Some veterans and mental-health advocates bristled at President Trump’s comments regarding the Thousand Oaks shooter and post-traumatic stress disorder, saying such broad-based remarks risked fueling inaccurate stereotypes about the condition and Americans who have served in combat.  

Trump began speculating about PTSD on Friday morning when asked about the shooting, in which authorities say 28-year-old Marine veteran Ian David Long opened fire at a country-music bar in Thousand Oaks, Calif., and killed 12 people. Officers found Long inside an office in the bar, dead of an apparently self-inflicted gunshot wound.

“He was a war veteran. He was a Marine. He was in the war. He served time. He saw some pretty bad things, and a lot of people say he had PTSD, and that’s a tough deal,” Trump said after describing the shooter as a “very sick puppy” who had a lot of problems.

“People come back — that’s why it’s a horrible thing — they come back, they’re never the same,” the president added, referring to Long’s military service.

Long served as a machine-gunner in the Marine Corps from 2008 to 2013 and deployed to Afghanistan, leaving the U.S. military as a corporal. 

It is not clear whether Long had been formally diagnosed with PTSD before his death or whether the president assumed he suffered from the condition based on his military service and comments in the news media by people who knew the shooter.  

Trump’s broad-brush remarks outside the White House on Friday prompted concern that the president was amplifying stereotypes suggesting PTSD turns veterans into violent killers and that all service members come home somehow damaged from combat.  

“Comments like this one from our Commander in Chief are extremely unhelpful,” Paul Rieckhoff, founder and chief executive of Iraq and Afghanistan Veterans of America, said in a statement. “They perpetuate a false and damaging narrative that veterans are broken and dangerous. Most people who suffer from PTSD, when able to access effective treatment, are able to live healthy, happy, meaningful lives.”

Rieckhoff said when veterans with mental-health issues hurt someone, it’s most likely themselves, not someone else.

“We lose 20 veterans and service members to suicide every single day,” he said.

“The problem isn’t with the phrasing, ‘you go to war and you come back and you’re not the same’ — that is true, you come back and you’re not the same,” said Kayla M. Williams, a former Army sergeant and senior fellow at the Center for a New American Security. “The concern I have is the idea that you come back more likely to be a mass shooter. That is not the case.” 

Williams said veterans come home from combat changed often in good ways, with a greater eagerness to be engaged with their communities and their country, and while there can be correlation with PTSD and increased anger and aggression, it’s unethical and dangerous to encourage Americans to be afraid of veterans because of their combat experiences and suggest they return home damaged.  

The wars in Afghanistan and Iraq dramatically increased the number of young Americans who had seen combat, reviving the stereotype of the damaged veteran, with PTSD becoming an acronym well known outside medical communities. 

In recent years, mental-health experts and veterans groups have taken steps to remove the stigma of the condition and show that veterans suffering from it aren’t ticking time-bombs, as stereotypes stemming from the Vietnam era began to suggest. 

“I think in reporting and in fiction movies and television, it’s interesting and graphic to create an archetype, to create a particular portrait — and the idea of the crazed killer coming back from war has a certain amount of resonance. It’s not true,” said Frank Ochberg, clinical professor of psychiatry at Michigan State University.

Ochberg has advocated renaming the condition PTSI — or Post Traumatic Stress Injury — rather than describing it as a disorder. He said there is some research that shows people with PTSD have an increased risk of violence but he said that applies to a vast minority, and sometimes veterans with the condition become reclusive or see reduced appetite for enjoying time with family and friends. 

“I think a president says let’s get facts before we affirm our prejudices or assumptions and really spread rumors about what’s going on here,” Ochberg said. “And then I think the president could take the occasion to say even if this veteran has PTSD, let’s not stereotype veterans with PTSD as being deadly dangerous, because most of them are not.”

PTSD varies in features and sometimes is seen as a “common cold” of psychiatry in that some people recover on their own and others face increasing severity that requires treatment, said Elspeth Ritchie, a retired Army colonel and psychiatrist with expertise in the condition. 

Service in combat doesn’t necessarily equate with PTSD. Ritchie said data on service members who served in combat in Iraq at the height of the war suggests about a quarter came back with some symptoms of PTSD but didn’t necessarily have the full-blown condition. 

“On the question about the relationship between PTSD and violence — like often with mental illness, there is a little bit of increased risk of violence, but it’s not the kind of violence where you go into a bar and shoot people,” Ritchie said.

In cases of mass shootings, she said, perpetrators are quite often suffering from a mental condition that involves delusion and paranoia, something far more severe than PTSD, even if they have served in the military and seen combat. 

“When you’re talking about going in and shooting some place up . . . nearly all of the time it’s something worse than PTSD,” Ritchie said. “It’s usually a psychotic episode. Psychosis means being out of touch with reality.” 

Correction: An earlier version of this story misquoted Elspeth Ritchie, a retired Army colonel and psychiatrist. Ritchie said: “Psychosis means being out of touch with reality,” not society.