Metzl on Mental Illness and Gun Violence

How the Rush to Blame Mass Shootings on Mental Illness Hurts All of Us

Photo of Jonathan Metzl
“Only 3 to 5 percent of American crimes involve mentally ill shooters,” says Dr. Jonathan Metzl. “In fact, the mentally ill are far more likely to be victims of violence than are sane people.” (DANIEL DUBOIS)


After the horrific mass murder at Sandy Hook Elementary School in 2011, several states passed bills requiring mental-health professionals to report “dangerous” patients to local officials. Wayne LaPierre, executive vice president and CEO of the National Rifle Association, called for a “national registry” of persons with mental illness. A conservative commentator claimed that “guns don’t kill people—the mentally ill do.”

Such responses trouble psychiatrist Dr. Jonathan Metzl, the Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society, professor of psychiatry, and director of Vanderbilt’s Center for Medicine, Health and Society. He believes such attitudes are based on misconceptions about mental illness and violence that obscure larger issues about gun violence in America.

Metzl, who has an M.D. in psychiatry and a Ph.D. in American culture, is a frequent guest on national television programs and at national conferences, where he speaks about mental illness and violence. A prolific scholar, Metzl is the author of three books and a vast array of scholarly articles.

Is it correct to say that the suspects in the recent mass murders in Isla Vista, California; Aurora, Colorado; and Sandy Hook, Connecticut, were mentally ill?

Without doubt, a number of mass shooters suffered from serious psychiatric symptoms. But the question of whether or not mental illness “caused” the shootings is more complicated than it seems—since a number of factors that are not linked to mental illness also push people to kill. As a society I believe we rush to blame mental illness while overlooking other issues that help us better understand these horrific crimes.

Aren’t the mentally ill more likely to commit mass shootings than persons without mental illness?

That’s the popular perception, but the reality is the opposite. Databases that track U.S. gun homicides find that only 3 to 5 percent of American crimes involve mentally ill shooters. In fact, the mentally ill are far more likely to be victims of violence than are sane people. And certain severe mental illness makes people less likely to commit violent acts. For example, schizophrenia can cause people to isolate and withdraw from society. But because the mentally ill can appear “odd,” people such as police officers often misinterpret their symptoms as violence.

What are some other myths surrounding mental illness and gun violence?

People believe that psychiatric diagnosis is a predictive tool. It is not. Psychiatrists see many patients who fit the criteria for violent behavior: They’re angry, threatening and sometimes paranoid. However, only a very small percentage of the patients we see are actually violent.

Is there any way to predict who will become violent?

Some factors that are predictive of violence include past histories of violence or the presence of alcohol or drugs during moments of conflict.

What about gender-based crime? Isn’t it true that shootings in the U.S. are overwhelmingly committed by young men?

In a recent essay I looked at the ways in which guns are depicted in some instances not just as symbols of individual or national defense, but also as symbols of male potency or anxiety. The Isla Vista, California, shooting brought these issues into public focus in powerful ways. I think that’s why gender scholars have been talking more about this issue in the aftermath of that awful shooting.

Several states, including Tennessee, have passed laws requiring mental health professionals to report patients they consider dangerous or threatening. Are such laws effective in preventing gun violence?

Persons with violent tendencies shouldn’t have access to weapons that could be used to harm themselves or others. But again, psychiatrists have a very hard time predicting violence. To be clear, I support having as many tools as possible to give police and clinicians many avenues to help prevent violence. At the same time, psychiatrists or the police alone can’t stop this problem—it’s a societal issue.

A number of states have significantly loosened laws that regulate where people can carry guns. What are your thoughts on potential effects?

I fully respect that many people feel very strongly on all sides of the gun-rights issue. At the same time, I believe these new laws force us to ask a series of hard questions about the psychological and public-health implications raised by the presence of guns in such places as bars, schools and airports. For example, we know that the presence of alcohol during moments of armed disagreement increases the risk that conflicts will be resolved by shootings. Thus, what do we gain and what do we lose by allowing guns in bars or at fraternity parties? To my mind, the sense of safety that someone might feel by having a gun at those times is mitigated by the increased risk that they will in fact use it. Plus, of course, the presence of guns potentially creates a society in which people start thinking differently about their neighbors, or about seemingly innocuous interpersonal interactions. I think the outcomes of these laws will be important to follow.

Why did you become interested in studying gun violence and mental illness?

I’m interested in exploring stigmatizations of mental illness. When I was writing my book about schizophrenia, The Protest Psychosis [2010, Beacon Press], I learned how stereotypes of persons with mental illness as violent often resulted from larger cultural and political anxieties. Over time I saw that similar issues played out every time we blamed shootings on mental illness without looking at the broader cultural contexts in which the shootings took place. Again, this is not to say that mental illness isn’t a factor—it absolutely is. But the conversation can’t start and end there.

What are some things that could be done to prevent gun violence?

We can invest in structures and infrastructures that help make people less fearful of each other. Perhaps we could start by asking people why they think they need guns in the first place—and then addressing those underlying issues if and when we can. That might sound insane—but to my mind, lost in the rancor is a deeper understanding of what guns mean to everyday people, and of why they feel they need them, or why they are against them. We’re losing out by not asking people these questions in a deeper way—whether guns are allowed, regulated or banned—as a way of creating a better conversation among reasonable people on all sides of the debate. Of course, we also need to strengthen mental-health delivery systems and community-health outreach networks so that people at risk can get help and support.

Jonathan Metzl was interviewed for this piece by Joanne Lamphere Beckham, BA’62, who worked as an editor at Vanderbilt for more than 25 years before retiring from a full-time career in 2006.