RALEIGH, N.C. (WGHP) — On October 12, 2022, a 15-year-old boy allegedly killed 5 people and wounded three others in a mass shooting that spanned several miles through a Raleigh neighborhood.

Very little information has been released specifically about the suspect, who was shot during the event and has remained in the hospital since. The Raleigh Police Department released information about the path the shooter took and the order in which the victims were confronted, the massacre allegedly starting with the death of his 16-year-old brother, James Taylor.

RALEIGH, NC – OCTOBER 15: People set up a memorial table with images of the victims of a shooting in the Hedingham neighborhood on October 15, 2022 in Raleigh, North Carolina. (Photo by Melissa Sue Gerrits/Getty Images)

Days later, two were killed and several more injured in a shooting at a St. Louis school. In a note left by the alleged shooter, he referred to himself as a “perfect storm for a mass shooter,” saying that “he had no friends, no family, no girlfriend and a life of isolation.” His family discussed his mental health issues and that he had been hospitalized in the past.

While discussions of mental health and how stigmas around mental health could play a part in the prevention of future tragedies become amplified after shootings, experts say mass shooters are often either not mentally ill at all or that mental illness was just one of many factors at play.

Crosses set up to honor those who lost their lives during the Robb Elementary School shooting in Uvalde, Texas on November 8, 2022. (Photo by Mark Felix / AFP) (Photo by MARK FELIX/AFP /AFP via Getty Images)

PsychiatryToday writes that mass shooters are often terrorists, with many being radicalized or motivated by specific ideologies, not usually people suffering from serious mental illness. They wrote, in the wake of the Uvalde shooting, that estimates put about 20% of mass shooters as having “serious mental illness” which means 80% either have less serious mental health issues or no known mental illness at all.

“Further, the contribution of serious mental illness to violent crimes involving a gun may be as low as 3%. In fact, individuals with mental illness are more likely to be the victims—not the perpetrators—of violent crimes,” the article explains. “What we are saying is that serious mental illness is not the issue in the majority of these cases.”

‘Serious mental illness’

There are a broad spectrum of mental illnesses. Mental illness is defined as disorders that impact your mood, thinking and behavior.

Most people will experience mental health issues in their lifetime. That is distinct from mental illness, which is defined as “ongoing signs and symptoms [that] cause frequent stress and affect your ability to function.”

Serious mental illness is defined as “a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.”

Many mass shooters are reported to have had mental health struggles, which is different from “serious mental illness.” Sudden personal crises like divorce, home instability or the loss of a job are more common inciting factors for acts of mass violence, the New York Times reported.

In a 2020 study, the National Institute of Mental Health estimated there were 14.2 million people suffering from serious mental illness in the United States, versus 52.9 million suffering from “any mental illness.” Young adults had a higher prevalence of serious mental illness than older adults.

Mentally ill vs. ‘insane’

Many people might refer to a suspect accused of committing acts of mass violence as “crazy” or “insane.” However, doing things that are morally or legally wrong is not a symptom of mental illness, and to be mentally ill or have mental health struggles is not the same as being insane.

Criminal insanity is defined by Cornell Law as a “mental illness or disease that makes it impossible for a defendant to know they were committing a crime or to understand that their actions are wrong.”

The Legal Dictionary at law.com describes it as “mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior.”

PARKLAND, FLORIDA – FEBRUARY 14: Eric Fishman places flowers on a memorial in front of Marjory Stoneman Douglas High School to honor those killed during a mass shooting on February 14, 2022 in Parkland, Florida. (Photo by Joe Raedle/Getty Images)

The suspect in the shooting at a supermarket in Buffalo is accused of having planned the attack online for months. Witnesses during the trial of Nikolas Cruz, who was sentenced to life in prison last month for the shooting at Marjory Douglas Stoneman High School, said that he “faked brain damage during testing and that he was capable of controlling his actions, but chose not to.”

Between the elaborate planning required for acts of mass violence and the presence of manifestos, many mass shootings are neither “impulsive” nor a result of a detachment from reality, with their written statements used as evidence of their mental state at the time of the crime.

James Holmes, the man who opened fire on an Aurora, Colorado movie theater during a screening of “The Dark Knight Rises” in 2012, used an insanity defense. Ethan Crumbley, who killed four students and wounded several others at his Michigan high school in 2021 was also reportedly going to pursue that defense.

Holmes was found guilty, and a psychiatrist who worked with him accused him of lying to her about his desire to kill people prior to the shooting, which indicates an element of premeditation that is in conflict with the legal definition of insanity.

Crumbley pleaded guilty in October to all charges, saying “yes” when asked if he “knowingly, willfully and deliberately” chose to shoot his classmates.

Crumbley’s parents are also charged with involuntary manslaughter due to the allegations that the school had made them aware that Crumbley needed mental health care and they ignored it, instead buying the teenager a gun as a “Christmas present” and telling him to not “get caught” looking up ammunition on his phone at school.

OXFORD, MI – DECEMBER 07: A memorial outside of Oxford High School on December 7, 2021 in Oxford, Michigan. One week ago, four students were killed and seven others injured on November 30. (Photo by Emily Elconin/Getty Images)

“Put simply, they created an environment in which their son’s violent tendencies flourished. They were aware their son was troubled, and then they bought him a gun,” prosecutors said in a court filing.

Crumbley will be sentenced in February, and his mental health is among several mitigating factors that will determine his sentence.

As PsychiatryToday writes, many mass shooters are motivated by ideology and several different types of ideology have been cited as a motivation for mass violence across the nation and the world in recent years.

Bigotry

Among ideological motivations for mass shootings, many of them fall under the heading of “bigotry.” These range from racism to homophobia to antisemitism.

BUFFALO, NY – JUNE 11: A memorial to the dead in the Tops grocery store mass shooting is shown during a March For Our Lives event on June 11, 2022 in Buffalo, New York. (Photo by Matt Burkhartt/Getty Images)

On May 14, a young white man allegedly shot and killed 10 Black people at a supermarket in Buffalo, New York. He had allegedly researched where he would commit his crime, picking a neighborhood that was demographically less than one percent white.

A manifesto was found, and, in it, the suspect discussed the “Great Replacement” theory, which is a racist conspiracy that alleges that white Christians are being “replaced” by ethnic or religious minorities. It is a topic that Tucker Carlson has discussed on his show, for which he faced criticism in the wake of the shooting.

The suspect has been charged with domestic terrorism.

The “Great Replacement” narrative was also a factor in the mass shooting at a Wal-Mart in El Paso that killed 22 and wound dozens more. The suspect posted a “racist screed railing against an influx of Hispanics into the U.S.” prior to the shooting, according to the investigators.

Survivors and members of the public react after the judgement and the last day of the sentencing hearing for Australian white supremacist Brenton Tarrant in Christchurch on August 27, 2020. (Photo by SANKA VIDANAGAMA / AFP) (Photo by SANKA VIDANAGAMA/AFP via Getty Images)

It was also the motivation for the attack on two mosques in Christchurch, New Zealand, in 2019 that killed 50 and wounded 40 more, carried out by an Australian man who was a self-described white supremacist who wrote an anti-immigrant, anti-Muslim manifesto before the attacks.

The massacre of churchgoers at a Black church in Charleston was also motivated by white supremacy. Dylann Roof did not allow jurors to hear evidence about his mental health and he was found competent to face the death penalty.

Antisemitism is another ideological motivation that drives mass violence. A gunman opened fire on the Tree of Life synagogue in Pittsburgh in 2018, killing 11 people in what was called “America’s deadliest antisemitic act.”

In 2016, a gay nightclub in Orlando was targeted and 49 people were killed, many of them LGBTQ. The suspect was described by an ex-wife as abusive. Studies have shown that as many as 2/3rds of mass shooters have a history of domestic violence.

“Incels”

Another ideology that has led to mass violence in recent years is that of “incels.” Incels, which is a portmanteau of “involuntary celibate,” are a group that promotes violence and hatred, primarily against women but also minorities and LGBTQ people.

Much of their ideology is based on their own sense of isolation because they do not have romantic or sexual partners or connections, blaming women and minorities for their lack of social success.

ISLA VISTA , CA – MAY 25: Flowers fill bullet holes in the windows of the IV Deli on May 25, 2014 in Isla Vista, California. (Photo by David McNew/Getty Images)

This group came to the forefront in 2014 when Elliot Rodger, the son of a Hollywood producer, killed six people by shooting or stabbing. In a manifesto, Rodger said he had “no choice but to exact revenge on the society” that he believed “denied” him sex and love.

“I am the true victim in all of this. I am the good guy,” he said.

Rodger inspired others within the incel movement, including Alek Minassian who used a van to kill 10 people in 2018 in Toronto and a Canadian teenager who allegedly killed a woman with a machete at a massage parlor.

Several men who have identified with the incel movement have attempted or plotted mass violence but have been caught before they were able to enact their plan. Incels have also been responsible for other non-lethal attacks, mostly on women.

Dissatisfaction with relationships also factored into October’s school shooting in St. Louis, but the alleged shooter’s note did not specifically reference incels. Sex also played a factor in the killing of several massage parlor workers in Atlanta, a case in which it was speculated the suspect had a “sex addiction.”

ATLANTA, GA – MARCH 17: Mourners visit and leave flowers at the site of two shootings at spas across the street from one another, in memorial for the lives lost, on March 17, 2021 in Atlanta, Georgia. (Photo by Megan Varner/Getty Images)

Non-ideological violence

Any act of mass violence where the suspect might personally know the victims, rather than a location being chosen for a demographic purpose, would hold a more personal, vendetta-based motivation. These don’t have a specific ideological tie but can be motivated by sudden individual crises.

These can be workplace related, such as the mass shooting at a railyard in San Jose, or related to issues of bullying, unhappiness or hatred of school, like in the Columbine shooting.

Focusing on mental illness, particularly psychotic illness, when talking about mass school shootings risks is missing other factors that contribute to the vast majority of cases, as well as exacerbating the already widespread stigma surrounding severe mental illness,” said Paul Appelbaum, professor of psychiatry, medicine and law at Columbia University.