In the wake of recent tragedies, such as the actions of Matthew Livelsberger and Shamsud-Din Bahar Jabbar, there has been widespread discussion about the mental health of those involved, with terms like depression and PTSD often cited as contributing factors. However, as we continue to hear these labels, it’s important to pause and ask: Do these mental health diagnoses truly explain the root cause of such horrific acts? Should we be creating new categories or diagnoses for individuals whose actions are so extreme?

The current psychiatric framework, as outlined in the DSM (Diagnostic and Statistical Manual of Mental Disorders), does not directly link depression or PTSD to events like terrorist attacks or mass murders. Yes, individuals like Livelsberger and Jabbar may have experienced trauma or depressive episodes in their lives—but so have millions of other Americans who would never consider committing such heinous acts. The vast majority of those living with mental health struggles do not resort to violence, highlighting that the connection between mental health and these extreme acts is far more complex than we are often led to believe.

Studies have consistently shown that mental health disorders alone are not predictive of violent behavior. According to a 2013 study by the National Institute of Mental Health (NIMH), mental illness is rarely the sole cause of violent actions. Research supports the idea that individuals with certain personality disorders (e.g., narcissistic personality disorder or antisocial behavior) or those who experience significant social or ideological influences may be more likely to engage in violent acts. However, these conditions are not typically classified under common diagnoses like depression or PTSD.

Furthermore, treating conditions like narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD) is particularly challenging. Individuals with these disorders often lack self-awareness and empathy, making it difficult for them to engage in therapy or acknowledge their behavior as problematic. They may resist treatment, as they don’t see a need for change, and often show little remorse for their actions. Traditional therapies, such as cognitive-behavioral therapy, can be slow and less effective without significant motivation from the individual, which is often lacking in cases of NPD and ASPD.

While it is crucial to acknowledge that many of these individuals may not have received proper mental health treatment, the reality is that early intervention might not always change the outcome. Predicting who will engage in violent behavior is difficult. Many individuals on the brink of committing mass violence or terrorist acts are unlikely to seek help or be honest during evaluations. Mental health professionals often encounter this challenge, and studies show that many individuals who go on to commit acts of violence do not show clear signs of needing psychiatric intervention beforehand. Even with proper diagnosis and treatment, there’s no guarantee that they would adhere to therapy or medication in a way that would prevent their dangerous behavior.

This brings us to a critical question: What is the real solution? It is clear that mental health treatment alone isn’t enough to address the root causes of these tragedies. While mental health support is undoubtedly important, it’s only one piece of a much larger puzzle.

There may be a need for new ways of categorizing and understanding these extreme behaviors, but it shouldn’t be framed as just a mental health issue. Perhaps we need a broader framework that considers factors such as social isolation, extremist ideologies, societal conditions, and access to weapons when identifying the significant roles in shaping violent behavior. Until we start to address these multiple layers, the cycle of tragedy will likely continue.

Ultimately, it’s not just about finding new diagnoses or blaming mental health alone. We need to have an honest, open conversation about the underlying factors that lead to mass violence and terrorist acts—one that goes beyond mental health alone. According to CNN, there were 83 school shootings in the United States between January 2024 and mid-December 2024. This is atrocious and unacceptable! Our solutions must be multifaceted, addressing both prevention and intervention in ways that help protect individuals and communities. I would love to hear your thoughts.