SPENCER: Ragy, welcome.

RAGY: Hi! Thank you for having me, Spencer.

SPENCER: Do people have a lot of misconceptions about mass murder?

RAGY: People have many misconceptions about mass murder, and then it's doubly a problem because people have misconceptions about mass murder and also about mental illness, which is, of course, my area.

SPENCER: I find your research on this so fascinating, especially because you take a really data-driven approach and ask what does the data tell us, and how does that compare to what people generally think is true? So could you talk a little bit about how you collected data on mass murders?

RAGY: That's a fundamentally important question. We gather all of our data from publicly available sources, for example, online police and court records, as well as reliable media sources.

SPENCER: So how many data points do you now have?

RAGY: We've collected to this point information on about 2,300 mass murders. The majority of those are mass shootings or mass murders perpetrated with firearms, because in many cases, about 20 to 25% multiple types of weapons are used. For example, a firearm and a knife or something similar.

SPENCER: Is it all over the world?

RAGY: We include mass murder from all over the world. About 65% of mass murders, at least, that we could find, have occurred in the US.

SPENCER: And how much do you think that's because the US really just has way more mass murders versus because it's just an issue of data collection, it's just harder to find in some countries?

RAGY: Number one, we are limited to English language databases and English language sources. But number two, the majority of mass murders are mass shootings, and mass shootings are very much a Western problem, and by and large dominated by an American problem.

SPENCER: It's fascinating to think that America has this problem way more than other countries and why that is. We'll go into that in a bit. But before we do, how do you define a mass murder, and how does it differ from just an ordinary murder?

RAGY: Sure, there are several different definitions of mass murder. We use a three-fatality definition. Some people use a four-fatality definition. Some people will include injuries in their definitions. We include a three-fatality definition to be consistent with the congressional definition of a mass killing.

SPENCER: And it has to be in one event. If someone committed a series of murders at different locations, where each location had just one person killed, that would not be a mass murder by your definition.

RAGY: There are multiple different types of mass murder. So technically, a mass murder would include three fatalities in one event in one location. Sometimes we have mass spree murders, where three or more people are killed in one event without what we call a cooling-off period, but in multiple locations. For example, the Elliot Rodger, "mass murder" in Isla Vista, California, around 2013 or 2014 on the UC Santa Barbara campus was technically a mass spree murder rather than just a mass murder, but we generally would include that as a mass murder.

SPENCER: And what are the different types of mass murders that you catalog?

RAGY: There are a number of ways to categorize mass murders. One way is by where they happen or who they involve. Overall, one way that we categorize them is by where they occur and who they involve. Using that categorization scheme, about 45% of mass murders are what we call domestic mass murders, meaning they include at least one or more family members. That actually is the largest number of mass murders. The second most common type of mass murder is the felonious or criminal mass murder. This is a mass murder in which the mass murder occurs as part of some other felonious event. However, this does not include gang violence or group-involved mass murder; these are all personal cause mass murders. For example, Thomas Doty, several decades ago, crashed a plane as a passenger to commit insurance fraud. That would be a felonious mass murder, some mass murder perpetrated in the context of some felony. The third type of mass murder, which is the type of mass murder with which we are most familiar, is the public mass murder. These are the mass shootings we are familiar with, the school shootings, those sorts of things. Then there are other less common types of mass murders.

SPENCER: It's fascinating to think that the mass murders that almost everyone talks about are actually just the third most common category. The public ones, whereas the other two sort of go under the radar much more. What percent is that third category, the public mass shootings?

RAGY: Depending on the sources, about 13 to 15%, but 13% is probably most accurate.

SPENCER: I suspect that the reason they get talked about so much relative to the other types is that they involve people relevant to us. It happens at a school, and people think, what if that was my child? Do you agree with that?

RAGY: One hundred percent. They're the type we're most familiar with, and they're the type that the media shares the most about or reports the most on, because they're the most attention-grabbing. They are similar to other types of mass murder, but there are significant differences between public mass murders and other types of mass murder.

SPENCER: I'm curious if you agree with me. I think the way that school shootings have been handled has been absolutely tragic. The events are horrendous and truly horrible, but at the same time, I think what has happened is that the media has drawn so much attention to them, and then policymakers have drawn so much attention to them that it ends up creating a lot of fear for students, teachers, and parents. That is almost totally unwarranted, because if you actually look at the statistics, I think it's way more likely kids are going to get hurt texting and driving or doing all kinds of other things, whereas it's incredibly unlikely to affect any particular kid. Not that they shouldn't get any attention, but the level of attention they get actually causes a lot more harm than good. Do you agree, or do you think I'm off base?

RAGY: They cause a lot of harm. In addition to the event itself, including what you mentioned, there are the school shooting drills that became relatively common over the past decade or so, but now we're understanding that these school shooting drills are actually more harmful than beneficial. We're kind of not continuing those school shooting drills. By school shootings, I mean in high schools and elementary schools. We found that the school shooting drills actually lead to more problems, for example, anxiety and depression and too much fear in young people. Number one. Then number two, there's the contagion or copycat effect. Public mass shooters are defined by or public mass murders in general are defined by perpetrating the murder or shooting in public. There's a reason why people, for the most part, perpetrate a mass shooting or mass murder in public versus privately, and that in one word is fame or infamy, publicity, but the technical term is fame. This was demonstrated in a very interesting paper published a few years ago in PNAS, where they looked at this fame or infamy factor, and that really distinguishes public mass shootings and mass murders from other types of mass murder.

SPENCER: Yeah, that's fascinating. So it might not only be harmful to children to focus on these things, but it might actually create more of the problem that they're trying to solve, which is, this is so horrible and ironic at the same time.

RAGY: That's exactly correct. There's almost no benefit to reporting on them. At least when people do report on public mass shootings or mass murder in general, the guidelines, and this is pretty well agreed upon by experts and many in the media, actually do kind of stick to these guidelines, and that is to report no personal details about the perpetrator, so no photographs, no name, nothing personal that could be identifying that limits the infamy or fame components of these sorts of events.

SPENCER: To what extent do they abide by that? Because I feel like I hear the names of these mass murderers in many cases, but I don't know if that's because maybe the mass media, like the New York Times, is following the guidelines, but maybe large YouTube channels with millions of followers are not.

RAGY: That's right. It's variable. Some stick to those guidelines, some don't. To give people an example, virtually all media will hide the names or identifying information of minors. So it's actually something very easy to do, but many don't. Some do, many don't. You're probably right. Probably most media organizations or influencers don't, but at least a few or some small minority do.

SPENCER: Let's start talking about the first category, the most common category. I think you said it was over 40%, the familicide side. Why do people kill their own family members?

RAGY: That's a really good question. We looked at this in a paper we published a few years ago. We looked at the motivations. We basically came up with a motivational system for all the mass murders we had in our database. There are a number of reasons, but the primary reason people perpetrate the familicide type mass murder falls into this kind of emotional upset category that we described, and then it has subsections. These femicide mass murders are primarily perpetrated by middle-aged men, and they have been usually in one of a few circumstances. One, these people just lost their job, and they have a very acute moment of upset, and they shoot themselves and their family. In almost all cases, the perpetrators also take their life at the time of the event. They take their life and their family's life. In another maybe 20% of cases, there's some sort of romantic issue involved. Again, usually a man finds out that his spouse or partner is cheating on him, and he takes the life of his spouse or partner, his family, and usually himself. There are a few other less frequent motivations for familicides, but those are the most common ones.

SPENCER: One might wonder, okay, so let's say they lost their job. You could understand why they'd be depressed. Obviously, suicide is not a good response to that, but at least someone could understand if they felt like their future was hopeless, why they might commit suicide. But why would they kill their family at the same time?

RAGY: It's an exaggerated acute stress response. We also have to understand these people have other characterological problems, without a doubt, something that makes them different characterologically or psychologically than other people. Even if they don't have a psychiatric disorder, which is relatively uncommon in these individuals, at least as a primary motivating factor. What we do see is that these people, in many cases, have an underlying feeling of severe nihilism. Nihilism is the feeling of emptiness, the feeling that they are of no value. The world is basically empty and over. There's nothing going on in their lives. That's often a characterological phenomenon that people just feel and that they've always felt. So that's part of it. Number two, although in many cases, or in most cases, psychiatric conditions or diseases are not the primary motivating factor, the suicide component is very important to understand and figure out, and of course, deal with it as a preventive factor. We understand mass murder, mass shootings, and we're particularly talking about mass shootings when we talk about taking one's life. I'll share more about why that is the case in a few minutes. There are three primary hurdles or barriers to a mass murder or mass shooting, any sort of severe behavior. Number one is one's own conscience or ego or religion, anything within oneself that prevents one from doing something like that. Number two is the moral system or values that one internalizes from people close to them, like their parents, their partner, even society. Number three is the fear of being caught. Once someone decides to take their own life, that third hurdle is removed, and that just makes it easier for someone like that to perpetrate a mass murder.

SPENCER: Interesting, because if they were not committing suicide, they might be afraid of being caught, but because they're committing suicide, they kind of remove that element tying it into the nihilism. Do you think that it's some kind of sense, "Oh, I'm doing my family a favor," some kind of twisted logic?

RAGY: Absolutely. If one puts oneself in the shoes of someone who's truly nihilistic and empty, you would feel exactly that. They feel that life is empty. There's nothing to life. Now, life is even just getting worse. What little they had has been taken away from them, and then it just becomes something that one wants to do, and one thinks is better for themselves and for their family. This is obviously very pathological, but that is how people think. This is part of what we do, both in psychiatry, dealing with people with mental illness and psychotic disorders, for example, which is my specialty, but also dealing with anyone who behaves in an extremely unusual or atypical way. There's almost always a logic, even, for example, when dealing with people who are psychotic and have delusions, abnormal thoughts. There's always a logic. It's just understanding the other person's logic, not trying to impose your own logic onto the situation.

SPENCER: Right. Because many people would not be able to relate to that at all, but there's an internal consistency, even though it's a very twisted and distorted logic. If you kind of flip to the person's perspective, you could at least see how someone with those distorted presumptions could come to that conclusion, right?

RAGY: Exactly the case.

SPENCER: Yeah, the world is hopeless. Nothing good is gonna happen, and oh, my God, I lost my job, and now we're gonna be in poverty. And then, they frame it as sort of a mercy killing.

RAGY: In the mind of a person like that, that's absolutely the case.

SPENCER: And it sounds there's also another subtype, which is somewhat less common, but it's more of an anger killing. They feel betrayed by their spouse, or it could even be that they weren't betrayed, but they're paranoid. They think they've been betrayed. How much do we know about whether these family killings are responses to true betrayal versus just delusion?

RAGY: That's a great question. In this case, almost always true betrayal.

SPENCER: Interesting. So in that particular category, yeah.

RAGY: Absolutely.

SPENCER: And obviously that's a horrible way to deal with that situation, but many people could probably relate to the idea of feeling so betrayed that you're so angry that you might even have an urge to kill someone, even if you would never do it. But they actually do it. Do you think that, in that case, suicide is more an attempt to escape the consequences, like they kill their spouse because the spouse betrayed them, and then they're like, "Well, I don't want to go to jail for the rest of my life."?

RAGY: That's an interesting question. I'll answer it this way. We know that people, for the most part, and we published this maybe, I think a year ago, do know they're going to take their life ahead of time. Whether it's planned, but whether that is because they don't want to suffer the consequences after they perpetrate the mass murder, or for another reason, is not known to me. I don't know, but they do plan to take their life. That's very important.

SPENCER: And then does it often involve taking the life of, let's say, they find their spouse is cheating on them, taking the life of the person they're cheating with, or that kind of thing? Or is that actually more rare?

RAGY: That's less common. I wouldn't say rare, but in those cases in which infidelity or cheating is part of the situation, it's less common. It's more about the partner, the cheating partner, and then the family, not just the partner, but also the kids, when children are involved. And then also, while we're talking about familicide mass murders, it's the men, of course, who use firearms. Women almost never use firearms. But when women perpetrate mass murder, it's almost always a familicide, really, almost always including a child. And then, of course, we can talk about this more later. When a woman perpetrates a mass murder or any type, they're much more likely to be psychotic. So there are differences between when females versus males perpetrate mass murders. But again, when a woman perpetrates a mass murder, one of the victims is almost always a family member, and usually a child.

SPENCER: Wow, what percent of the mass murder database are women?

RAGY: Five or six percent.

SPENCER: Yeah, it's almost unbelievable how the gender difference on that.This is tough to answer, but do you chalk that up to fundamental personality differences between men and women?

RAGY: Definitely, definitely, and we can even go more specific. There are a number of reasons. But we know that men, especially younger men, but men in general, tend to be more violent for a number of reasons. There are biological, social, and cultural reasons, many reasons.

SPENCER: What about age? Is it almost always in the 20 to 40 range, or do you find a lot of these happening after 40?

RAGY: Looking across all mass murders, the average age of a mass murderer is about 32 years old. When we're talking about familicides, the age is a little older, towards middle age. When we're talking about public mass shootings, the age is a little younger.

SPENCER: Is it pretty clumped where most people are near that age? Is it pretty rare that a 60-year-old commits a mass murder?

RAGY: The ages of perpetrators of mass murder tend to follow a bell curve, kind of a standard bell curve. It's pretty uncommon to see people who are less than 10 and in their early teens, and then we see more who are 15, 16, and then more and more until about 32, and then there are a lot between 32 and 45 or 50, and then a lot less as people become older. One would see a typical bell curve when we look at ages of mass murderers.

SPENCER: So is it fair to say that mass murder is largely a problem of young men?

RAGY: Definitely men.

SPENCER: Young to middle-aged, I guess.

RAGY: Young to middle-aged. And four times young. We're talking about 25 to 50.

SPENCER: Let's talk about the second category, which I think you called felonious mass murder, which means it's crime-related, right, related to criminal activity?

RAGY: Perpetrated along with some other criminal act, felonious activity, that's right.

SPENCER: And what percent was that of all mass murders?

RAGY: About 33% that happens much more commonly, for example, in America, even as a ratio compared to other types of mass murder. That's more common in America than in other countries.

SPENCER: Now, are those typically crimes where they're intending to kill people, or the sort of thing where they're robbing someone that goes wrong, and they kill people because the altercation starts, or their face gets seen, or whatever?

RAGY: Exactly the latter.

SPENCER: Okay, so usually it's not intentional. We're intentional, maybe at the time when they did it, but it wasn't intended that they were going to kill people.

RAGY: Yes, or the goal is not necessarily to kill any one specific person. It's to, for example, in the case of Thomas Doty, to perpetrate insurance fraud. That happened again a few decades ago. They brought up the perpetrators. Thomas Doty brought up a bomb, basically, in some sort of package on the plane. The goal was to make it look like the plane crashed and he died for other reasons, so that his family could benefit from his insurance claim. Jack Gilbert Graham did something similar, where he actually, I believe he placed the bomb, and I want to say in his mother's luggage. It crashed the plane. He was not on the plane. In that case, he wanted to benefit from the insurance payout. I believe both were found out. Well, one, of course, died. The other was found out.

SPENCER: And if you think about the most typical scenario, would it be in the middle of a robbery or drug deal, or what is the most typical kind of felonious mass murder?

RAGY: That's right. Yeah, good question. Robberies are very common.

SPENCER: Yeah, so they get caught right in the robbery, and then they go kill everyone.

RAGY: Exactly. That's exactly right.

SPENCER: When we talk about people who do that kind of thing. Do you think the personality is really different from the familial side? I would imagine it is.

RAGY: It is somewhat different. So again, these people are younger. They're more likely to have a criminal history, those sorts of things. But one thing that's very interesting. So I think maybe what you're getting at is maybe these people are lifelong criminals, are psychopaths, or more like serial killers. It's very interesting because despite that, and despite that, you know, 33% of these mass murderers, or felonious mass murderers, in many cases, these people are not lifelong criminals, even if they are more likely to have a criminal history. One key difference, for example, between mass murderers and serial killers is that 87% of serial killers are psychopaths. Psychopathy is a technical term that's a medical or psychological term. And basically that means that these people, the psychopaths or serial killers, kill because it brings them pleasure. It's just pleasurable for them to do so, and in many cases, serial killing is associated with some sort of sexual assault or dismemberment or cannibalism or something like that. These people are psychopaths in almost every case.

SPENCER: Would you say that it's fair to assume that they don't experience empathy, they don't experience remorse, they don't experience guilt?

RAGY: By definition, exactly that is a psychopath. Mass murderers, including felonious mass murderers, are rarely psychopaths. There is some other clear motive going on. They might be driven for other reasons to perpetrate the crime or the mass murder, for example, insurance fraud and these sorts of things. They're doing it for some sort of other aim besides pleasure.

SPENCER: Right, making money or that kind of thing.

RAGY: Yes.

SPENCER: Okay, so let's go on to the third category, which is the one that everyone talks about, which are what they call public mass murderers. Is that right?

RAGY: We refer to them as public mass murderers.

SPENCER: Yes, these kinds of situations seem much more intentional. Is that correct? They are actually trying to kill people.

RAGY: These are the most intentional. We know that people who perpetrate public mass shootings or mass murders usually plan these for at least several months or years. These much less commonly happen on the spur of the moment.

SPENCER: Are they under the impression that they're going to somehow get away with it, or have they basically accepted that this is the last act they're going to take? They're either going to end up dead or they're going to end up in jail.

RAGY: In more than 50% of cases, these people take their life at the time of the event. That doesn't even include the so-called suicide by cop, where someone plans to go in knowing they'll be killed by law enforcement. In almost all cases, they actually take their own life, or at least over 50 percent of the cases. So we're talking about the vast majority of cases.

SPENCER: And they tend to do that. It's not just to spread them a decision; that was part of the plan.

RAGY: That was the plan, yeah, and they planned it for a long time. You can see that in almost every case you look at. They plan even when there isn't a mass murder or mass shooting, per se by definition. For example, we can almost assume it in many cases, and it happens most of the time.

SPENCER: You can imagine different motivations people might have to do that. One is fame that we talked about. Another is revenge. You hear about how they felt rejected in school, and they want to take revenge. Obviously, it's a completely crazy thing to do, but in their kind of twisted logic, you could understand it's an act of revenge. Another is psychosis; they could have a misunderstanding, like they could believe that the kids in school are demons or something like that. How do you break down the different motivations for why these public mass murders occur?

RAGY: That's a really good question. To address the mental health issue, to start, this was our primary motivation for answering these questions and coming up with answers from the beginning. Again, our research here is focused on schizophrenia and psychosis; that's what we do. Our primary objective for pursuing this line of research, when we began pursuing it about six years ago, was to answer the question of how mental illness, and we're talking about mental illness, we're really talking about psychotic disorders, are related to mass shootings. That was the primary answer that we wanted to come up with. I can tell you the exact number: 5% of mass shootings are motivated primarily by mental illness. Again, we're talking primarily about psychosis, so a delusion [inaudible].

SPENCER: Just to clarify, so we're not talking about any social personality disorder or sociopathy. We're not talking about narcissistic personality disorder. You're just talking about psychosis, such as schizophrenia. Is that right?

RAGY: Exactly. Or psychosis that accompanies depression or bipolar disorder. Psychosis is the common end stage of any severe psychiatric illness. We're primarily talking about affective disorders, depression or bipolar disorder, and then, of course, psychotic disorders like schizophrenia. Psychosis is the final common pathway for the most serious stages of all of these conditions. Other conditions, anxiety disorders, which are, of course, the most common mild depressive disorders, are all much more common. There's no association with those and violence, and certainly not murder, but even any type of violence in any way. If we're talking about psychiatric disorders, we're really just talking about psychotic disorders. The numbers show that 5% of personality disorders do increase violence. The primary personality disorder that would increase violence, at least in the case of murder, would be psychopathy, present in about 2% of cases.

SPENCER: Wow. So it's actually really uncommon. What about antisocial personality disorder, which is obviously very related to psychopathy?

RAGY: It's very related to psychopathy, almost indistinguishable. In the case of a mass murderer, I can't think of any case in which someone had antisocial personality disorder that wasn't also a psychopath and did not also contribute to the mass murder.

SPENCER: What about narcissistic personality disorder? Because you might think that being prone to more selfishness, more grandiose thinking, could contribute.

RAGY: Sure, so other types of personality disorders were observed in about, I think the number is 8% of all mass murders, and they contributed exactly. I want to say that the number is very low, but about 2%, you might say that's a lot, or it's not a lot, that's probably quite a bit. About 2% of mass murders are primarily motivated by a personality disorder that isn't psychopathy or antisocial personality disorder. So we're talking about narcissistic personality disorder, borderline, histrionic personality disorders, which are all very similar, or a schizoid personality disorder.

SPENCER: So that's really interesting, because it suggests that these mass murders that are public are usually not connected to any kind of psychiatric condition most of the time. But I think most people intuitively would say, "Well, if you're willing to do a thing like that, surely there's something deeply wrong with their psychology." So is that a problem with our diagnostic system, or how could one do this and not have something severely wrong with their psychology?

RAGY: There could be something wrong with their psychology. I guess we need to define our terms. There are mental illnesses and psychiatric disorders. For example, schizophrenia, bipolar disorders, depression, anxiety, those sorts of things. Also, to be clear, I'll make these two points now. Number one, there's a difference between a psychiatric condition being the primary cause of something and it being present or incidental. So the lifetime prevalence of any psychiatric disorder among adults in America right now is about 40 to 45%, so a lot of people who perpetrate mass murder will have some sort of diagnosed psychiatric condition. We see that about 45 to 50% of mass murders actually have some sort of diagnosed psychiatric condition.

SPENCER: Prior to that, they were diagnosed?

RAGY: Prior or concurrent with the perpetration of the mass murder. When you look at the motivations for the mass murder, we find that about 5% are primarily motivated by a psychiatric disorder. We have other conditions, such as personality disorders that you mentioned, which are a different type of psychiatric disorder, quite different, that contribute a few percent. Then we have everything else. As psychiatrists or psychologists or anyone in the mental health field, we deal with all sorts of abnormal behavior, abnormal thinking, including forensic issues, criminal behavior, severe criminal behavior. There are many motivations for all of these, but we need to distinguish between psychiatric disorders that can be helpful, for example, with medications and therapy, and all sorts of other types of atypical or abnormal behavior. Certainly, anyone who perpetrates a mass murder is doing something extremely atypical and must have something going on. What we're saying is just 5% of them have a bona fide Axis I, as we used to call it, psychiatric disorder. The rest have some sort of characterological issue, or what we refer to in psychodynamic parlance, or maybe an ego deficit, or they're just bad people. Probably most of them are just really bad, evil people. Who else would perpetrate a mass murder? Despite that, we as psychiatrists still deal with that, but it doesn't mean that we define psychiatry or mental illness by what psychiatrists deal with. We deal with all sorts of abnormal behavior and conditions, but that doesn't mean they're all psychiatric.

SPENCER: Are the public mass murders much more likely to have a mental health connection than the other types?

RAGY: Yes, they are, by a little, by about five to seven percent. We would expect 10 to 12 or maybe upwards of 15% of public mass murders, especially mass shootings, to be perpetrated by someone with a severe mentality.

SPENCER: So it's still pretty rare. I mean, it's really quite amazing. I think very few people would realize that the vast majority of these public mass murders are not done by someone with a psychiatric condition. Sure, that's fascinating to me.

RAGY: Those are the ones we hear about. The media determines which mass murders we hear about, but we don't hear about even most of them. We don't hear about all the public mass murders. We hear about the ones that the media thinks the public will be most interested in. Those usually involve something unique or atypical, or a mental illness or a psychiatric medication or something else we don't hear about.

SPENCER: So they're worse than random in terms of understanding the problem because they're actually picking up on atypical features that make them especially interesting to the news media. Is that right?

RAGY: Exactly. We hear about mass murders in which many of the mass murders we hear about are probably linked to mental illness and probably involve psychiatric medications, just because that's what the media likes reporting on. They know that will bring the most attention to their stories.

SPENCER: So what, then, is the most typical kind of public mass murder? People always think about school shootings, but what is actually happening?

RAGY: Usually, school shootings account for about, well, there have been, if we're talking about mass murder defined by three fatalities, there have been approximately 65 in the world since 1900 for school shootings. Yeah, it's about 1900, and that's of approximately 250 public mass murders since 1900.

SPENCER: So maybe a little over 20% of the public ones have been school shootings. And so then, what is the most typical kind? What's the most common situation?

RAGY: That might be, even though I don't think there's one type that comprises the majority, but that might be the most common type.

SPENCER: And what are some other types? Besides that, people don't necessarily have an idea of what other kinds there might be.

RAGY: Sure, absolutely. Other types are the types that happen in places of employment, so work. People are familiar with the colloquial phrase "going postal." That refers to an early mass shooting in particular that happened at a post office. A disgruntled postal worker actually went to a post office and perpetrated a mass shooting. Another very common type of public mass shooting is the type that happens at either a police station or some sort of military installation. Again, we're talking about what we refer to as personal causes of mass murders or mass shootings. These are not associated with war, gangs, state or group-sponsored terrorism, but these are individuals who, for some reason, decide to go to a military base often and perpetrate a mass shooting. Those are also a very common type of public mass shooting. There have been about 50 of those since 1900.

SPENCER: You might think that's bizarre. Why would you go to a military base or police station where you're definitely going to get shot? But maybe that's part of the point?

RAGY: Exactly the point, and that's what we have to understand. That has such implications for prevention. The point is to go to a place where you know you're going to die, whether you take your own life or someone else takes your life. You know this is the end of your life. That's critical. This is one of the three key features of the psychological profile of these public mass shooters. One is severe nihilism, which in its most severe form manifests in taking one's life or suicide. That's critical. Number two is infamy or fame, or this toxic narcissism. When we mention the word narcissism, we're not referring to the narcissism as maybe other people or the general public understands it. We're referring to a toxic or malignant narcissism. These people do not feel good about themselves; they feel very badly about themselves. These are what we refer to in psychodynamic parlance as — Kernbergian or Kernberg narcissists. They are empty. They have what we refer to as identity diffusion. They use splitting-based defenses, sorry for all the technical terms, or projection. These people do not feel good about themselves, and they project their feelings onto other people, which makes them upset at other people because they feel that those other people are having negative feelings about them. Number three, very critically and also very relevant to prevention, is the firearm you'll find in almost every case of a public mass shooting. These people do not just have access to firearms; they have a marked affinity for or fascination with firearms. So firearms are the motivation.

SPENCER: So it's not just incidental. It's not, "Oh, if they didn't have firearms, they would do it with a knife."

RAGY: Yes, you are correct. That is absolutely the case. We know that. It's very clear they choose firearms number one because firearms are most associated with suicide or taking one's life. That's just number one. Number two, there's this fascination or affinity for firearms. They know that it's going to bring them the most attention and exposure. And then number three, one thing that a lot of people also maybe misunderstand or don't know, and of course, they wouldn't know. There's no reason for them to know this. Back to your point about the choice of the firearm being kind of not so random. Mass murderers do not go into the events thinking that they want to take the lives of a lot of people, and then they just choose the most effective weapon. That is not the way they go about it. If they were to go about that, the data show that the average number of fatalities when a method other than a firearm is used is much greater than when a firearm is used.

SPENCER: That's really crazy to think about. So how is that even possible?

RAGY: That's exactly it. How is that possible? Some people might think, oh, well, that's because you're talking about mass poisonings and using planes, as in the Thomas Doty, Jack Gilbert Graham examples and those sorts of things. But this is actually a finding that we were the first to publish, and then another group published it, focusing on even mass stabbings. So mass stabbings are associated with more fatalities than mass shootings. So why is this the case? Number one is, the mass shooters take their own lives, and of course, they use firearms, so the event ends earlier. People who use other weapons take their lives much less frequently than do people who use firearms. Number two, the method of mass shooting makes a difference. Most mass shooters use this rampage method of perpetrating the mass shooting, going from room to room or door to door, rather than the sniper method of mass shooting.

SPENCER: So the way they do it is clearly not about inflicting maximum damage. It's about doing it a certain way.

RAGY: They want to do it a certain way that'll bring them the most attention, that'll allow them to take their life, that'll incur the greatest response from law enforcement. Ensuring that either law enforcement will take their life or ensuring that they will go through with the act themselves, because of the pressure being put on them, is the most likely way to bring them attention. So it is a firearm. If there were no firearm, there would be much less motivation to perpetrate a mass murder, by orders of magnitude.

SPENCER: To what extent does this explain why the US is such an outlier, because we're such a gun country? You might say, "Well, maybe that's why we have so many mass murders, because of our affinity for guns."

RAGY: That is 100% the case. The data are so clear. Sometimes you might watch the news and other things that we all watch on the internet and on television, and one might think that the data are equivocal or not quite clear about it. The data could not be more clear. It's really unsettling. I'll throw out some facts that people may not be aware of, if that's okay. There are between 400 and 500 million firearms in the US. It's hard to know exactly how many because 1% of guns are registered in America.

SPENCER: It's well over the number of people, which is really amazing.

RAGY: Well over the number of people, 1% are registered. 30% of people in the US own a firearm. Now, all firearms, whether legal or illegal, and it's hard to know which are legal and illegal, just because, again, guns aren't, for the most part, registered. So it's hard to keep track of them. Almost all firearms come from gun manufacturers. For example, all illegal firearms come from gun manufacturers. The firearms used by drug cartels, for example, are all originally legally owned and legally bought firearms in the US. For the most part, there's no illegal gun manufacturing.

SPENCER: Why would you even need to? There are so many guns. What's the point?

RAGY: You don't need to. There are three ways that legal firearms become illegal firearms. First, all firearms are made by these gun manufacturers. The three ways they become illegal are: number one is what we call a straw purchase, where someone buys a firearm for someone else but doesn't declare that. You're allowed to buy a firearm for someone else, for example, as a gift, but you have to declare that. Number two, selling a firearm that you bought legally to someone else and not reporting it. You know you're just not allowed to do that. Both of those are against the law. And then the third is theft of a firearm. This generally involves a legal firearm owner driving to a public area, leaving their gun kind of strewn about in their car, like on the floor, in clear view, and then having it stolen. That is where almost all illegal firearms come from. All of those methods or ways in themselves are actually illegal. The laws that we have on the books to prevent the illegal sale of firearms are actually very good in almost every state. They're actually very good, but they're not enforced.

SPENCER: And you said almost none of the guns are registered. So how would anyone be able to enforce that?

RAGY: Well, exactly, that's the info. There are many ways we can enforce these laws which would greatly limit illegal firearms. And also, just to be clear, without you, I don't even want to digress too much. We just published this a couple of months ago. Almost all firearms used in mass murders are actually legal firearms. So there's more than just kind of. I think 13% of firearms used in mass shootings are illegal.

SPENCER: Even if you completely prevented all illegal sales, it would only affect 13% of mass murders.

RAGY: Other types of gun violence, maybe a little more. But this is mostly a problem of legal gun ownership.

SPENCER: Yeah, that's wild. I want to go back to something. You mentioned that narcissism comes up a lot in these public mass murders, but at the same time, you said narcissistic personality disorder is actually quite rare, so should we think of this as they wouldn't meet criteria for narcissistic personality disorder, but they might be more on the narcissistic spectrum?

RAGY: That's right. Yeah. This is more a matter of definition, and in theory, narcissistic personality disorder does overlap to some degree. I guess we're looking at a Venn diagram. It is a categorical diagnosis. Categorical diagnoses are great. It comes from the Diagnostic and Statistical Manual of Mental Disorders, which is a very important book that's a categorical diagnosis. In psychiatry and in the field of mental health and general psychology, we understand the word I've discussed before. Personality is also maybe more technically referred to as character. And we refer to characterological traits and spectra and ego strengths and weaknesses, ego functions, defense mechanisms, which some people might be familiar with. These are defined in terms of a few different types of theories, and especially by Otto Kernberg, who was actually faculty at Columbia and is a giant in the field. By levels of organization, there are four primary levels of personality organization. The most uncommon type is the completely mature level of personality organization. These are the highest functioning people we all know. They're friendly with everyone. Almost nothing affects them. They're sought out by other people because of their psychological health, strength, and maturity. That represents probably 5 to 10% of people. Most of us are in the neurotic range. We get anxious. We use reaction formation. We react in ideological ways, but we don't lose reality testing. We don't engage in projection, where we basically project our own feelings onto other people and think that they're the cause of these feelings. We have a sense of ourselves. We know who we are. We understand our strengths and weaknesses. We are generally able to tolerate differences, changes in our environment. We have pretty good mood stability, anxiety tolerance, those sorts of things. The third is the borderline level of organization, and this includes what we would call narcissistic personality organization. These people have identity diffusion. They don't understand how they interact with people, how other people see them. They aren't sure about how they should interact with other people. They use these splitting-based defenses, lots of projection.

SPENCER: So splitting is seeing people in all good or all bad terms, this person is the best person, a demon, or, kind of this...

RAGY: The black or white thinking, those sorts of things, extremely emotionally labile, severe problems with anxiety, intolerance, those sorts of things, and can lose reality testing in times of major stress. And then there are the people at the fourth level, the psychotic level of organization, even without having a psychotic disorder, these people don't have reality testing and those sorts of things, in addition to all the other problems.

SPENCER: So it's the third category of the borderline, not borderline personality disorder, but this borderline level of functioning that is common.

RAGY: That's where we look when we think about mass murderers and those sorts of people.

SPENCER: You mentioned how they often are not happy with themselves. In my experience, talking to narcissists and researching the subject, narcissists often engage in this comparison. On some level, they believe they're better than other people, but they're constantly comparing themselves, and their ego can get very hurt very easily if someone puts themselves above them. Is that the kind of behavior you're talking about when you're talking about them being unhappy with themselves?

RAGY: That's exactly right. Narcissists, by definition, have very low self-esteem. It might seem on the outside that they have high self-esteem, but it's actually the opposite. That's the projection. They feel badly about themselves. They're projecting it onto you.

SPENCER: But they're working hard to try to build up their ego, to feel good, right?

RAGY: Exactly. They fail by definition. They couldn't do that, but they're trying. So they're sensing that you must feel very badly, you must be horrible at whatever you do. And so when one receives that, one feels like that's the other person's aura of narcissism and feeling kind of superior, when it's actually just a sign of how badly they feel about themselves and how low their self-esteem is.

SPENCER: How about spectrums? Is it for public mass murders, do the perpetrators also tend to be more callous or less empathetic kind of people?

RAGY: By definition, narcissists, people on the borderline personality organization spectrum, or especially those who have narcissistic qualities, do lack empathy.

SPENCER: So it seems then that it's sort of less surprising that they don't. They're not technically narcissists in terms of NPD, they're not technically sociopaths, but they are sort of on that spectrum. If we're talking about what kind of person they are?

RAGY: Antisocial personality, narcissistic, borderline, histrionic. These all fall on the same spectrum, psychopathy, or psychopathic or antisocial personality being the worst. Narcissists also have problems with empathy, that's what identity diffusion is, that they can't empathize. It's just not in them. They're just not capable of it.

SPENCER: So if we think about these public mass murders, they tend to have these traits: they are more callous and unempathetic and more narcissistic. They're looking for fame. Guns are heavily involved; they often have a fascination with guns. What about anger or revenge? If you read the manifestos of these people, they often talk about that, but I don't know if that's just the ones we hear about.

RAGY: Again, you're right. That's part of this level of personality organization. They have difficulty modulating their affect, so their affect becomes exaggerated, and their affect is often negative rather than positive because there's nothing for them to feel positive about. They feel badly about themselves. They think that everybody hates them because they hate themselves, but they project it onto other people so that they think everyone hates them and feels badly about them, and that manifests as anger and these sorts of things.

SPENCER: If you ask them what they are trying to accomplish, why are they planning to do this? What would they say?

RAGY: That's a very good question. A lot of these people, over 50%, end up taking their own life, so we don't know too much directly from perpetrators.

SPENCER: But sometimes they have journals or things, yeah.

RAGY: From what we do know, usually there's a theme just kind of along the lines of what we've been discussing, themes of rejection, themes of other people treating them very badly, in a way that wouldn't ring true to people who know them. That's why you often hear about people describing a mass murderer or mass shooter as just some nice, quiet kid who seemed to be getting along in his life and doing fine, the whole "I had no idea" about it.

SPENCER: They're internally experiencing all of these painful thoughts and feelings about being rejected or not good enough.

RAGY: Exactly, exactly. And they don't always necessarily reflect pure reality. They're not in the psychotic realm, per se, but they don't necessarily reflect reality. People, again, they have identity diffusion. It's hard for them to get a grip or a grasp on exactly where they fit in in the world, how other people think about them, how they think about other people. They just don't understand. To a lot of us, we think that doesn't even make sense. "I know that people who like me and who don't like me, and whether people think I'm funny or not funny, or whether everyone's just lying to me or no one's lying to me." These people can't understand that. It's just not in their makeup. A lot of this is nature. There's some nurture to it, but a lot of this is actually quite biological, and it's something that they've been dealing with since they were born. They just don't understand how they fit into the world.

SPENCER: What about beliefs about the world, you hear terrorist attacks, right? They're often motivated by some philosophy or belief or religion. Does that often play a role? Or is that not so common that there's some kind of ideal philosophy that they're trying to enact, even if totally crazy or misguided?

RAGY: Sure, this is an important distinction. These people are very frequently ideologically motivated, and they're radicalized in some ways. So there are many people who have these sorts of problems, but relatively few then go on to perpetrate mass murder. So what's the difference? In many cases, these people are very ideologically warped or just radicalized in some way. Now, again, we are focusing on personal causes of mass murder. We're not focusing on things that involve group or state-sponsored terrorism. For example, 9/11 was a mass murder. That was kind of a group, not quite state-sponsored, but that was group-sponsored mass murder.

SPENCER: That would fall outside of the category you're talking about.

RAGY: It's kind of outside of the category, just in terms of defining things. However, individuals can still have political motivations. That, per se, is less common among personal cause mass murderers, but it does happen. More generally, radicalization is very common because you need something like that to push someone over the edge. There have been political personal causes of mass murders motivated by political gain or ideology. Those people tend to use methods other than firearms because their motives are different. Their motive is not attention, and it's not to end their life. You see how things kind of fit together. For example, who's probably the most common politically motivated mass murderer in American history? One of the most common personal cause mass murderers is Timothy McVeigh, the Oklahoma City bombing. That was a personal cause, and there were two people involved, but you can have more than one person. This was a personal cause, politically motivated mass murderer. Their goal was to enact some sort of political change. They didn't want to die. That certainly wasn't the point. The point was also not fame. They used bombs and took a lot of lives, but you can see how those are different from school shooters of today, the Columbine shooters, the Elliot Rodger types. They're very different.

SPENCER: What do we know about other precipitating factors like drug use or childhood trauma or head injury, things like that?

RAGY: Substance use, in and of itself, is seen in about 25% of mass murders. Now, substance use is very common.

SPENCER: Just so that may not be, that may not be even very causative.

RAGY: What we found is that, again, in science, there are so many different variables and things going on. What we want to do is tease apart different variables and different contributing factors. It's sometimes hard to get at causation, but one way to at least get at association and minimize bias is by comparing groups. What I can tell you about substance use is that it seems like about three or four percent of public mass murders in general are primarily motivated by substances, meaning this person would not otherwise have perpetrated mass murder. They were using so many substances that they became so disorganized that they just kind of went amok, again, a technical term, and took the lives of three or more people. That happens a few percent of the time. What we can say with more certainty, though, is that when a mass murderer has used substances, they're more likely to use a firearm rather than another method. All these other potential causes or contributing factors that you mentioned are important. You mentioned...

SPENCER: Childhood trauma.

RAGY: Which is so common, it doesn't distinguish, so it's hard to know how it contributes. But it's so common.

SPENCER: But it's not like the people committing mass murders have so much more than other people that it sort of stands out.

RAGY: The number is so high, it's hard to — yeah, it's like 60 percent, probably more than the average, you know, the background population. But it is so common, it's just hard to know how it contributes. That's the problem with some of these variables. Again, they're so common and it doesn't necessarily distinguish between types of mass murderers. So head injury is very interesting. Head injury, as people know, what we technically refer to as traumatic brain injury, definitely increases impulsivity or decreases impulse control. It increases impulse control. That injury became something that everyone would think about whenever a school shooting would occur because in 1966, a very seminal school shooting occurred at the University of Texas at Austin, in which the perpetrator had, I think, a tumor in their brain. And so there was a question of how much the tumor contributed. It wasn't traumatic brain injury, per se, but some sort of brain pathology contributed to the event. It's not clear. A lot of people refer to this 1966 event, the clock tower event, as a case of the first school shooting. It wasn't, but we refer to it that way. But that's how traumatic brain injury kind of worked its way into our understanding of public mass shootings. There were only a couple of the thousands now, 1600 mass shootings involving some sort of traumatic brain injury or tumor or something like that.

SPENCER: Taking a step back. People have all these recommendations for what to do. ""We need to prevent these kinds of events from happening. We need mental health screening or these kinds of things. We need to put armed guards in schools." My view, and I'm curious if you disagree, is that almost all of these are completely useless in the sense that they're extremely unlikely to actually change the numbers substantially. Would you agree with that? Or do you think some of these proposals are actually good ones?

RAGY: We can go right to the data and think about the numbers. Let's just address each of them individually quickly. So mental health is responsible for 5%, so it's not going to make much of a difference. What we know is that the contribution of psychosis in particular to mass murder and mass shootings in general, which we published five years ago, has gone down over time. The reason it's gone down is because we have AOT or assisted outpatient treatment, meaning that vans with clinicians go to patients we know who are very psychotic to ensure they take their medication. Almost all mass murders associated with psychotic disorders are perpetrated by young people with psychotic disorders. That is when people with psychotic disorders are most vulnerable to perpetrating violence, and they're almost always unmedicated. The bottom line is medical screening is good. What's more important to make that 5% number zero is to make sure people in the early stages of psychosis are medicated with antipsychotic medication.

SPENCER: That has huge benefits for other reasons, too. That seems like a no-brainer, just in terms of public health in general, but it's not going to move the needle. It's not going to prevent a large number of these events, I assume.

RAGY: It would help the 5% that are caused by mental illness. So what about the safety officers at schools? Peterson and Densley from the Violence Project published this, I think, two or three years ago in JAMA Network Open. They clearly demonstrated that school safety officers don't prevent school shootings. In fact, they would probably only increase the frequency of these sorts of events, knowing that, as we discussed, these perpetrators choose places where they know there's going to be a strong response. They want to die.

SPENCER: So a school with no armed guards is actually maybe a less appealing target, right?

RAGY: Schools are a prime target because perpetrators know there's going to be a strong response. There are so many of them, and that's going to bring a lot of media attention. Per capita, military installations and police headquarters are much more likely to be targeted. Per capita, meaning there are many more schools than there are military installations. A military installation or a police headquarters is 60 times more likely to be targeted by a mass shooter than a school. Why is that the case? Because they know they're going to be confronted with a serious response. To go into the firearm question, maybe with more data. Just to be clear, we kind of alluded to this before, but the data are very clear. Both for gun violence and mass shootings, and mass murder in general, in particular. But I'll be very clear with the data: states with greater gun regulation or stronger gun laws have less mass shootings. The data are very clear. There's no doubt states with lower levels of regulation have higher rates of mass shootings. The data are very clear. Also, to be clear, we discussed the per capita frequency of public mass shootings, and again, this goes back to what we discussed about biased media reporting. Most mass shooting events occur in locations where guns are allowed and available. We mostly just hear about school shootings because that's what the media reports. But most mass shootings, like the vast majority, occur — about 70% — where there are guns. And I'm not just talking about military installations and police headquarters and offices. They occur in all sorts of other locations where guns are available. So the primary method to decrease mass shootings and gun violence in particular is to decrease gun availability by law. That's really the primary method by which we could decrease gun violence and mass shootings. Now this is nuanced, and I want to get to, for example, issues around the Second Amendment, those sorts of things. This is not necessarily a Second Amendment issue. Sometimes I sense that people bring up the Second Amendment, maybe meaning leaders, because they know that's really a non-starter, and it's not actually going to go anywhere. That might be a little bit of virtue signaling because that's just really not going to go anywhere. There are many other things we can do. We could have smart gun technology. Smart gun technology would take care of virtually all illegal gun issues and manage a lot of legal gun issues.

SPENCER: How does that work? Can you not fire the gun unless you have the right fingerprint, or what kind of thing are we talking about?

RAGY: Whether it's a fingerprint or a ring that you wear or some other very low technology locking mechanism. These are very simple.

SPENCER: But it would only actually prevent mass murders if it prevented the mass murderer from getting the weapon. Because the locking technology doesn't matter if they own the weapon. I thought that something like 70% or 80% of them own the weapon anyway.

RAGY: That's right. So it would take care of all the illegal, or most of the illegal, mass murders and other types of gun violence. It would also take care of about the 20 to 25% that are perpetrated by legal weapons, but by someone who did not primarily purchase the weapon. So that's about 35 to 40%.

SPENCER: That does seem like a bit of an overestimate, though, because presumably, if this was put in place, some of them would find other ways to get weapons, right? That'd be the best case scenario.

RAGY: That's, of course, the best case scenario, but if smart gun technology were, if that were just kind of the requirement, if all weapons had smart gun technology, that's just an example of a method that doesn't require regulation, because the concern is regulation. The phrase that some people say is, "Regulation equals confiscation, or leads to confiscation," that's kind of a concern. So that's a way of addressing the gun problem without even regular per se. That's a type of regulation, but without but then, as you said before, registration licenses, just checking up on guns the way we have to have our motor vehicles examined every year, that sort of thing. That's maybe simple, maybe it's not simple, but there are a lot of strategies. But then we can't ignore the effects of culture. In addition to romanticizing guns, our culture romanticizes guns and gun violence. I'm talking about movies, television, video games, and music. We need to stop that. I mean, these guns are not cool. Guns for self-defense is fine, but we don't want to be gratuitous with how we treat guns in any form of media. And we have, you know, to go back even further in terms of thinking about how society and culture has contributed to the problem. You know, the rate of mass murders, all types of mass murders, was exactly seven in a billion people between 1970 worldwide, primarily, we're talking about the US. But we published this five years ago, until 1970, it didn't change. Seven has increased. Mass shootings, the prevalence of mass shootings per capita has increased four times since 1970, and the prevalence of other types of mass murders has increased two times since 1970. So we have to think about what has changed so much. Why was the rate so steady for so many years, and then why has it increased, and what happened around the 70s and 80s? A lot of things happened. One, there's been a great increase in gun ownership per capita since that time. Number two, semi-automatic weapons have become more available since that time. They were always available, but they became more available, especially to the public. Since that time, and before the 1970s, the media didn't have as much of a role in our lives. The primary influences on young people were teachers, parents, clergy. Since the 1970s, the media has dominated in terms of influence on young people. A lot of people might not remember that we couldn't even rent movies, like home movie rentals, or renting wasn't even really a thing until, you know, the early 80s, or something like that. Social media is obviously very new. Music videos weren't really a thing until the 80s. So the media has really taken over. And to mention that to go back to focus even more on the gun issue, there's a lot of misunderstanding about how guns are related to suicide and violence and all those things, just to drive the point home, because there's also this relationship between suicide and mass murder. And then to throw in the antidepressant question, which is an important question I really want to address, because a lot of people may be under the misunderstanding that antidepressants are responsible for violence, mass murder, suicide. The suicide rate was relatively stable, maybe increasing for quite a while, and then the SSRIs came out, like fluoxetine...

SPENCER: Prozac..

RAGY: Exactly in the 80s. Through the 90s, there was a slight increase in mass murder and a decrease in suicide, through the 90s, SSRIs led to a decrease in suicide, while mass murders increased a little. Since 2000, the rate of suicide has increased substantially in the US per capita, as well as the rate of mass shootings. However, the rate of suicide worldwide since the introduction of SSRIs has gone down significantly, whereas, again, the rate of suicide has increased per capita. Gun ownership was pretty stable in the 90s, might have even decreased a little because we had the Federal Assault Weapons Ban and those sorts of things. Since the 2000s, gun ownership in America has skyrocketed. The suicide rate has skyrocketed, importantly, almost only among people who use firearms to perpetrate suicide, right, and among men in rural areas. So it's all related to firearms. Other countries without firearms, or without any substantial availability to firearms, have essentially no gun violence and no mass shootings and other types of mass murder. So all the data kind of together coalesce around the same conclusions. There are a lot of ways to address all the different types of mass murder, but if there's one strategy that's better than any other or will lead to the greatest decrease in mass murder, and mass shootings in particular, it would be to limit gun availability.

SPENCER: People talk about mental health screening, but it does seem like there are some personality traits that are more likely among mass murderers, as you described. For familial cases, it would be nihilism, and for public mass murders, it would be narcissistic or low empathy tendencies. Do you think there's any hope to screen for those, not to pre-punish people, but to try to help them and reduce the chance that they hurt people?

RAGY: Sure, this is a really good question. These sorts of psychological characteristics are pretty common. That is why we focus on, especially for public mass shooters, the three-point psychological profile that is relatively specific. I don't want to get too technical, but when we understand prevention and how wide or narrow we want to cast our umbrellas, we need to think about terms like sensitivity, specificity, positive and negative predictive value. We could, for example, consider screening or paying attention to people with these characteristics, also maybe those who have been exposed to childhood neglect and those sorts of things, or childhood maltreatment. But that casts too wide of a net. That's the problem.

SPENCER: Because if the false positive rate is too high, then it's completely pointless. If 99% of the people you screen you think could be mass murderers or not, then it's like, what are you even doing?

RAGY: Exactly, that becomes difficult. We want something that's more specific, so it doesn't capture so many people who aren't going to perpetrate anything. That's why we really focus on that three-point psychological profile, specifically for the public mass shooter: the affinity or fascination with firearms, severe nihilism, and then infamy. That is pretty narrow and specific. Identifying someone like that would be a little more possible. The other primary way to identify someone who could perpetrate a mass shooting, when we're thinking about prevention without identifying too many people and without making it too unwieldy, is to identify people who say they're going to perpetrate a mass shooting. That actually is more common than not, and as we discussed, especially with regards to public mass shootings, these are planned, and in many cases, these individuals do tell someone or imply to someone that they're going to perpetrate a mass shooting. That characteristic probably has the highest predictive value of any, and that's what we should be focusing on.

SPENCER: Now, do they commonly just say it to people one on one, or is it common that they post on the internet or say it on forums or things like that?

RAGY: The former, so individually, to people farther back. They tend to, based on the manifestos that we have and those sorts of things, report more publicly shortly before the event. So that might be too late. It might be a little hard to identify them at that time.

SPENCER: And what about proposals to do things like, let's ban assault weapons. Let's ban automatic or semi-automatic weapons. Would that really have any bearing on this, or would it do almost nothing?

RAGY: Well, we have the data. If I could share the data with you, that might help us figure out how these different types of weapons make a difference. Semi-automatic weapons became more widely available in about the 70s. For the first 100 years since 1900, the split was about 60% non-automatic to 40% semi-automatic. Right now, the split is 51% semi-automatic or automatic, but primarily semi-automatic, compared to about 49% non-automatic. So non-automatic weapons are still very commonly used. When a semi-automatic weapon is used, the fatality count is a little higher. It's about five and a half to four and a half, but the primary predictor of fatality count in a mass shooting is the number of weapons.

SPENCER: That's wild, because everyone would assume that the semi-automatic weapons are causing many more people to die, but if they come with two handguns, that might actually be a higher risk factor than the semi-automatic weapon.

RAGY: By far, the number of weapons is more predictive than the type of weapons. Semi-automatic weapons are worse than non-automatic weapons. But what's more important in terms of decreasing things down is the number of firearms, and also all sorts of weapons. People also don't realize in a lot of these cases, other weapons are used. We just don't hear about it. For example, with regards to the 1966 University of Texas shooting, that person first went and I want to say he either smothered or stabbed his mother or grandmother. I was confused about that one with another one, but he either smothered or stabbed his mother or grandmother before he went to the clock tower at the University of Austin. In about 20% of mass shootings, another type of weapon is used. So either way, the number of weapons is highly predictive. In terms of the Federal Assault Weapons Ban, we have the data, and we just published this a couple of months ago. There was a Federal Assault Weapons Ban in place between, I believe, 1994 and 2004. We examined mass shooting events per capita, of course, and fatalities per capita. There was no change before or during the Federal Assault Weapons Ban in terms of fatalities and events. However, after the assault weapons ban, the number of fatalities and events was much higher than before the assault weapons ban, not even during. So after, much higher than before. The question is, was that because of the assault weapons ban? Was that for other reasons? Again, no difference between during and before the assault weapons ban, but a big difference comparing after to before. So the data are somewhat inconclusive. They're not conclusive enough for us to really make a statement about it.

SPENCER: But either way, you're saying it didn't seem to help. You're saying, if anything, things got worse after the ban.

RAGY: No, I mean, things got worse after the ban, but that could mean the evidence isn't strong, but that would lean towards us thinking that the ban was preventing things from getting worse earlier, because once they stopped the ban, things got so much worse. So it's that the ban kind of prevented or slowed down something that was already getting worse. But again, those data, I mean, they're not quite conclusive.

SPENCER: It's tough to say, so maybe there's reason for a little bit of cautious optimism that banning some of these weapons could help a bit. But was that your final view on that?

RAGY: Banning them or limiting them is likely to have some effect, but most important is the number of weapons. The number of weapons is by far the biggest predictor of the number of fatalities and injuries. We've been talking about fatalities, but we also examined injuries. We published this in the journal Violence and Victims several years ago. Injuries almost perfectly mirror and match fatalities. So everything we're saying about fatalities also applies to injuries.

SPENCER: The final thing I want to ask you about before we wrap up: to what extent do your conclusions apply to regular murder? When someone's murdering just one other person or two other people, it's not a mass murder. Obviously, there may be really big differences there. So what can we apply and what is not relevant? In what ways are those really different?

RAGY: Yeah, they are a bit different. This is really important. So we mentioned before that serial killers are almost always psychopaths. Mass murderers are almost never psychopaths. Single or double murders are kind of, excuse me, are in between. They're literally in between. So you have serial killers on one side in terms of motivation and other characteristics, mass murderers over here, and in the middle, you have single and double murders. One might think that serial killers and mass murderers would be here and single and double murders would be here. It's single and double murders that are in the middle, serial killers over here, and mass murderers over there.

SPENCER: Got it. My understanding is that a lot of single murders are just people getting in fights. Two young men bump into each other. Maybe they don't like each other. Maybe one of them stepped on the other's toe, and then they got into an argument, and one of them has a weapon. Is that true, that that's a really common cause of single murders?

RAGY: It's one of them. It's somewhat similar to what happens in about 10% of mass murders. So that is pretty common in single and double murders. You're right. It's right in the center between serial and mass, but that is one way in which single or double murder is somewhat more similar to mass.

SPENCER: Ragy, thank you so much for coming out. This was a fascinating discussion.

RAGY: Thanks for having me, Spencer. I'm glad we were able to talk about this issue.