Who is the next Dylan Klebold, the next Adam Lanza, the next James Holmes? Who is the next Dylann Roof? Can we figure that out in advance who they are, help them, and prevent the next atrocity?
The events at Columbine, Sandy Hook, Aurora, and now Emanuel A.M.E. (and elsewhere) are so horrifying that rather than look, we choose instead to look away.
But as we keep looking away, these events keep happening, and they seem ever more distant from the bounds of comprehension, civility, and community.
By doing nothing, we are making a choice. Doing nothing is a decision, one that brings with it a whole new mirror of horrors. We are not reflecting on ourselves, but it is being reflected upon us.
This is a multi-faceted problem that requires integrated solutions, but the national narrative is piecemeal and focuses on flags and weapons and illnesses. But this problem requires a holistic solution.
Today, we must ask how we stop the next mass murderer using a public health approach.
We can reduce mass murder by thinking about it as a public health problem, with prevention as the cornerstone vaccine.
• Primary prevention reduces all of our risk.
• Some of us have more risk factors than others, and targeted prevention (secondary prevention) reduces that risk.
• Some of us already have a disease and tertiary prevention (what we commonly consider to be a direct intervention) reduces harms.
This holistic approach is the foundation of our public health system. And it may reduce mass murder.
Each facet limits the probability of violence. None singularly cures, but as a portfolio the cumulative effect would could be large.
Primary prevention would have two facets. One is reducing access to instruments of violence, and one around predilection toward violence.
Limiting the availability of semi-automatic weapons and high capacity gun clips would prevent some mass murders. Sandy Hook would have been less likely with those prevention practices, while the likelihood of a Charleston style shooting would likely have been unaffected.
Creating a culture where hate is not tolerated also has primary preventative effects. That means thinking about racism (does the Confederate flag flying over the Capitol motivate hate?) misogyny (does our cultural objectification of women create hate?) capitalism and coolness (do we need to think about creating a society that is more inclusive?). Primary prevention requires a nation curriculum built on inclusive values.
Secondary prevention. Some people are at greater risk of becoming mass murderers. People who have experienced great trauma and individuals who have strong racist, misogynistic, religious and political values that is out of the mainstream are at higher risk. These individuals often have suicidal ideation and have committed particular crimes: rape, child sex offenses, burglary. Developing targeted assessments at intake into the criminal, juvenile or public health systems would help to identify these individuals and target evidence-based interventions to them.
Tertiary intervention. Decisions about what type of intervention we choose appear to lie in research, in the field of predictive analytics. For many crimes, we can predict, albeit imperfectly, where crime and violence are likely to occur next. We can even get a general sense of who is likely to be a perpetrator.
In the case of the Charleston shooter Dylann Roof, there were clear red flags. Here was a young man (and mass murderers are predominantly young men) who exhibited one particular pattern of behavior that was quite instructive: he was arrested multiple times in a short period of time, without prior history of that type of behavior. That should be a red flag to law enforcement.
We know a little about the risk factors for mass shooters. With research we could learn a lot more.
There is no one policy change that will stop all mass murder, but a layered approach might reduce the general likelihood. Sophisticated research can help us to unlock this box, to identify future offenders, and to save lives. Yes, there are privacy and civil liberties concerns. Yes, the analytic process needs to be improved. Yes, there needs to be rigorous, transparent and objective oversight.
But without proactive action, another church and another school is destined to become yet another memorial to tragedy.
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