As reports began to appear of the disturbed background of Aaron
Alexis, the media seems to have universally decided that mass
shootings are readily explained by severe mental illness.
The assumption is that as psychiatric disorder is so obviously
linked to violence, there should be no surprise that the Washington
Naval Yard killings involved someone with a mentally troubled
New research finds that media reporting of mass murder, such as
this most recent tragedy, leads to more negative public attitudes
to the mentally ill. This in turn may contribute to a pessimistic
stereotyped image for psychiatric problems and services. As a
result, people who suffer symptoms, as it appears Aaron Alexis
could have, may not access treatment which possibly prevents these
A vicious cycle is thus created, ironically perpetuated by media
coverage. Is it possible the reporting is part of the cause of such
senseless violence? Not because this encourages one sub-type of
mass killers - 'infamy seekers' (which it may do) but also as it
may discourage early psychiatric intervention?
Emma McGinty, Daniel Webster and Colleen Barry, from the Johns
Hopkins Center for Gun Policy and Research, and the Johns Hopkins
Bloomberg School of Public Health, Baltimore recently found that
reading a news story about a mass shooting, heightened negative
attitudes toward sufferers from mental illness.
The study entitled 'Effects
of News Media Messages About Mass Shootings on Attitudes Toward
Persons With Serious Mental Illness and Public Support for Gun
Control Policies', involved a national sample of almost two
thousand participants. Their findings suggest public perception is
that serious mental illness, more than access to guns, accounts for
The study, recently published in the 'American Journal of
Psychiatry', concludes that in the aftermath of mass shootings, the
barrage of news stories describing the shooter with psychiatric
symptoms, his history, and his actions during the shooting might
raise public support for gun control policies. But such coverage
also contributes to negative attitudes toward the mentally ill.
The authors go on to point out that pessimistic public attitudes
are linked to poor treatment rates among persons with serious
mental health conditions.
But if there were better psychiatric services, and if the taboo
surrounding mental illness was less, so more people accessed better
treatment earlier, would it make a difference to these tragic
shootings? Could psychiatric interventions prevent these atrocities
in the future?
'The American Journal of Psychiatry' was partly prompted by the
Johns Hopkins media effects study, to wrestle with the question of
how psychiatrists could make a difference to the apparently rising
incidence of mass killing incidents.
Psychiatrists Richard Friedman and Robert Michels, were in fact
responding to the Newtown Connecticut school shooting, at the time
of their editorial. Yet their comments anticipate the likelihood
that such tragedies would recur soon.
They did indeed, when Aaron Alexis recently killed 12 people in the
Washington Naval Yard.
The media reports suggested the navy contractor was wrestling with
mental illness. He appears to have been hearing voices and
complained he was being followed by people using a microwave
machine to send vibrations through his body.
Doctors Friedman and Michels agree that mass killings attract the
kind of blanket media coverage which can create misleading
impressions. For example, the attention they attract distracts from
the fact mass killings are very rare. Friedman and Michels point
out that in 2011, mass killings accounted for only 0.13% of all
homicides in the United States.
Friedman and Michels believe the conundrum the public find most
difficult to grasp is that although mass murderers probably suffer
more mental illness than other killers, the mentally ill as a group
actually pose relatively little risk of violence.
For example, their editorial entitled 'How
Should the Psychiatric Profession Respond to the Recent Mass
Killings?' quotes that only 4% of violence generally can
be attributed to persons with mental illness. The prevalence of
violence amongst those with serious mental illness throughout their
lifetime is 16%, as compared with 7% among people without.
Alcohol and drug abuse are far more likely to produce aggression.
Those who abuse alcohol or drugs but have no other mental disorder,
are nearly seven times as likely as those without substance abuse,
to commit violence.
One possibility is that improving mental health services might make
a difference; Aaron Alexis appears to have fallen through the net
But, remarkably, should a psychiatrist have been able to evaluate
this man before the shootings, suffering though he appeared to be
from hearing voices and delusions, it's not clear he could have
been easily detained involuntarily by current mental health
legislation. The law, both in the USA and the UK, supports doctors
in seeking involuntary admission to hospital, only if they can
convince the authorities that a patient is an immediate danger to
himself or others.
Perhaps in the wake of these recent shootings, involuntary mental
health legislation and practice should be loosened from 'imminent
danger', to a 'reasonable likelihood of violent behaviour'.
But Friedman and Michels argue that lowering the threshold for
involuntary treatment could discourage consulting doctors. People
could become more wary of being candid or seeking help
Heightened fears of being committed to an institution against their
will, might mean some of most unwell patients would be driven
further away from the mental health system.
Mental illness is very treatable, and sufferers can and do return
to productive well-being with the right healing, implemented early
enough. Yet the fear of being 'locked away' forever in an asylum
continues to stigmatise the system.
As psychiatrists, when we hear these tragic stories of what mental
disturbance lay behind a mass shooting, we have a further concern.
It is that sufferers from these severe psychiatric symptoms, over
and over again, were not receiving adequate treatment.
The media clouds the key lesson to be learnt, which is that it's
neglected and untreated mental illness, not psychiatric disorder
alone, which is involved.
If the truth was more widely understood, about how effective modern
treatment of psychiatric problems can be, particularly if dispensed
by properly trained professionals, then it is possible that these
incidents could indeed become rarer. Clinics might then attract
adequate public funding, and even better clinicians, which would
all help services become ever more effective.
Some may possibly argue that even the best mental health system
would likely have little impact on deterring mass killings, as some
of these killers largely avoid psychiatric treatment - but for the
others - and those who might be influenced by friends and relatives
observing something amiss, we still believe there could be a
If the USA is not going to embrace tougher gun control, as it
appears reluctant to, then it may well be even more imperative they
develop absolutely excellent mental health services.
In the aftermath of yet another mass shooting tragedy, this might
just be our only hope.
Raj Persaud is joint podcast editor for the Royal College of
Psychiatrists and also now has a free app on iTunes and google play
store entitled 'Raj Persaud in conversation',
which includes a lot of free information on the latest research
findings in mental health, plus interviews with top experts from
around the world.