Interview: Is There a Relationship Between Mental Illness and Armed Attacks?

The recent shootings in the United States have once again opened the debate on the use of weapons and the regulation of their sale. However, the role of mental illness in these violent acts has also been discussed.

Gun with ammunition on a surface

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LatinAmerican Post | María Fernanda Ramírez Ramos

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Leer en español: Entrevista: ¿Hay una relación entre enfermedad mental y ataques armados?

In fact, the governor of Texas, Greg Abbott, affirmed, after the shooting in Uvalde, that these events responded to a mental health problem. This approach has received various criticisms from experts since it avoids talking about regulation in the sale of weapons and shifts the responsibility to mental health problems. Likewise, several investigations indicate that there is not such a close relationship between criminality and mental illness. In this regard, an investigation, published by the Harvard Review of Psychiatry, points out that this approach falls short and it is necessary to "go beyond the simplistic profiles of mass shooters and the formulations of "diagnosing the shooter" promoted by the media".

In this regard, we interviewed Fermín Pérez Pérez, clinical psychologist, member of the Ethics and Deontology Commission of the Official College of Psychology in Andalusia and who was director of the Psychiatric Hospital of Cádiz for more than a decade.

LatinAmerican Post: From your experience in clinical psychology and in the management of psychiatric institutions, what is the relationship between criminality and mental illness? Is there necessarily a causal relationship?

Fermín Pérez: No, in principle. Obviously, it is not convenient to talk about criminality versus mental illness because studies indicate that there is a relationship between around 1% of crimes committed by mental patients. So it is sane who kill; criminals are not the mentally ill.

Rather, the mentally ill person directs his aggressiveness toward himself, toward his inner conflict. When criminal acts occur, they can be the product of delusions and hallucinations. If you think that you feel persecuted or that there is collusion against you, that paranoid state can lead to defense response. But I insist criminality and mental illness are not similar.

LP: After several attacks with firearms in recent years, the shooter has been profiled as someone with a disorder, a history of bullying or abuse, or emotional instability. Is it possible to determine which person could potentially use a weapon with early intervention in mental health?

FP: Yes, indeed what you say are traits that can be in the profile of an aggressor. But, by itself, impulsiveness or emotional instability does not imply a mental illness. We should rather talk about traits and personality disorders.

A borderline personality disorder is a behavioral disorder with a fixed pattern of thinking that does not match social reality. Looking for a profile, the one that would fulfill it the most would be this one. But as I say, it's not a mental illness, it's a behavioral disorder. Characteristics include emotional instability, problems in interpersonal relationships, attacks of unjustified or inappropriate anger, or a series of dangerous activities in at least two areas such as sex, drugs, and addictions in general.

Personally, you have a real or not imaginary feeling of abandonment. They are always on the lookout for not losing that feeling of the company. But they express it in an impulsive way. Added to this are identity problems, self-image problems, aggressiveness, instability of affections, and the aforementioned inappropriate anger.

With all that I tell you, there is already an important borderline personality disorder. And it could be that it coincides with a profile of the aggressor of these events that have occurred. However, by themselves, none of them, like suffering bullying, determines you with the profile of an aggressor.

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L:P: Taking these answers into account, an aggressor could indeed have certain behavioral traits, but not necessarily all people who have a mental disorder or illness are going to be criminals. In relation to the above, what should be the focus and role of a mental health policy within a society to prevent violence?

A mental health policy regarding these problems must be fundamentally preventive. The approach, apart from individual and group, is very important to do from family psychoeducation. That is to say, what I have told you about the signs and others, you have to explain them to the families who have to understand it and see how one can face those demands or those reactions of anger or impulsiveness.

In health, in general, prevention is perhaps the last thing that is done, but it should be the first, it is the most necessary. If we identify the signs early, we can address them from the beginning with a psychosocial and fundamentally family approach.

When these events occur, the moment of attack or shooting, no one explains it to him, not even the family, who says it was unpredictable. But hey, delving into the data that we have described in these symptoms, we could arrive at prevention. Not exactly to have a profile of the attacker of a school and how he will act, but we could point to the detection of a possible serious problem.

LP: Do you think that generalizing criminals as sick could generate stigmatization of mental illnesses?

Yes effectively. The stigma is already on the mentally ill. The madman has his stigma, his rejection, his barrier, and his lack of relationship with others. So, if we put a criminal name on top of it, what are we doing? We turn the madman into a criminal and the criminals, in order to save themselves from judicial punishment, are considered insane. Because as is known, some lawyers say "crazy" is better, which has a much milder sentence. Thus we turn the sick into evil and the evil we save for supposedly being ill.

For example, schizophrenia is the worst of the diseases that exist, with significant mental confusion and serious effective effects. In addition, with a lot of production of hallucinatory and depressive symptoms, but also delusional. Especially with a departure from reality and a poor concept and an important dissolution of himself. Which guilt, depression, and aggressiveness, are directed inward, not outward. However, the stigma is created more so when political leaders say so. That is somewhat counterproductive.