What are we doing?

"What are we doing?" These are the words repeated over and over again yesterday by Senator Chris Murphy in an excoriation of his colleagues on the floor of the U.S. Senate. He was urging them to take action towards better gun safety and background checks in the hopes of preventing the horrible tragedies like the one we just experienced in Uvalde, Texas, where 19 school children and 2 teachers were killed by an 18-year-old with an assault rifle. Yet, as important as Senator Murphy's challenge is, I fear this opportunity will go unfulfilled, once again, just as many others have gone since that fateful day in 1999 in Columbine, Colorado.

The debate on this issue isn't over whether guns kill people or people kill people - both do. It is about what things in our world precipitate gun violence like this and what things are we willing to do to reduce this characteristically American phenomenon. Neither is this a matter of good vs. evil, identifying those at fault, or being able to tell the difference between the bad guys and the good guys. And, focusing our efforts at how to "take down" the bad guy once the shooting starts is merely reactionary and short-sighted, only giving us a smug sense of justice, yet leaving the problem untouched while we wait for the next mass shooting. So what do we do?

All too often the debate centers on mental illness and how we need "better mental health care" as a solution. But this is wildly off target.

Whether or not someone has been diagnosed with mental illness, or even if they were never diagnosed but meet the clinical diagnostic criteria for a mental disorder, has no impact on their propensity for violent acts like this. The common belief that it does merely reflects a gross misunderstanding. The science is clear about that. The science is also clear that a few basic factors increase one's risk of committing such acts:

     1) being male;
     2) being younger;
     3) being unempathetic, remorseless, and callous;
     4) having committed prior acts of violence, especially starting in youth;
     5) having easy access to weapons, especially lethal ones like guns;
     6) having poor social support;
     7) feeling paranoid, persecuted, and mistreated, and;
     8) using alcohol and drugs to cope with distress.

You'll notice that a mental disorder is not one of these. You might think that #7 is about mental disorder, but it is not. Those things (feeling paranoid, persecuted, and mistreated) do not fulfill diagnostic criteria. Many people feel those things without ever having been thought of as mentally disordered or having been diagnosed as such. In fact, many of us have felt that way at some point, and likely at many points, in our lives.

Nevertheless, as with previous tragedies like the one in Uvalde, mental illness is sure to be targeted and then a simplistic "better mental health care" will be proposed as the answer, as well as background checks to disallow the "mentally ill" from buying guns. Such a strategy will not address the people who have the risk factors listed above. But, there will still be a false sense of comfort addressing the problem as the hype dies down and other events in our life crowd out the realization that 21 people have just been massacred. 

To make matters worse, psychiatric interventions typically imposed on people thought to be "mentally ill" would include psychiatric drugs, which ironically is one of the risk factors above (#8 - See the film "Prescripticide"). At present, there are 30 commonly prescribed psychiatric drugs that are well-known to increase the risk of violent behavior by those taking them.

The people subjected to these interventions would also feel paranoid, persecuted, and mistreated in the process (risk #7), especially if they are committed to a hospital against their will, are forced to take the drugs, and are prohibited from owning guns. All these things together are likely to increase the chances they become socially disconnected from others (risk #6). Therefore, this form of intervention will have the opposite effect of actually increasing the risk of these violent acts in this wrong-headed strategy of reducing the risk.

What are we doing?