While the roots of school violence are complex and multi-determined, the origins remain deeply embedded in our society. It is now established that there is a high prevalence of mass shooters with undiagnosed and untreated psychiatric illness. The author uses case material to illustrate the psychodynamic and psychosocial determinants of school shootings. Shooters typically experience loss, trauma, bullying, abandonment, and undiagnosed psychiatric illness. They are often unwanted and marginalized children living in abusive environments. The author describes the psychodynamic relevance of the concept of soul murder and emphasizes the extreme isolation and loneliness experienced by shooters. The cases described might have been prevented had the assailant, after typically being identified as “troubled” by secondary support systems, such as families, schools, and law enforcement officials, received appropriate psychiatric treatment. There is an urgent need for more of an interdisciplinary approach involving families, school counselors, law enforcement, mental health workers, and lawyers, with a redoubling of efforts to secure appropriate psychiatric treatment for children with mental illnesses who are marginalized and may have a higher risk of violence than the general population.

Nina E. Cerfolio MD, DFAPA, Assistant Clinical Professor at the Icahn School of Medicine at Mount Sinai, is a renowned psychiatrist and psychoanalyst specializing in trauma and terrorism. With over 30 years of experience, she integrates psychiatry with decades of spiritual training to promote healing, and mindful psychiatry. Formerly the Chief of the Psychiatric Emergency Room at St. Vincent's Hospital, she actively writes and speaks on transcending emotional suffering. Featured across prominent media outlets, including The New York Times, NBC, and CBS, she has been recognized for her humanitarian outreach and research contributions. Her recent book, Psychoanalytic and Spiritual Perspectives on Terrorism: Desire for Destruction, explores terrorism's roots and spiritual healing. Dr. Cerfolio has earned numerous accolades, including Castle Connolly Top Doctor.