I think it's very nearly a difference without meaning here. If you commit mass violence out of insanity, you're probably going to be in a mental hospital for th

I think it's very nearly a difference without meaning here. If you commit mass violence out of insanity, you're probably going to be in a mental hospital for the rest of your life. Functionally akin to a lifetime prison sentence in that in both cases the perpetrator is removed from society forever. It's not that I have no empathy for the mentally unwell, it's just that when your illness begins to cause actions that will harm the world around you, you're defined in terms of those acts as well as your illness. A mentally unwell person who kills someone is still a killer (I purposely stay away from murder as I do not know law or that murder can be applied to those who are not convicted for reasons of insanity).