Before a child pulls the trigger
Recently, another teenager walked into a school carrying a gun, opened fire on classmates and others around him, and ultimately took his own life.
Again, we are left with the same anguished question: What has happened to our children?
The horror may erupt in minutes, but school shootings are rarely born in a single moment. Long before the first shot is fired, there may have been distress, grievance, humiliation, isolation, suicidal thinking, threatening behavior, fascination with violence—or other warning signs that went unnoticed, were misunderstood, or never reached someone able to intervene.
Increasingly, one explanation is offered: social media.
There is reason for concern. Online platforms can magnify bullying, grievance, and social isolation; expose vulnerable adolescents to violent or self-harm content; provide communities that reinforce destructive thinking; and, after an attack, transform perpetrators into figures of macabre notoriety.
But blaming social media alone is as medically unsatisfactory as blaming fever for an infection. It may be part of the presentation without being the underlying disease.
School shootings are rare and extraordinarily complex events. There is no single psychological profile of a school shooter, and mental illness by itself is a poor explanation. The overwhelming majority of people living with mental illness are not violent.
The gunshot is the final event. Prevention begins much earlier— when the first cry for help is still quiet but loud enough to be heard.
Research instead points toward what violence-prevention specialists call a “pathway to violence”: a convergence that may include personal crisis, grievance, suicidal thinking, escalating or threatening behavior, social and environmental influences, and access to lethal means.
That distinction is crucial. If there is a pathway, there are also places along that pathway where someone—a parent, classmate, teacher, counselor, doctor, or community—may still be able to interrupt it.
The challenge, therefore, is not merely to explain the shooting after it happens. It is to recognize the trajectory before the child reaches for the gun.
When homicide and suicide converge
One of the most disturbing findings in research on school shooters is how frequently violence against others intersects with violence against oneself.
A US National Institute of Justice review found that most perpetrators of K-12 mass shootings were in crisis beforehand, frequently communicated or “leaked” their intentions to others, and almost all in the cases studied were actively suicidal.
This should profoundly alter how we understand these attacks.
Some school shootings are not simply homicidal acts followed by suicide. They may represent a catastrophic fusion of grievance, despair, revenge and self-destruction.
For doctors, that matters.
We know that suicidal crises can involve cognitive constriction—the person’s psychological world narrows until alternatives seem to disappear. Add rage, humiliation, fixation on perceived enemies, and access to a firearm, and an inward crisis may become outwardly lethal.
Yet we should resist retrospectively diagnosing every shooter. There is no laboratory test for future violence, and mental illness should never become shorthand for dangerousness.
The medical model should instead ask about risk.
Is the adolescent becoming increasingly isolated? Being severely bullied? Expressing hopelessness? Talking repeatedly about death? Threatening particular people? Fascinated with previous attackers? Posting violent intentions? Acquiring or seeking access to weapons? Saying goodbye?
One sign may mean little. A constellation of escalating behaviors demands attention.
Is social media the villain?
Social media deserves scrutiny—but with scientific precision.
The US Surgeon General has warned that we still cannot conclude that social media is sufficiently safe for children and adolescents. Young people can encounter hate, cyberbullying, self-harm material and other disturbing content online. Heavy use is associated with poorer mental-health outcomes in some populations.
In the CDC’s 2023 national survey, 77% of American high-school students reported using social media several times daily. Frequent users also reported higher levels of bullying, persistent sadness or hopelessness, and some measures of suicide risk. But association does not prove causation. Vulnerable adolescents may use social media more, social media may worsen vulnerability, or both may occur simultaneously.
WHO similarly concludes that technology’s effects on young people’s well-being are mixed and bidirectional, with particularly vulnerable children disproportionately experiencing harms.
So social media is neither innocent nor omnipotent. Its particular danger may lie in amplification.
An adolescent’s humiliation ends when he leaves school. Cyberbullying can follow him home.
A grievance once remained within a small circle. Algorithms can lead vulnerable users toward communities that validate anger.
And an obscure killer can become internationally notorious within hours.
After suicide, social media can also sensationalize or glorify the deceased and potentially contribute to contagion among vulnerable young people, according to CDC guidance.
We should therefore be exceedingly careful about turning perpetrators into celebrities—publishing manifestos repeatedly, endlessly replaying videos, romanticizing their photographs or converting body counts into scoreboards.
Report the tragedy. Remember the victims. But do not manufacture an antihero.
The gun changes the prognosis
There is another uncomfortable variable that cannot be omitted: access to firearms.
CDC research found that firearms involved in school-associated homicides and suicides were primarily obtained from the perpetrator’s home or from friends or relatives. Ninety-five percent of multiple-victim school-associated youth homicides in its historical dataset involved firearms.
From a medical standpoint, access to lethal means changes prognosis.
An impulsive suicidal crisis without a gun may remain survivable. The same crisis with immediate access to a firearm may not.
That is why the American Academy of Pediatrics recommends that clinicians caring for adolescents at risk of suicide assess access to firearms and other lethal means and counsel families about secure storage or removal when risk is elevated.
This need not become an ideological argument.
It is injury prevention—the same principle by which we use seat belts, childproof medicines and barriers around swimming pools.
Stop looking for the ‘School shooter’
Schools should not attempt to identify dangerous children by appearance, personality or diagnosis.
There is no reliable “school shooter profile.” Profiling will inevitably stigmatize countless introverted, depressed, bullied or unconventional adolescents who would never harm anyone.
A better approach is behavioral threat assessment.
A multidisciplinary team—educators, counselors, mental-health professionals and, when appropriate, law enforcement—examines concerning behavior in context: What was said? Is there a specific target? Is there planning? Weapon access? Escalation? Suicidality? What grievance lies underneath it?
The objective is not merely punishment. It is interruption.
Evidence reviewed by the National Institute of Justice suggests that properly implemented threat-assessment programs can resolve threats while allowing most students eventually to remain in school, rather than reflexively suspending or criminalizing them.
Anonymous reporting can help. CDC-supported research examining one school reporting system found that tips over four years contributed to mental-health interventions, interruption of suicide crises and violence, and prevention of several planned school attacks.
Students often know before adults do. We need to give them a safe way to speak.
What the Philippines should learn now
The Philippines fortunately has not experienced the scale of recurrent mass school shootings seen in the United States. That is precisely why prevention should begin before such violence becomes normalized.
Our own warning signs are already troubling.
DepEd reported that PISA 2022 data showed roughly one in three Filipino students experienced bullying weekly. One large public secondary school cited by DepEd recorded 382 bullying incidents in a school year while having only one guidance counselor for more than 12,000 students.
There has been important progress. Republic Act 12080, the Basic Education Mental Health and Well-Being Promotion Act, mandates school-based mental-health programs and creates school-counselor positions. DepEd says P2.9 billion has been allocated to its School-Based Mental Health Program, including suicide-prevention efforts.
But a law becomes prevention only when a distressed child can actually find a trained adult before crisis becomes catastrophe.
Every school should eventually have access to a multidisciplinary threat-assessment pathway, confidential reporting mechanisms, clear protocols for credible threats, strong anti-bullying programs, referral networks with mental-health professionals, and genuine partnerships with parents.
Pediatricians and family physicians should routinely ask adolescents about mood, bullying, sleep, substance use, suicidal thoughts and—in appropriate circumstances—access to lethal means. WHO estimates that one in seven adolescents aged 10 to 19 worldwide lives with a mental disorder.
Digital literacy must also evolve. Parents cannot realistically police every screen. But technology companies can design safer systems; schools can teach children how algorithms manipulate attention; and adults can learn that an alarming online post should not be dismissed as teenage drama.
Treat the symptoms
Medicine teaches us something useful about catastrophe.
A heart attack may appear sudden, but coronary disease often develops silently for years. A stroke occurs in seconds, yet hypertension may have been damaging the arteries for decades.
School violence can be similar. The gunshot is the final event.
Before it may have been months of distress, humiliation, grievance, isolation, suicidal thinking, threatening messages, fascination with violence, weapon access—and missed opportunities for somebody to intervene.
We will never prevent every tragedy. But we can stop pretending that our only choices are to blame social media after the shooting or fortify schools before the next one.
The wiser approach is upstream: healthier families, safer digital environments, less bullying, accessible mental-health care, responsible firearm storage, behavioral threat assessment, anonymous reporting and adults trained to recognize escalating danger.
When a teenager reaches the point of entering a classroom with a weapon, prevention has arrived terribly late.
The real work begins when the first cry for help is still quiet but loud enough to be heard.
