American Journal of Public Health

Mass Shootings and Psychiatric Deinstitutionalization, Here and Abroad

Dimitrios Pagourtzis, the student accused of shooting 10 people to death at a Texas high school in May 2018, was on the honor roll. His pre-AP language arts teacher, Valerie Martin, described him as bright, and “quiet, but he wasn’t quiet in a creepy way.” His football teammate Tyler Ray admired his commitment to summer workouts and his family’s commitment to attending his games. By many accounts, Pagourtzis was an active participant in the civic and cultural institutions of Santa Fe, supported by a caring community of family and friends.

Yet, in the wake of such atrocities, observers now instinctively begin to comb the suspect’s mental health history for signs of disorder. In this case, we have discovered his Facebook page, where a photo of a t-shirt reading “Born to Kill” appeared. Although this image should be enough to raise suspicions about an adolescent’s psychological development, when placed in context, it may not have been enough to commit Pagourtzis to psychiatric services, neither voluntarily nor involuntarily, even if these services were widely available.