Dylann Roof, who allegedly shot and killed nine people at the Emanuel AME Church in Charleston, S.C., last week, showed all the signs of severe and worsening mental illness.

We know, of course, that Roof expressed hateful white supremacist opinion. But we also know that psychiatrically ill people can channel their paranoia or depression or extreme self-loathing into bizarre beliefs that sometimes lead to the destruction of others. Those beliefs can look just like intense hatred — of a particular person or a whole race of people.


When an isolated 21-year-old has a history of dropping out of high school (in the 10th grade), using drugs (reportedly including benzodiazepines and opiates), withdrawing from friends, starting to sleep in his car and beginning to tell people that he intends to start a race war and then kill himself, one can reasonably conclude that he may not be well.

Yet no one intervened in any way to prevent Roof from allegedly committing a mass killing. His uncle didn’t — even though he noted that, at 19, Roof was mostly staying in his room and hadn’t even gotten a driver’s license. His roommate didn’t, even though he has been quoted as saying that Roof was “planning something like this for six months.” His black friend didn’t, even though Roof reportedly outlined his murderous plans to him a week before he carried them out. Neither did a white friend who said he was so concerned when Roof went on a drunken rampage recently that he confiscated his gun.

Why does it always seem that there are good and decent and intelligent people around killers like Dylan Roof, who see clear signs of serious trouble, yet do nothing or almost nothing?

Why not? Why does it always seem that there are good and decent and intelligent people around people like Dylann Roof who see clear signs of serious trouble, yet do nothing or almost nothing?

One reason is that people wish to believe they are safer than they are. They exercise denial. No one wants to believe he might be living in a real-life psychological thriller. And the reason for that may be connected to other unspeakable, unthinkable fears we harbor: Any of us could die today, this very hour. Any of us could be shot tomorrow. Any of us could get a headache, then an MRI, then learn he has a brain tumor. To admit that someone close to us could be descending into the abyss is, in some measure, to admit that we, too, stand close to the edge of one (albeit a very different one).

Another reason is that we, as a society, are profoundly ignorant about the real signs of mental illness. It is as if many of us think that mentally ill people froth at the mouth or run around screaming. The truth is that some severely mentally ill people can, come to brood on perceived injustices, see the world as harboring great evils they must oppose and speak openly and dramatically about such matters. Does that sound familiar?

There is reason to believe that if just one of the people in Dylann Roof’s life had called 911 to report that a family member of theirs (or a friend of theirs) who owned a gun and used drugs was speaking about starting a race war and killing himself, that Roof would have been picked up by police and transported to an emergency room. Once there, he might well have voiced those very same beliefs to a psychiatrist. After all, Roof wasn’t shy about sharing his bizarre opinions. That could have led to him being admitted to a locked psychiatric unit, being detoxed from street drugs and being treated with the right psychiatric medicine. And, then, all this might not have happened.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team.