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Could Psychiatrists Have Prevented the Washington Naval Yard Shootings

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As reports began to appear of the disturbed background of Aaron Alexis, the media seems to have universally decided that mass shootings are readily explained by severe mental illness.

The assumption is that as psychiatric disorder is so obviously linked to violence, there should be no surprise that the Washington Naval Yard killings involved someone with a mentally troubled history.

New research finds that media reporting of mass murder, such as this most recent tragedy, leads to more negative public attitudes to the mentally ill. This in turn may contribute to a pessimistic stereotyped image for psychiatric problems and services. As a result, people who suffer symptoms, as it appears Aaron Alexis could have, may not access treatment which possibly prevents these atrocities.

A vicious cycle is thus created, ironically perpetuated by media coverage. Is it possible the reporting is part of the cause of such senseless violence? Not because this encourages one sub-type of mass killers - 'infamy seekers' (which it may do) but also as it may discourage early psychiatric intervention?

Emma McGinty, Daniel Webster and Colleen Barry, from the Johns Hopkins Center for Gun Policy and Research, and the Johns Hopkins Bloomberg School of Public Health, Baltimore recently found that reading a news story about a mass shooting, heightened negative attitudes toward sufferers from mental illness.

The study entitled 'Effects of News Media Messages About Mass Shootings on Attitudes Toward Persons With Serious Mental Illness and Public Support for Gun Control Policies', involved a national sample of almost two thousand participants. Their findings suggest public perception is that serious mental illness, more than access to guns, accounts for mass shootings.

The study, recently published in the 'American Journal of Psychiatry', concludes that in the aftermath of mass shootings, the barrage of news stories describing the shooter with psychiatric symptoms, his history, and his actions during the shooting might raise public support for gun control policies. But such coverage also contributes to negative attitudes toward the mentally ill.

The authors go on to point out that pessimistic public attitudes are linked to poor treatment rates among persons with serious mental health conditions.

But if there were better psychiatric services, and if the taboo surrounding mental illness was less, so more people accessed better treatment earlier, would it make a difference to these tragic shootings? Could psychiatric interventions prevent these atrocities in the future?

'The American Journal of Psychiatry' was partly prompted by the Johns Hopkins media effects study, to wrestle with the question of how psychiatrists could make a difference to the apparently rising incidence of mass killing incidents.

Psychiatrists Richard Friedman and Robert Michels, were in fact responding to the Newtown Connecticut school shooting, at the time of their editorial. Yet their comments anticipate the likelihood that such tragedies would recur soon.

They did indeed, when Aaron Alexis recently killed 12 people in the Washington Naval Yard.

The media reports suggested the navy contractor was wrestling with mental illness. He appears to have been hearing voices and complained he was being followed by people using a microwave machine to send vibrations through his body.

Doctors Friedman and Michels agree that mass killings attract the kind of blanket media coverage which can create misleading impressions. For example, the attention they attract distracts from the fact mass killings are very rare. Friedman and Michels point out that in 2011, mass killings accounted for only 0.13% of all homicides in the United States.

Friedman and Michels believe the conundrum the public find most difficult to grasp is that although mass murderers probably suffer more mental illness than other killers, the mentally ill as a group actually pose relatively little risk of violence.

For example, their editorial entitled 'How Should the Psychiatric Profession Respond to the Recent Mass Killings?' quotes that only 4% of violence generally can be attributed to persons with mental illness. The prevalence of violence amongst those with serious mental illness throughout their lifetime is 16%, as compared with 7% among people without.

Alcohol and drug abuse are far more likely to produce aggression. Those who abuse alcohol or drugs but have no other mental disorder, are nearly seven times as likely as those without substance abuse, to commit violence.

One possibility is that improving mental health services might make a difference; Aaron Alexis appears to have fallen through the net of treatment.

But, remarkably, should a psychiatrist have been able to evaluate this man before the shootings, suffering though he appeared to be from hearing voices and delusions, it's not clear he could have been easily detained involuntarily by current mental health legislation. The law, both in the USA and the UK, supports doctors in seeking involuntary admission to hospital, only if they can convince the authorities that a patient is an immediate danger to himself or others.

Perhaps in the wake of these recent shootings, involuntary mental health legislation and practice should be loosened from 'imminent danger', to a 'reasonable likelihood of violent behaviour'.

But Friedman and Michels argue that lowering the threshold for involuntary treatment could discourage consulting doctors. People could become more wary of being candid or seeking help voluntarily. Heightened fears of being committed to an institution against their will, might mean some of most unwell patients would be driven further away from the mental health system.

Mental illness is very treatable, and sufferers can and do return to productive well-being with the right healing, implemented early enough. Yet the fear of being 'locked away' forever in an asylum continues to stigmatise the system.

As psychiatrists, when we hear these tragic stories of what mental disturbance lay behind a mass shooting, we have a further concern. It is that sufferers from these severe psychiatric symptoms, over and over again, were not receiving adequate treatment.

The media clouds the key lesson to be learnt, which is that it's neglected and untreated mental illness, not psychiatric disorder alone, which is involved.

If the truth was more widely understood, about how effective modern treatment of psychiatric problems can be, particularly if dispensed by properly trained professionals, then it is possible that these incidents could indeed become rarer. Clinics might then attract adequate public funding, and even better clinicians, which would all help services become ever more effective.

Some may possibly argue that even the best mental health system would likely have little impact on deterring mass killings, as some of these killers largely avoid psychiatric treatment - but for the others - and those who might be influenced by friends and relatives observing something amiss, we still believe there could be a worthwhile impact.

If the USA is not going to embrace tougher gun control, as it appears reluctant to, then it may well be even more imperative they develop absolutely excellent mental health services.

In the aftermath of yet another mass shooting tragedy, this might just be our only hope.

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