Mr. President, Please Do Not Commit More Violence by Blaming the Mentally Ill

Those who suffer from mental illness become the object of slander whenever mass shootings happen. The aftermath of the tragedies in El Paso, Texas, and Dayton, Ohio, has been no different: “Mental illness and hatred pull the trigger. Not the gun.” As it was after Thousand Oaks, California: “But he was a very, very mentally ill person.” Or Pittsburgh, Pennsylvania: “I think that mental health is a problem here,… this isn’t a guns situation.” Or Parkland, Florida: “So many signs that the Florida shooter was mentally disturbed.” And Sutherland Springs, Texas: “Mental health is your problem here. This was a very … deranged individual…. This isn’t a guns situation.” These are all words coming from the president of the United States.

As mental health experts, it seems we could never repeat enough times that individuals with mental illness are not any more dangerous than the general population. Those suffering from mental illness are more often victims of violence than perpetrators. Not only that, less able to defend their rights, they have borne the brunt of the onslaught of budget cuts, in state after state, year after year, until jails and prisons have replaced mental hospitals (about 75 percent of those who should be treated in hospitals are incarcerated). Still, even when mentally ill persons become violent, what has caused their violence is. often not the mental illness but social factors.

I have been consulting with the World Health Organization since its landmark publication that approached violence as a public health issue in 2002. Applying the ecological model, 20 years of research had shown that social, cultural, economic and environmental factors are far greater determinants of violence than individual factors. Violence, therefore, is best thought of as a societal disorder.

This makes the problem much easier to prevent before it happens, but much harder to try to identify or treat in individuals after they have become violent. The best we can do is to predict dangerousness through past dangerousness. However, even the most violent persons are not violent most of the time. When and how a violent act occurs is almost accidental, depending largely on situational factors, such as environment and access to weapons.

When mental health experts evaluate dangerousness, we assess violence risk that has very little to do with diagnosing mental illness. We ask questions such as: Did the person live with both biological parents to age 16? Did the person have discipline or attendance problems in elementary school? Did the person or close blood relatives have alcohol problems?

We look for personality traits: Is the person glib with superficial charm? Does the person have a grandiose sense of self, boasting about his skills and abilities? Does she seek stimulation in constant activity, being prone to boredom? Does he engage in pathological lying, conning, and manipulation? Does she lack remorse and have shallow affect? Does he lack empathy?

We look for lifestyle: Does the person lead a parasitic lifestyle, exploiting others or position for financial gain? Does she have poor behavioral controls, exhibiting irritability and verbal abuse? Is he sexually promiscuous, impulsive, and irresponsible?

We look at behavior: Does the person have difficulty accepting responsibility for her actions? Has he had many short-term marital relationships? Was there juvenile delinquency, or behavioral difficulties between the ages of 13 and 18? Are there signs of carelessness and criminal versatility?

The president was separated from his parents at age 13 to go to a military boarding school because of numerous behavioral problems since childhood. Although he claims to have avoided alcohol, his older brother died of it. As for personality traits and behavior, Donald Trump so obviously fits them, one would have believed violence risk assessments were written for him. This is perhaps why there was a near-consensus among mental health experts from the beginning, leading some of the most renowned professionals to contribute to the book, The Dangerous Case of Donald Trump, at the onset of his presidency.

When we have a president who is dangerous, a societal disorder is far more likely to erupt. Violence is particularly contagious. An office as powerful as the presidency can lay the social and cultural groundwork for epidemics of violence.

While there is not much we can do to diagnose or treat Mr. Trump without being his personal psychiatrist, there is a lot we as experts can do, through shared knowledge, to help curb the public health threat he poses. We already know his presidency has caused record levels of stress and anxiety, according to studies by the nation’s leading mental health associations. He does not have to cause more harm by blaming those who are suffering from mental illness.

Blaming psychiatric patients is a form of scapegoating in order to deflect one’s own responsibility by tagging the problem on “the other.” Dehumanizing a group of people as “mentally ill monsters” is a form of violence that can also make them a target of deadly violence. It also increases their suffering, making them more likely victims not only of others but of themselves.

The president has said himself: “We … must make sure that those judged to pose a grave risk to public safety do not have access to firearms and that if they do, those firearms can be taken through rapid due process.” These are the exact recommendations we made of the president: to remove him from access to nuclear weapons and war-making powers.

We made these after our analysis of the hard evidence on him in Robert Mueller’s report. My colleagues and I also made them to Congress members when they consulted with us in December 2017. It is about time we carried them out, rapidly, since time translates into lives. And of all who pose a risk to public safety, the president’s is the gravest.

Forensic psychiatrist, violence expert, president of the World Mental Health Coalition (, and editor of "The Dangerous Case of Donald Trump.”

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