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While the roots of school violence are complex and multidetermined, the origins remain deeply embedded in our society. It is now established that there is a high prevalence of mass shooters with undiagnosed and untreated psychiatric illness. In this article case material illustrates the psychodynamic and psychosocial determinants of school shootings. Shooters typically experience loss, trauma, bullying, abandonment, and undiagnosed psychiatric illness. They are often unwanted and marginalized children living in abusive environments. This article describes the psychodynamic relevance of the concept of soul murder and emphasizes the extreme isolation and loneliness experienced by shooters. The cases described might have been prevented had the assailant, after typically being identified as “troubled” by secondary support systems, such as families, schools, and law enforcement officials, received appropriate psychiatric treatment. There is an urgent need for more of an interdisciplinary approach involving families, school counselors, law enforcement, mental health workers, and lawyers, with a redoubling of efforts to secure appropriate psychiatric treatment for children with mental illnesses who are marginalized and may have a higher risk of violence than the general population.