3 weeks, 2 days ago
Random gun violence is a terrifying fact of American life, because of both the violence and the randomness. Terror bred by violence does not really require comment; they are twinned. But terror bred by randomness does, especially when it leads people to accept as true a reasonable story that is false, when a myth functions as an explanation. And that is what is happening with the way we talk about mental illness and random gun violence. Thankfully, a just published report in the Annals of Epidemiology pulls together the facts we need to consider if we really want to adopt evidence-based policies to reduce random gun violence.
The article, “Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy,” is a comprehensive, critical survey of the available data (and it is surprisingly accessible and well-written for an academic treatise). It concludes that “most violent behavior is due to factors other than mental illness.”
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Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the article in Annals of Epidemiology was quoted in the UCLA Newsroom saying ”but even if schizophrenia, bipolar disorder and depression were cured, our society’s problem of violence would diminish by only about 4 percent.”
That is not very much. When people with mental illness do act violently it is typically for the same reasons that people without mental illness act violently.
In other words, advocacy for mental health checks and blame of the “mentally ill” for violence in the U.S. is not only unfair, it is a ruse intended to hide the real reasons for the advocacy, which is to intrude on civil rights and the moral duty of self defense.
It’s nice to see the recapitulation of things already said about this issue, in fact things I have cataloged.
Clinicians treating patients hear their fears, anger, sadness, fantasies and hopes, in a protected space of privacy and confidentiality, which is guaranteed by federal and state laws. Mental health professionals are legally obligated to break this confidentiality when a patient “threatens violence to self or others.” But clinicians rarely report unless the threat is immediate, clear and overt.
Mental health professionals understand that, despite our intimate knowledge of the thoughts of our patients, we are not very good at predicting what people will do. Our knowledge is always incomplete and conditional, and we do not have the methods to objectively predict future behavior. Tendencies, yes; specific actions, no. To think that we can read a person’s brain the way a scanner in airport security is used to detect weapons is a gross misunderstanding of psychological science, and very far from the nuanced but uncertain grasp clinicians have on patients’ state of mind.
What about diagnoses?
If mental health professionals were required to report severe mental illness (such as paranoid schizophrenia) to state authorities, it would have an immediate chilling effect on the willingness of people to disclose sensitive information, and would discourage many people from seeking treatment. What about depression, bipolar disorder, substance abuse or post-traumatic stress disorder, along with other types of mental illness that have some link to self-harm and impulsive action? The scope of disclosure that the government could legally compel might end up very wide, without any real gain in predictive accuracy.
Diagnosis is an inexact and constantly evolving effort, and it is contentious within the profession. To use a diagnosis as the basis of reporting the possibility of violence to the authorities would make the effort of accurate evaluation much more fraught. And what of the families and friends of the mentally ill? Should their weapons purchases be restricted as well? A little reflection shows how unworkable in practice any screening by diagnosis would be.
“We’re not likely to catch very many potentially violent people” with laws like the one in New York, says Barry Rosenfeld, a professor of psychology at Fordham University in The Bronx….
A study of experienced psychiatrists at a major urban psychiatric facility found that they were wrong about which patients would become violent about 30 percent of the time.
That’s a much higher error rate than with most medical tests, says Alan Teo, a psychiatrist at the University of Michigan and an author of the study.
One reason even experienced psychiatrists are often wrong is that there are only a few clear signs that a person with a mental illness is likely to act violently, says Steven Hoge, a professor of psychiatry at Columbia University. These include a history of violence and a current threat to commit violence ….
Perhaps most important, although people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perpetrators of violent crime overall. Researchers estimate that if mental illness could be eliminated as a factor in violent crime, the overall rate would be reduced by only 4 percent. That means 96 percent of violent crimes—defined by the FBI as murders, robberies, rapes, and aggravated assaults—are committed by people without any mental-health problems at all. Solutions that focus on reducing crimes by the mentally ill will make only a small dent in the nation’s rate of gun-related murders, ranging from mass killings to shootings that claim a single victim. It’s not just that the mentally ill represent a minority of the country’s population; it’s also that the overlap between mental illness and violent behavior is poor.
Whether folks engage in myth-telling because they believe in myths, or just want to mislead, the result is the same. Communicating lies is both hurtful and sinful. We are required to tell the truth, and the truth is that there is little to no correlation between mental health, whatever that is, and violence.