Mass Shootings, Mental Health and Gun Control. A Medical Response

Americans are angry. Left or right, rich or poor, white or black or brown or yellow, we are all angry. 9 people are dead, killed on a community college campus by a lunatic with a grudge against humanity. As always happens after such senseless tragedies the national conversation has focused on one question. What can be done?

There is a sense that we “have to do something," but there is little agreement on what that something is. It reminds me of the patient who called to tell me about her advancing cancer. She had been diagnosed months previously and been told that there was no cure. She felt she had to do something so she went to Mexico and pursued multiple alternative therapies. They were unproven and ultimately ineffective but doing nothing did not seem like a viable option. The family wasted thousands of dollars and countless days pursuing the dream of a cure yet changed nothing.

Her story provides a reference point for any discussion about guns in America. Gun violence is terrible, mass shootings are an evil blight on our society, and too many young and innocent people have lost their lives. There is a naturally intense desire for something to be done. That desire is so strong that we need to exercise caution, as it can result in our doing things that ease our guilt and calm our fears but do nothing to actually solve the problem.

As I listen to proposed solutions there are two that are most often repeated. Many say we need stricter gun laws, that we need to make it more difficult for bad people to obtain guns. Others say we need to improve treatment of the mentally ill so we can identify potentially dangerous people in advance. The question that needs to be asked is, “Will these treatments cure the disease?”

When it comes to stricter gun laws it is logical to assume that making it more difficult to obtain a weapon would make crime less likely to occur. As logical as it may appear the truth is that gun laws are as worthless at stopping gun crime as coffee enemas are at curing cancer. Cancer cells are not impacted by coffee in the colon and criminals don’t respond to gun laws. The shootings in Newton, Connecticut and at the community college in Oregon both occurred in states with strict gun laws. A recent survey of men incarcerated for violent crimes confirmed that over 95% of them purchased their weapons illegally. Strict gun laws would not have stopped any of them.

What if we eliminated guns altogether? To return to the cancer analogy, proposing that we remove all of the diseased cells from a person’s body sounds wonderful, but it is impossible and therefore not worth discussing. In a nation with over 300,000,000 million firearms there is no rational or viable way to remove guns from our society. When we remember that we have thousands of miles of unsecured borders and that in such a scenario black market gun sales would be lucrative, such a proposal is not reasonable.

As desperately as we all long to live in a nation where mass shootings do not exist, an honest and thoughtful evaluation of the issue leads to the conclusion that the answer to the problem cannot be found in stricter gun laws. These laws, like alternative medicine for cancer, allow us to feel as if we are doing something and address our need to not feel powerless and to have a sense of hope but offer no chance of curing the disease.

Many have therefore declared that the solution within reach is for us to do a better job of caring for the mentally ill in our society. If we could identify and treat the potentially violent among us the problem might go away. As lovely as this sounds, honest mental health practitioners will admit that there is no effective way to identify these individuals. Those of us who treat mental illness on a regular basis (I see patients with depression, anxiety or bipolar disease daily) can tell you that not all patients who need therapy will consent to it. For patients with personality disorders and bipolar disease refusal of treatment is so common that it is expected.

What most Americans do not know is that the NIH estimates that in any given year 2.2% of the American adult population will suffer from severe bipolar disease. In 2014 that equates to 5,400,000 people. When we add in the 2,690,000 people with Antisocial Personality disorder, and the 2,450,000 people with schizophrenia, we have over 10 million mentally ill adults with diagnoses that might lead to violence. Given the rarity of mass shootings it would literally be easier to find the needle in the haystack. Mental health care in our country is a disaster and it needs to be fixed but any who think that this is the answer to mass shootings is dealing with a different kind of altered reality.

So what can we do?

1-      We can quit glorifying the perpetrators. Media should never release their names. I am personally in favor of all mass shooters being addressed by a derogatory term (I like “pathetic loser”). It will not eliminate the problem, but it will cost nothing and infringe on no one’s rights if the news anchor said, “9 People are dead at a community college in Oregon after a Pathetic Loser opened fire in a classroom.” Let’s remove some of the incentive.

2-      We can be honest about our options and likelihood of success. We do each other no favors when we mean-spiritedly debate proposals that will ultimately accomplish little.

3-      Let’s be willing to consider uncomfortable alternatives. We need to improve the ability of institutions and individuals to defend themselves against attacks. We should consider having trained and armed guards at schools and other vulnerable locations and give thought to allowing trained and qualified civilians who pass appropriate screenings to carry weapons if they so desire. While the thought of millions of Americans having the ability to carry a concealed handgun makes many uncomfortable, the fact is that over 4 million Americans already do, and that the incidence of crime or misuse of weapons for such individuals is lower than that of police officers.

-          Bart

I typically avoid political posts, and tried to remain objective. Thoughtful questions and comments are welcomed. Feel free to share this post with others.