Muhammad Youssef Abdulazeez was a 24-year-old man, born in Kuwait, raised a Muslim in Chattanooga, naturalized as a U.S. citizen. On July 16, this young man, irregularly employed as an engineer, made use of his rather ample supply of arms and ammunition to commit violent murder against unarmed military personnel in the very city that had sheltered his immigrant family for decades.
He was shot dead himself, and it seems he intended this — there was a strongly suicidal aspect to his murderous rampage. There are credible though incomplete reports indicating that he suffered from mental illness, possibly depression, maybe bipolar disorder. Even more ominously, he had problems with drug and alcohol abuse, resulting in run-ins with the law. So far, there is little to no evidence linking him directly to any terrorist network, though it seems he has viewed speeches by violent Islamic extremists on his phone in the past.
With emotions high, everyone wants answers. A small, vocal minority wants to spread blame. The ultimate responsibility for the crime lies with the perpetrator alone, not with any demographic he belonged to, any stressor he faced, any terrorist he had listened to. There are some key red flags for violence risk in Youssef's life story, and some lessons to guide us in the future. However, only a very small percentage of people who match his description to any significant extent would actually commit murder, let alone mass-murder. Psychiatrists, forensics experts and law enforcement specialists alike struggle to predict who is actually going to do it.
The link between mental illness per se, and violence is quite weak. The vast majority of people with severe mental illness (schizophrenia, bipolar disorder, recurrent major depression) are not violent, and only a very small percentage of violence in society is committed by people with severe mental illness.
Having said that, during some phases of their illness, mentally ill patients are two to four times as likely as the general population to commit a violent crime. Notably, they are more than 10 times as likely as the general population to be the victims of violent crime. Most psychiatrists treat post-traumatic stress disorder every day, and come across sociopaths rarely.
There are key factors that increase manifold the risk of violence by someone suffering from mental illness. Studies have documented much higher risks in males, substance abusers and in those belonging to impoverished communities (Youssef's employment issues and debt burden were significant), all risk factors they share with non-mentally ill criminals.
Suicide and mental illness
What is too often forgotten is that severe mental illnesses are potentially life-threatening medical conditions. Over 40,000 people in the U.S. kill themselves every year, about one every 13 seconds. For young adults, suicide is the third leading cause of death in the United States. And up to 90 percent of people who commit suicide are thought to suffer from mental illness. Access to care is critical, and the barriers to this access are multiple, starting with insufficient or misleading information about mental illness. Add to this our lack of universal health care coverage, and the tremendous stigma (public but also self-stigma) that continues despite our persistent efforts. There is increasing realization that this stigma runs stronger in certain subsets of our population, including Muslim Americans of diverse ethnic backgrounds.
What should we make of Abdulazeez's faith? Are any and all Muslim Americans bound to attack sooner or later, ticking time bombs, best managed in internment camps? Or, having seen the picture of this disturbed young man, a psychiatric patient and drug abuser, witness to domestic violence, unbetrothed, underemployed, debt ridden and facing a felony court date, should we ignore his religious preference altogether, as we do for all nonMuslim criminals?
To me, there is significant meaning attached to the timing of his attack on the last day of Ramadan, the day before Eid. If the month of fasting emphasizes patience and selflessness, and Eid is a celebration of community, he could scarcely have enacted a more shocking rejection of these holidays.
It is worth considering, too, what he didn't do: He didn't write a suicide note and hang himself or take a lethal drug overdose. He didn't assault his allegedly abusive father. He didn't hide by an overpass, shooting random strangers for as long as possible, without getting caught (Beltway snipers). He didn't attack a movie theater (Holmes, Houser), a former employer's office (Patrick Sherrill, Mark Barton), a church (Roof), or — and I shudder as I write this — a school (Sandy Hook, Columbine). Neither did he flee from Jordan to join ISIS, though one imagines he could have.
Instead, he directly attacked unarmed U.S. military personnel, in his very own hometown. Quite contrary to what the warmongers proclaim, it seems a tragic case of us against us. Fratricide really, by a formerly accomplished high school martial artist, quite helpless in the world of grown men and women.
And indirectly, what could be a bigger blow to his family, his friends, the community he grew up amidst? Where would they find peace now, physically and emotionally? Didn't they listen, understand, include, guide?
Did ISIS and its ilk manage to reach out to this desperate and angry young man, to offer him some meaning, some sense of belonging, however morbid and destructive? Don't our inner city gangs and supremacist, xenophobic groups trade in this very currency? Is there anyone, anywhere who can interpret his cowardly act as heroic, as serving any worthwhile purpose? Wouldn't it take quite a sick spirit to do so?
Answering the questions
It is the job of our great nation to answer these questions, and to answer them correctly. Chattanooga started to do so immediately. Interfaith vigils blossomed the very next day. On day two, the murderer's neighbors gathered to tend to his garden.
As mourners, we were one community, regardless of color, faith, socioeconomic status. Yes, a few divisive voices were heard, a little hatred was spewed — mostly from the usual suspects here and their fellow firebrands in the Middle East. But for the most part, the freshly spilled blood was honored as it should be — as all such blood should be that is shed to preserve and renew a just democracy for us all.
Mohsin Ali, a child, adolescent and adult psychiatrist, has lived and worked in Chattanooga for more than nine years after moving to the United States from his former home in Pakistan.