Mass Shootings and Mental Illness: How Can the Media Avoid Fanning the Flames of Stigma?

Newtown, Connecticut. Las Vegas. Parkland, Florida. Annapolis, Maryland. And just two days ago, Jacksonville, Florida, where the details are still coming in. With each ghastly mass shooting in a school, workplace, or other public location, journalists scramble to piece together what happened, and speculation runs high as to whether the gunman had mental illness. But critics say the media coverage perpetuates deep-seated, stigmatizing attitudes about diagnoses such as schizophrenia or bipolar disorder. What can journalists do to cover the mental health connection in these mass murders in a responsible way?

Of science, ethics, and us.

Earlier this month, police investigators released a final report on the massacre at a Las Vegas concert last October, the deadliest shooting in modern American history. The motives of the 64-year-old gunman — a wealthy high-stakes gambler — remain unclear, they conceded, but he had burned through much of his fortune and shown potential signs of a troubled mind. While some news outlets made only brief reference to suspicions that the shooter may have had mental illness, others blared it.

It’s a familiar theme. In recent years, the national conversation about gun violence has boiled down to a narrative — amplified by the media — that essentially blames mental illness as a prominent cause of these cold-blooded public mass shootings. Mental illness has become highly politicized in the gun-control debate, yet the link between psychiatric problems and violence isn’t so straightforward. And mental health advocates say the over-simplistic narrative unfairly labels millions of Americans who have a psychiatric diagnosis with the false stereotype of being dangerous.

All of this makes the harrowing task of covering mass shootings even more challenging for journalists, particularly in the U.S., which has a unique gun violence problem. It seemed worth taking the time to unpack some of the issues around violence and stigma, so I reached out to a few experts.

“Journalism is far too quick to try to guess at the ‘why’ behind these sorts of things,” said Kathleen Culver, director of the Center for Journalism Ethics at the University of Wisconsin-Madison. We may never come to know the answer, but “speculation can have serious consequences.”

Reporters aren’t trying to be sensationalistic, of course. Answering the basics of who, what, when, where, how — and yes, why — is part of the DNA of journalism, Culver noted. “But sometimes our standard practices can just get on a roll,” she added. “They become this snowball rolling downhill, and we always have to stop and think about what we’re rolling over.”

Patrick Corrigan, a psychologist at the Illinois Institute of Technology in Chicago, agreed that it’s natural for journalists — and for their readers — to ask “why?” We have a fundamental need to explain why bad things happen, he noted. Societies used to look to the religious concept of evil to understand terrible crimes of violence, but in modern times, perhaps the easiest alternative explanation is that the killer “must’ve been mentally ill,” he said.

It’s an assumption most people readily leap to. After all, why would anyone of sound mind indiscriminately slaughter strangers and children?

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There is indeed some truth to such thinking: In certain high-profile public mass shootings — as in Tucson, Arizona, and Aurora, Colorado — it’s clear that psychotic symptoms, such as delusions or hallucinations from schizophrenia, drove the killer’s actions, said E. Beth McGinty, a mental health policy researcher at Johns Hopkins University. But the problem is that people then incorrectly overgeneralize that the same is true for all mass shootings.

Furthermore, intensive news coverage of mass shootings typically includes discussions that equate violent and dangerous behavior with mental illness, Corrigan said. “The equation’s incorrect,” he told me. “If anything, it tends to fan the flames of stigma.” People with mental illness are more likely to be victims of crime than the aggressors, after all — and the majority of them don’t engage in violence. (More on this later.)

Corrigan is principal investigator of the National Consortium on Stigma and Empowerment, a group that studies the effects of negative attitudes toward mental health conditions. Sadly, even though societal awareness about the biological roots of psychiatric disorders has grown since the 1950s, prejudice remains high against serious mental illnesses such as schizophrenia, bipolar disorder, and major depression. Stigma against schizophrenia has even worsened over time, Corrigan said: One meta-analysis found a decrease from 1990 to 2006 in public willingness to accept someone with that diagnosis as a neighbor or co-worker. In a more recent survey from 2013, 71 percent of people said they would be unwilling to work closely with a person with serious mental illness, and 46 percent viewed such individuals as far more dangerous than the general public.

As with racism, people with serious mental illness face discrimination that hurts their ability to find a place to rent, advance in their careers, and get proper health care when they see a primary care doctor, Corrigan said. Many also struggle with feelings of internalized self-stigma. “People won’t go seek out treatment from a psychiatrist or psychologist, so they don’t get labeled as being ‘crazy,’” he added. Which means they don’t get the help they need.

Research suggests that the media feeds this stigma when its coverage of people with mental health conditions is disproportionately focused on violent behavior. In a 2016 study from Johns Hopkins, McGinty and colleagues found that 38 percent of major news stories about people with mental illness mentioned violence against others, while 29 percent mentioned suicide. And in an online experiment published in 2013, McGinty’s team asked participants to read a news brief about a mass shooting by a man with serious mental illness. Responding to a survey immediately afterward, they indicated less willingness to live near or work closely with individuals with a serious mental disorder, compared with other study participants who didn’t see the news piece.

So what do the numbers actually tell us about the relationship between gun violence and psychiatric illness? It’s complicated, and a bit of a mixed bag. Compared to people without mental health issues, for example, individuals with serious mental disorders have been found to be 3.6 times more likely to engage in violent behavior, according to the National Epidemiologic Survey on Alcohol and Related Conditions. Yet, only a small minority, just 2.9 percent, actually do so in any given year, so the overall risk is quite low in contrast to public misconceptions about mental illness and dangerousness. What’s more: Fewer than 5 percent of the 120,000 gun-related killings in the U.S. from 2001 to 2010 were committed by people diagnosed with mental illness, according to the National Center for Health Statistics database.

Meanwhile, however, in other research reviewing police reports and media stories relating specifically to mass shootings, criminologists Grant Duwe of the Minnesota Department of Corrections and Michael Rocque of Bates College in Maine found a high prevalence of mental illness: Around 60 percent of perpetrators of 185 public mass shootings had either been diagnosed with, or exhibited symptoms of, serious mental illness — typically, paranoid schizophrenia, or depression (including the depression of bipolar disorder). (Duwe and Rocque narrowly define public mass shootings as incidents in which four or more people are killed in a public location in a 24-hour period, not including situations related to other criminal or military activity.)

McGinty and other researchers have expressed skepticism regarding these sorts of estimates, because accurate diagnosis would require expert medical assessments of each perpetrator close to the time of the shooting. That’s just not possible, since many of these murderers commit suicide after their rampage, or are killed by police. And other factors are generally much more strongly implicated in fueling violence, McGinty noted, including alcohol or substance use problems, a history of abuse or trauma, and anger and impulsivity. These things often co-occur with mental illness.

Still, Duwe argues that downplaying the role of mental illness in public mass shootings is also a mistake. For one thing, such incidents as defined by Duwe and Rocque’s criteria are exceedingly rare, and account for less than 1 percent of deaths from all U.S. homicides each year. The pattern of risk factors for these extreme cases may not be the same as for violence in general, and Duwe thinks it’s misleading to conflate the two. He also says he’s not arguing that 60 percent of these cases were directly caused by mental illness — but it is a risk factor, he said, “that we should be considering.”

Whatever the different factors were that were actually in play, that notion of cause-and-effect is an important thing to keep in mind, and it’s a point on which both McGinty and Duwe apparently agree. If a mass shooter did have a mental illness, “that’s a correlation, not causation,” McGinty said.

“Just because someone had a diagnosis does not mean that it’s the symptoms of that mental illness that caused the violence,” she said.

Given all the above, what’s a well-meaning journalist to do when covering mass shootings? After all, while the Society of Professional Journalists’ Code of Ethics calls for the media to seek and report the truth, it also advises minimizing harm and being accountable. “What harms are we doing,” asked UW-Madison’s Culver, “if we report too quickly, if we report incompletely, if we report something incorrectly?”

We can reduce those harms, for starters, by avoiding speculation. Don’t leap to the conclusion that a killer or suspect must have had a psychiatric problem if that isn’t known to be true, said Eve Byrd, director of the mental health program at the nonprofit Carter Center in Atlanta. Verify that any information about a diagnosis comes from a reliable source. “I would even question if [the information came from] a friend or neighbor,” Byrd said.

If a diagnosis of mental illness is solidly documented, it’s important to find out whether the gunman had access to and received treatment for it — and experts also recommend that journalists provide some of the counterbalancing context about mental illness and violence that we just walked through.

Another piece of advice: When we describe a person’s diagnosis, “the language that’s used is extraordinarily important,” Byrd added. A guide developed by the Carter Center on covering behavioral health issues urges reporters to avoid derogatory terms such as “crazy,” “lunatic,” or “psycho.” (The Associated Press Stylebook echoes this advice.) Such language can interfere with a person’s willingness to seek help for a mental health condition, Byrd said.

Several other organizations offer additional advice on how to report on mass shootings. These include recommendations put forth last year by the Suicide Awareness Voices of Education, the Poynter Institute, and other partners.

Culver, meanwhile, simply calls on the press to be more methodical. “It would be fairly easy for any individual journalist or news organization to simply resolve, ‘We’re not going to speculate on any reason or cause until we have some sort of confirmation of a reason or cause,’” she said.

To minimize harm, she added: “Put down the brakes a little bit.”

Ingfei Chen is a California-based writer whose stories have appeared in publications including Scientific American, The New York Times, and Spectrum. She is a former Knight Science Journalism fellow at MIT.

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