American civil-commitment law has produced one of the largest preventable public-safety disasters in modern governance. The Supreme Court’s Connor v. Donaldson (1975) decision effectively made it nearly impossible to hold someone involuntarily until they had already demonstrated imminent danger. The real-world consequence: a steady stream of suicides, murders, rampage killings, family annihilations, and urban collapse that our legal system was structurally barred from preventing.
The Legal Misconstruction
Connor held that a state cannot involuntarily confine a non-dangerous person. Over time, this has calcified into a rigid judicial rule: no detainment without imminent risk. Lawyers call this liberty. Families call it too late.
Aggregate Costs of the “Too Late” Rule
Suicide in the U.S. (2023): over 49,300 deaths annually. National Institute of Mental Health
Firearms alone account for about 27,300 suicides of that total. CDC
For decades, the mental-health system has been the de facto suicide prevention system — and it fails because the standard for intervention is too high.
Homicide in the U.S. (2023): approximately 22,830 deaths. National Institute of Mental Health
A non-trivial subset of homicides involve perpetrators with untreated or poorly managed serious mental illness; research estimates range around ~10% in broad homicide contexts and much higher in personal-cause mass killings and spree murders. Treatment Advocacy Center -
Murder-Suicides: An estimated ~1,200 deaths per year in the U.S. occur in murder-suicide incidents — a pattern often tied to untreated mental crises. Violence Policy Center
Iconic Rampage and Mass Killings
Notable deadliest attacks often involved individuals whose psychosis went untreated or uncontained under current legal standards:
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Virginia Tech shooting — 32 killed, perpetrator died by suicide. Wikipedia
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Sandy Hook Elementary School shooting — 26 killed.
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Aurora theater shooting, Tucson shooting, Parkland, and others each added dozens more — murders that might have been preventable with earlier, capacity-based intervention.
Each of these atrocities shares a lead-in period of documented deterioration, warning signs, or treatment refusal — exactly the scenarios where current laws say “you must wait.” Waiting means after bloodshed.
Systemic Social Harm
The consequences of too-late intervention ripple outward:
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Homelessness: People with untreated psychosis appear disproportionately in unhoused populations. Cities with high concentrations of untreated severe mental illness have skyrocketing public costs.
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Real-estate decline: Municipal assessors and urban economists consistently find double-digit (≈15%) property value declines in areas with concentrated street disorder and chronic homelessness — effects real enough for mortgage appraisals and investment decisions.
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Quality of life collapse: Wealthy urban neighborhoods once insulated now report sustained erosion of livability metrics: public safety measures, commercial flight, escalating sanitation and emergency-service costs.
These outcomes are not collateral damage. They are direct downstream costs of a legal regime that delays help until after violence or complete functional deterioration.
The Core Pathology: Anosognosia
Many individuals with serious mental illness (SMI)—particularly schizophrenia-spectrum conditions—suffer from anosognosia: a loss of insight that makes them unable to recognize their own illness. It’s not denial. It’s a neurological incapacity.
Current law treats anosognosia as autonomy.
That is the structural flaw.
A Predictable Failure
Rampage killers, family annihilators, and murder-suicide perpetrators often exhibit:
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escalating delusional fixation,
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worsening reality testing,
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treatment refusal,
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social isolation,
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mounting risk that goes unchecked until a violent act.
The law insists on imminent danger even when every clinical indicator points to inevitable catastrophe.
Public Safety vs. Legal Catch-22
The everyday application of Connor has produced this tragic paradox:
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Too much liberty for the incapacitated.
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Too little protection for victims, families, and communities.
Conclusion
Connor v. Donaldson was not a civil-rights triumph. It was a jurisprudential mistake with measurable social costs: tens of thousands of preventable suicides, thousands of murders, mass killings that scar entire generations, homelessness that reshapes urban geography, and real-estate markets that sag under disorder.
The legal refusal to intervene before the violence, anchored in a rigid imminent-danger standard and blindness to anosognosia, is a public safety failure with daily casualties.
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Rampage Killings, Mass Murders, and Family-Annihilation / Parricide Cases
with documented or strongly supported serious mental illness (SMI)
I. Rampage Killings / Mass Murders (Public Settings)
Sandy Hook Elementary School shooting — Newtown, CT (2012)
Perpetrator: Adam Lanza
SMI: Severe psychiatric pathology; profound withdrawal, paranoia; untreated
Deaths: 26
Virginia Tech shooting — Blacksburg, VA (2007)
Perpetrator: Seung-Hui Cho
SMI: Major depression with psychotic features; prior psychiatric intervention
Deaths: 32
University of Texas tower shooting — Austin, TX (1966)
Perpetrator: Charles Whitman
SMI: Severe emotional disturbance; amygdala-adjacent brain tumor
Deaths: 18
Aurora theater shooting — Aurora, CO (2012)
Perpetrator: James Holmes
SMI: Schizoaffective/schizophrenia-spectrum illness; florid psychosis
Deaths: 12
Tucson shooting — Tucson, AZ (2011)
Perpetrator: Jared Lee Loughner
SMI: Paranoid schizophrenia; found incompetent, later restored
Deaths: 6
Parkland high school shooting — Parkland, FL (2018)
Perpetrator: Nikolas Cruz
SMI: Severe developmental/psychiatric disorders; long system failures
Deaths: 17
Columbine High School massacre — Littleton, CO (1999)
Perpetrators: Eric Harris & Dylan Klebold
SMI: Mixed pathology (depression, suicidality; not classic psychosis)
Deaths: 13
Included for completeness
II. Family-Annihilation / Parricide (Private / Domestic Settings)
John List — NJ (1971)
Victims: Wife, mother, 3 children
SMI: Long-standing paranoid/religious delusions
Outcome: Life imprisonment
Andrea Yates — TX (2001)
Victims: Five children
SMI: Severe postpartum psychosis; command hallucinations
Outcome: NGRI; committed
Bradford Bishop — MD (1976)
Victims: Wife, 3 children, mother
SMI: Severe emotional disturbance; paranoid traits
Outcome: Fugitive
Robert William Fisher — AZ (2001)
Victims: Wife, 2 children
SMI: Paranoid/control delusions; personality pathology
Outcome: Fugitive
Mark Hacking — UT (2004)
Victims: Wife, mother-in-law
SMI: Psychotic depression; grandiose/paranoid delusions
Outcome: Guilty but mentally ill
Anthony Todt — FL (2019)
Victims: Wife, 3 children
SMI: Delusional beliefs (psychosis disputed at trial)
Outcome: Life imprisonment
Camden Burton Nicholson — CA (2019)
Victims: Parents; housekeeper
SMI: Claimed psychotic break; sanity phase litigated
Outcome: Convicted
Joel Guy Jr. — TN (2016)
Victims: Both parents
SMI: Severe psychopathology; extreme violence
Outcome: Life imprisonment
Geneviève Lhermitte — Belgium (2007)
Victims: Five children
SMI: Serious mental illness under psychiatric care
Outcome: Convicted; later euthanasia
Pierre Rivière — France (1835)
Victims: Mother, sister, brother
SMI: Classic psychotic parricide; foundational forensic case
Outcome: Committed
III. Attempted or Single-Target Political / Public Attacks (SMI)
John Hinckley Jr. — DC (1981)
SMI: Schizophrenia/erotomanic delusions
Outcome: NGRI; decades hospitalized
Key Clinical Pattern (Across Categories)
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Untreated or undertreated psychosis
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Anosognosia (lack of insight)
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Repeated warning contacts with systems
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Legal barriers to sustained care
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Victims often dependents or symbolic targets
This list reflects system failure, not typical mental illness behavior.
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