Hi, I am Elle, and this is Quid Pro Quo, your friendly neighborhood forensics psych podcast. The Quid Pro Quo podcast deals with crime, psychology, and related themes. This particular episode deals with mass murders, though no graphic information is presented, discretion is advised. Episode 15, Diagnosis, Murderer.
So it's in a bit, it's mid-June of 2020, and there are a few things going on right now. I will not be addressing any of the current events today, as this episode has been several years in the making, and I need to get it off my plate before moving forward. I apologize in advance for any sirens I may miss in editing, but such as home audio engineering in the time of COVID. Aside from a lovely 2018 guest spot on the Barman's podcast, it has been a really long time.
Those of you who have graciously and optimistically left me in your podcatcher of choice have long since earned an explanation. In June 2017, my father had a bad fall. His health was already poured due to the ravages of smoking, and as a result, this touched off a cascade of issues which developed into a mysterious and persistent anemia. He was finally diagnosed in late September with an unidentified form of terminal bone cancer, and was gone by sunrise with the next day.
Two days beforehand, I learned that I had been chosen to spearhead an all-new, incredibly immersive collaborative project. It seems the universe abourrs a Stuart vacuum, and so my child was born in the spring of 2018. She has inherited part of my father's name, and near as I can tell, all of his stubbornness, which is impressive. She has been a joyous touchstone to help bring my family through a dark time, but a very time-consuming one.
True crime is my usual distraction of choice, but murder is not the easiest of topics to while away or leisure time at the best of times, much less while simultaneously mourning a parent and trying to keep a small human alive on even less sleep than I'm used to. It was a long time before I could even tolerate the slightest amount of true crime content, and I'm still limiting it pretty severely, but in these days of the 24-hour news cycle, it's impossible to escape entirely, which brings me to this episode. I helped run operations for a convention for many years. One of the most consistently useful rules for life I developed during that time is that if I have to answer the same question more than twice, I write down that answer in big-friendly letters and post it in a brightly lit place.
In many ways I approach this podcast as a conceptual extension of these convention information posters. Every time there is a mass shooting, I find myself rehashing the same talking points on mental illness and violence. I can't in good conscience call this a forensics-like podcast and continue to skirt this particular intersection of mental health and the law. I've been putting off this episode for a time when it would not be directly socially relevant, but here in the United States that's not feasible anymore.
For reference, I finish the primary copy editing of this very episode on the 4th anniversary of the Pulse nightclub massacre. In the aftermath of the 2017 Las Vegas mass shooting, my friend Brian asked me a question. How is someone who is not mentally ill actually do this? Is this a definition thing?
This is a reasonable question. The willingness to commit mass murder is generally considered to be aberrant behavior. So why don't we consider being a murderer, much less a mass murderer, to be a psychological disorder? So let's start with that definition issue.
Up until fairly recently, psychology was the realm of philosophy. Thousands of years of people hanging out in forums and colleges and salons and courts and shooting the shit, making conjectures based on their interactions with the world. These were people with the means and leisure to sit down and think about what other people do and the clout to actually have it written down for posterity. Plenty of smart observant people made for a reasonable start, considering but hardly representation.
Psychology was theoretical. It was not generally well researched aside from case studies. The access to the specific of these conclusions were often limited to colleagues, i.e. incredibly affluent men for the vast majority of history, and the popularity of anyone approach was usually based more on utility to social control and cult of personality than any objective functionality.
All that is to say, that the theories which gained ground were the ones with the most utility to the people teaching the classes and publishing the books. While many of these people had fantastic insights which have informed the modern understanding of the mind, there's all matter of good reason psychology has been dismissed as a so-called soft science for so many years. Psychology was weird and inaccessible and simply not built on much of a solid theoretical foundation. The popular western understanding of the mind that most people thought or even still think of as psychology can be basically boiled down to Sigmund Freud saying, okay everyone, gather round, I had these messed up thoughts about my penis and my mom when I was really high on cocaine.
So that's what we're gonna go with. And lots of really influential people over decades just shrugged and went, I don't know, seems legit. And psychoanalysis entered the world. Have you ever bled Freud?
It's very clearly pulled right out of the ass of a very strange person. It's no wonder people have been distrustful and confused about psychology. Thankfully, over time, people realize that old school Freudian theory is straight up hot garbage and so that surprisingly widespread approach to mental illness theory has been mostly replaced by the scientific process. We research and codify predictable groupings of behavioral symptoms which provide predictive and therapeutic guidance.
As neurological measures improve, we continue to add increasingly objective physiological features into these definitions. That is not to say the way people go about this process is perfect. Science is performed by people and even the most earnest people have biases and misunderstandings and an imperfect view of questions. So we're way not there yet.
Even good research is shaped by who is asking the questions and who is funding the investigation and who is reading those results. But that's where science shines. The scientific process itself requires transparency and the ability to challenge, test, and refine our conclusions over time. It doesn't have to be perfect, but it does have to be transparent.
A diagnosis is a discoverable definition with decades, if not centuries, of contributing writers which ideally is being scientifically reviewed for consistency. When you diagnose someone with any kind of melody, you are saying that they are displaying a meaningful set of known documented symptoms which have been shown through the years of research to happen together. You can use that information to predict certain things, for example how that diagnosis is likely to have come about, what will exacerbate it, what treatments might alleviate their symptoms, and in many cases the likelihood that other members of a given population can be expected to have the same issues. A symptom is a single piece of information which can inform a diagnosis but is not usually in and of itself sufficient to be a diagnosis.
You may have heard the term constellation of symptoms, and this can tell us a lot about how we view a diagnosis. A constellation is an arrangement of stars which people have found useful and distinct enough down the centuries to clearly define, pass on, and references a shorthand. An American astronomer today could speak with an ancient Greek sea captain or Renaissance era explorer or a Victorian map maker about any of a million individual named stars. If they used modern naming systems to start out, they would likely not get very far, but start with Capricorn or Orion or Ursus, and they would have a well-defined shared set of reference points to work out from.
When we say that someone who commits mass murder must be mentally ill, we're responding to an instinct which says, my observation of the day-to-day workings of humanity tells me this act is important. I want to put a pain in it. And this is absolutely understandable, but modern psychology is not about assuming something must be a useful distinction because it's the most obvious. Psychology is about discovering the factors which refine our understanding of classification, prediction, and ultimately treatment.
If the only listed criteria for this supposed mental illness is a single act which causes the diagnosis after the fact that is not exactly granular. Murder is an indication of disorder thinking. Yes, absolutely. But that one data point, no matter how dire, is not useful as a mental illness classification, much less functional for prevention in a wider population.
A single act in a vacuum tells us what happened, but provides little to no predictive or therapeutic benefit for people who have not yet committed the same act. This is like leaving a voicemail for someone which says, there's been a bad accident, call me back, and expecting that the person who gets that message will glean anything useful from that information. Supposed for the sake of argument that we diagnose everyone who killed someone as murderer, not otherwise specified. The sum and total of what that would tell you is that they already murdered someone.
We already have a handy word for that. It's called being a murderer. The murderer is the what, and what is not very useful without a whole lot of who, when, where, why, and how. When a modern, science-minded practitioner diagnoses someone with a psychological disorder, they signal they have come to that conclusion by looking at the totality of their behavior.
They look at test results and self-reporting and their own observations and rule out other causes and potentially appropriate diagnoses. Once they compare everything they know to this previously agreed upon scientifically-based, narrow definition and agree that it's the best fit as the description of the symptoms, then they can talk about diagnosis. The idea is that if this imaginary practitioner ran away to be a beach-hurt tomorrow, another practitioner could pick up that file and get a solid idea of the symptoms in question and a rundown of what challenges and treatments they might expect to see just by looking at that named disorder. That patient's future therapists would have an array of tested treatment protocols at hand, and after looking into the literature, they could be fairly confident that they understood how research and theoretical discussion might be applicable to the specific case.
This diagnosis is a useful and discerning label which references an entire body of research. Now imagine you went to the doctor with a really nasty rash, and without asking anything about how you got it, they said, yep, that's a clear case of itchy bromitis, and they sent you home with a bottle of calamine lotion and a friendly wave. A rash could be the result of a bug bite, a food allergy, poison ivy, or even a skin reaction from lymphoma. We don't assume that you should prevent, diagnose, and treat every case of itchy bromitis exactly the same way.
But that's what happens when your sole diagnostic criteria is the most obvious frustrating symptom. You can't categorize them together in a study and you can't even begin to take steps to prevent the problem when you are treating the most obvious symptom as the only relevant piece of information. This is exactly what diagnosing someone as murderer looks like. We could define the willingness to take human life as a sort of illness, but hinging the diagnosis on one symptom eclipses the big picture.
Go ahead and stick your hand into the files of any homicide detective, pull out a case, and read it. How much is that going to tell you about the next thousand randomly selected homicide cases around the country? Do the facts of that one case give you enough information to go out into the population, predict who is going to commit the same crime, and preemptively treat them for the shortcomings, which may lead them down that same path? Of course not.
Murder is the symptom. It's an awful symptom, and it may be the one that gets your attention, but it's simply not enough information to make predictive conclusions. You can't be in the mass murder factor, and you have even less cohesive data to go off of. There are a lot of different metrics commonly used to determine what constitutes a mass murder for research and statistical purposes.
Do you include drive-byes, deadly armed robberies, family annihilators, organized crime? Depending on the conversation you're having, there are reasonable arguments for any of them. But we're talking about mental illness here. So pulling out murders with a clear external motive, such as profit, we could make up mass random out of the blue murderosis, but it would define somewhere around 200 to 250 people over the last hundred-ish years of US history, with vastly different backgrounds and intense.
It's not as noticeable after the fact by the Commission of the One Act. Headlines move large and are designed to attract attention, so I don't think people have much idea of the relative scale of this group. Imagine developing a psychological diagnosis based on only the people who have visited the International Space Station, or who reached the peak of K2, the world's deadliest mountain. People are calling for sweeping reaches of privacy, resulting in psychological and legal limitations on otherwise-obstaining members of the American public based on the actions of an incredibly disparate group of people who you could comfortably see on three to four yellow school buses.
I want to know, what does the mind of a mass murderer look like? Well, what does the life of former Marine sharpshooter Charles Whitman predict about the infamy-seeking teenagers Harrison Klebold? What can we generalize from the life of 16-year-old elementary school shooter Brenda Spencer to Gulf War veteran Oklahoma City bomber Timothy McVey? What does studying Las Vegas mass murderer real estate businessman Steven Patek tell us about Aurora's shooting perpetrator and neuro-science doctoral student James Holmes?
While all of them set out to kill, and all would be Schuins for this murderer-not-otherwise specified diagnosis, each had a unique path to that defining act which individually provides little to no predictive value for future incidents, and the points in common between them are surprisingly minimal and as things go, non-descript. Defining the willingness to murder as a mental illness is pretty much the ultimate in locking the barn after the horse. While being a murderer is a great warning flag to predict future violence from the specific person who committed the murder, it says almost nothing predictive about the rest of the population. We can have a stadium full of people with the same markers as someone who commits one of these infamous crimes, but until they do it, we can't predict they will.
Being angry isolated men in their 30s with depressive markers and a tendency to shift blame outwards for their life disappointments will get you basically a huge swath of the internet. Imagine having to determine whether every angry dude broke with a chip on his shoulder who ever picked a pointless fight with you on Twitter was truly likely to commit a mass murder, and you may start to see the scale of the issue here. What makes one person kill when a thousand exactly like them do not is probably one of the oldest questions we have asked about our fellow man, and we have been failing spectacularly at answering it for thousands of years. Murderers are being studied.
It's just not a line of inquiry that's going to get us very far until we understand a lot more about basic human behavior. This does lead us to one of the few solid bits of predictive information which we can glean about our murderer, not otherwise specified individual. Murderers are more likely to murder than non-murderers. There now, do you feel your understanding of the universe and ability to predict violence has been functionally enhanced by that fact?
Yeah, me neither. We already label and follow these people and consider them a greater risk to the population, leaving aside the structural issues in our criminal justice system, which admittedly is a, ah, human-tulous side. That's what the whole murder, conviction, jail, and parole thing is supposed to be about. It is the pin our society puts into this problem.
There are a number of notable individual and serial killer recidivists. I'm looking at you in 1970s California, and prior convictions are fairly predictive of other interpersonal violent crimes. But when it comes to mass killings, we're already pretty well on it. Most of these people do not have prior murder charges, and whatever predictive utility there is in labeling murderers to avoid mass and spree killings seems to have already been mostly well achieved by our current system, with one caveat to be addressed in a little bit.
Okay, so we've addressed why we don't define mass murder as a distinct mental illness. What about the flip side of the question? A 2013 National Public Opinion Survey found that 46% of Americans believed that persons with serious mental illness were, quote, far more dangerous than the general population, end quote. Mind you, this is before Pulse, Mandalay Bay, Sutherland Springs, El Paso, Parkland, Virginia Beach, Thousand Oaks, the Washington Navy Yard, the Tree of Life Synagogue, Santa Fe High School, etc., etc., etc.
Stop looking to mental illness to predict extreme violent acts. The statistics simply aren't there. Yes, these 200 or so mass murders may arguably be more statistically likely than the population have mental illness features. The actual number is up for endless debate, as a number of these diagnoses are post-mortem determinations.
However, being one of a couple hundred people literally infamous for an act is a pretty solid clue that someone is not representative. Per the national lines on mental illness, one in five American adults can be expected to experience mental illness, or one in 25 if you want to limit it to serious mental illness. By that metric, there are over 13 million people in the US today who can be expected to exhibit severe mental illness. That's more than the entire population of the state of Pennsylvania.
Statistically, there would have been ten times the number of severely mentally ill people as our hundred years of mass murderers just among the crowd who physically attended the Super Bowl in 2020. I know I'm going at this hard, but I really need to make sure you grasp this scale. We're talking about a tiny convoy of school buses worth of people over the last hundred years. This is not a representative sample of American mental illness.
There is a reason these people are infamous. In the general population, the symptom clusters which practitioners define as mental illness are, on their own, negatively correlated with violent crime and positively correlated with victimhood. According to mental health myths and facts page from mentalhealth.gov, even though 20% of American adults experienced a mental health issue, only three to five percent of violent acts can be attributed to individuals living with a serious mental illness. A 1990 National Institute of Health Survey of 10,000 randomly selected adults from three American cities found that for those who do qualify as seriously mentally ill and commit violence in their words, it is often, though not always, for the same reasons that non-mentally ill people engage in violent behavior.
In short, violence is a complex societal problem that is caused more often than not by other things besides mental illness. In contrast, people with severe mental illnesses are over ten times more likely to be victims of violent crime than the general population. In the late 2000s, the Bureau of Justice Statistics looked at a sample of just under a thousand people in treatment for severe mental illness in Chicago. They compared the prevalence of violent victimization in this population to create the National Crime Victimization Survey.
More than one-quarter of the researched group had been victims of a violent crime in the past year, a rate more than eleven times higher than the general population rate, even after controlling for demographic differences between the two samples. Despite being not even remotely applicable to the vast majority of people with mental illness, we certainly do like to use this violent, mentally ill concept to frame our view of what we expect from people who murder. This is the point where I remind you that we do already have a legal mechanism for limiting the rights of people whose mental status contributed to an illegal act. It's called Insanity, and as previously discussed in Episode 6 and 7, it's kind of a big deal.
In the discussion of violence about controlling behavior of people with mental illness directly targets the very people most in need of protection from violence. Now, there is a longstanding category of carefully quantified and illegally defined behavior with considerably more predictive value for future violence. But for some reason, it does not typically inspire the same call for social restrictions as a mental health diagnosis in the wake of a public tragedy. The Washington State Institute for Public Policy did extensive analysis of the system designed to predict recidivism and shape post-parole interactions with offenders.
Why are we scrutinizing the mental health of the American public based on perceived comparisons to perpetrators of one in a million incidents after the fact? When, according to this policy analysis, a domestic violence felony conviction is the strongest predictor of male perpetrated violent crime. Men who feel free to hurt the people they know develop a sense of entitlement to hurt those they don't. Between 80 and 90% of murderers have prior police records in contrast to 15% of American adults overall.
Domestic murders are preceded by prior domestic violence more than 90% of the time, and 46% of domestic murderers have had a restraining order against them in the past. Based on current American law, the Sutherland Springs Baptist Church shooter should not have been able to get a gun. He was convicted of domestic violence offenses against his wife and child in a military court, and six times the Air Force failed to follow proper procedure to ensure his convictions were recorded by civilian authorities. Had they done so, he should have been refused firearms access.
While he did undergo treatment for mental health issues, all recorded mental health treatments he received were intimately tied in with these domestic violence convictions, so the limitations of his rights that should have happened based on well-established, objective legal grounds would have well-proceded any theoretical legal status change due to his mental illness if we were to enact some kind of limitation of this sort. If we want to save people's lives, focusing on domestic abusers is an objective and achievable legal path. Every day in the US, approximately two to three women are killed by current or former intimate partners. Domestic violence follows known patterns and is one of the most robust predictors we have of violence to both partners and strangers.
But you don't hear much call for a psychological diagnosis of domestic violence perpetrator not otherwise specified to protect the public. Despite compelling evidence to the contrary, partner abuse is widely considered a private issue and not a public health issue. As if we needed to add a sickly neon red cherry on top of this whole mess, let's take a moment to contemplate the mechanism of psychological diagnosis in the US and how that might play out for these post-tragedy calls to action. Mental health treatment here has basically contorted itself to fit the construction of private insurance, much to everyone's detriment.
Even the simplest treatment can stack up to be staggeringly expensive, so to receive payment for treatment or even time to form a solid diagnosis, insurance carriers basically require that practitioners give some sort of diagnosis, quote unquote, severe enough to warrant further treatment. Between fine-tuning that initial placeholder diagnosis, changing providers, changing definitions, and changing life circumstance, people in treatment for even fairly mundane issues can rack up long lists of sometimes contradictory diagnoses, which can follow them through life. When people talk about nebulously doing something about people with mental illness, later not, that's what we have to work from. There's no oversight on the validity of these labels or mechanism for record perches because they are and should be private.
So if you have a poorly informed GP who didn't feel the need to refer a patient to an expert or a maverick provider that has decided that they just like labeling things a particular weird way or a jerk practitioner that didn't like you and decided somehow that was your malfunction, or even someone from an out-of-date mindset, well, that's probably now on your permanent record. That's a scary thing we get mixed up in this do-something-about mental illness mindset. Unless location is both an expert in their own issue and capable of advocating for themselves, how would they even work through that in a situation where their freedoms were being limited by nothing but one of these diagnoses? We're talking about creating a prophetic umbrella legal construction on the freedom of Americans based on an 80 or so year-long dumpster fire of subjectivity, which our health insurance system is happily feeding with oily rags and sawdust.
There are absolutely ways to save people's lives by focusing on mental health as a risk factor in the legal system. If we focus attention to the factors which inflame domestic violence issues, attention to those at risk for suicide, attention to protecting people with severe mental illness, research into breakdowns of empathy and the factors which lead to a demonstrated willingness to hurt people and animals, and research into outward bleamschifting, just to name a few obvious roots, we have potential for making a real difference in the incidence of violent crime. But slapping a diagnostic label on a murder after the fact for the purpose of legality, when we already have a legally defined status for them because I guess it feels good to do with anything in the face of the unthinkable? Well, that isn't going to help, and impinging on the rights and privacy of all individuals diagnosed with a mental illness based on the actions of a couple hundred people who, aside from that pesky mass murder thing, look quite a bit like nearly everyone you've ever argued with on Twitter isn't going to do it either.
If you want to weigh in on the myriad problems with equating someone's mental health status with their legal status, or if you have other questions about true crime and forensic psych, seek me out at quidproquocast.com and we're fine, internet's are sold. If you happen to want a t-shirt, head over to quidproquocast.threadless.com because that's a thing you can do now. On a couple of more administrative notes, per my promises on Patreon, patronage would be paused until after I had another published episode, so let this be your heads up. Thank you to my newest Patreon subscribers and five star reviews from iTunes and Facebook, point Randall, Ray Gather, murder road trip, Canadian true crime, psych nurse 9, RN-H-O, Hinchlands, Smoke and Grace, Melbany, and Ariel.
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