The False Connection Between Mass Violence and Mental Illness

Andrew A. Nierenberg, MD

It is all too easy for politicians to, yet again, blame people with mental illness for the epidemic of mass shootings in the United States. It is also wrong.1 Study after study shows that those who live with serious mental illness are far more likely to be the victims of violence rather than the perpetrators.1 The narrative is, however, complicated because mental illness is associated with a statistically significant increase in violence, but accounts for only 4% of violent acts.2 In an FBI study of active shooters, 25% had a diagnosable psychiatric disorder and based on the literature determined that a psychiatric diagnosis was not a specific predictor of violence.3 In contrast, the group most likely to commit acts of mass violence are alienated young adult white males who have access to guns, especially high capacity automatic rifles. And if the cause is not mental illness in these young men, then what seems to be among the common variables? Alienation, isolation, rage in response to rejection or humiliation—especially by women, revenge after getting fired from a job, perceptions that one’s group is under attack (eg, that immigrants are taking over and threatening white control and white supremacy) or feeling screwed by the “system” magnified by social media, and sometimes a desire for fame or infamy.

To falsely blame those with mental illness for mass shootings is not only expedient, but leads to hollow calls for more facilities to lock up patients who have mental health challenges to protect the public; although it would be laudable to increase funding for psychiatric care and research, increases in funding rarely follow the hollow calls after a disaster. Rather than protecting the public, to blame the blameless leads instead to an increase in stigma for people who live with mental illness and their families.

To call those young men “sick” makes them “other” and confuses evil with illness. The argument goes that they must be sick to commit such heinous acts. But one does not need to have mental illness to act in ways that are vindictive, destructive, and evil. Then how can our society decrease the risk of these all too often mass shooting disasters? We cannot eliminate the conditions under which these men become enraged and violent. We can, however, restrict access to high capacity automatic rifles as was done in Australia in 1996, which led to a dramatic decline in mass shootings. As tragic and dramatic as mass shootings are, they account for a small fraction of the total deaths due to guns in the US; instead, two-thirds of all gun deaths are due to suicide and the risk of suicide by guns is higher than the risk of violence to others.4 This means that those who oppose reasonable gun control laws want people to have the right to go ahead and kill themselves.

To the politicians who oppose reasonable gun control laws, stop blaming people with mental illness and instead, consider banning automatic weapons as was done in Australia. And while you are at it, increasing funding for psychiatric care and research is still a good idea in and of itself.

Rozel JS, Mulvey EP. The link between mental illness and firearm violence: implications for social policy and clinical practice. Annu Rev Clin Psychol. 2017;13:445–469. doi:10.1146/annurev-clinpsy-021815-093459 [CrossRef]28375722
McGinty EE. Mental illness and gun violence: disrupting the narrative. Psychiatr Serv. 2018;69:842–843. doi:10.1176/ [CrossRef]29921191 A study of pre-attack behaviors of active shooters in the United States between 2000 and 2013. Accessed September 10, 2019.
Baumann ML, Teasdale B. Severe mental illness and firearm access: is violence really the danger?Int J Law Psychiatry. 2018;56:44–49. doi:10.1016/j.ijlp.2017.11.003 [CrossRef]29701598

Andrew A. Nierenberg, MD, is the Thomas P. Hackett, MD, Endowed Chair in Psychiatry, the Director, Bipolar Clinic and Research Program, and the Director, Training and Education, MGH Research Institute, Massachusetts General Hospital; and a Professor of Psychiatry, Harvard Medical School.

Address correspondence to Andrew A. Nierenberg, MD, via email:

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