German Lopez: What do we know about a connection between mass shootings and mental health?

Jonathan Metzl: In the work that I do, I construct arguments that call on the growing body of gun research in fields such as medicine and public health.

One is that there's no real way of predicting a mass shooting. Mass shootings are very often statistical anomalies. The trouble people get into a lot of times is that they think, "Oh, he must have been crazy or something, and a psychiatrist should have been able to see him before and predict it." That's a complete miss, unfortunately.

As an aggregate group, people with mental illness are less likely than the general population to shoot other people, and they are far more likely [to be] victims of violence rather than perpetrators of violence. So I think this intense psychological profile of mass shooters as a way of preventing other mass shootings is really the wrong path to go down, even though it's understandable.

"People with mental illness ... are far more likely [to be] victims of violence rather than perpetrators of violence"

Point number two is that there is research that shows a certain proportion [up to 60 percent] of mass shooters do have some kind of psychiatric or psychological symptoms. As an aggregate group, mass shooters are very often young, white, paranoid men who've had histories of depression and possibly sometimes psychosis. So at least there are profiles that can allow you to aggregate some of these mass shooters into particular groups.

But there are a lot of other factors that aren't linked to mental illness that are equally predictive if not more predictive: access to firearms, substance use or abuse, and past history of violence or arrests. These are all far more predictive than a diagnosis of mental illness — and they're more preventive in the long run.

So while I do think there's a particular profile that many mass shooters fit into, the problem we get into when we diagnose the individual mass shooter and say mental illness is the cause is twofold. One, mental illness is really not causal for shootings; there's no mental illness that causes people to shoot other people. Two, focusing on mental health takes the shooting out of context. If you look at recent mass shooters, whiteness, for example, is a theme that runs through many, many mass shooters, but we would never say whiteness is a cause of this. It shows we collapse and oversimplify the roles of mental illness in shootings, and mass shootings in particular.

German Lopez: The way I look at it is that there are some serious mental illnesses like psychosis or schizophrenia that might contribute to mass shootings, but the vast majority of people with these conditions are not going to participate in an event like this. Is that correct?

Jonathan Metzl: Yeah.

One of the major symptoms of schizophrenia is what are called negative symptoms: people with schizophrenia, they tend to stay home because they lack energy. So even though people tend to jump on schizophrenia as the cause of the cause of many mass shootings, if you look at people diagnosed with schizophrenia as an aggregate group, people with schizophrenia aren't more likely to shoot other people than are sane people. In other words, we might do better by looking at predictive factors from people we deem sane. I can't say that more clearly.

I understand why people jump to this narrative. It's because mental illness is some sort of contributor. And killing strangers seems so far outside the bounds of civilized society and sanity that looking to insanity is understandable. But at the same time, there's no causal link between the diagnosis of something like schizophrenia and shooting somebody else.