I repeat my intention in this series of blogposts to limit discussion as much as possible to the issues of mental illness and its relationship to gun violence. The previous blogpost ended with an assertion that mental health specialists might well hold the key pre-emptive solutions to the problem. The same authors, Jonathan M. Metzl, MD, PhD and Kenneth T. MacLeish, PhD, Mental Illness, Mass Shootings, and the Politics of American Firearms, Am J Public Health. 2015 February; 105(2): 240–249, published online February, 2015, made it very clear that the problem is not so simply understood; and the solutions are not so simply arrived upon. In fact, they point out that even the data upon which researchers and ultimately legislators must rely to formulate legal controls over the mentally ill to prevent violent outbreaks is hotly debated among experts.
Consider first the assumption that mental illness causes gun violence (and ignore for the purposes of this discussion, the violence perpetrated by hate groups in the name of their ideology, their god, or their spurious assertions of being fighters against violent oppression by outsiders). This decade is hardly the first to focus on mental illness as a cause of gun violence. There has been a multi-decades-long history of debates in psychiatry and law about guns, gun violence, and “mental competence.” As far back as the 1960s, psychiatric articles deliberated ways to assess whether mental patients were “of sound mind enough” to possess firearms. Following the 1999 mass shooting at Columbine High School, a researcher named Breggin decried the toxic combination of mental illness, guns, and psychotropic medications that contributed to the actions of the shooter. After the 2012 shooting at Newtown, another psychiatric researcher, Torrey, reasserted his earlier warnings about “dangerous ‘subgroups’ of persons with mental illness who;” he contended, “were perpetrators of gun crimes.” Speaking to a national television audience, Torrey, claimed that “about half of… mass killings are being done by people with severe mental illness, mostly schizophrenia, and if they were being treated they would have been preventable.”
The same kind of debates have been seen throughout those past decades in legal dialogues as well. The U.S. Supreme Court strongly affirmed a broad right to bear arms in 2008 but endorsed prohibitions on gun ownership “by felons and the mentally ill” because of their special potential for violence.
There is, however, very little population based evidence to support the hypothesis that individuals diagnosed with mental illness are more likely than anyone else to commit gun crimes. “According to [researcher] Appelbaum, less than 3-5% of U.S. crimes of any kind involve people with mental illness…[in fact] the percentages of crimes that involve guns are lower than the national average for persons not diagnosed with mental illness. Databases that track gun homicides, such as the National Center for Health Statistics, similarly show that fewer than 5% of the 120 000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness.” Furthermore, there is an accumulating body of research suggesting that mass shootings are anecdotal distortions of—instead of accurate representations of, the actions of mentally ill people as a defined subgroup. “There were fewer than 200 mass shootings reported in the United States—often defined as crimes in which four or more people are shot in an event, or related series of events—between 1982 and 2012.”
There appears to have been a change in the prevalence of such terrible events beginning in 2009. Reports in research literature and by the media suggest that 160 of these events occurred after that time “and that mass shootings rose particularly in 2013 and 2014. Statistical analyses after 2009 were based on a different set of standards regarding what constitutes mental illness. “As anthropologists and sociologists of medicine have noted, the time since the early 1980s also marked a consistent broadening of diagnostic categories and an expanding number of persons classifiable as “mentally ill.” Statisticians who study the best means of preventing violence thus “contend that mass shootings occur far too infrequently to allow for the statistical modeling and predictability—factors that lie at the heart of effective public health interventions.” Some researchers argue that mass shootings denote “rare acts of violence” that unfortunately have little predictive or preventive validity when taking into account the finding that there are “32, 000 fatalities and 74, 000 injuries caused on average by gun violence and gun suicide each year in the United States.” The United States is by all evidence, a violent place, and mental illness is just one of the many causes.
Links between mental illness and all types of violence are similarly contentious among researchers and statisticians who study such trends. “Several studies suggest that subgroups of persons with severe or untreated mental illness might be at increased risk for violence in periods surrounding psychotic episodes or psychiatric hospitalizations [more commonly than throughout most of their lives]. Writing in the American Journal of Psychiatry, Keers et al. found that the emergence of ‘persecutory delusions’ [at least] partially explained associations between untreated schizophrenia and violence. [However], at the same time, a number of seminal studies asserting links between violence and mental illness—including a 1990 study by Swanson et al. cited as fact by the New York Times in 2013—have been critiqued for overstating connections between serious mental illness and violent acts.
Connections would seem self-evident to intelligent and informed members of the U.S. general population, and affirmed by media reports that assume an obvious distinction between mild versus severe mental illness. The more severe form of mental disease, it goes, connects severity to behavioral unpredictability and especially to lack of self-control. “However, this distinction, too, is called into question by mental health research… A number of the most common psychiatric diagnoses, including depressive, anxiety, and attention-deficit disorders, have no correlation with violence whatsoever. Community studies find that serious mental illness without substance abuse is also ‘statistically unrelated’ to community violence.” The overall accumulation of evidence confirms that the vast majority of people diagnosed with psychiatric disorders do not commit violent acts. Only about 4% of violence in the United States can be attributed to people diagnosed with mental illness. That suggests strongly the mental illness, per se, is not a valid reason to restrict gun ownership on the basis of mental illness alone because the stereotypes of “violent madmen” are at odds with scientific realities. There are researchers who posit the suggestion that “serious mental illnesses such as schizophrenia actually reduce the risk of violence over time, as the illnesses are in many cases marked by social isolation and withdrawal.” Rather, the best evidence indicates that the risk is exponentially greater that individuals diagnosed with serious mental illness will be assaulted by others, rather than the other way around. The extensive surveys of police incident reports collected by Brekke, et al. “demonstrate that, far from posing threats to others, people diagnosed with schizophrenia have victimization rates 65% to 130% higher than those of the general public.” “Media reports sound similar themes: a 2013 investigation by the Portland Press Herald found that ‘at least half’ of persons shot and killed by police in Maine suffered from diagnosable mental illness.”
A more accurate conclusion to be arrived at from the majority of credible research is that
the issue is the result of a number of risk factors more strongly correlated with the assortment of causes of gun violence than mental illness alone. These risk factors include alcohol and drug abuse which “increase the risk of violent crime by as much as 7-fold, even among persons with no history of mental illness.” There is less evidence against mental illness than there is against persons protected by “recent legislation that allows persons in certain U.S. states to bring loaded handguns into bars and nightclubs. Other factors as important as mental illness include, a history of childhood abuse, binge drinking, and male gender. Much as the NRA and the people who favor a lassie faire approach to gun ownership, “a number of studies suggest that laws and policies that enable firearm access during emotionally charged moments also seem to correlate with gun violence more strongly than does mental illness alone.” That is, the plethora of guns in the general population, thus making access to firearms available to persons susceptible to violence during times of stress, trumps the number of mentally ill with the proclivity to violence.
The NRA and other advocates of free or nearly free opportunity of gun ownership argue along with advocate, Lott, “that… ‘more guns’ lead to ‘less crime,’ [rather than the opposite popular view]. Serious researchers have “found that homicide was more common in areas where household firearms ownership was higher… [and that] states with high rates of gun ownership had disproportionately high numbers of deaths from firearm-related homicides.” For instance, “Webster’s analysis uncovered that the repeal of Missouri’s background check law [not mental illness] led to an additional 49 to 68 murders per year, and the rate of interpersonal conflicts resolved by fatal shootings jumped by 200% after Florida passed ‘stand your ground’ in 2005.” Availability of guns is statistically “a more predictive factor than is psychiatric diagnosis in many of the 19, 000 U.S. completed gun suicides each year.” An uncomfortable fact for the NRA is that “gun-related homicides and suicides fell precipitously, and mass-shootings dropped to zero, when the Australian government passed a series of gun-access restrictions in 1996.”