S3E25 / The Psychology of Mass Shooters / Adam Lankford, J. Reid Meloy, Jillian Peterson, Sue Klebold

Saying mass shooters are “evil” is overly simplistic and doesn’t do much to prevent them from killing. But understanding what they have in common, like suicidality, may help us intervene before it’s too late.

 

Celine Gounder: Another week in the U.S. … another mass shooting. The latest… in Odessa, Texas.

Celine Gounder: Seven lives lost, and many more injured. Leilah Hernandez. Edwin Peregrino. Mary Granados. Kameron Karltess Brown. Raul Garcia. Joe Griffith. And Rodolfo Arco. These are the names we should remember.

Celine Gounder: We’ve all got to do our part to end gun violence in America. That starts by learning about the problem… and the solutions. Over the past year and a half, I’ve devoted myself to this cause. If you agree that more people need to learn about the science of gun violence and what we can do about it, please share this podcast with them. These are important conversations we all need to hear. Thanks for listening. Now… on with the show.

Celine Gounder: This episode of “In Sickness and in Health” talks about suicide… and mass shootings. Please listen at your own discretion.

Adam Lankford: …they feel like nobodies, and by killing large numbers of innocent victims, they’re able to guarantee that they become somebodies…

Jillian Peterson: People know that if they do this, they get noticed and they get talked about…

J. Reid Meloy: …the young man in his own mind will have developed the belief that he has a right to kill other people for the injustices that have been delivered upon him.

Celine Gounder: Welcome back to In Sickness and in Health, a podcast about health and social justice. I’m Dr. Celine Gounder. This season we’re looking at gun violence in America.

Celine Gounder: To start off today’s show, I’m just going to get out of the way. I want you to hear from someone who’s been impacted by gun violence and suicide… in one of the worst ways imaginable. This is Sue Klebold talking about her son. He was a high school student in Colorado.

Sue Klebold: He had been accepted at four colleges. He had been accepted at the university of his choice. A couple weeks before, we had gone on a college visiting trip… and… As far as we knew, he was finishing up his school year, he was living those happy, pre-college years that many of us remember.

Sue Klebold: And he had a prom. He went to a prom with a friend of his. And they rented a limousine, and they all had their tuxes and their long dresses, and they went out to dinner. And while they were at the prom, they went dancing, and he picked up his tuxedo and his corsage and it was a happy time. I remember I filmed him. He was joking into the camera. He threw a little snowball at my husband because he was annoyed at being filmed. … And it was about 4:30 in the morning when he got home. I got up to talk to him.

Sue Klebold: And he said, “Mom… I’ve had the best time I’ve ever had in my life, and I just wanted to thank you… for making it possible for me to go.” I just felt like this was a wonderful time, a wonderful boy. Everything was fine.

Sue Klebold: Four days later, he was dead, and he had participated in the school shooting.

Celine Gounder: Sue is the mother of one of the Columbine shooters.

Sue Klebold: When people say to me, “How could you not know?” I have to go back and say, “I saw a child who was preparing for his future, talking about his future, thanking me for things that I had done for him.” I was totally baffled by what he did and had no concept that such a thing could be on his mind.

Celine Gounder: What was going on in the mind of this young man? If his mother couldn’t see what was festering within him… who could?

Celine Gounder: Mass shootings seem to us impulsive, random… just… plain evil. But there are common traits and triggers that many mass shooters share.

Adam Lankford: …if we look at the trajectory of these individuals’ lives, often you see that they were suicidal before they were homicidal.

Celine Gounder: Many of our reactions—from schools to the media at large—are backfiring.

Jillian Peterson:…we’ve created this mythology and this script around this form of violence, and so I think that’s why we see it on the rise.

Celine Gounder: But there are warning signs…

J. Reid Meloy: …an FBI study that was published in 2018, they found that 88% of the adolescent public attackers had told a third party of their intent to attack.

Celine Gounder: …that… if acted on… can stop someone who’s planning mass murder.

Sue Klebold: …if they are aware that a friend has obtained the means by which to die or kill, that they have a big responsibility to share that information…

Celine Gounder: In this episode of “In Sickness and in Health,” the psychology of mass shooters.

Sue Klebold: Before his death, if you had asked me how well I knew my son, I would have said I knew him very well, that we had a good relationship, and that I had no doubt that he would grow up to be a good person, a good citizen, a good steward of the planet. He was somebody that I had great faith in and adored.

Sue Klebold: He was extremely bright. That was the first thing that struck me about him as a child. He learned so quickly, and everything came so easily to him.

Sue Klebold: He was the kind of boy who liked to manage his life.

Celine Gounder: Sue says her son was the only one in their family who could save money. He asked how to do his own laundry when he was 10. He liked to be in control.

Sue Klebold: When you take a kid… for whom everything has gone his way most of his life, when these kids begin to experience thoughts that are frightening or suicidal, they don’t know what to do with that. They don’t know how to handle those feelings, and they’re so used to considering themselves perfect and in control, that when these things start to happen, it hits those kinds of kids especially hard.

Sue Klebold: I believe that when his thoughts started to become unpleasant, and that he started having suicidal thoughts and feelings, I think he believed that that was a personality flaw, that was something wrong with him. And he had trouble accepting that and that imperfection.

Sue Klebold: Then when this happened… it made me realize that I’ve been living a life of, that was just delusional. It didn’t exist. What I was feeling was his reality, and our reality was not.

Celine Gounder: Sue saw her son getting ready to graduate, going to prom with friends, going off to college. But after the Columbine shooting, another version of her son came to light.

Sue Klebold: I learned long after his death that he was talking and thinking about suicide, and we found something that he’d written, the police found it and returned it to us, that when he was 15 years old, he had written a page where he described being in agony and wanting to die and wanting to get a gun and to kill himself. He described cutting himself. And these were things that were happening that I had no idea.

Sue Klebold: In terms of really being alone, from my perspective, I’m here telling him that I love him, and I’m hugging him. That was such a shock to me as a mother to see writings when he would talk about feeling alone or being alone, because I couldn’t understand how someone could feel that way when they were so loved. But it’s not uncommon, and many people do feel that way.

Celine Gounder: In our last episode we talked about why people die by suicide: isolation, thinking they’re a burden on others, and the capability to act on those suicidal thoughts. In hindsight, some of these traits could be seen in Sue’s son. But in the case of mass shooters, suicidal thoughts… can metastasize… into something else.

Sue Klebold: …there were incidents of having trash thrown at them or being knocked down in the hallway, people picking on them and shoving them around and squirting them with ketchup, and really humiliating experiences that I think drove the two boys together because they experienced these things when their friends were not around to see it.

Sue Klebold: …he was so self-focused on just these little micro feelings of whatever he was experiencing: vengeance, rage, and wanting life to be over…

Sue Klebold: From what we were able to observe… failed belongingness, being bullied, those were things that we really were not aware of… the important thing here is that if one has a feeling of that they don’t belong, that they’re different, it’s very difficult to understand that someone may have that feeling and yet, to us, that may not look like it’s possible.

Celine Gounder: The U. S. saw its first mass shooting in 1949… when a twenty-eight year-old man killed thirteen people while walking through his neighborhood in East Camden, New Jersey.

Celine Gounder: But the Columbine shooting… in 1999… which took place some 50 years after that first mass shooting… marked the beginning of a new, gruesome, and uniquely American phenomenon: school shootings.

Celine Gounder: Mass shootings feel like they happen all the time… and there’s something to that. They’ve become a lot more frequent. In the month of August alone… 53 people were killed in four different mass shootings in the United States. But despite the attention they attract, mass shootings… are relatively rare.

Jillian Peterson: It feels like they’re not, but they account for less than a half of a percent of all gun violence in America. 60% of gun deaths are suicides… and the majority [of the rest] is gang-related.

Celine Gounder: This is Jillian Peterson. She’s a professor at Hamline University. She’s also the co-founder of the Violence Project.

Jillian Peterson: For the past two years, we have been researching the psychosocial life histories of all mass shooters

Celine Gounder: Jillian’s research is trying to understand the motivations of mass shooters. Her team has been interviewing people who knew them, family and community members, and… sometimes even the shooters themselves.

Jillian Peterson: When you look at hundreds of mass shooters, there is no profile that really emerges where I can check these boxes and say, “Here’s what everybody has,” but we did see these patterns emerge in the data that led us to these four key pieces that you see across the board…

Celine Gounder: Those key pieces tend to be: early childhood trauma…

Jillian Peterson: ….so you see things like parental suicide, sexual abuse, physical abuse, pretty significant trauma.

Celine Gounder: …a triggering event… that speeds up their planning and preparations…

Jillian Peterson: This could be days, weeks or even months before the incident, but something happens that is the last straw.

Celine Gounder: Mass shooters… study… other mass shooters.

Jillian Peterson: …when someone’s talking about mass violence or suicidality or showing a great interest in the Columbine killers, those are huge red flags.

Celine Gounder: …and, the means and capability to follow through with the killing.

Celine Gounder: The vast majority of these mass shootings… are suicides.

Jillian Peterson: The vast majority of people who are suicidal would never dream of doing something like this, but I do think what we’ve seen is that these truly are suicides. There’s only been one or two cases where the person went in and had a plan to get out. Most of the time, they go in with the intention of dying in the act.

Adam Lankford: …or they’re what I’d refer to as “life indifferent,” meaning that they don’t care whether they live or die…

Celine Gounder: This is Adam Lankford. He’s a professor at the University of Alabama.

Adam Lankford: And I’ve been researching mass murderers and terrorists and mass shooters for frankly far too long now.

Celine Gounder: Adam agrees that most mass shooters are suicidal.

Adam Lankford: …if we look at the trajectory of these individuals’ lives, often you see that they were suicidal before they were homicidal.

Adam Lankford: So we saw that with, for example, the Parkland school shooter, who I believe referenced committing suicide after some family trauma and the loss of his mother, and then moved on to the idea of mass murder-suicide, although he actually ended up surviving.

Celine Gounder: Adam’s research also looks at some of the other motivations behind these attacks. One of the most important is that shooters see themselves as the victims of whatever group they target.

Adam Lankford: …both of those perpetrators in the case of Columbine had a sense that they were disrespected and underappreciated, which actually interacts with the third factor that is not always present in the case of public mass shooters, but is more common among the deadliest perpetrators, which is that they often seek fame or attention.

Celine Gounder: It’s no accident many of these shooters target schools… it’s not because they’re gun-free zones… it’s because this is where they think they were victimized.

Adam Lankford: In the case of the Columbine shooters… you can understand their desire for fame and attention as overcompensation for their sense that they weren’t respected or appreciated enough. So they said things… won’t it be great to get the respect we’re going to deserve. They anticipated unfortunately correctly that… movies would be made about them, that their faces would be on the front of magazines and things like that.

Celine Gounder: They didn’t get respect in life, so they seek it out in death.

Jillian Peterson: …individuals who do this want notoriety… in death that they don’t have in life.They want this to go viral. They want people to watch and see it, and to read their manifestos and to talk and say their names afterwards. … These are performances meant to be watched.

Celine Gounder: And the media is rewarding mass shooters… with the fame and attention… they seek.

Jillian Peterson: I think that the media plays a big role in terms of spreading the contagion.

Jillian Peterson: I turned on some 24-hour cable news network the other day… and it was just constant pictures of the perpetrator. It just made me so sad because that’s the exact opposite of what we want to be doing. We should be covering victims and heroes in these acts more so than we’re covering perpetrators.

Celine Gounder: Adam Lankford agrees:

Adam Lankford: …really the key here is that it’s possible to give the public the information they need about these incidents, the details on what happened, and why it happened, and how to prevent it from happening, and what the warning signs were, without giving attention to the individual perpetrators. Just as one example, no one ever looks at the face of someone who committed a public mass shooting and thinks, “Oh, I’ve seen this person’s face. Now I know how to prevent mass shootings.” That’s not actionable information. It’s simply putting it out there really to get clicks or to put a face and a name with a crime. But what the research suggests is that that’s actually contributing to the problem.

Celine Gounder: This kind of fame-seeking connects with other psychological traits shared by mass shooters: narcissism and paranoia.

J. Reid Meloy: The narcissism is very pervasive in these cases… where there is a sense of grandiosity that one is larger than life, and there’s also a very strong sense of entitlement that, “I can do what I want when I want to.”

J. Reid Meloy: Unfortunately, that entitlement can also drive the desire to kill other people in retribution for how one has been treated.

Celine Gounder: This is Reid Meloy.

J. Reid Meloy: I’m a forensic psychologist…

Celine Gounder: Reid says paranoia and narcissism can play different roles for different shooters. Paranoid shooters believe they’re the target of a conspiracy by a specific group.

J. Reid Meloy: One of the really concerning things we’re seeing in our culture, in our society, now… where individuals will develop a general animus for a group. For instance, the young man who has been spurned or rejected by a young woman he wanted to go out with begins to think that now, not only does this young woman not like him, but all women are bad, all women are evil and conspiring against him and actively withholding from him.

J. Reid Meloy: We call it “target dispersion.”

J. Reid Meloy: We see this prominently in a group called the “incel movement,” which are the “involuntary celibates.”

Celine Gounder: These targets could involve anyone: women, immigrants, Muslims, African Americans. There’s often a manifesto that attempts to justify attacks on these groups.

J. Reid Meloy: The Swedish security gave this a name that they communicated to me that I thought it’s really good. They call it “copy-paste ideology,” where these young men will just, in a sense, copy-paste from various documents to try to create some kind of belief system to provide a rationalization for their killings. And a lot of times, there’s contradictions between those beliefs.

Celine Gounder: Reid says shooters’ paranoia and narcissism coalesce into something he calls a “compensatory fantasy.”

J. Reid Meloy: In other words, they turn inward, and they spend a lot of time having fantasies that are both violent and grandiose and also oftentimes retaliatory.

Celine Gounder: This is especially true for adolescent shooters.

J. Reid Meloy: This is a very, very critical aspect of their internal lives that moves an adolescent, whose life perhaps is not going very well in the real world… they, again, withdraw into this fantasy life where they’re, in a sense, compelled by the pleasure of both violent and grandiose thoughts of, oftentimes, retaliation, revenge, and then perhaps notoriety as they think about carrying out violence toward other individuals.

Celine Gounder: The act of shooting someone to death seems like it would seize someone in the moment. But, like suicide, mass shootings are rarely impulsive. Reid calls it “predatory violence.”

J. Reid Meloy: I think that we are wired to maintain a sense of calmness and a sense of focus when we’re in a predatory mode of violence, and that’s what we see with mass murderers. That does make it difficult if you’re only looking at intense anger or intense rage or fear as a marker for risk of carrying out an act of targeted violence, but those of us in the field know that just intense emotion is not telling us anything about whether or not this person is planning an attack.

Celine Gounder: But that doesn’t mean there aren’t warning signs. Sue didn’t realize it at the time, but in retrospect there were clues.

Sue Klebold: He had a brush with the criminal justice system. He had stolen something… well, that was completely out of character for him.

Sue Klebold: …they practiced, and they were rehearsed, and they went out to the woods apparently, and they shot guns, and they purchased guns, and they had a plan, and yes, they were enacting that to be able to carry that out…

Sue Klebold: I think there certainly was a series of thresholds that they crossed over… Even talking about cutting himself when he was 15 years old, was that a threshold? Was that him trying to acclimate to some kind of self-harm so that would be something he could practice, perhaps, his own death? Or was that an attempt to calm his bad thoughts and focus himself on his body and get it out of his mind where it was so uncomfortable?

Celine Gounder: The warning signs other mass shooters have displayed… are eerily similar… to those of the Columbine shooters.

Jillian Peterson: The other thing that we’re seeing is just a marked change in behavior, and this is going to look different for everyone, but somebody just acting differently, and something that you’re feeling concerned about. Of course, 99.99% of the time, a person in crisis is not going to do a mass shooting, but it’s better to cast a wide net.

Celine Gounder: Adam Lankford.

Adam Lankford: …there are some blatant and glaring warning signs that actually are surprisingly common, and specifically, I’m saying one of the major findings from looking at the most deadly attacks is that in many cases, the perpetrators specifically admitted having homicidal or suicidal thoughts, or even that they were interested in mass killing.

Celine Gounder: This was the most surprising thing I learned speaking with these experts. The vast majority of shooters actually tell other people… they want to die… and they want to commit mass murder.

J. Reid Meloy: …adolescent mass murders and adolescent target attackers will typically communicate their intent 60% to 90% of the time.

Celine Gounder: Reid Meloy.

J. Reid Meloy: This figure is very robust… and has been now validated by studies up to and including an FBI study that was published in 2018 that found that 88% of the adolescent public attackers had told a third party of their intent to attack.

Celine Gounder: Even adult mass shooters will tell someone of their plans between 50% and 60% of the time.

Celine Gounder: So what are we missing if mass shooters are literally telling others their plans?

Jillian Peterson: We see two things.

Celine Gounder: …which have to do with the people they’re talking to…

Jillian Peterson: One is that people just don’t take it seriously, or they don’t want to get someone in trouble. They don’t want to be seen as overreacting to something.

Jillian Peterson: Two, we see that these things do get reported to the authorities, but the authorities really don’t have any means to do anything about it because a crime hasn’t actually been committed.

Celine Gounder: But even if a shooter has all the immediate warning signs—suicidality… deifying past shooters… collecting guns… openly expressing interest in violence—there are legal limits to what law enforcement can do. Adam Lankford told me a story that shows just that.

Adam Lankford: There was a case in 2018 in Orlando after the Parkland shooting, where a university student was identified by police, and he cited the Las Vegas and Parkland shooters as his heroes. He posted that online that they were his heroes. And, when he was interviewed by police, he said, “It would take a lot to push me over the edge,” but basically said that he would consider committing a shooting at a middle school or a high school where he’d been bullied growing up if he had some sort of crisis, if he had a romantic breakup, or if he was fired from a good job or something like that. And remarkably enough, in that case, the judge basically said, it’s the student’s free speech to say that mass shooters are heroes and that maybe the quote was just the young man maybe want to look like a badass on Reddit.

Celine Gounder: Jillian Peterson agrees.

Jillian Peterson: Right now, the police usually don’t have a means to go in and take weapons away. We interviewed one parent … of a would-be perpetrator who actually went to the police and said, “Will you take these weapons away?”… and they couldn’t because they just don’t have that jurisdiction.

Celine Gounder: If the would-be shooter is still a minor, there’s at least the chance for a parent or some other adult to step in. Sue Klebold again:

Sue Klebold: …if they are aware that a friend has obtained the means by which to die or kill, that they have a big responsibility to share that information

Sue Klebold: …with a responsible adult because if I had known that… I would have totally freaked out, been parenting differently, doing everything differently.

Sue Klebold: I recently talked with somebody… she said that when the kids were in the car, and they drove by the school… they once pointed to the school with their fingers, like they were guns, and went [gun sound]. It was a playful thing, it was just something that kids would do when they drove by their school, to act like they were shooting or they’re blowing it up, but is that leakage? Do we consider something like that leakage? She certainly didn’t, because they were just in the car messing around. I think anything is potential leakage. He wrote a paper… about being a bullet and telling a story from the point of view of the bullet. Is that leakage? What we have to do is be incredibly aware… Don’t let anything go by and not question it and assume that everything is fine when any little hint that something may not be.

Celine Gounder: So, with all this information, what can be done to stop a potential mass shooter?

Celine Gounder: Unfortunately, many of our reactions to these tragedies… even when we have the best of intentions… can backfire. For example, shooter drills at school.

Jillian Peterson: Our data has made me think that we should not be drilling children. I think certainly we want all adults in the school to be trained and know what to do in the worst-case scenario, but our data found that 91% of the time, the perpetrator is a student of the school. So, if you think about that, 91% of the time, the perpetrator is running through the lockdown drills, and they know the school’s exact response, and so all of the money that we put into heightened security measures and into training run/hide/fight, the students are going through that training, and they know how to get in and out of that school. We’ve even seen that, in certain cases, that knowledge increases casualties. It doesn’t decrease them.

Jillian Peterson: Then secondly, I’m a psychologist and I’ve done some work looking at the psychological impact of those training drills, and we do know that it has an effect on kids and the way they see the world.

Jillian Peterson: And then the third concern is the fact that we know these are socially contagious, we know that students follow a script and get fascinated by it. And are we inadvertently handing out the script and normalizing this at very young ages?

Celine Gounder: But there is one aspect to these attacks that works in favor of prevention. Shooters often plan their attacks weeks, months… or even years in advance. This creates an opportunity for someone to notice… and take action.

Celine Gounder: Sue Klebold wrote a book, in part, to tackle this on a personal level. All proceeds from her book, A Mother’s Reckoning: Living in the Aftermath of Tragedy, are donated to support research on mental health and suicide prevention. In her book, Sue explains that just because profiling doesn’t work… doesn’t mean violence can’t be prevented. Prevention… does not require… prediction.

Sue Klebold: I think one of the most important things we have to do as a society is to learn how to talk to somebody to find out if they are struggling. If we observe behaviors that are different to be able to say to them, “I notice that.” And then fill in the blank, “You’re not sleeping” or “You’ve been sleeping in class” or “You did this, you wrote a violent paper. You weren’t at an event that I thought you wanted to go to.” And when people do those kinds of things, sometimes they’re really struggling with bad thoughts and feelings. “Are you having bad thoughts and feelings?” And not being afraid to ask someone, “Do you ever feel so bad that you wish you could just die?” “Are you having thoughts of suicide?” These are things that most of us are very uncomfortable talking about and asking about, but if we are able to do that, and give someone a chance to express that, we can save lives, we can prevent suicides, and in many cases, I believe we can prevent mass violence as well for those people who are suicidal and also homicidal.

Sue Klebold: So there are countless opportunities to try to help people in every aspect of society. The school systems can do much to teach children what is good mental health? What is mental wellness? How can you tell if your thoughts are bad and causing you discomfort, and what do you do about that? Who are the adults in your life that you can talk to? Who would you talk to, if one of your friends told you that they were thinking of killing themselves? So, the schools can play a huge role. Medicine can play a huge role. What about emergency rooms and people going because they’re having bad thoughts, anxiety, suicidal thoughts? What about the family practitioner? What about corrections? What about our churches and our clergy, what can they do to help and counsel people?

Celine Gounder: Jillian Peterson thinks any approach to prevention needs to go beyond punishment. For one thing… someone who’s suicidal doesn’t really care about being punished… even punishments as severe as, say, the death penalty.

Jillian Peterson: This is unfortunately not a problem that you can suspend or expel your way out of…

Jillian Peterson: …we’re advocating more for is more of a care team approach. So there’s threat assessment teams, which are really focused on is this person a threat or not? Versus the care team is thinking about, “Okay, this person has expressed that they want to do this in many ways… they don’t care if they live or die. How can we bring them back into this community? Who has the closest connection with them? Who can reach out and talk to them and figure out what type of resources they need? Is this mental health? Is it substance abuse? Is it social services? Is this peer support? What can we do long term to bring the student back into this community and get rid of the grievance?”

Celine Gounder: This approach has already stopped some mass shootings.

Jillian Peterson: There have been cases of students who had planned some things, and the school really embraced them back in. There was a principal we talked to who talked a shooter down who was in the bathroom on his own. The shooter was dressed in camouflage and holding two shotguns, and the principal was able to talk him down.

Jillian Peterson: That principal said that really the best violence prevention method he knows is to have good strong relationships with students because that will make it so students tell you when they’re concerned about other students, and make it so you have relationships in place that you notice when somebody is off, and you can connect with them and try to get them through the crisis.

Celine Gounder: Many political leaders in the U.S. call mass shooters “evil.” Their crimes are horrendous—there’s no denying that. But Sue points out that talking about shooters in this way… is dangerous.

Sue Klebold: When one of the people I loved most in this world did one of the most horrible things that had ever been done in this country, I had trouble looking at my youngest child, who was my precious boy, that I was so proud of as evil. And I know the world viewed him as evil, but I could not see him as evil. But everywhere I went, people were calling him evil, they were calling us evil. And what I concluded was that if we look at incidents like this, and we reduce it down to this is either good or evil, it’s a dangerous, useless precedent because its un-actionable.

Sue Klebold: If we just look at some people and say, “These people are evil,” then that doesn’t give society any shared responsibility in how to help anybody who is struggling. So I don’t believe that we should look at this problem as an issue of good and evil. It’s too simple. I know too many people who have struggled, and up to the moments of their death, they were struggling with their own morality, their own religious principles. They were unable to control their behavior because something in their thought process had broken down.

Sue Klebold: And so, I don’t like the idea of lumping acts that hurt other people all under the umbrella of evil. I think if we do that, we’re never going to be able to examine how to help people before they get to that place in their lives.

Celine Gounder: Only a very small proportion of people who are suicidal… become mass shooters. But the vast majority of mass shooters… want to die. What makes someone go from being suicidal… to homicidal? They think they’ve been victimized… and they want to go down in history as having done something big. That transition from being suicidal to homicidal… it’s often put on fast forward by a crisis at work… or in a relationship. And mass shooters… especially younger ones… often drop clues… and leak details of their plans to others. Recognizing all of this… creates a window… an opportunity… to intervene.

Celine Gounder: As the number of mass shootings continues to rise… some of us may start to recognize the warning signs we talked about in this episode… and what to do in response.

J. Reid Meloy: Now, we’ve seen some really striking changes since the series of attacks that just occurred—primarily in Gilroy, California and in El Paso and in Dayton, Ohio. We’ve seen an uptick in people being willing to report behaviors of concern. The question is whether people will continue to do that.

J. Reid Meloy: There have been, I think, at last count, like twenty-eight publicized, successful interdictions by police that may have stopped somebody from carrying out a mass murder.

J. Reid Meloy: So there may be hope that people now are much more willing to report behaviors of concern than they were prior to these series of attacks that we’ve just seen in the United States.

Celine Gounder: Next time, we’ll look at one option for disarming would-be shooters before they kill: red flag laws. Politicians on both sides of the aisle have started to come out in favor of red flag laws… but who do these laws target? and how well do they work? That’s next time on “In Sickness and in Health.”

Celine Gounder: If someone you know is in crisis or thinking of hurting themself:

• Do not leave them alone.

• Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt.

• Take them to an emergency room or seek help from a medical or mental health professional.

• Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255).

• Or text the Crisis Text Line at 741-741.

• Another resource for LGBTQ youth is the Trevor Project’s Lifeline at 866-488-7386.

Celine Gounder: Today’s episode of “In Sickness and in Health” was produced by Zach Dyer and me. Our theme music is by Allan Vest. Additional music by The Blue Dot Sessions.

Celine Gounder: If you enjoy the show, please tell a friend about it today. And if you haven’t already done so, leave us a review on Apple Podcasts. It helps more people find out about the show!

Celine Gounder: You can learn more about this podcast and how to engage with us on social media at insicknessandinhealthpodcast.com. That’s insicknessandinhealthpodcast.com. I’m Dr. Celine Gounder. This is “In Sickness and in Health.”