Although experts agree with President Trump's condemnation of this weekend's two mass shootings in El Paso, Texas, and Dayton, Ohio, they strongly denounce his contention that mental illness is linked to gun violence and his characterization of psychiatric patients as "mentally ill monsters."
"Mental illness and hatred pulls the trigger, not the gun," Trump said during yesterday's press conference.
In response, the American Psychiatric Association (APA) quickly issued a statement saying that the "overwhelming majority" of people with mental illness are more likely to be victims of violent crime rather than the perpetrators.
"Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment. Individuals can also be emboldened to act violently by the public discourse and divisive rhetoric," the organization said.
Discussing the need for new legislation for dealing with mass shootings, Trump said that coming up with solutions is "not up to mentally ill monsters, it is up to us."
APA Past-President Renee Binder, MD, professor and director of the Psychiatry and Law Program at the University of California, San Francisco, School of Medicine, noted that although these types of shooters are "highly disturbed in some way or another," there is not a strong correlation between mental illness and violence.
"It's correlated with people who are angry and see violence as a solution. And that's not the same thing as saying 'mentally ill,' which has a very specific definition," Binder told Medscape Medical News.
In addition, using the term "monsters" to describe patients with mental illness "does a lot of harm," she said. "There's already so much stigma against people who have a diagnosis of mental illness."
Reassessing Blame
Binder was the senior author of an article published last year in JAMA Psychiatry titled, "A Reassessment of Blaming Mass Shootings on Mental Illness."
In the article, the authors note that this type of attribution "distracts public attention from policy changes that are most likely to reduce the risk of gun violence."
They add that research shows that individuals with psychiatric conditions commit only about 4% of criminal violence and that "violence perpetrated by individuals with serious mental illness is rarely lethal."
"Although the paper is a year old, I would still agree with everything in there," Binder said.
"Who does these types of crimes? I'd say they're very angry; they have a grievance against something; they may have some links with an extremist group; they may want to make a name for themselves," she said.
However, these types of individuals are "totally different" from those who suffer from schizophrenia, severe depression, bipolar illness, or any other illness listed in the DSM-5, noted Binder.
"The problem with labeling everything 'mental illness' is that it stigmatizes people who have a mental disorder...and who would never be violent," she said.
"Urgent Resolve"
"We vow to act with urgent resolve," Trump said during his press conference regarding this weekend's two mass shootings, which occurred less than 24 hours apart.
The death toll from Saturday's shooting in El Paso now stands at 22; an additional 22 people were injured. The shooting in Dayton, Ohio, in the early hours of Sunday killed nine and injured 27.
In addition, a shooting at the Gilroy Garlic Festival in California on July 28 resulted in four deaths and 13 injuries. Also, as reported by Medscape Medical News, at least seven people were killed and 48 were injured by guns in Chicago this past weekend, causing Mount Sinai Hospital to temporarily stop accepting patients because capacity had been reached.
Trump said that he will be directing the Department of Justice to work with state and federal agencies and social media developers to create tools to identify mass shooters "before they strike." He also noted that many shooters, including the one who killed 17 students and staff members last year at Marjory Stoneman Douglas High School in Parkland, Florida, disclosed several "red flags."
"This is why I have called for red flag laws, also known as extreme risk protection orders," he said.
However, he added, mental health laws need to be reformed "to better identify mentally disturbed individuals who may commit acts of violence and to make sure those people not only get treatment but, when necessary, involuntary confinement."
Binder noted that these so-called red-flag laws sound like a good thing, albeit with an elimination of focusing on those with mental illness.
"It means guns should be taken away from people who are thought to be dangerous, at least temporarily; and that danger could be because they're involved with domestic violence, they're suicidal, they're intoxicated, or they've posted things on one of the social media sites. You don't want someone like that to have easy access to firearms," she said.
Asked whether she had concerns that an initiative into identifying "mentally disturbed individuals" could turn into identifying anyone with mental illness and thereby upping the associated stigma, Binder again stated that "what we typically call 'mental illness' is really not correlated" with the perpetration of violence.
Twitter Responds
Many Twitter users were upset by the president's comments, which they believe generate prejudice against individuals with psychiatric disorders, and they railed against the use of the term "monsters."
"POTUS [president of the United States] referring to the shooters as 'mentally ill monsters' stigmatizes mental illness and does nothing to address the epidemic of #masshootings," said @LailaAlarian.
"Thinking of my student affairs colleagues at UTEP [the University of Texas at El Paso] and UDayton this morning who face starting a new semester having to assure their students with mental illness that they are not 'monsters' and an inherent danger to the community," said @DrDLStewart, adding "I have a mental illness and I am not a monster."
"Statement from the American Psychiatric Association on the link between gun violence and mental illness. (Spoiler: No link, just like we said the last 98 times)," said @Rob_Tarzwell.
Paul Appelbaum, MD, professor of psychiatry, medicine, and law at Columbia University Department of Psychiatry, New York City, also chimed in.
"The problem of mass shootings is not due to mental illness: it's a function of inflammatory rhetoric, easy access to weapons, and a failure of political leadership," Appelbaum tweeted as @appelbap.
Binder noted that it would be difficult for patients with mental illness to perpetrate these types of crimes because of the need for organization and preplanning.
"This really has nothing to do with severe mental illness," she reiterated.
In a statement, the American Psychological Association agreed with Binder.
"Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available," said Arthur C. Evans Jr, PhD, who is CEO of the organization.
"There is no single personality profile that can reliably predict who will resort to gun violence. Based on the research, we know only that a history of violence is the single best predictor of who will commit further violence. And access to more guns, and deadlier guns, means more lives lost," he added.
Evans noted that the president's call for identifying and acting on red flags "requires research to ensure we are making decisions based on data, not prejudices and fear."
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Cite this: Experts, Patients Decry Trump Characterization of 'Mentally Ill Monsters' After Mass Shootings - Medscape - Aug 06, 2019.
