A high school classmate and FB friend has asked an interesting question, intended, I suspect, to generate discussion. As my answer is too long for FB, I reply here. His question is-
"I'm curious as to your opinion on the topic of mental health services and gun control. I'm sure you support enhancing access, but does it not distract from an equally dangerous source - the perfectly calm, from all appearances reasonable, citizen who loses it for a moment and makes a tragic mistake? Is his motivation not fed by easy access to firearms? Suicides by firearm are 20,000 a year. Mental health services are important, and perhaps they can effect the "normal" person who is at risk of "losing" self-control for a moment, but how realistic is it to expect a normal person's engagement with mental health services?"
This question has many implications, of which mental illness is only a part. My answer references the Second Amendment and 'The Gift of Fear', by Gavin de Becker. The text of the former reads 'A well regulated militia being necessary to the security of a free State, the right of the People to keep and bear arms shall not be infringed.' The latter is a book about violence written by an international expert on prediction of and protection from threats. I have recommended it for years to my patients, especially those in abusive relationships. I also reference Wikipedia for a brief discussion of what assault weapons are-
Wikipedia-assault weapons
The elements of the question, as I hear it, are-
legality of private arms possession;
legality of regulation of private arms possession and purchase;
meaning of 'assault rifle';
the role of guns in societal violence;
the role of mental illness in societal violence.
The media, including FB, have generated a great deal of heat and virtually no light on these issues. The reports are phrased in highly provocative language to appeal to, or inflame, various elements of the viewership. Here is my extended sense of the 'gun issue'.
Private possession of guns is obviously legal. There is debate over what type of gun ought to be possessed by individuals, and why there is a private right to arms. The language of the 2nd Amendment is archaic and vague. It appears to state that the individual right to keep arms is a necessity for having a militia. The need for the amendment stems from the origins of the United States. Our Continental 'army' had only a few thousand regular soldiers and many thousands of militia. This latter force used its own weapons, guns typically kept in homes for hunting or home defense. American rifle fire was a source fo trouble for the British, since a rifle is much more accurate and has a longer range than a smoothbore musket. It was impossible in 1795 to have a readily raised militia without personal arms. There was also an established practice of autocrats of banning weapons possession by the citizenry, and restricting it to police and military units. This unwritten motivator for the 2nd Amendment was a significant mover of thought and thus policy.
None of this has changed. We like to think of our way of government being benign, and immune from the possibility of exploitation or abuse. The most cursory reading of American history shows this assumption is false. Our government has engaged in all manner of power abuse. An armed citizenry can resist armed efforts by government to oppress or suppress them. Private gun ownership is not simply legal, it is an essential part of a balanced society.
Regulation of guns has become necessary as military weapons have become increasingly lethal. Personal and military weaponry were once identical; not any more. While hand guns and hunting weapons remain broadly acceptable to Americans, automatic and semi-automatic weapons are more debatable. Machine guns, referenced in one reply to the FB post, are irrelevant, since they are banned as a title 2 weapon (This is similar to the banning of certain controlled substances, which have similar classifications). The argument has been over assault weapons.
This term is unique to the US. It is shorthand for any weapon with a pistol stock, detachable multi-round magazine and semi-automatic fire. The semi-automatic part is only to distinguish them from belt fed weapons. Most assault weapons are capable of three modes of fire- single action, 2-3 round bursts, and complete automatic fire. Many weapons are manufactured in military form, with all 3 settings, or in 'civilian' form, with only 2. Oddly enough, the entire assault weapon argument is virtually irrelevant; only 1.7% of all gun sales in the US are assault weapons. Many of these are to collectors, not users.
A further non-issue with assault weapons is their non-lethality. Without significant training an automatic weapon is difficult to use. An automatic weapon must fire 20-50 rounds for each hit. Magazines hold 30 rounds most commonly. At maximal rates of fire the magazine is empty in 2-3 seconds. Without multiple mags, an assault weapon rapidly becomes a complex, metallic club.
This is reflected in the virtual absence of assault weapons in murders. More than 80% of gun murders are with hand guns. Legislation banning assault weapons did nothing to decrease the gun murders, which rose steadily through the early 90s, and has paradoxically fallen by 25% even as assault weapons again became legal.
There is well established legality to regulating ownership of lethal devices in the US, a balancing of private rights with public responsibilities that is and should be a source of debate in a free society. We regulate cars, guns, certain knives, chemicals. Despite legality, regulation has done nothing to reduce crime and murder. Some of the most regulated portions of the country have very high murder and violent crime rates, such as Detroit or Chicago.
Guns and mental illness, the heart of the question, are an interesting story. News outlets are fond of citing total gun deaths when wishing to alarm about guns. This is very different from the gun murder rate, since 2/3 of gun deaths are suicides. Women attempt suicide more frequently than men, but men are much more successful, because they choose highly lethal means. Tight regulation of guns in no way decreases suicide rates. Suicide rates in the US are lower than Ireland, Poland, Lithuania, France, Iceland, Finland, Belgium, and the Czech Republic, despite all these societies having very strict gun laws. Guns are the choice of suicide implement in the US. In other countries it is poison, or knives, or hanging, or jumping.
One FB reply says that the desire to own an assault weapon is a priori evidence of mental illness. This is prima facie false, of course. Ownership of guns is associated with suicide, but not causally. Ownership of assault weapons is not associated with murder, but rather with collection and survivalist mentalities. Labeling these mental illness is an opinion, and a derogatory one, not fact. There is no DSM diagnosis for ownership of a weapon.
Gun ownership does fulfill one part of de Becker's criteria for violence- available means. It is impossible to use a gun to harm anyone if you don't own one. This of course underlies some pressure for stringent gun control. de Becker describes four elements required for violence- justification, available means, non-fear of consequences, and no perceived alternatives. He is eerily accurate in predicting violence using this and what he calls pre-incident indicators. Virtually all people who engage in violence toward spouses, co-workers or others have multiple pre-incident indicators of violence. This is where our mental health system fails.
If you review all the mass shootings of the last 15 years, you will see again and again indications of violence, withdrawal, mental or emotional instability, job loss, humiliation, violence to animals, etc, etc etc. Our society does not allow a person to be detained for such reasons. There is no prophylactic policing or mental health intervention, only post facto disaster review. Again and again we hear in the media how relatives, neighbors and co-workers thought the shooter was unstable, or depressed, nuts, angry, etc. But our society does nothing for or about these people. In the name of individual autonomy and freedom, we require either a direct act for police intervention or the initiative of the individual to seek mental health evaluation. The great majority of mass shooters are mentally ill, schizophrenics or bipolars, deeply depressed or very angry. Few have had meaningful interactions with mental health facilities or providers.
We are defending and infringing upon exactly the wrong rights regarding guns. The vast majority of gun owners are peaceful and law-abiding. Regulating guns has done nothing to reduce violent crime, and yet we call constantly for more gun regulation. MEntally ill people and drug addicts are involved in a highly disproportionate amount of societal violence, yet we refuse to detain or evaluate these people. Our mental health system has a role in prevention fo gun violence, if we will only let it.
In summary, I believe-
- we have a right to own guns;
-the State has a fiduciary responsibility to all citizens to regulate ownership of dangerous objects, including guns;
-there is no rational basis for assault weapons bans;
-gun education should be an essential part of ownership;
-mental health policy in the US is defective and a failure.
Ted
"I'm curious as to your opinion on the topic of mental health services and gun control. I'm sure you support enhancing access, but does it not distract from an equally dangerous source - the perfectly calm, from all appearances reasonable, citizen who loses it for a moment and makes a tragic mistake? Is his motivation not fed by easy access to firearms? Suicides by firearm are 20,000 a year. Mental health services are important, and perhaps they can effect the "normal" person who is at risk of "losing" self-control for a moment, but how realistic is it to expect a normal person's engagement with mental health services?"
This question has many implications, of which mental illness is only a part. My answer references the Second Amendment and 'The Gift of Fear', by Gavin de Becker. The text of the former reads 'A well regulated militia being necessary to the security of a free State, the right of the People to keep and bear arms shall not be infringed.' The latter is a book about violence written by an international expert on prediction of and protection from threats. I have recommended it for years to my patients, especially those in abusive relationships. I also reference Wikipedia for a brief discussion of what assault weapons are-
Wikipedia-assault weapons
The elements of the question, as I hear it, are-
legality of private arms possession;
legality of regulation of private arms possession and purchase;
meaning of 'assault rifle';
the role of guns in societal violence;
the role of mental illness in societal violence.
The media, including FB, have generated a great deal of heat and virtually no light on these issues. The reports are phrased in highly provocative language to appeal to, or inflame, various elements of the viewership. Here is my extended sense of the 'gun issue'.
Private possession of guns is obviously legal. There is debate over what type of gun ought to be possessed by individuals, and why there is a private right to arms. The language of the 2nd Amendment is archaic and vague. It appears to state that the individual right to keep arms is a necessity for having a militia. The need for the amendment stems from the origins of the United States. Our Continental 'army' had only a few thousand regular soldiers and many thousands of militia. This latter force used its own weapons, guns typically kept in homes for hunting or home defense. American rifle fire was a source fo trouble for the British, since a rifle is much more accurate and has a longer range than a smoothbore musket. It was impossible in 1795 to have a readily raised militia without personal arms. There was also an established practice of autocrats of banning weapons possession by the citizenry, and restricting it to police and military units. This unwritten motivator for the 2nd Amendment was a significant mover of thought and thus policy.
None of this has changed. We like to think of our way of government being benign, and immune from the possibility of exploitation or abuse. The most cursory reading of American history shows this assumption is false. Our government has engaged in all manner of power abuse. An armed citizenry can resist armed efforts by government to oppress or suppress them. Private gun ownership is not simply legal, it is an essential part of a balanced society.
Regulation of guns has become necessary as military weapons have become increasingly lethal. Personal and military weaponry were once identical; not any more. While hand guns and hunting weapons remain broadly acceptable to Americans, automatic and semi-automatic weapons are more debatable. Machine guns, referenced in one reply to the FB post, are irrelevant, since they are banned as a title 2 weapon (This is similar to the banning of certain controlled substances, which have similar classifications). The argument has been over assault weapons.
This term is unique to the US. It is shorthand for any weapon with a pistol stock, detachable multi-round magazine and semi-automatic fire. The semi-automatic part is only to distinguish them from belt fed weapons. Most assault weapons are capable of three modes of fire- single action, 2-3 round bursts, and complete automatic fire. Many weapons are manufactured in military form, with all 3 settings, or in 'civilian' form, with only 2. Oddly enough, the entire assault weapon argument is virtually irrelevant; only 1.7% of all gun sales in the US are assault weapons. Many of these are to collectors, not users.
A further non-issue with assault weapons is their non-lethality. Without significant training an automatic weapon is difficult to use. An automatic weapon must fire 20-50 rounds for each hit. Magazines hold 30 rounds most commonly. At maximal rates of fire the magazine is empty in 2-3 seconds. Without multiple mags, an assault weapon rapidly becomes a complex, metallic club.
This is reflected in the virtual absence of assault weapons in murders. More than 80% of gun murders are with hand guns. Legislation banning assault weapons did nothing to decrease the gun murders, which rose steadily through the early 90s, and has paradoxically fallen by 25% even as assault weapons again became legal.
There is well established legality to regulating ownership of lethal devices in the US, a balancing of private rights with public responsibilities that is and should be a source of debate in a free society. We regulate cars, guns, certain knives, chemicals. Despite legality, regulation has done nothing to reduce crime and murder. Some of the most regulated portions of the country have very high murder and violent crime rates, such as Detroit or Chicago.
Guns and mental illness, the heart of the question, are an interesting story. News outlets are fond of citing total gun deaths when wishing to alarm about guns. This is very different from the gun murder rate, since 2/3 of gun deaths are suicides. Women attempt suicide more frequently than men, but men are much more successful, because they choose highly lethal means. Tight regulation of guns in no way decreases suicide rates. Suicide rates in the US are lower than Ireland, Poland, Lithuania, France, Iceland, Finland, Belgium, and the Czech Republic, despite all these societies having very strict gun laws. Guns are the choice of suicide implement in the US. In other countries it is poison, or knives, or hanging, or jumping.
One FB reply says that the desire to own an assault weapon is a priori evidence of mental illness. This is prima facie false, of course. Ownership of guns is associated with suicide, but not causally. Ownership of assault weapons is not associated with murder, but rather with collection and survivalist mentalities. Labeling these mental illness is an opinion, and a derogatory one, not fact. There is no DSM diagnosis for ownership of a weapon.
Gun ownership does fulfill one part of de Becker's criteria for violence- available means. It is impossible to use a gun to harm anyone if you don't own one. This of course underlies some pressure for stringent gun control. de Becker describes four elements required for violence- justification, available means, non-fear of consequences, and no perceived alternatives. He is eerily accurate in predicting violence using this and what he calls pre-incident indicators. Virtually all people who engage in violence toward spouses, co-workers or others have multiple pre-incident indicators of violence. This is where our mental health system fails.
If you review all the mass shootings of the last 15 years, you will see again and again indications of violence, withdrawal, mental or emotional instability, job loss, humiliation, violence to animals, etc, etc etc. Our society does not allow a person to be detained for such reasons. There is no prophylactic policing or mental health intervention, only post facto disaster review. Again and again we hear in the media how relatives, neighbors and co-workers thought the shooter was unstable, or depressed, nuts, angry, etc. But our society does nothing for or about these people. In the name of individual autonomy and freedom, we require either a direct act for police intervention or the initiative of the individual to seek mental health evaluation. The great majority of mass shooters are mentally ill, schizophrenics or bipolars, deeply depressed or very angry. Few have had meaningful interactions with mental health facilities or providers.
We are defending and infringing upon exactly the wrong rights regarding guns. The vast majority of gun owners are peaceful and law-abiding. Regulating guns has done nothing to reduce violent crime, and yet we call constantly for more gun regulation. MEntally ill people and drug addicts are involved in a highly disproportionate amount of societal violence, yet we refuse to detain or evaluate these people. Our mental health system has a role in prevention fo gun violence, if we will only let it.
In summary, I believe-
- we have a right to own guns;
-the State has a fiduciary responsibility to all citizens to regulate ownership of dangerous objects, including guns;
-there is no rational basis for assault weapons bans;
-gun education should be an essential part of ownership;
-mental health policy in the US is defective and a failure.
Ted
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