Homicide is shocking and horrific, but it can be justified, as in self-defense. It can be comprehensible, as in crimes of passion, mutual affrays, and even murder for hire or revenge. Some are unfathomable, beyond any rational explanation, such as those committed by serial killers and mass murderers. While the actions of the killers may be irrational, there is evidence that these crimes are not as random as the acts themselves may imply. Using case studies, statistical, and historical data to examine deinstitutionalization as juxtaposed against mass shootings between 1982 and 2019, this research explores how the use of psychotropic medications created a series of circumstances that ushered in the demise of psychiatric institutionalization, and may have directly contributed to violent attacks. The policies credited with a precipitous drop in inpatient mental health treatment, have also seen an inversely proportional rise in mass shootings. While psychotropics cannot be proven to be a direct contributing factor in many of the studied shootings, the effects of their widespread use and the resultant deinstitutionalization of psychiatric treatment linked, and should be addressed both culturally and legislatively.