Is there a link between mass shooting and mental illness?
In Stephen King’s The Shining, the character Jack Torrance epitomises the popular horror trope of crazed killer who can no longer distinguish reality from hallucination. As Jack slowly descends into madness, he befriends a number of murderous spirits who eventually convince him to kill his wife and son – or die trying.
在斯蒂芬·金（Stephen King）的小说《闪灵》中，杰克·托兰斯（Jack Torrance）这个角色是人们熟悉的恐怖形象的缩影，即分不清现实与幻觉的疯狂杀手。当杰克慢慢地陷入疯狂的时候，他结交了几个凶残的鬼魂，最终说服他去杀死自己的妻子和儿子，至死方休。
The audience may conclude that Jack fell victim to an evil, supernatural force occupying the story’s famous hotel. Or they may interpret his downward spiral in a very different way: that Jack was a mentally ill man – likely schizophrenic – in the grips of a violent psychotic episode.
The Shining is clearly a work of fiction. But when it comes to mental illness and violence, the public, media and policy-makers often have difficulty discerning fact from fantasy. Opinion polls consistently reveal that the majority of adults in the US believe that people with mental illnesses are more likely to be violent than those without.
《闪灵》显然是一部小说。 但是在精神疾病和暴力方面，公众、媒体和政策制定者往往难以辨别想当然与事实。 所有的民意调查一致表明，美国的大多数成年人相信，精神疾病患者比没有精神疾病的人更容易出现暴力行为。
That assumption is further reinforced each time a new mass shooting takes place, inevitably followed by calls for mental healthcare reform. But what does the evidence say about the relationship between mass shooters and mental illness? Are these acts of violence really a mental health problem?
每当新的大规模枪击案发生，这种想当然就会得到进一步加强，之后必然有关于精神医疗改革的呼吁。 但是，有证据表明大规模枪击案和精神疾病之间是相关的吗？ 这些暴力行为是否真的是精神健康问题？
If social media and sensationalist headlines are a guide, the fear of extreme violence from the mentally ill is common. “The idea of losing the capacity to control one’s thoughts or behaviours is scary and alien, which translates into fear of mental illness – particularly in its more severe manifestations,” says Paul Appelbaum, a psychiatrist at Columbia University College of Physicians and Surgeons. “We also have a tendency as human beings to pay particular attention to unusual events in our environment, so when acts of violence are committed by people with mental illness, they may be particularly salient in our minds.”
如果社交媒体和耸人听闻的新闻标题是一种导向，那么可以说，对于精神病患會产生极端暴力的恐惧应该是比较普遍的。哥伦比亚大学医学院(Columbia University College of Physicians and Surgeons)的精神病学家阿佩尔鲍姆(Paul Appelbaum)说，“想到人会失去控制自己思想或行为的能力，是相当可怕而又感觉怪异的，这可以理解为是对精神疾病的恐惧——尤其是对行为严重的精神病。作为人类，我们也有一种倾向，那就是特别注意我们的环境中非同寻常的事件，所以当患有精神疾病的人犯下暴力行为时，也许我们的大脑中的印象尤为深刻。”
Senseless tragedies like mass shootings also provoke and demand answers – preferably ones that are also accompanied by easy fixes, says Jeffrey Swanson, a professor of psychiatry and behavioural sciences at Duke University School of Medicine. “We want life to be safe and predictable and to make sense,” he says. “The normal reaction is to want an oversimplified master explanation so you can put it in this box and say, ‘Ah, it’s mental illness’..’”
杜克大学医学院(Duke University School of Medicine)的精神病学和行为科学教授斯旺森(Jeffrey Swanson)说，大规模枪击案这类无谓的悲剧也会促使人们要求答案——最好还有简单的解决方法。“我们希望生活是安全的、可预测的、有意义的，”他说。“普遍的反应是想要一个过度简化的终极解释，所以你可以把它放在这个框框里然后说，'啊，这是精神疾病惹的祸。'”
That knee-jerk conclusion is problematic, he continues, because it encourages even more stigmatisation of people who have a mental illness, many of whom already have extremely difficult lives and already face discrimination in several areas, namely housing, jobs, and relationships. Individuals suffering from mental illnesses are actually three times more likely than the average person to be victims of violence, as they are more vulnerable.
It is true that some mass shootings and other atrocious acts of violence are committed by people who are seriously mentally ill. In 1998, for example, Wendell Williamson, a law student who was later diagnosed with paranoid schizophrenia, fatally shot two strangers on the street in Chapel Hill in North Carolina. Williamson claimed that he had been operating under the belief that he was saving the world, and a jury eventually found him not guilty by reason of insanity.
确实，一些大规模枪击案和其他残忍的暴力行为是严重精神疾病患者犯下的。 例如，1998年，一名法律学生威廉姆森（Wendell Williamson）在北卡罗来纳州教堂山（Chapel Hill）的街道上枪杀了两名陌生人，后来他被诊断患有偏执型精神分裂症（paranoid schizophrenia）。 威廉姆森声称，他相信自己正在拯救世界，自己的行为一直基于这一信条。陪审团最终认为他无罪，理由是他精神失常。
But such cases, Swanson says, are in the minority. In fact, few mass killers actually suffer from a diagnosable, serious mental illness such as schizophrenia, bipolar disorder and psychotic spectrum disorders. A 2004 analysis of more than 60 mass murders in North America, for example, found that just 6% were psychotic at the time of the killings. And when it comes to mass shootings, those with mental illness account for “less than 1% of all yearly gun-related homicides”, a 2016 study found. Other studies indicate that people with mental disorders account for just 3-5% of overall violence in the US, (much lower than the prevalence of mental illness in the general population – up to 18%) which “still leaves you with around 96% of violence, even if you’re able to eliminate all people with mental disorders”, Appelbaum points out.
但斯旺森说，这种情况属于少数。事实上，很少有大开杀戒的凶手患有可诊断的、严重的精神疾病，如精神分裂症（schizophrenia）、双相情感障碍（bipolar disorder）和精神病谱系障碍（psychotic spectrum disorders）等。例如，2004年对北美60多宗大规模谋杀案的分析发现，只有6%的人在杀人时精神错乱。2016年的一项研究发现，在大规模枪击案中，枪手为精神疾病患者的案件所占比例还“不到全年枪支杀人案的1%”。精神病学家阿佩尔鲍姆指出，其他研究发现，精神障碍患者的暴力行为仅占美国整体暴力事件的3%-5％（远低于普通人群中高达18％的精神疾病患病率），这意味着“即使你能够消除所有精神障碍患者，你仍然要面对96％的暴力”。
Moreover, much of the violence that people with serious mental illnesses commit are minor infractions, such as verbal assault or hitting, not homicide (suicide, however, is a significant problem), and such infractions tend to be directed at those the perpetrator lives with, not at strangers and not at a mass scale. Large attacks also require a level of planning and organisation that often defies many with serious mental illness. A 2014 study, for example, found that just 2% percent of 951 patients discharged from a psychiatric hospital committed a violent act involving a gun, and just 6% committed a violent act involving a stranger.
A 2011 meta-analysis of over 700 homicides committed by people with a diagnosed psychosis likewise revealed that just between 3% and 14% of the victims were strangers – the rest were known to the killer.
But even in cases in which people with a serious mental illness do become violent, it’s difficult to peg their crimes solely on their diagnosis, Swanson says. Confounding variables such as a history of childhood abuse or use of alcohol or drugs can increase the odds of violence. “If you remove additional risk factors and look at mental illness alone, it’s almost unrelated to violence,” Swanson says. “There’s consensus in the field that the unique contribution of psychopathology to violence in the population is very small.”
In the wake of an incomprehensible tragedy, however, the implications of that conclusion can be difficult for many to process. “When one of these horrible mass shootings occurs, people say, ‘Anyone who would do such a thing must be mentally ill,’” says Renee Binder, a professor and director of the psychiatry and law program at the University of California San Francisco School of Medicine. “But we need to be careful with our definitions because, while something is clearly wrong with them, it’s often not a serious mental illness.”
然而，一场难以理解的悲剧发生后，这一结论的含义对许多人来说难以接受。“可怕的大规模枪击案发生时，人们会说，'会干这种事的一定是精神病人，'”加州大学旧金山分校医学院（The University of California San Francisco School of Medicine）的精神病学教授兼法律项目主任宾德（Renee Binder）说。“但是我们下定论需要谨慎，因为，虽然他们明显有问题，但通常不是严重的精神疾病。”
Making this inaccurate link can also shift the focus of policy debates in the US. In debates over limiting access to firearms, some people start talking about fixing the mental healthcare system instead. “Suddenly you hear the gun lobby – which is very powerful in this country and has a vested interest in not having guns be regulated – become an advocate for better mental health care in America,” Swanson says. “It’s a distraction so we don’t talk about guns.”
It’s difficult to psychologically profile mass shooters because they often commit suicide or are killed during their attack. But what doctors and scientists do know is that the perpetrators of such events are frequently angry young men, who feel they have been mistreated by society and therefore seek to extract revenge.
The problem, however, is that tens of thousands of individuals fit that description – yet the vast majority do not commit a mass shooting. “If we could do something about maleness, we could really reduce violence and crime,” Swanson says. “But you can’t round up all the males.”
Predicting who could turn into a mass killer is virtually impossible, Swanson says. Some mass killers had even visited psychiatrists for behavioural problems prior to their attacks, but had no diagnosis of a specific mental illness. “Most of the people who commit mass shootings don’t want treatment and don’t meet the criteria for treatment,” Binder points out. Nor can individuals be committed to a mental hospital just for being angry.
This means that bolstering treatment for mentally ill people (a welcome development in its own right), would not actually solve the gun violence problem in the US, Swanson argues. The majority of perpetrators would still slip through the system.
So, in debates over how to reduce mass shootings, the evidence suggests that framing these events as caused by mental illness is unlikely to help prevent further attacks – and may only serve to perpetuate an ungrounded fear of the mentally unwell that is rooted more in fiction than fact.