As if the complexities and vagueness described in the previous six blogposts on Mental Health and Gun Control were not sufficient to muddy the waters of understanding about mental illness and violence almost to make it impossible to come up with sensible objective decision making on the part of governments, law enforcement, attorneys, and judges–to say nothing of run-of-the-mill citizenry–there are still more complicating and thwarting issues. 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 cited previously continued their explanations of the difficulty of arriving at good legislation to deal with mental issues and gun ownership. “Complicating matters further, associations between violence and psychiatric diagnosis shift over time. For instance, schizophrenia—far and away the most common diagnosis linked by the U.S. media to mass shooters—was considered an illness of docility for much of the first half of the 20th century. From the 1920s to the 1950s, psychiatric literature often described schizophrenia as a “mild” form of insanity that affected people’s abilities to “think and feel.” Psychiatric authors frequently assumed that such patients were nonthreatening, and were therefore largely harmless to society.
“Only in the 1960s and 1970s did U.S. society begin to link schizophrenia with violence and guns. Psychiatric journals suddenly described patients whose illness was marked by criminality and aggression. Federal Bureau of Investigation (FBI) most-wanted lists in leading newspapers described gun-toting “schizophrenic killers” on the loose.
“Historical analysis suggests that this transformation resulted, not from increasingly violent actions perpetuated by “the mentally ill,” but from diagnostic frame shifts that incorporated violent behavior into official psychiatric definitions of mental illness… In 1968, the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) recast paranoid schizophrenia as a condition of “hostility,” “aggression,” and “projected anger”, and included text explaining that, ‘the patient’s attitude is frequently hostile and aggressive, and his behavior tends to be consistent with his delusions.’” This resulted in a new and distinctly negative mindset about schizophrenia and the condition’s propensity for violence.
PTSD [posttraumatic stress disorder] is another mental illness which is associated with gun violence with disturbing frequency. From the mid-19th century through the end of World War II, military leaders and doctors promulgated their conviction that combat-related stress afflicted only neurotic or cowardly soldiers. Research about the experience of combat veterans of the Vietnam War resulted in the DSM-III recasting PTSD as a normal mind’s response to exceptional events. Fairly soon, the image of the traumatized soldier became the common sense “knowledge” presumed by the body politic. However, serious real events caused an evolution from sick and cowardly to sympathetic victim, and then PTSD increasingly became associated with violent behavior in the public imagination and understanding. That went on to create the stereotype of the “crazy vet” which persists to the present day. Currently, supposedly sympathetic news coverage drawing attention to veterans’ suffering frequently makes its point by linking posttraumatic stress with violent crime. This generalized mind-set about this particular form of mental illness persists despite the paucity of data linking PTSD diagnosis with violence and criminality. Violence did and does happen, but it is a very infrequent manifestation of the behaviors associated with the disorder.
The result of such evolution in opinions created nearly fixed ideas associated with imagined potential for violence. Even psychiatrists–not just the general public–came to define violent acts as symptomatic of mental illness. Those fixations of opinions came to associate racial, economic, educational, and social stereotypes with a propensity to commit gun violence.