In light of the increasing salience of mass shooting incidents within the public consciousness, questions arise regarding the potential role that media may play in influencing perpetrators and future incidents. Interviews of and consultations with psychiatrists by news media in the aftermath of mass shootings offer opportunities for public education and stigma reduction but pose unique challenges. Additionally, psychiatrists may be called upon to assess risk for mass violence in certain persons who exhibit potential warning signs of media influence. This article reviews information from the fields of social psychology, media research, and threat assessment relevant to the psychiatrist in considering the potential impact of media on such incidents of mass violence. Of note, possible effects of violent entertainment/media on behavior will not be reviewed and is beyond the scope of this article.
Contagion Effects and Clustering of Mass Shootings
The term contagion is derived from the Latin word contagio meaning “contact or touch,” and therefore refers to a process of transmission. Through the works of James Mark Baldwin, Jean-Gabriel Tarde, and Charles-Marie Gustave Le Bon, the concept of contagion as a model for social psychological phenomenon first became popular in the late 19th century.1 Although originally applied to crowd behavior, modern-day social contagion research typically is divided into examining emotional contagion and behavioral contagion. Whereas emotional contagion is concerned with the spread of affect and mood, behavioral contagion is concerned with the tendency for certain behaviors demonstrated by one person to be imitated by observers.
Thus, contagion theory applied to media reflects the spread of ideas, attitudes, and behaviors between individual people and groups as facilitated through mass media. Such contagion effects may be seen in disordered eating, mass psychogenic illness, emotions, self-harm and suicide, and violence toward others. Although various related terms (ie, copycat, generalized imitation) have been used in describing mass shootings,2 for purposes of this article, we use “contagion” as an umbrella term for these various processes.
Several studies have noted apparent contagion in mass shootings given the temporal clustering of incidents. For example, Towers et al.3 conducted an analysis using a mathematical model of media coverage of school shooters and mass killings that found after a previous school shooting or mass killing involving firearms, there was, on average, a 13-day period of increased likelihood of another related incident. These authors demonstrated that each mass killing involving firearms led to at least 0.30 new incidents (ie, for approximately every three incidents, there is at least one new incident within a 13-day period on average), and each school shooting led to at least 0.22 new incidents (ie, for approximately every 4 to 5 incidents, there is at least one new incident within a 13-day period on average). The authors noted that although they assumed contagion occurred due to media coverage, their analysis did not examine the specific causes of the contagion.3
However, other studies examining social media indicate that media coverage likely influences the contagion. Analyzing a mass shooting archive, Lee4 observed an increase in the number of mass shootings after the proliferation of mass shooting news on social media platforms, using the year 2011 as a benchmark due to the surge of social media milestones that year. Garcia-Bernardo et al.5 confirmed that social media publicity about school shootings correlates with an increased probability of new incidents. The probability of a school shooting increased with the number of tweets talking about school shootings (eg, the probability of a shooting in the following week doubles when the tweets increase from 10 to 50 tweets per million).5
Media coverage that is sensational and inadvertently promotes the notoriety of the perpetrator may increase the likelihood of contagion effects. In the analysis by Towers et al.,3 the authors noted that no significant evidence of contagion was found in shootings in which fewer than four people were killed, possibly indicating that these relatively more frequent shooting events were not dramatic enough to garner 24-hour headline attention.
Although contagion research may help inform psychiatrists about media-related effects on mass shootings at the population level, clinicians are often faced with questions about potential media effects on a specific person who may be at risk for mass violence. To better understand how media-related factors may promote mass violence in a susceptible person, we need to discuss specific media-related factors that may be involved in a person's path toward mass violence.
Potential Media Influence Warning Signs
Although a violence risk assessment or threat assessment for targeted violence must take into account the broader psychological and socio-cultural context of a person and not look at any specific factor in isolation, several potential warning behaviors related to media influence may suggest the need for further assessment or forensic/threat assessment referral.
Identification and Popular Culture
It is a typical psychological process to associate with other people and assimilate some of their characteristics and views. However, identification can be a warning behavior for escalating risk for targeted violence.6 Here, a person may admire and wish to emulate certain (usually militaristic) cultural archetypes, fictional characters, or historical attackers. In the case of the latter, perpetrators may aim to surpass their predecessors in body count and in media publicity. Mass murderers may follow a cultural script that guides and frames their interactions with others, resulting in violence through copycat effect. Take, for instance, the recurrence of the “Columbine effect” after the 1999 mass shooting in Colorado.7,8
Similarly, such copycat effects being inspired by cultural scripts derived from fictional media have also been seen. In fact, several shooters, including the perpetrators of the Columbine incident, were inspired by the film Natural Born Killers.9,10 Another identification warning behavior is a person believing oneself to be an agent of a particular cause or belief system, often with justification for violence. This can also apply to fictionally derived causes or belief systems; consider concerns generated by Arthur Fleck's character arc in the film Joker,11 an embodiment of a mass murderer cultural script.12
Identification may be communicated in many ways, including through appearance and clothing, references, and behaviors. Pop culture symbols (eg, icons, emblems, logos, and memes) taken from fictional media and internet culture (and often shared via social media) may serve as identification indicators. For example, Pepe the Frog, a “peaceful frog-dude” created by artist and children's book author Matt Furie, was co-opted by Alt-Right extremists as a hate symbol. Thus, it would behoove psychiatrists to familiarize themselves with such pop culture symbols that may have developed a double entendre.
Radicalization and Cultivation of Extreme or Fringe Beliefs
Although typically associated with terrorism, the concepts of radicalization and cultivation of extreme or fringe beliefs also apply to mass shootings. Media can shape our worldviews and can also function as an echo chamber by amplifying and normalizing extremist views, indoctrinating those at risk for perpetrating mass shootings. Such people may then affiliate with extremist online communities, paving the path toward radicalization.
One such community is the “incel” (a portmanteau of “involuntary” and “celibate”), which is part of the larger “manosphere” that came to light after Elliot Rodger perpetrated the 2014 Isla Vista mass shooting.13 Subsequently, prior to perpetrating a mass killing by driving a van down a busy Toronto street, Alex Minassian hailed Elliot Rodger and pledged allegiance to the “Incel Rebellion” on a Facebook post. Using computational social science methods in studying the manosphere over the last 14 years, Ribeiro et al.14 found a trend toward extremism. The authors noted a substantial migration of active users to more extremist communities, potentially indicating steps down a radicalization pathway.
Fixation, Incitement, and Leakage
According to Meloy et al.,15 fixation warning behavior is any behavior that indicates an increasingly pathological preoccupation with a person or a cause. As an individual person cultivates extreme beliefs, that person may become immersed in media content that promotes perseveration on toxic worldviews, increasing fixation upon a personal cause and grievance. Sometimes, extremist online communities may encourage or incite other members to take action. For example, on the day of Alex Minassian's attack, some members of the online community instigated other “incels” to follow up with “mass rape” and “acid attacks.”16 A clinician may become aware of “leakage” via alarming posts on social media. Often signs of impending attack, leakage warning behaviors are defined by Meloy et al.15 as communications to a third party of an intent to do harm to a target through an attack.
Considerations for News Media Reporting on a Mass Shooting
After a mass shooting, a psychiatrist may be consulted by the media regarding responsible coverage of the incident. The psychiatrist should, therefore, be aware of considerations related to contagion mitigation strategies.
Do Not Name Perpetrators: Move Them from Infamy to Anonymity
Many mass shooters seek fame and may compete for notoriety by outdoing their predecessors in body count, ingenuity of attack, and publicity. In fact, many attackers have explicitly admitted that they sought fame through their acts of mass violence, with some perpetrators even reaching out to the media prior to or during the killings to ensure media coverage.17 Moreover, online communities, which may include fan bases, can subsequently reinforce a perpetrator's fame.18 For some mass shooters, gaining notoriety is a way of reclaiming social capital; for others, it's a way of feeding their narcissism.19
Various recommendations regarding media coverage of mass shootings exist. Most of these recommendations center around efforts to avoid inadvertently bestowing fame and notoriety on the perpetrator and efforts to minimize identification with the perpetrator. These principles are also reflected in campaigns such as “Don't Name Them” and “No Notoriety.” Key recommendations regarding media coverage of mass shootings can be found in Table 1.
Key Recommendations Regarding Media Coverage of Mass Shootings
Lessons from Suicide Reporting Guidelines
Given that nearly one-half of people who commit mass shootings in the United States kill themselves or refuse to surrender and are killed by police (ie, “suicide by cop”), the media coverage of suicide effects are also relevant to mass shootings.15 Although outside the scope of this article, several guidelines for suicide reporting exist and psychiatrists interfacing with the media should familiarize themselves with them.20–22 Of note, several recommendations from suicide reporting guidelines mirror recommendations from mass shooting reporting guidelines, including avoiding sensationalizing, inadvertently glamourizing or romanticizing the incident, avoiding prominent placement of the story, and avoiding oversimplified explanations of the cause of the incident.
Considerations for Psychiatrists Interviewed by the Media After a Mass Shooting
The media often turns to psychiatrists and other mental health professionals for interviews and statements after events involving mass violence. Through interviews with media outlets, psychiatrists have the unique opportunity to educate the public on mental health topics and can significantly help to destigmatize mental illness,23 particularly with regard to the association between mental illness and violence.24 However, these opportunities also present unique challenges that the psychiatrist should consider; because interviews are part of the public record, it is especially important that psychiatrists carefully weigh the ramifications of their comments.
The Goldwater Rule
After a mass shooting, news media often attempt to construct or frame a narrative to help understand the tragedy. Reporters may turn to psychiatrists for public comments based on their professional expertise and call for an analysis of an alleged perpetrator. Psychiatrists in such situations should be mindful of the Goldwater Rule and related ethical principles.
Originally created in 1973, the Goldwater Rule refers to Annotation 3 of Section 7 of the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry.25 This guideline stemmed from a magazine article enlisting more than 1,800 psychiatrists' opinions regarding Senator Barry Goldwater's psychological fitness to be President of the United States immediately preceding the 1964 Presidential election between Goldwater and President Lyndon Johnson.26
Based on this guideline, psychiatrists should not give professional opinions about people in the public light who they have not examined without authorization for the public statements. Instead, a psychiatrist may share expertise about psychiatric issues in general.
Conflation of Mental Illness and Violence and Resultant Stigma
In the wake of a seemingly senseless mass shooting, it is normal to try to rationalize how a person could engage in such hostile and deadly behavior. Breaking news about such events tends to infer causality to mental illness, leading to misguided assumptions among viewers about mental illness and violence. McGinty et al.27 found that after being exposed to a media story about a mass shooting, people had increased negative attitudes toward people with serious mental illness. Sensationalized statements about a perpetrator's mental health made by the media and political figures only serve to perpetuate unfounded assertions that further stigmatize people who experience mental illness.28 These statements also result in unrealistic expectations about psychiatrists' ability to prevent mass violence and that our profession fails in its duty to protect society.24 In response to the 2019 mass shootings in El Paso, TX, and Columbus, OH, President Donald Trump said, “Mental illness and hatred pull the trigger, not the gun.”29 Such reductionistic statements distract and detract from multifaceted public health crises30 in the US involving violence, gun control, and access to mental health services.
In commenting to reporters after a mass shooting, psychiatrists have an opportunity to address stigmatizing misconceptions and relay accurate and reliable data. Research suggests that severe mental illness has a limited correlation to violent crime.31 Only 3% to 5% of yearly violent crime is attributable to serious mental illness, and of those incidents, an even smaller percentage involve firearms.32 The National Center for Health Statistics database shows that people diagnosed with mental illness perpetrated less than 5% of gun-related homicides in the US from 2001 to 2010.28
Stress-Related Reactions in Viewers
Exposure to media coverage of mass violence can result in unintended adverse effects, including an increase in stress-related symptoms.33 Trauma research indicates that people are generally more resilient when they experience a greater sense of control over how they experience potentially traumatic exposure.34 Encouraging viewers to protect themselves from overstimulating and distressing images by limiting the amount of coverage watched, as well as engaging in relaxation and breathing exercises to normalize biological alarm systems, and various other self-care activities stimulates feelings of control and self-efficacy.
In addressing the media and the public, psychiatrists can shift focus away from the perpetrator to efforts to reduce potential trauma and to promote resilience in impacted people and communities. In the absence of a consensus among mental health experts regarding effective interventions in the several-month period after an incident of mass violence, one evidence-informed approach suggests five guiding principles for intervention efforts. These principles include promoting (1) a sense of safety, (2) calming, (3) a sense of self– and collective efficacy, (4) connectedness, and (5) hope.35 Additionally, access to reliable support resources and websites, such as The National Child Traumatic Stress Network,36 Substance Abuse and Mental Health Services Administration,37 and The National Mass Violence Victimization Resource Center (Resilience Tools)38 may further stimulate feelings of self-efficacy.39
Mass shootings are inherently high-profile news events. Psychiatrists can play an important role in increasing public awareness of accurate mental health information and addressing stigmatizing misconceptions related to mental illness and violence. In such situations, psychiatrists should be mindful of ethical and professional considerations and contagion research to minimize the risk of inadvertent harm. Some tips for psychiatrists participating in media interviews after a mass shooting can be found in Table 2. Similarly, psychiatrists should continue to interface with news media regarding responsible coverage of mass shootings and be mindful of contagion research during these consultations.
Tips for Psychiatrists Participating in Media Interviews after a Mass Shooting
Additionally, psychiatrists may be called upon to assess risk for mass violence in certain people. Although an analysis of the broader psychological and socio-cultural context of such people is needed, psychiatrists should be aware of potential media influence warning signs that may suggest the need for further assessment or forensic/threat assessment referral.
More research is needed to elucidate predisposing/vulnerability factors and modifying/buffering factors to better understand why certain people are more susceptible to these media-related influences. Multidisciplinary research and crosstalk between different areas of study may help further advance knowledge; for example, radicalization research has historically been focused on terrorism and may help inform knowledge about the radicalization process for mass shooters.
- Ellwood CA. The theory of imitation in social psychology. Am J Sociol. 1901;6(6):721–741. doi:10.1086/211015 [CrossRef]
- Meindl JN, Ivy JW. Mass shootings: the role of the media in promoting generalized imitation. Am J Public Health. 2017;107(3):368–370. doi:10.2105/AJPH.2016.303611 [CrossRef] PMID:28103074
- Towers S, Gomez-Lievano A, Khan M, et al. Contagion in mass killing and school shootings. PLoS ONE2015:10(7): 1–12, e0117259.
- Lee KJ. Mass shootings and media contagion theory: social media's influence on frequency of incidents. Elon J Undergrad Res Commun. 2018;9(2):27–35.
- Garcia-Bernardo J, Hong Q, Shultz JM, et al. Social media appears to affect the timing, location, and severity of school shootings. Accessed August 11, 2020. https://arxiv.org/abs/1506.06305
- Meloy JR, Mohandie K, Knoll JL, Hoffmann J. The concept of identification in threat assessment. Behav Sci Law. 2015;33(2–3):213–237. doi:10.1002/bsl.2166 [CrossRef] PMID:25728417
- Larkin RW. The Columbine legacy: rampage shootings as political acts. Am Behav Sci. 2009;52(9):1309–1326. doi:10.1177/0002764209332548 [CrossRef]
- Langman P. Different types of role model influence and fame seeking among mass killers and copycat offenders. Am Behav Sci. 2018;62(2):210–228. doi:10.1177/0002764217739663 [CrossRef]
- Helfgott JB. Criminal behavior and the copycat effect: literature review and theoretical framework for empirical investigation. Aggress Violent Behav. 2015;22:46–64. doi:10.1016/j.avb.2015.02.002 [CrossRef]
- Rutowski R, Stone O, Veloz D. Natural Born Killers [movie]. Los Angeles, CA: Warner Bros. August26, 1994.
- Phillips T, Silver S. Joker [movie]. Los Angeles, CA: Warner Bros. October4, 2019.
- Pozios VK, Saragoza P, Kambam P. Why ‘Joker’ shouldn't have relied on mental illness. The Hollywood Reporter. October10, 2019. Accessed August 11, 2020. https://www.hollywoodreporter.com/heat-vision/why-joker-shouldnt-have-relied-mental-illness-1246869
- Hoffman B, Ware J, Shapiro E. Assessing the threat of incel violence. Studies Conflict Terrorism. 2020;43(7):565–587.
- Ribeiro MH, Blackburn J, Bradlyn B, et al. From pick-up artists to incels: a data-driven sketch of the manosphere. Accessed August 11, 2020. https://arxiv.org/abs/2001.07600
- Reid Meloy J, Hoffmann J, Guldimann A, James D. The role of warning behaviors in threat assessment: an exploration and suggested typology. Behav Sci Law. 2012;30(3):256–279. doi:10.1002/bsl.999 [CrossRef] PMID:22556034
- Futrelle D. Incels hail Toronto van driver who killed 10 as a new Elliot Rodger, talk of future acid attacks and mass rapes. We Hunted the Mammoth: Misogyny, Tracked and Mocked. Accessed August 18, 2020. http://wehuntedthemammoth.com/2018/04/24/incels-hail-toronto-van-driver-who-killed-10-as-a-new-elliot-rodger-talk-of-future-acid-attacks-and-mass-rapes/
- Lankford A, Madfis E. Don't name them, don't show them, but report everything else: a pragmatic proposal for denying mass killers the attention they seek and deterring future offenders. Am Behav Sci. 2018;62(2):260–279. doi:10.1177/0002764217730854 [CrossRef]
- Raitanen J, Oksanen A. Global online subculture surrounding school shootings. Am Behav Sci. 2018;62(2):195–209. doi:10.1177/0002764218755835 [CrossRef]
- Bushman BJ. Narcissism, fame seeking, and mass shootings. Am Behav Sci. 2018;62(2):229–241. doi:10.1177/0002764217739660 [CrossRef]
- World Health Organization. Preventing suicide: a resource for media professionals. Accessed August 18, 2020. https://www.who.int/mental_health/prevention/suicide/resource_media.pdf
- American Association of Suicidology. Suicide reporting recommendations. Accessed August 18, 2020. https://suicidology.org/wp-content/uploads/2018/12/Suicide-Media-Reporting-Extended-4-merged-1.pdf
- Centers for Disease Control and Prevention. Suicide contagion and the reporting of suicide: recommendations from a national workshop. Morb Mortal Wkly Rep. 1994;43(RR-6):9–18. PMID:8015544
- Louie AK, Beresin EV, Schlozman SC, et al. The psychiatrist being interviewed by the media. Acad Psychiatry. 2019;43(3):270–274. doi:10.1007/s40596-018-0970-y [CrossRef] PMID:30155604
- Majeed MH, Sudak DM, Beresin E. Mass shootings and the news media: what can psychiatrists do?Acad Psychiatry. 2019;43(4):442–446. doi:10.1007/s40596-019-01066-2 [CrossRef] PMID:31025205
- American Psychiatric Association. The principles of medical ethics: with annotations especially applicable to psychiatry. Accessed August 18, 2020. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/principles-medical-ethics.pdf
- Cooke BK, Goddard ER, Werner TL, Cooke EO, Griffith EE. The risks and responsible roles for psychiatrists who interact with the media. J Am Acad Psychiatry Law. 2014;42(4):459–468. PMID:25492072
- McGinty EE, Webster DW, Barry CL. Effects of news media messages about mass shootings on attitudes toward persons with serious mental illness and public support for gun control policies. Am J Psychiatry. 2013;170(5):494–501. doi:10.1176/appi.ajp.2013.13010014 [CrossRef] PMID:23511486
- Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. 2015;105(2):240–249. doi:10.2105/AJPH.2014.302242 [CrossRef] PMID:25496006
- Thomas E. Trump's claims and what experts say about mental illness and mass shootings. Accessed August 11, 2020. https://abcnews.go.com/Politics/trumps-claims-experts-mental-illness-mass-shootings/story?id=65101823.
- Zibler C. An ethical response to mass shootings. Psychiatr News. 2016;51(2):1. doi:10.1176/appi.pn.2016.1a12 [CrossRef]
- Fox JA, Fridel EE. The tenuous connections involving mass shootings, mental illness, and gun laws. Violence Gend. 2016;3(1):14–19. doi:10.1089/vio.2015.0054 [CrossRef]
- Appelbaum PS, Swanson JW. Law & psychiatry: gun laws and mental illness: how sensible are the current restrictions?Psychiatr Serv. 2010;61(7):652–654. doi:10.1176/ps.2010.61.7.652 [CrossRef] PMID:20591996
- Woodward JB, Lin YR, Lynn SK, et al. Psychological impact of mass violence depends on affective tone of media content. PLoS ONE. 2016:14(4):1–20, e0213891. doi:10.1371/journal.pone.0213891 [CrossRef]
- Hobfoll SE, Watson P, Bell CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry. 2007;70(4):283–315. doi:10.1521/psyc.2007.70.4.283 [CrossRef] PMID:18181708
- Rees G. Developing your own standard operating procedure for handling traumatic imagery. Accessed August 11, 2020. https://dartcenter.org/resources/handling-traumatic-imagery-developing-standard-operating-procedure
- Peterson S. Mass violence resources. Accessed August 11, 2020. Available at: https://www.nctsn.org/what-is-child-trauma/trauma-types/terrorism-and-violence/mass-violence
- Meissner B. Incidents of mass violence. Accessed August 11, 2020. https://www.samhsa.gov/find-help/disaster-distress-helpline/disaster-types/mass-violence
- The National Mass Violence Victimization Resource Center. Resilience tools. Accessed August 11, 2020. https://www.nmvvrc.org/
- Sidhu SS. Name no names: the role of the media in reporting mass shootings. J Am Acad Child Adolesc Psychiatry. 2017;56(1):3–4. doi:10.1016/j.jaac.2016.10.004 [CrossRef] PMID:27993225
- Follman M. How the media inspires mass shooters. Accessed August 11, 2020. https://www.motherjones.com/politics/2015/10/media-inspires-mass-shooters-copycats/
Key Recommendations Regarding Media Coverage of Mass Shootings
Focus on victims, survivors, and others who took action to end the incidents
Do not put the perpetrator's name in a headline
Avoid/minimize use of the perpetrator's name
Avoid/minimize use of pictures of the perpetrator
Do not fixate on the number of fatalities
Avoid publicizing videos and manifestos from the perpetrator except when clearly valuable to the reporting
Do not use names, photos, or likenesses of past perpetrators
Tips for Psychiatrists Participating in Media Interviews after a Mass Shooting
Be mindful of the impact your statements may have on contagion
Be mindful of the Goldwater Rule and related ethical considerations
Address public/media misconceptions, especially the overblown link between mental illness and violence
Avoid using the violent incident as a reason to advocate for mental health resources
Do not oversimplify the causes of a shooting
Strive for objective truth telling
Mention support resources