When the news broke in October that a gunman in Las Vegas had killed 58 people and wounded nearly 500 more at an outdoor concert—the worst mass shooting in American history—Jonathan Metzl braced himself for the inevitable question: Was the shooter insane?

As one of the nation’s foremost experts on gun violence, Metzl has been fielding versions of this question for much of the past decade whenever a mass-murder incident involves firearms. “As a psychiatrist I very often get asked: Is this person mentally ill? Are they insane? Are they schizophrenic, or severely depressed?” he says.

“It’s beyond comprehension that someone would commit mass murder on such a scale. But the relationship between that horrific act and mental illness is far more complicated than it might seem.”

Metzl often is called upon by the media to debunk commonly held misbeliefs about violence and mental illness that have more to do with cultural stereotypes and preconceptions than they do with reality. As both a Vanderbilt professor and research director for the nonpartisan Safe Tennessee Project, he has a unique platform through which to put his findings into action.

A mass shooting like the one in Vegas, Metzl says, opens the possibility of many causes. “Certainly, we want to know what would lead someone to kill in cold blood,” he says. “But while questions of individual psychology often are the first ones we ask, we need at some point to step back and address larger social issues such as gun policy, access to firearms, politics, and even larger cultural scripts about race.”

After all, when an incident of mass violence involves a person of color, politicians and media commentators are quick to blame radical Islamic terrorism or other violent ideologies. When the shooter is white, they are much more likely to blame mental illness, as President Trump did when he called the shooter, Stephen Paddock, “a very sick man” and a “very demented person” before the facts had come in.

“When perpetrators of violence are people of color, journalists, politicians and many citizens treat their violence as natural, expected. But when shooters are white men who kill white victims, politicians like Trump, and indeed many other facets of white America, reach for the notion of an unstable, angry, isolated person driven to mass murder,” Metzl wrote in a recent Washington Post editorial.

Metzl has spent his career investigating the structural inequities that lead to different health outcomes in the United States. He investigated similar claims of mental health issues involving African American protesters in the 1960s and 1970s, culminating in his pathbreaking 2010 book, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon).

Several years ago Metzl collaborated with Vanderbilt colleague Kenneth MacLeish, assistant professor of medicine, health and society, in analyzing decades of research on gun violence and mental illness, and found surprisingly little correlation—with only 3 to 5 percent of American gun crimes involving “mentally ill shooters,” a percentage far lower than for people deemed sane.

While mental illness sometimes can be a factor, especially in mass killings, rarely is it the whole story. When translated into public policy, laws that focus on stopping mentally ill shooters could be at best a waste of energy, or at worst counterproductive, if not linked to other common-sense interventions, Metzl says. In most of the 32,000 annual gun deaths in the U.S., substance abuse, interpersonal conflicts, and past history of violence are much greater risk factors.

“It’s not like it’s a big mystery,” Metzl says. “Mass shootings are very difficult to foretell, but everyday shootings often follow more predictable social patterns linked to access, policy and context, as well as to the past histories of high-risk individuals.”

Through his work with Safe Tennessee, Metzl has tried to find a middle ground in the gun-control debate, supporting gun rights while at the same time advocating for the closing of gun-show loopholes, requiring of background checks on gun sales, and the banning of tools that allow semiautomatic weapons to be converted into automatic weapons, as in the Vegas attack.

“Do we really want to make it as easy as it is for individual citizens to amass arsenals or inflict mass casualties?” he asks. “Every country has people who are imbalanced, but no country has the level of gun violence and death that we do. It’s beyond time that we come together to find centrist solutions rather than continually talking past each other.”

The Frederick B. Rentschler II Chair was created in 2010 from the growth in funds supporting the Nelson O. Tyrone Jr. Chair in American History, established in 1995 by Frederick B. Rentschler II, BA’61. A longtime Vanderbilt supporter and volunteer, Rentschler was elected to the Vanderbilt University Board of Trust in 2003 and served until his death in 2010.

This article was originally posted in the November issue of Vanderbilt Magazine