Clare S. Allely, a reader in forensic psychology at the University of Salford, recently published a case report in the journal Aggression and Violent Behavior that examined the role of psychopathology in the mass shooting carried out by James Holmes in Aurora, Colorado.

Allely, who is the author of the new book “The Psychology of Extreme Violence: A Case Study Approach to Serial Homicide, Mass Shooting, School Shooting and Lone-actor Terrorism” and also an affiliate member of the Gillberg Neuropsychiatry Centre at Gothenburg University in Sweden, found strong evidence that Holmes suffers from a chronic and severe mental illness associated with psychotic features.

This finding is based in part on the treatment he received when he was at graduate school and interviews conducted by psychiatrists Jeffrey L. Metzner and William H. Reid, who interviewed Holmes during his court trial.

Allely told PsyPost about her investigation into Holmes and other mass shooters. Read her comments below:

On May 23, 2014, a 22-year-old man embarked on a “premeditated, murderous rampage” in Isla Vista Santa Barbara, California killing six people, and himself and injuring 14 others. On December 14, 2012, a 20-year-old man shot his mother multiple times in the head before going out and killing 26 people, 20 of them young children, inside Sandy Hook Elementary School in Newtown, Connecticut. A man known as the “Unabomber” sent through the mail or hand delivered 16 package bombs mainly to scientists and academicians over the course of 17 years, which resulted in the death of three and the injury of 23 people. On July 22, 2011, a Norwegian man killed 77 people during two well-planned attacks. The first involved the bombing of government buildings in Oslo and the second the shooting spree on the island of Utøya.

In the aftermath or detection of such tragedies and extreme acts of violence, I always find myself asking the same questions. What motivated the individual to carry out such extreme acts of violence? Where they mentally ill? Where they insane? Did they have any brain abnormalities that may have been one of the contributory factors giving rise to the extreme act of violence? Did they come from an abusive background? What red flags or warning signs did they individual exhibit in the days, months or even years leading up to the tragedy? And crucially, could it have been prevented?

These are the questions which interest me in this topic and propel me to carry out research in this area in order to further our understanding of these extreme acts of violence and how we can avoid more of these tragedies in the future.

Despite popular interest in this topic and the importance, there is relatively little empirical research investigating such extreme acts of violence. As a result, there are still many unanswered questions.

My colleague Dr. Lino Faccini and I are trying to add to the limited body of research in this area by adopting a case study approach to further our understanding of some of the factors involved in the pathway to intended violence.

We have explored the path to intended violence using a case study approach in a number of contemporary mass shooter cases including: Anders Behring Breivik, Elliot Rodger, Dean Allen Mellberg, Adam Lanza, and Dylann Roof, amongst others. By adopting this approach, we aim to identify the critical and distal factors that contributed to the act.

Similarly, in the article on James Eagan Holmes, by identifying the instigators and situational factors (impelling or disinhibiting) it could help to increase understanding of potential points in the pathway to intended violence where intervention can disrupt the process (the pathway to violence).

(In the case of Holmes, some these factors included his breakup with his girlfriend, academic failure at graduate school, chronic mental illness with psychotic features, and “overcoming fear” of the consequences of killing people.)

I think the takeaway message from the article is that it will always be extremely challenging to predict which individuals will go on to perpetrate a mass shooting attack, particularly given the relative rarity of such acts. We will never be able to predict with accuracy which individuals will go on to engage in such extreme acts of violence – for instance, there would be too many false-positives.

Nevertheless, it is important to emphasise that there does exist specific features in the individual in the months or even years leading up to the attack that can indicate the need for the mental health professional to refer the individuals to further, intensified primary care.

For example, social isolation and limited social support has been highlighted by Fox and Levin (1998) to be a common feature in shooters. However, it is important to recognise that an isolated individual who is contemplating violence following a strain (such as a divorce, losing a job or custody of children) is unlikely to seek psychological help/support from mental health professionals.

Having rudimentary psychological services (which have the ability to refer the most at-risk individuals on to appropriate services) readily accessible may be one way to address this issue. Such rudimentary services may be able to help an individual to the point where they are no longer an immediate threat, considering violence to be their only option.

But there are currently insufficient mental health services available. For instance, it has recently been pointed out that “school-based mental health services are lacking or often fragmented, marginalized, and/or underutilized despite the federal mandate to improve education for the whole student” (Lenhardt, Graham & Farrell, 2018, p. 17). It has been argued that schools should be enabled to hire more school-based mental health professionals (e.g., school counsellors, school psychologists and school social workers) and that there should be funds which are allocated for hiring these mental health professionals.

Additionally, there is a need for more intensive specialized mental health screening of troubled students in school-based programs so they can receive the help and support that they need. Such services would be important regardless of whether the individual would go on to carry out an extreme act of violence.

There are many individuals who need such support and services who do not carry out extreme acts of violence but are, for instance, experiencing worsening mental health issues, are unable to obtain a job, unable to develop romantic relationships, etc. These are still potentially negative consequences of the lack of appropriate and timely services for these vulnerable individuals.

There is also the need to understand what the protective factors might be. Protective factors are those factors which prevent or reduce the risk of the individual carrying out an extreme act of violence (despite, for instance, having similar risk factors as individuals who do go on to perpetrate such an act).

It is now well recognised that shooting attacks are rarely impulsive and are typically methodically well-planned over some time. This means that warning behaviors will be exhibited by the individual before the attack takes place.

The vast majority of mass shooters are not individuals who simply “snap”. However, Professor Mary Ellen O’Toole and her colleagues have argued that, by the time warning behaviors are exhibited in the individual, it may be too late.

Trying to identify the early warning signs of antisocial behavior or mental health conditions, and addressing these issues as early as possible in the developmental trajectory may be more effective in trying to avoid these tragic events.

Indeed, there is evidence that suggests that treatments that are specifically focused on children who are exhibiting early signs of behavioral risk are more effective. More school-based mental health services is one promising approach to identifying and addressing the mental health concerns of young people. Additionally, there is a need for more funding for programs for young people already suffering from mental illness and individuals at risk.