Misconception: Spree killers must be mentally ill.
Actually: These lone killers usually don't fit into an existing category of mental illness, and there's usually little evidence that early treatment would have helped.
Their crimes are so repulsive that the assumption is automatic: Mass killers must be severely mentally ill. How else could someone slaughter schoolchildren or gun down college students apparently at random. (Terrorists like those in Belgium, who murder random, unarmed strangers, too, are even less likely to be mentally unstable; on the contrary, suicide killers are vetted for diligence and reliability. It's their radical ideology that is bloodthirsty.)
In fact, the sort of young, troubled males who seem to psychiatrists most likely to open fire in a school -- identified because they have made credible threats -- often don't fit any diagnosis, experts say. They might have elements of paranoia, deep resentment or narcissism that are noticeable but don't add up to a specific disorder, according to strict criteria. And there's no good evidence that mental health treatment would have made a meaningful difference.
The college student who killed six people before shooting himself in Isla Vista, Calif., in May 2014 saw multiple therapists; they disagreed whether he had emotional problems or high-functioning autism. The Sandy Hook shooter, who killed 26 people in an elementary school in Newtown, Conn. in 2012, had seen numerous psychiatrists and psychologists for years before his mass murder, including therapists at Yale's renowned Child Study Center. After details of the young man's childhood and home life emerged, some experts saw evidence of early psychosis or obsessive compulsive tendencies. But the only official diagnosis Adam Lanza, the shooter, had received was Asperger's syndrome, a mild form of autism that by itself does not dispose people to violent acts.
Dr. Michael Stone, a New York forensic psychiatrist who created a database of about 200 mass murderers, including spree and serial killers, has determined that about half had no clear evidence of mental illness before their crimes. About a quarter showed signs of depression and psychopathy -- that is, hopelessness combined with a lack of remorse.
The spree killers in particular are odd types: moody, unpredictable, inhabiting an internal world that is not easily put into any category, Dr. Stone said.
''The really scary ones, you have a gut feeling right away when you talk to them,'' said Dr. Deborah Weisbrot, the director of the outpatient clinic of child and adolescent psychiatry at Stony Brook University. She has interviewed about 200 young people, mostly teenage boys, who have made threats. ''What they have in common is a kind of magical thinking, odd beliefs like they can read other people's minds or see the future, or things that happen in their dreams come true.''
Intervening early to address the resentments and fantasies of this group -- an approach called threat assessment -- is thought to reduce the risk that the boys will act out. But spree killings are rare enough that it has been difficult to know how well such preventive measures work.
The remaining 25 percent in Dr. Stone's database form the groups that most possibly could respond to treatment, he and other experts say. These killers were likely to have had paranoid schizophrenia, he has determined. This group includes Jared Loughner, the Arizona man who shot then-Representative Gabrielle Giffords and 18 others in 2011. In these cases, early treatment and a commitment to taking antipsychotic drugs, which blunt the paranoid delusions and hallucinations that can
cause people to lash out, could have made a critical difference, many experts say.
Questions about mental disorders inevitably follow mass killings. Those questions are appropriate to ask but often a distraction; urges to destroy the world and everyone in it are just as often rooted in the darkest corners of minds that, if warped, are not disabled.
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