In the immediate aftermath of the Sandy Hook Elementary School shootings the National Rifle Association (NRA) declined to comment. Not usually known for reticence, the group’s longtime spokesman, Wayne LaPierre, said his organization would need to garner all of the facts before an appropriate statement could be formulated. A week later, presumably having collected whatever facts he needed, Mr. LaPierre, assessed blame for Sandy Hook and by inference the other approximately 32,000 annual gun related deaths in the U.S. on, in no particular order, the video game industry, Hollywood and our mental health treatment system. Referring to the individuals who commit these heinous crimes, Mr. LaPierre called them, “monsters,” “lunatics,” and “predators” who, he said, are “insane.”
President Obama also addressed the common sense nexus between gun violence and mental health in his call to the country, and congress, to confront and find solutions for the growing problem. Specifically, the president effectively overrode congress to give funding back to the Center For Disease Control for use in researching the role mental illness plays in gun violence. The override was necessary because in 1996, under pressure from the NRA and other Second Amendment aficionados, Congress approved a bill denying that funding. More recently, the information addicts at the NRA inveigled the majority leader in the senate, democrat Harry Reid, to add a last minute amendment to the Affordable Care Act which prevents health care providers, including mental health specialists, from discussing with their patients their use of or access to weapons. That provision, called Title X of the ACA, remains in effect and undiluted.
The assumption that violence and mental illness are closely related seems logical. Indeed, when any of these horrible events shock our conscience, our immediate reaction is that of “of course the perpetrator is crazy.” Who but an insane person would shoot 6 and 7 year old kids? Who but a monster would stare into small unblemished faces and pull a trigger, over and over and over? Seems obvious enough.
We can’t comprehend in any palliative way how we could do these things to each other so we attribute the act to something beyond our control and, more importantly, beyond our responsibility. We immediately label the people who commit these crimes as something different from us, different from our neighbors and friends. It makes us feel a bit better. And we need to do that because, in the minds of proponents of unfettered access to guns, we then need look no further for explanations or solutions. We, the law abiding, constitution loving, real Americans can go about our lives without the weight of the next massacre, the next suicide, the next robbery, the next accident, on our shoulders. Why should we be made to feel responsible for the acts of crazy people? Somebody ought to do something, let’s the rest of us go shopping.
In the criminal justice system there is a concept known as “not guilty by reason of insanity.” Simply, the plea is that while I may have committed the act I didn’t know what I was doing at the time I did it. Most, but not all, crimes require the prosecution to prove that the accused acted “knowingly.” And in most states there is a version of an insanity plea that asks two questions: Did the accused know the difference between right and wrong at the time he committed the crime, and was he able to comport his behavior with that standard? Any defense lawyer will confirm it is a very difficult standard to meet. What an average person considers an insane act does not mean the perpetrator is insane by a legal definition and it does not mean he would be diagnosed as mentally ill by any medical definition.
Not everyone who pulls the trigger of a gun while pointing it at another person or at himself is mentally ill in a clinical sense. One study found that 4 percent of all violent crimes are committed by a person with a serious mental disorder. They don’t all hear voices. Some are depressed, some feel disenfranchised by life, some are broke, some are high or want to be, some are just pissed off and some are evil.
Although mass murders like the ones at Sandy Hook or at the Aurora, Colorado theater attract the most dramatic and persistent media coverage, they by no means comprise the majority of gun related deaths in the US. A study recently published in the New England Journal of Medicine found that on average seven children and young adults are killed by guns every day in this country, the statistical equivalent of a Sandy Hook event every three days. Across all categories, 33 people are killed by guns each day. A Virginia Tech every 24 hours. Mostly, the victims are the consequence of unpredictable, random acts of opportunity by people who had ready access to a gun. As a cop, I once responded to a domestic violence report to find a middle class, professional male, with no criminal history, extremely intoxicated and upset over a Broncos’ loss. He had destroyed his living room and was terrorizing his wife and three children. The first question I asked, one asked by every police office in similar circumstances, is if there were any firearms in the house. The man’s wife told me the condition of the house was the result of her frantic husband looking for the handgun he kept to protect the family from intruders but that he’d forgotten where he put it. I don’t know what he would have done if he’d found the weapon but I do know he had never come to the attention of any mental health professional.
In the spirit of Justice Potter Stewart’s famous quip about pornography, you want to see an example of nuts? Watch Alex Jones’ tirade against Piers Morgan on CNN or Tactical Response head James Yeager’s video promise to “start killing people… if it (efforts to control gun access) goes one inch further.” Yeager also shills for Monster Energy drink and makes a good case for restricting access to caffeine as well. Yeager and Jones both have concealed weapons permits.
Third, although the remedy argued by the NRA and many other pro-gun organizations is conspicuously vague, it begs the two-part question of how we deal with medical privacy issues. A fundamental tenet of medicine is the care-giver/patient privilege. How many people would seek treatment for mental disorders if they understood that their personal information would be shared in a national database? And how many care-givers would easily reconcile the competing responsibilities of the law and their professional commitment to the patient?
No one serious about addressing the problem of gun violence disagrees with the notion that part of the solution is addressing the confluence of guns and mental illness.
It is true, as every politician and special interest spokesman has said over the past few weeks, that mental health must be a component of the discussion of gun violence. But it is fanciful and naïve to believe it should be the only component. As disparate as all crimes are, there are two components of each and every gun-related death — in fact, of each and every gun related crime. The only omnipresent common denominators in gun violence are people, nuts or not, and guns. The only thing that stops a bad guy with a gun is a bad guy with no gun. Without recognition and agreement on that fact a solution to the problem will remain beyond our reach and by 2015 more people will die each year from guns than from automobile accidents.