate before I came to see that “psychosis” involves a disordered state of consciousness. Some in the medical professions would assert that delirium is overlaying psychosis in some cases, but then what is so-called delirium. It is a type of “psychosis”, albeit involving a different form of disorientation, and have an underlying cause that is not neurodevelopmental in nature.

      Mental Health Awareness is a legacy of the Mental Hygiene Movement which was premised on the gross fallacy of so-called mental illness being caused by maladaptation to life’s difficulties and family dynamics. Today the watchwords are ‘childhood adversity’, resilience, transgenerational trauma, etc. We have never recovered from Freud and from Meyers’ Mental Hygiene Movement. In fact, society is slipping farther and farther away int the realm of pseudoscience and nonsensical psychological ideas about human behavior.


  2. There is such a thing as the biopsychosocial theory of what causes so-called mental illness So called, because I think “mental illness” is a ridiculous term that needs to be done away with. This blog article seems to be putting forth a biopsychosocial cause for violence in which “mental illness” is just one factor.

    I wholly disagree with that proposition. So-called psychosis (another legacy term of misguided beliefs) is a neurological status that cannot just be relegated to being a factor. If a man hates women and loves violence video games, for example, if he is connected to reality, not in a state of disordered consciousness, he is just a vile man that hates women. He may treat women very badly but he will not walk into a facility and gun down women. So-called psychosis exploits whatever skills a person has or underlying attitudes, hijacking them and expressing the disordered state of consciousness through them like an interface. I also think that the term ‘depression’ is problematic. Biological psychiatry (another term that ruffles my feathers…anything to do with psychiatry really) shares the same terminology with psychosocial psychiatry and that is a huge problem. I think the term depression is the wrong term for what is a form of dysphoria and probably an altered state of consciousness…some type of severely disordered neurocircuitry. I think the term ‘depression’ should be reserved for psychosocial issues.

    The criminal adjudication system operators such as prosecutors, judges, “forensic” clinicians (who should call themselves criminologist rather than clinicians) all try to piece together the biopsychosocial and as a result, find cause for criminal responsibility in almost every case. “Forensic” clinicians’ favorite, go to quack diagnoses are dissociative disorders, depression or “personality disorders”. The fingerprints of “forensic” psychiatrists and psychologists are on the unjust convictions of hundreds of thousands of people that have a severe cerebral disorder or illness.

    “Psychosis” has something to teach human beings about what they really are and how brutal and disordered nature is…dashing ancient notions of good and evil. Human beings only understanding of themselves is through religion and psychology…and most of what those belief systems have to tell us are flat out wrong. That is not to say that there is no evil in the world driving violence and bad behavior, but in the most horrific and bizarre episodes of violence, brain dysfunction is to blame. Many of these mass shootings and intrafamilial killings are what I would call natural disasters – except to the extent that many are preventable. We cannot prevent what we fundamentally and profoundly misunderstand.


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