Ronald W. Pies, MD

The horrific mass school shooting in Uvalde, Texas, is the deadliest such shooting at an American school in nearly a decade.

 A mass shooting is frequently defined as a single attack in a public place, in which 4 or more victims were killed. Sadly, there are few reasons to believe that the frequency of such tragedies will decline anytime soon. On the contrary, unless a wide range of contributing factors change, there are compelling reasons to expect more mass shootings in the US, some of which will target schools.

The reasons for this rather gloomy prediction are detailed below. It is not my intent to dissect the specific details of the Uvalde shooting or to speculate on the psychology or motives of the shooter; but rather, to provide a framework for understanding why the US seems caught in an endless, repeating loop of gun-related carnage.

1. There is an almost inexhaustible supply of marginalized, emotionally disturbed, rage-filled young men in this country

Since 1982, at least 123 mass shootings have been carried out in the US by male shooters, versus 3 by females.

 I will say more about the gender issue and its cultural roots presently. According to psychology professor 

, most of the perpetrators of K-12 shootings are under the age of 18.

And while there is no single psychological or demographic profile that can proactively identify likely school shooters, there are some general features school shooters tend to share, such as profound feelings of rejection and a history of having been bullied. Many shooters also display a fascination with guns and/or a preoccupation with violence.

There is no credible, clinically-based evidence that mass shooters, as a group, are psychotic or delusional when carrying out their violence.

 Furthermore, blaming “mental illness” for school shootings stigmatizes those with clinically-diagnosed psychiatric disorders, who are rarely violent when adequately treated.

 That said, Kowalski and her colleagues found that more than half of K-12 shooters had a history of “psychological problems” of various sorts.

2. Handguns are easily obtainable in the US, and are often poorly-secured by family members.

 Though the Uvalde shooter apparently used a rifle,Kowalski found that handguns were used in over 91% of the K-12 shootings, and almost half of the shooters stole the gun from a family member.

 According to Daniel Flannery, a professor at Case Western Reserve University and the director of the Begun Center for Violence Prevention Research and Education, “It’s way easier to get a handgun than it is to do just about anything else in this country…our background check is woefully inadequate.”

 Furthermore, more than half of gun owners do not safely store all their guns, according to a survey of 1444 US gun owners conducted by researchers at the Johns Hopkins Bloomberg School of Public Health.

3. Violent acts, including mass shootings, are on the rise nationwide, possibly related to the pandemic and its attendant socioeconomic dislocations.

Recent data from cities across the US show a trend of increased violent crimes as the COVID-19 pandemic has lingered on, though the numbers vary from city to city.

 Moreover, a cross-sectional study showed large increases in mass shootings with the start of the COVID-19 pandemic, “…consistent with the notion that mass shootings, an extreme form of violence, may be influenced by social and economic factors.”

 While acknowledging that such correlations do not necessarily represent causation, the recurrent and largely unpredictable surges of COVID-19 infection, coupled with their adverse socioeconomic repercussions, probably represent a risk factor for more mass shootings.

4. Psychological distress is increasing among teens and adolescents, and there is a shortage of mental health support for this age group.

In December 2021, the United States surgeon general, Vivek Murthy, MD, warned that young people are facing devastating mental health effects as a result of generational challenges, including the coronavirus pandemic. Dr Murthy’s report noted significant increases in self-reported depression and anxiety in younger age groups, along with more emergency room visits for mental health issues.

 Murthy observed that, “Young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good-looking enough, popular enough, smart enough or rich enough [and]…that comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic and gun violence feels too slow.”10 While it is not clear that these trends will have a direct effect on the likelihood of school shootings, we need to recall Dr Kowalski’s finding that most perpetrators of K-12 shootings are under the age of 18.

 Unfortunately, obtaining professional help for this troubled age group has become increasingly difficult in the US, and shortages of mental health workers have only been worsened by the pandemic.

5. Media attention may encourage the copycat effect.

After mass shootings, the general media are often fixated on the shooter’s motives, family background, signs of mental disturbance, social media postings, etc. Almost inevitably, this lurid coverage is linked to the shooter’s name and face. Unfortunately, there is reason to believe that this sort of sensational publicity may encourage copy-cat killers, bent on outdoing the previous shooter.

 To the tens of thousands of disaffected, rejected, and bullied young men who imbibe this sort of cultural glorification, the temptation to “make history” by violent and vengeful means may prove irresistible. Alas, I see no sign that the media are becoming more restrained in their publicity of these horrific events—and this does not bode well for the future.

Though it is easy to give in to despair, there are ways, as a society, that we can reduce the frequency and lethality of mass shootings. As my colleague, James L. Knoll IV, MD, and I argued in a previous article,

“While solid, evidence-based methods of preventing mass shootings are still lacking, we believe that progress will come through work on a number of fronts. First, better reporting of ominous behaviors and careful use of extreme risk protection orders may avert at least some mass shootings. Second, the use of Threat Assessment and Management (TAM) teams in our schools may also help preempt planned attacks. TAM teams are interdisciplinary groups of professionals that include law enforcement, mental health providers, and other security stakeholders, collaborating in a structured effort to accurately assess and mitigate the risk of violence.”

Beyond these remedies, I believe that we Americans, as a society, need to do some serious introspection. That begins by asking ourselves some serious questions, like: what must we do to reduce the likelihood that troubled adolescents with violent intentions will get hold of unsecured firearms? What resources are required to address the mental health needs of younger populations? And what must we do to counteract the allure and glamor of these unspeakably violent deeds?

Originally published on our sister brand, 

1. Kornfeld M, Iati M, Knowles H, et al. Biden says Second Amendment ‘not absolute’ as more details of school shooting emerge. 

https://www.washingtonpost.com/nation/2022/05/25/texas-school-shooting-uvalde-victims-live-updates/

2. Statista Research Department. Mass shootings in the U.S.: shooters by gender, as of May 2022. May 25, 2022. Accessed May 26, 2022. 

https://www.statista.com/statistics/476445/mass-shootings-in-the-us-by-shooter-s-gender/

3. Kowalski RM. School shootings: What we know about them, and what we can do to prevent them. Brookings. January 26, 2022. May 26, 2022. 

https://www.brookings.edu/blog/brown-center-chalkboard/2022/01/26/school-shootings-what-we-know-about-them-and-what-we-can-do-to-prevent-them/

Mass murder: causes, classification, and prevention. 

6. Shapiro E, Andreano C. The type of gun used in most US homicides is not an AR-15. ABC News. October 26, 2021. Accessed May 26, 2022. 

https://abcnews.go.com/US/type-gun-us-homicides-ar-15/story?id=78689504

7. Survey: more than half of U.S. gun owners do not safely store their guns. Johns Hopkins Bloomberg School of Public Health. February 22, 2018. Accessed May 26, 2022. 

https://publichealth.jhu.edu/2018/survey-more-than-half-of-u-s-gun-owners-do-not-safely-store-their-guns

8. Beals M. How violent crime has gone up since the pandemic. 

. February 15, 2022.Accessed May 26, 2022. 

https://thehill.com/policy/national-security/594291-how-violent-crime-has-gone-up-since-the-pandemic/

Mass shootings in the US during the COVID-19 pandemic.

10. Richtel M. Surgeon General warns of youth mental health crisis. 

 December 7, 2021. Accessed May 26, 2022. 

https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html

11. Axelson D. Addressing the youth mental health crisis with coordinated systems of care. 

https://www.psychiatrictimes.com/view/addressing-the-youth-mental-health-crisis-with-coordinated-systems-of-care

Reducing media-induced mass killings: lessons from suicide prevention. 

13. Pies RW. After Las Vegas, the danger of copy-cat killers. 

http://www.psychiatrictimes.com/trauma-and-violence/after-las-vegas-danger-copy-cat-killers

14. Knoll JL IV, Pies RW. Moving beyond “motives” in mass shootings. 

. January 14, 2019. Accessed May 26, 2022. 

https://www.psychiatrictimes.com/view/moving-beyond-motives-mass-shootings

Kowalski RM, Leary M, Hendley T, et al. 

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