WASHINGTON — In the wake of mass shootings like the ones in Las Vegas or at Marjory Stoneman Douglas High School in Parkland, Florida, people often wonder whether improving mental health care would have prevented the perpetrators from committing mass murder.


But experts say psychological science can’t identify who might go on to commit a mass shooting. The bible of the field, the fifth edition of “Diagnostic and Statistical Manual of Mental Disorders,” or DSM-5, has no chapter on what makes a mass murderer.


Instead, the manual squeezes the characteristics of mass murderers into boxes where they don’t fit, said Dr. Frank Farley, a former president of the American Psychological Association and a psychologist at Temple University.


“It’s such an extreme psychologically that it’s a special category. In a sense, every mass murderer and serial killer has mental problems beyond the standard nomenclature,” he said.


Why can’t current diagnostics understand these outliers? Farley said it’s because they haven’t been studied enough. Many mass murderers end up dead by their own hands or by the police at the scene of the crime, he said. So there are few mass killers for criminal psychologists to analyze, and little data from which to draw conclusions.


“The mind of a mass murderer has not been sufficiently studied to find commonalities. We don’t learn much from most perpetrators, so we go on the usual historical fishing expedition, trying to find some signs of where he or she was headed,” he said.


Farley said the brains of mass murderers need to be studied thoroughly to understand the common ingredients in the “diverse recipes” of these outliers in mental illness. He said present metrics are “iffy science.” With no nuanced understanding of mass murderers, schizophrenia and bipolar-related disorders are often used as indicators for violence, Farley said, but the link between those diseases and mass violence is murky.


Dr. Daniel Mosely, a psychologist in Denver, Colorado, says some DSM-5 diagnoses like schizophrenia and psychosis can in fact indicate a propensity for excessively violent behavior.


Yet he cautioned that there’s no clear warning sign. “There’s not one specific diagnosis that would be a red flag for this kind of event. There’s no discrete constellation of symptoms we can point to,” Mosely said.


Even working within the lines of the DSM-5 offers little confidence, he said. Field testing of DSM-5 diagnoses has found striking disparities in how different psychologists will evaluate the same patients’ psychological conditions. Criteria the manual offers, said Farley, are based on “far-from-precise science.”


But Andrew Patrick of the Coalition to Stop Gun Violence said that meaningful mental health diagnoses are besides the point. Instead, he said, the goal should be to identify “dangerousness,” which he defined as simply irrational or violent behavior. He said states should pass legislation that allow family members and police officers to remove guns from people that act out violently.


Four states – Oregon, Connecticut, California and Washington – allow police to issue what amounts to restraining orders for guns without requiring a mental health diagnosis. Oregon’s Extreme Risk Protection Orders accept court petitions about access to guns by people who may pose a threat. If the court finds evidence that a person might be dangerous, police will seize his or her firearms and restrict him or her from buying, selling, or possessing guns going forward. The other states’ laws work in a similar way, and 18 states are considering their own “red flag laws” laws this year.


Mosely said mental health issues are an easy answer in a confused and scared national climate. For this reason, he said, mass murders are over-attributed to concrete psychiatric issues.


It’s “easier to tolerate” that mass killing is the “result of a person having mental illness,” said Farley, “than the less easy answer about how someone could possibly commit some sort of atrocity.”


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