This series has focused on one specific aspect of American gun violence: gun suicide. Gun suicides account for the majority (61%) of all fatal shootings in America today. But gun suicides rarely receive attention in the American media or the halls of congress. Public mass shooting events - such as school shooting and theater shootings – do get a lot of media attention, though such mass shooting events are relatively rare and account for only a minor fraction of the over one hundred thousand Americans shot every year.
Because of long-standing associations of suicide with psychiatric disorders, and because some of the public mass shooting events have been done by people diagnosed with a psychiatric disorder, mental illness has taken a prominent place in public discussions of gun violence in America. Some Americans have blamed all of gun violence on the mentally ill. Perhaps not surprisingly, the NRA – America's premier lobbying group for the gun industry - suggests the only way to reduce gun violence in America is to a) sell more guns and bullets, and b) address issues of mental health and illness.
Gun violence in America is a complex problem and multi-factorial in nature. Blaming all of gun violence on the mentally ill is both wrong logically, and a derogatory insult to the millions of Americans who suffer from mental illness. And while psychology (the study of mental processes) and psychiatry (the study of mental disorders and their treatment) have both helped us to understand and ameliorate a variety of social problems, neither psychology nor psychiatry alone can solve the problem of gun violence in America.
Here is why:
1) Blaming gun violence on the mentally ill mischaracterizes and stigmatizes mental illness. The vast majority of psychiatric illness (depression, schizophrenia, anxiety disorders, etc) tend to make people shy and retiring, not explosively aggressive. It is a gross mischaracterization to suggest that everyone with a psychiatric illness is a ticking time bomb ready to explode into violence. Such ideas further stigmatize mental illness.
2) Blaming gun violence on the mentally ill has a chilling effect on those needing or seeking help. Suggesting publicly that everyone who goes to a psychiatrist's office is a ticking time bomb of violence and should have their names entered into a national database for federal scrutiny and/or suffer a further erosion of their civil rights is a good way to make people avoid the psychiatrists' offices.
3) Suicides and school shootings are not diagnostic of psychiatric illness. By itself, using a gun to kill oneself, or to shoot first-graders in a public school is not diagnostic of any psychiatric illness. Certainly, using a gun to kill oneself or to shoot first-graders fits our colloquial definition of “crazy”, and such behaviors may occur in a variety of different psychiatric disorders. But in the absence of any other signs or symptoms, such behaviors of themselves do not qualify a person for any specific psychiatric diagnosis under the formal criteria by which psychiatrists establish a diagnosis. The proper and accurate diagnosis of a psychiatric disorder does not depend on any one particular act, but rather on a multitude of behaviors displayed repeatedly over a period of time.
4) The limited powers of psychiatry. When it comes to suicide or violence, psychiatry has no magic bullets. Psychiatrists determine the likelihood that an individual may be contemplating hurting themselves or others by sitting down with the individual and asking them about their plans – a process that can take hours. When a potentially dangerous person is identified, violence is prevented by simply watching that person and keeping them away from dangerous objects and situations. Keeping a person from dangerous objects and situations may mean involuntary treatment: a loss of freedoms and liberty for someone who may well have no prior record of wrongdoings. The case of James Holmes - the shooter at the Aurora, CO. theater - is illustrative. Mr. Holmes had been seeing a psychiatrist who became convinced that Mr. Holmes was becoming homicidal. The psychiatrist reported her concerns to the authorities (as the psychiatrist is required to do by law), but could do nothing more to intervene. One month later, Mr. Holmes committed his act of mass violence. Even in this case where a psychiatrist was involved prior to the act of violence, and whose clinical judgment was that there was a good chance that violence could occur, the psychiatrist could do nothing by herself to prevent the violence. Psychiatry may be able to identify some of the people who later become violent; doing so accurately in a nation of over 300 million is almost impossible. What then happens to those so identified is a social and legal problem of Herculean proportions.
5) Any fixes to a broken mental health system will require years to effect changes in overall levels of gun violence. Fixing a broken mental health system will require changes in private and government funding, advances in clinical research, and a new attitude balancing medical necessity and profits among clinicians and hospital administrators. All of this could take years and even decades before any differences in violent behaviors among Americans are observed. None of the over 100,000 Americans who will be shot this year want to wait that long.
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