Mass Shootings: Research and Lessons

February 12, 2013

The news media has always been in the business of searching for "the right sort of madness" to capture the public's imagination.

Mass murder-the killing of 4 or more people at one location within one event-is a rare but appalling tragedy. The body of research on mass shootings is relatively small and hampered by the low base rate, questionable methods, and lack of data regarding thwarted events. Mass shootings are not new, but since the 1990s, they have taken on a different quality. This quality has been affected by cultural shift, social media, and enhanced media coverage.

The research

While the existing research is hampered by methodological problems, certain psychosocial factors are consistent (eg, problems with self-esteem, a persecutory/paranoid outlook, narcissism, depression, suicidality, social rejection). The problem of focusing too heavily on these factors is that too many false positives result. The reality is that “no consistent and reliable profile of school shooters exists, and most researchers and clinicians would agree that predicting violent behavior is a slippery slope.”1

In an excellent review of school-associated homicides in kindergarten through 12th grade, Flannery and colleagues1 noted that “a need remains for researchers and commentators to examine other factors beyond the individual that may explain school shootings, including culture, the social ecology of the school, or other community factors.” For example, there are differences between urban and suburban school shootings-some acts are related to threats to the perpetrator’s social identity.2,3 Suburban and rural shootings may be characterized by social alienation, whereas urban incidents may be associated with a general inner-city tolerance of violence. The issues of social marginalization and familial dysfunction are other common findings.4

Lindberg and colleagues5 noted that peer groups played a role in facilitating school shootings; they sought to study whether adolescents who had expressed an online threat of a school massacre differed from those who had expressed a threat offline. Those who expressed their threats online were more likely to have been bullied and depressed, more often made threats with clear intention, and more often were prepared. In contrast, those who expressed threats offline were more likely to have problems with impulse control and to have shown delinquent behavior before the threats.

In another study, Lindberg and colleagues6 attempted to characterize adolescent copycats who had threatened to carry out a school massacre. A majority of these copycats were found to have a history of mental health treatment, depressive symptoms, suicidal ideas, and impulse control problems. The prevalence of pervasive developmental disorders was high.

Prevention

The assertion that severe mental ill-ness is to be blamed for mass shootings is a distraction. In reality, research shows that “even if one assumes that the association between severe mental illness and recorded violent crime is entirely causal . . . the overall contribution of patients with severe mental illness [is a mere 5%].”7

Given that both prediction and profiling are unhelpful, what are we left with? Most authorities recommend a careful threat assessment approach. The problem is that these endeavors are complicated and time-consuming and need to be done by well-trained professionals working as a multidisciplinary threat assessment team. The process also relies on a thorough psychiatric evalua-tion, which is a resource that is in short supply. Flannery and colleagues1 give the sensible advice that “particular attention should also be paid to a youngster’s access to or fascination with firearms and the presence of writings or drawings with violent themes,” as well as dysfunctional peer relationships, including bullying.

In response to the Sandy Hook tragedy, the Interdisciplinary Group on Preventing School and Community Violence provided a rational set of recommendations.8 The key element of their recommendations is improved communication. Their report states that “the most effective way to prevent many acts of violence targeted at schools is by maintaining close communication and trust with students and others in the community, so that threats will be reported and can be investigated by responsible authorities.” They recommend that schools develop “channels of efficient, user-friendly communication,” so that “community members, students, and staff members feel comfortable bringing concerns regarding safety to the attention of school administrators.”

Third parties, such as other students and family members, may have pre-offense knowledge or significant concerns because potential perpetrators often “leak” their intent. The National Alliance for Mental Illness, which has offices all over the country, is a good resource for friends or family who suspect that a problem is brewing.9,10

Narcissism and the news media

In response to the plea by Flannery and colleagues1 to examine other factors that contribute to mass shootings, particularly cultural and social ones, it is impossible to avoid the issues of narcissism and media responsibility. Narcissism is the classic American pathology, but there is concern that it may be proliferating “virally” and gaining momentum. In their excellent work The Narcissism Epidemic, Twenge and Campbell11 note that while crime has dropped overall since the 1990s as a result of a variety of factors, crimes due to narcissism or a wounded ego are directly relevant to mass shootings.

Harvard psychologist Steven Pinker12 laid out an impressive overview of how the “civilizing process” has reduced violence among homo sapiens over the centuries. Indeed, this was also seen by Freud,13 who noted that civilization itself required a strenuous renunciation of biological impulses. Pinker now wonders if we might have reached a point of limited returns-we no longer hack and impale each other at the drop of a hat, instead we seek further and comparatively smaller gains that are more difficult to appreciate and achieve. Those harder to achieve gains may arguably lie in the realm of facing and somehow attenuating the problem of narcissism.

Narcissism and social rejection are risk factors that work in tandem to cause aggressive behavior, and these have certainly been described in the histories of mass shooters. Twenge and Campbell11 note that “given the upswing in the narcissistic values of American culture since the 90s, it may be no coincidence that mass shootings became a national plague around the same time.” Extensive media attention in the 1990s may have provided a script and unwitting adulation of those who would seek an impatient route to their entitled respect. This hints at a deeper societal pathology-a culture that has “grown more focused on self-admiration and more enamored with celebrity and fame.” One might argue that we hold celebrity as the single greatest achievement of life-one that should be attained by any means.

It becomes difficult to deny that the media coverage given to mass shooting perpetrators has sent the message that committing a spectacular act of murder or killing is a great way to get attention. A study confirms that perpetrators who were captured alive were influenced by previous, heavily publicized cases of mass shooting.14 The news media has always been in the business of searching for “the right sort of madness” to capture the public’s imagination.15 This may involve exploiting violent and tragic acts and/or overemphasizing the alleged role of mental illness. A universal media reporting code has been recommended that would cover the tragedy yet reduce the impact of the copycat effect.16 Most recommendations involve ensuring that the perpetrator is neither glorified nor demonized and generally avoiding much emphasis on the perpetrator.

There are countries in which mass shootings are quite rare. Brazil has had only one major school shooting. The Scandinavian countries and Thailand are other examples of cultures with both a large social safety net and social structures that “buffer against narcissism.”17 And so the question is inevitable-can we see past the distracters, such as mental illness, violent video games, and armed teachers, and grasp the roots of the problem? Freud18 once observed that “those who love have, so to speak, pawned a part of their narcissism.” Can we, as a society, pawn part of ours?

References:

References

1. Flannery DJ, Modzeleski W, Kretschmar JM. Violence and school shootings. Curr Psychiatry Rep. 2013;15:331.

2. Flannery DJ, Singer MI, Wester K. Violence exposure, psychological trauma, and suicide risk in a community sample of dangerously violent adolescents. J Am Acad Child Adolesc Psychiatry. 2001;40:435-442.

3. Brown RP, Osterman LL, Barnes CD. School violence and the culture of honor. Psychol Sci. 2009;20:1400-1405.

4. Newman KS, Fox C, Harding DJ, et al. Rampage: The Social Roots of School Shootings. New York: Basic Books; 2004.

5. Lindberg N, Oksanen A, Sailas E, Kaltiala-Heino R. Adolescents expressing school massacre threats online: something to be extremely worried about? Child Adolesc Psychiatry Ment Health. 2012;6:39.

6. Lindberg N, Sailas E, Kaltiala-Heino R. The copycat phenomenon after two Finnish school shootings: an adolescent psychiatric perspective. BMC Psychiatry. 2012;12:91.

7. Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006;163:1397-1403.

8. Interdisciplinary Group on Preventing School and Community Violence. A Call for More Effective Prevention of Violence. http://curry.virginia.edu/articles/sandyhookshooting. Accessed January 17, 2013.

9. Small J, Foster B. Mother speaks out about son accused of plotting to shoot up theater in Bolivar. http://www.kspr.com/news/kspr-mother-of-man-accused-of-plotting-to-shoot-up-bolivar-theater-speaks-out-20121120,0,7523945.story. Accessed January 17, 2013.

10. National Alliance on Mental Illness. http://www.nami.org. Accessed January 17, 2013.

11. Twenge JM, Campbell WK. The Narcissism Epidemic: Living in the Age of Entitlement. New York: Free Press; 2009

12. Pinker S. The Better Angels of Our Nature: Why Violence Has Declined. New York: Viking Penguin; 2011.

13. Freud S. Civilization and Its Discontents. Reprint ed. New York: WW Norton & Company, Inc; 2010.

14. Mullen PE. The autogenic (self-generated) massacre. Behav Sci Law. 2004;22:311-323.

15. Ronson J. The Psychopath Test: A Journey Through the Madness Industry. New York: Riverhead Books; 2011.

16. Etzerdorfer E, Sonneck G. Preventing suicide by influencing the mass-media reporting. The Viennese experience 1980-1996. Arch Suicide Res. 1998;4:67-74.

17. Borowitz A. Terrorism for Self-Glorification: The Herostratos Syndrome. Kent, OH: Kent State University Press; 2005.

18. Freud S. On Narcissism: An Introduction. New Haven, CT: Yale University Press; 1991.