That's how the ex-wife of Omar Mateen described the Florida man who shot to death 49 people early Sunday in a gay nightclub in Orlando. Sitora Yusifiy spoke of her ex-husband's history of domestic violence and abuse. By now you have probably seen or heard some variation of this quote in news reports about the massacre.
Lately, the term mental illness has come up a lot when we talk about mass shootings. For many, words such as "bipolar" have become almost synonymous with violent and unpredictable. It's human to look for reasons, to find any cause that could explain senseless or atrocious acts. But blaming "mental illness" is a dangerous precedent that moves the conversation in the wrong direction.
The fact is, we cannot know yet why Mateen took his disastrous course; the reasons are likely complex, and we are in no position to hazard a guess, much less diagnose from afar.
As psychiatrists, it scares us whenever we read the words bipolar in relation to mass shootings. It increases the stigma against an already vulnerable population without addressing any attributable cause.
Those with a psychiatric diagnosis are actually more likely to be victims
of violence or suicide, not to be perpetrators in acts of violence.
Mental illness is a broad term, one that can mean a lot of things to a lot of people. It doesn't really help us understand a person's state of mind, and it does not always correlate to an actual psychiatric diagnosis.
The term "bipolar" has become a colloquialism. It has come to mean someone who is irritable, has frequent mood swings, outbursts of rage, lacks restraint. Urban Dictionary
offers this definition
-- "(d)escribes one who has bipolar disorder. This disorder causes the person to have mood swings frequently, usually triggered by something small."
But that's not bipolar disorder. Bipolar disorder is not outbursts of anger. In fact, when someone has daily mood swings from minute to minute with trivial triggers, bipolar disorder is a pretty unlikely diagnosis.
Bipolar disorder occurs in 2.6% of the population, according to the National Institutes of Mental Health, and is characterized by distinct episodes of depression, distinct episodes of mania or hypomania, and distinct episodes of normal mood, or euthymia.
It is not a set of pervasive characteristics that a person displays daily throughout his or her life. It is an illness, separate and distinct from the person, which has no bearing on his or her character and is not related to personality traits. This is an important distinction to make, particularly when we look at risk factors for violence.
So what do we have to explain a level of hostility and anger that would lead to mass violence? Again, we can't judge Mateen's particular case. Our objective here is not to diagnose but to explain the differences in disorders.
We do know
, in general, that when we look at the risks for violence, a history of violence, substance abuse and personality disorders represent known risks. Antisocial personality disorder
in particular commonly presents with aggression, anger, irritability, deceitfulness, hostility and lack of empathy for others.
In fact, most times what the public calls bipolar disorder or generalizes to be "mental illness" could actually qualify as antisocial personality disorder or some variant. Those people know the difference between right and wrong and may feel no remorse for their actions.
Other risk factors such as ease of access to firearms and other weapons as well as excessive alcohol use are also strongly associated
with multiple types of violence. The prevalence of firearm ownership has a significant association with the incidence of mass killings with firearms.
In the aftermath of a mass shooting, people call for change, and many times that change is propositioned as an increase in mental health funding. We in fact do need more mental health funding for those with psychiatric illnesses because they are underserved and underfunded.
Lacking access to care, they frequently die
from self-harm and chronic physical illnesses, including heart disease, stroke and diabetes.
That is why, even as this terrible attack recedes, we must continue the conversation about the cause and prevention of mass shootings, and about gun violence and the lives lost. And we must continue to talk about mental health disparities and the need for treatment to save the lives of those who are victim to a different kind of injustice.
But what we must not do is scapegoat an already vulnerable population to shift the conversation away from other factors -- such as improved regulation of firearms -- that we can change.