The Mind of the Mass School Shooter.

The mass school shooting at Robb Elementary School in Uvalde, Texas, coming nearly 10 years after the eerily similar massacre at Sandy Hook Elementary School in Newtown, Connecticut, shook America to its roots. Nineteen children and two adults were shot dead by an isolated, grievance-filled former student who shot his grandmother in the face before attacking the school. At Sandy Hook, 20 children and six adults were shot dead by an isolated, grievance-filled former student who also shot his mother in the head before attacking the school. The drumbeat of so many additional school shootings, before, in between, and since these catastrophes, continues unabated. The names are chillingly familiar: Columbine, Virginia Tech, Parkland, Oxford, and so many more. We stand back aghast, unable or unwilling to intervene, staring at the heart of the question of what it is that enables human beings to violate the most central of moral tenets in so gruesome a fashion, to shoot to death children who stand in front of them. The modern era of mass school shootings dates to 1966 when Charles Whitmore took to the bell tower at the University of Texas, Austin. In all the years since, we have made very little progress in understanding, predicting, and preventing mass shootings of any type. At the center of the conundrum is the shooter (almost always a male) and the limitations of our predictive abilities. The mass school shooter presents a distinct and special challenge. So many other mass shootings are motivated by hatred and bigotry. Hatred of Black, LGBTQ, Asian, Hispanic, and Jewish persons has clearly driven most of the mass shootings of the last decades. But there is no evidence that mass school shootings have been motivated by hatred of school children or of ethnic, racial, cultural, or political groups. In retrospective analyses of mass school shootings, we have been able to piece together a sense of the personal qualities and motivations driving the shooters, but we are left adrift as we ponder the qualities that enable a person to pull the trigger, face to face with the young children he will kill. We have profiles provided by the Federal Bureau of Investigation (FBI), the Secret Service, and others, but for every potential perpetrator fitting these profiles, a vanishingly small number become shooters. As is the case for all low-base-rate events, even highly accurate predictive tools (which we do not have) would be rendered virtually useless by excessive false positives. We have diagnoses as well, derived from the past histories of shooters and, in some instances, from assessments of surviving shooters. Although profiles help us to categorize the type of person who may become a shooter and diagnoses point to typical psychopathologies we find in shooters, they do not help us to understand who, among all those fitting these profiles and carrying these diagnoses, lacks the protective factors that would prevent them from actually shooting or even what those protective factors are. A few clarifications are needed before proceeding. The largest number of mass shootings are the result of nonrandom acts of domestic and other forms of community violence. While acknowledging their terrible toll, these shootings, which are generally targeted, are not the subject of the present discussion. Rather, we are discussing those mass shootings which Dr Schwartz is Psychiatrist in Chief, Emeritus, the Institute of Living, Hartford Hospital, Hartford, CT, and Professor of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT. Address correspondence to: Harold I. Schwartz, MD. E-mail: Harold.Schwartz@hhchealth.org.