In the aftermath of mass shootings, high-profile murders, or targeted attacks, it’s common to immediately speculate about the perpetrator’s mental health. Social media is flooded with opinions on potential psychiatric conditions. Defense lawyers begin preparing evaluations prematurely. A conclusion is reached prematurely: the individual must be mentally unwell.
This automatic response provides a comforting but potentially harmful function. It offers a basis for lessening the perpetrator’s responsibility. It also provides a false sense of security by suggesting that such acts arise from a diagnosable condition rather than the potential for darkness that exists within normal human behavior.
My experience conducting psychiatric assessments in forensic and correctional settings aligns with research. I’ve learned that only a small percentage of violent acts are committed by people with severe mental illness. In fact, people with severe mental illness are more likely to be victims of violence than perpetrators.
However, our collective reaction persists. We engage in a form of psychological self-preservation when we quickly pathologize cruelty. It’s easier to believe that the capacity for brutality exists in a separate category of “sick” individuals than to recognize that danger may be close to home.
This isn’t to say that mental illness never plays a role in violence. I’ve seen cases where untreated psychosis or mania contributed to violence. These cases are genuine and tragic, but they are not the norm. The issue isn’t that mental illness is never relevant; it’s that we automatically assume it is.
By labeling violence as a symptom of mental illness, we maintain the illusion that human nature is fundamentally good. We maintain our illusions by medicalizing brutality. However, this illusion comes at a price.
I once evaluated a man who intentionally disfigured a woman because she rejected him. He showed no regret, confusion, or psychiatric symptoms. Instead, he expressed a sexist belief system. His reasoning was consistently monstrous.
We struggle with these cases, not because they’re uncommon, but because they’re disturbingly logical. The unsettling reality is that violence often stems from people with perfectly sound cognitive abilities. Their reasoning is intact; it’s their moral code that’s twisted.
Individuals may use flawless logic based on abhorrent beliefs, such as the idea that certain groups are inferior or that humiliation warrants retaliation. We’re not always dealing with disordered thought; sometimes, it’s deliberate justification.
In , mental health evidence often dominates the narrative. The succeeds in a small number of cases, yet it reinforces a flawed public belief that mental illness is a common cause of violence. It usually isn’t.
Diminished capacity defenses are more concerning because they blur the distinction between explanation and justification. Defense teams present histories of trauma, substance abuse, or personality disorders as mitigating factors, but correlation doesn’t equal causation. Many people experience trauma without harming others, while others with stable lives commit acts of extraordinary cruelty.
The limitations of medical framing become apparent when individuals who make violent threats online are sent to psychiatric hospitals. But what are we treating? I’ve evaluated people previously hospitalized after making threats and acquiring weapons. Their planning was detailed and consistent. The hospitalization didn’t address their grievances or their belief that violence was justified. They were released because they no longer met the legal criteria for mental illness commitment, but ended up in jail after acting on their plans.
Part of the confusion arises from the definition of terms. Poor mental health, characterized by emotional distress, unhealthy coping mechanisms, or relationship problems, is common. Mental illness refers to specific, diagnosable conditions with established clinical criteria. Conflating these ideas may seem compassionate, but it harms both science and society.
The rush to pathologize violence also reinforces stigma. It strengthens the link between psychiatric illness and dangerousness, making it harder for people to seek help. The irony is that while we wrongly attribute violence to mental illness, we simultaneously make treatment less accessible.
I’ve worked with people living with schizophrenia, bipolar disorder, and other severe conditions who would never harm another person. They may experience hallucinations or delusions, but they understand right from wrong and feel empathy. They struggle with illness, not malice.
Most violence is driven by entitlement, ideology, revenge, or the pursuit of power, not psychiatric symptoms. Mass shootings are often carefully planned. The perpetrators are aware of their actions and believe they are justified. They are not confused.
We seek psychiatric explanations because they provide a sense of security. They lead us to believe that violence can be identified, treated, and prevented through clinical means, but this belief is both false and dangerous.
Most violence is intentional, and most perpetrators are not mentally ill. They are fully aware of their actions. These are not symptoms; they are choices.
We must differentiate between the rare instances where illness plays a direct role and the more common situations where diagnosis is used to excuse responsibility. This requires confronting the belief systems that justify harm, refusing to medicalize deliberate cruelty, and holding people morally accountable for their actions.
The uncomfortable truth is that some people commit terrible acts because they choose to, not because they are ill. When we rush to diagnose their actions, we sacrifice justice for complexity and accountability for pathology.