How Do We Talk About Guns And Mental Health?

Disclaimer: This is not a blog post about guns. This is a mental health blog. That said, I do believe that we need gun laws to prevent unspeakable tragedies like these from occurring again.

21 crosses stand in front of Uvalde's Robb Elementary to honor those killed  : NPR
Robb Elementary School.
https://www.npr.org/2022/05/26/1101514723/uvalde-school-shooting-victims-memorial

May is Mental Health Awareness Month, and it’s­ apparently National Gun Violence Month, so here we are – engaging in heated partisan debates over the connection between mental illness and gun violence. On May 14, 18-year-old Payton Gendron walked into a supermarket in a predominantly black neighborhood in Buffalo and opened fire, killing ten people. Only ten days later, on May 24, Salvador Ramos, also 18 years of age, gunned down 21 people in Robb Elementary School in Uvalde, Texas. The scale and chronological propinquity of these tragedies have reignited gun debates, with mental illness being an important battleground. Let’s start with the facts. Ramos had no documented mental health issues or criminal record, but accounts from those close to him indicate a history of hostility and violence, both to others and himself. He had a troubled family history – his father was mostly absent, and his mother dealt with personal issues. He lived with his grandmother, whom he shot before carrying out the shooting at the school. In middle school, he was quiet, but had friends and did not seem as troubled. However, upon entering high school, he became more volatile, lashing out whenever something upset him, including when he was rejected by romantic interests. Ramos’s social media content included images of weapons, a dead cat, and videos of himself punching a wall or cutting himself. 

The day after the shooting, NBC reports, Texas governor Greg Abbott said that his state needed to deal with mental health better – after all, in the previous month, he had cut $11 million from the budget of the state department that manages mental health programs, and in 2021 the State of Mental Health in America report ranked Texas last of all the states with respect to access to mental health care. Conservative parenting groups in Texas have attacked schools’ mental health programs, claiming that they are secretly meant to spread “Critical Race Theory.” In Uvalde County, where 20% of residents live in poverty, only $2.8-$3.8 million are allocated to health and welfare. On the other hand, Texas has more guns per capita than any other state, with over one million registered firearms in 2021 (almost twice that of Florida, the runner-up). In response to claims that pro-gun officials are trying to blame mental health for gun problems, Abbott said that “Anybody who shoots somebody else has a mental health challenge.” However, public health experts disagree, asserting that shooters rarely have diagnosed mental illnesses (less than 10% of shooting suspects have a mental illness) and rationally plan for a shooting in advance. So, what are people’s opinions? Two opinion articles, from the Daily Beast and the Los Angeles Times, offer two different perspectives.

In the Times, written after the Buffalo shooting, Mark Follman criticizes the narrative that shooters are insane and impulsive. He writes:

Extensive case history shows that mass shooters don’t just suddenly break — they decide. They develop violent ideas that stem from entrenched grievances, rage and despair. In many cases they feel justified in their actions and regard killing as the sole solution to a problem. They arm themselves and prepare to attack, choosing where and when to strike. Often this is a highly organized and methodical process.

Grand Jury Indicts Accused Buffalo Shooter Payton Gendron On First Degree  Murder Charge
Payton Gendron.
https://www.forbes.com/sites/madelinehalpert/2022/05/19/grand-jury-indicts-accused-buffalo-shooter-payton-gendron-on-first-degree-murder-charge/?sh=4e8de076564b

Gendron took months preparing for the shooting – engaging with radical message boards, developing his racist ideology, acquiring the necessary equipment, practicing shooting, and even surveilling his intended targets. Gendron was given a psychiatric evaluation last year when he threatened to commit a murder-suicide. He was released two days later, and the results have not been publicly disclosed. A 2018 FBI investigation found that only 25% of 63 shooters had a mental illness, and only three had a documented psychotic disorder (that’s about 5%). Not only does research indicate that mental illness is not useful as a predictor of gun violence, but such notions are stigmatizing for the millions of people living with a diagnosis. Instead, we can look out for the behaviors that potential shooters commonly exhibit, such as “threatening comments, personal deterioration, patterns of stalking and other aggression, as well as fixating on guns, graphic violence and previous mass shooters.” For many shooters, there was a period in which employment, housing, and health intervention was possible, but was not delivered in time. In other words, blaming mental illness alone is counterproductive, and the country needs to address gun violence from multiple perspectives.

James Holmes to face second mental exam
James Holmes.
https://www.usatoday.com/story/news/nation/2014/02/19/colorado-theater-suspect-james-holmes-new-mental-exam/5621295/

In the Daily Beast (a publication notorious for strong opinions), Freddie DeBoer insists that, while it is difficult to know if Ramos had a mental illness, it is incorrect and harmful to instantly assume that he did not. Whenever something important happens, the nation scrambles to interpret the story along partisan lines – for example, the race or religion of a shooter offers an opportunity to fit the shooting into a particular political narrative, whether it be white supremacism or Islamist terrorism. Mental health is by no means exempt from what DeBoer aptly calls “knee-jerk political tribalism” – One such argument is that pro-gun legislators use mental illness as a scapegoat to dodge gun debates. The tendency has been to fall back on principles before examining the facts, and in this case it turns out that mental illness is very prevalent in the US – nearly 20% of US adults have a diagnosed mental illness – and that mental illness, unfortunately, is capable of producing mass shooters. DeBoer cites the 2012 Aurora, Colorado shooting that killed 12. The shooter, James Holmes, was diagnosed with schizotypal personality disorder, but the court psychiatrist maintained that he was rational. He had been flagged as potentially dangerous in graduate school and had even called a mental health hotline before attacking, but no one answered. No one had offered him help or forced him to get help (a common problem – see my post titled “Forced Treatment and the Law”). Moreover, he continues, there is, despite activist pushback on this idea, a significant correlation between mental illness and violence, citing a source from the Treatment Advocacy Center. If mental illness really is not to blame for any violent conduct, then the fault lies with the person, who will be punished instead of given treatment. Far from benefitting those with psychiatric morbidities, denying the influence of mental illness takes the spotlight off the very real need for mental health infrastructure in this country. DeBoer offers a more provocative possible description:

An uglier potential reason is that these people support the mentally ill only as far as they can maintain a vision of them as entirely pure and blameless; their antipathy to “ableism” extends only so far as they are never put into a position where they must sympathize with people who have committed heinous acts… in a society that’s obviously broken and seemingly impervious to positive change, all people feel they can hold on to is their judgment, their searing and perfect moral righteousness.

In short, the insistence that mental illness is not to blame for mass shootings is merely an empty gesture, an implicit, desperate desire to look for moral simplicity and gratification and avoid having to sympathize with a mass murderer on account of mental illness. The reality, however, is that the world is not so black-and-white, and that while mental illness will not and cannot condone murder, it is necessary to consider it in all court cases.

Before we move on, however, I want to discuss a discrepancy in DeBoer’s assertion that mental illness is a significant factor in gun violence. He cites a page from the Treatment Advocacy Center, which takes you to an intimidating page of dense bullet points. Indeed, many of these studies state that psychosis makes a person anywhere from two to five times more likely than the normal person to commit a violent crime. However, these studies say nothing about the likelihood of a mentally ill person to resort to gun violence specifically, especially mass shootings. Is it really okay to jump from this raw data to the conclusion that there is a significant correlation between mental illness and gun violence? Bayes’ theorem states that, for events A and B,

where P indicates probability. Let’s say that P(A) is the probability of a person having schizophrenia, and P(B) is the probability of a person being violent. Using the statistic that “Of 8,003 individuals with schizophrenia in Sweden, 13.2% committed at least one violent crime compared with 5.3% of the general population” and assuming that 0.14% of Swedes have schizophrenia, the actual probability of a violent person having schizophrenia is 0.35%! Don’t believe me? Here is the math:

Yes, this calculation is based on a single study conducted in Sweden God knows how long ago, which researches all violent crime – which could be anywhere from assault to homicide. 0.35% is likely far from an accurate representation of the probability. But that’s not the point – I want to illustrate that raw data are not always what they seem like. It is better to look statistics examining the direct relationship between shooting and mental illness, such as those given by NBC or Follman. In addition to a previous post I wrote about gun violence (titled “Is Mental Illness Related to Gun Violence?”), these sources maintain that mental illness is not a predictor of gun violence. DeBoer criticizes the commonly heard statement that mentally ill people are likelier to be victims of violence rather than perpetrators, but it is true, and significantly so. 

So what is my opinion? Though Follman’s argument may be trite, that does not detract from its value. Just as some people took the idea that mental illness is not to blame for gun violence and ran with it, so too can the mental illness of a shooter be misconstrued and cause stigma. As a writer for Michelle Hammer of schizophrenic.nyc, I cringed slightly when I saw DeBoer mention James Holmes and schizophrenia; I was worried that there was potential for misunderstanding – after all, schizophrenia has a less than positive public light. Moreover, let’s not forget that, just like the popular representation of mentally ill people as violent is somewhat rooted in reality, so too is the “trite political narrative” that DeBoer criticizes so much. Though mental illness likely played a role, we shouldn’t overcompensate and focus too much on mental illness either – in Gendron’s case, white supremacism and conspiracy theories undoubtedly played a role as well. In both shootings, guns were the biggest problem, and people are right to place the emphasis on them – which DeBoer acknowledges. Even if schools implement mental health services, it is very difficult for these services alone to identify potential shooters, and so political change is necessary as well.

However, DeBoer also makes a good point. Mental health is currently entangled with the dichotomization and vitriol of politics and cancel culture (once again, I’ve written posts about this – “The Mental Health of Cancel Culture” or “Think Stigma Isn’t Real? Think Again.”). It saddens me to no end to see how, as political debates intensify even more (which, at this point, I don’t think is even possible), middle ground is rapidly disappearing. Political orientation is increasingly becoming a matter of absolute mutual exclusivity – each party tends to describe itself as what the other party is not, only further alienating each other and deepening the divides. Mental illness was swept up in these conflicts: Abbott admitting that Texas needs more mental health infrastructure would normally be received well, but the fact that it was in response to gun violence changed the situation entirely. Those who support gun legislation railed against the idea of mental illness being responsible, and so was born the “mental illness denial” that DeBoer talks about. Even if Abbott’s remarks may have been a method of dodging the question of gun violence, he’s not wrong – Texas does need to work on its mental health system, as the statistics indicate.

In addition, the idea of desperate black-and-white morality seems a bit cynical to me, but to some extent I agree. We should be facing the realities of mental illness head-on, as denying its influence in all but the most benign cases detracts from the real gravity of the mental health situation in our country – Holmes, for example, received no psychiatric help whatsoever, even after he was identified as potentially dangerous and even tried to get someone to stop him. Even though I disagree with the idea that mental illness can predict gun violence, in the Treatment Advocacy Center source that DeBoer cites, there are many studies demonstrating a significant link between mental illness and violence. However, the Treatment Advocacy Center makes sure to provide caveats: “Those who had been violent were more likely to have been homeless, to be substance abusers, and to be living in a violent environment. Those who had been violent were also 1.7 times more likely to have been noncompliant with medications.” Moreover, with proper medication, the violence rates are significant reduced. The significant correlation between mental illness and violence is largely due to the system’s failure to address mental illness – for example, the lack of housing initiatives, which I have written about before in the post titled “The Shortcomings of Healthcare Part 2”. If those with schizophrenia, for example, are denied adequate long-term treatment and housing, then their situation will only deteriorate further in an endless self-perpetuating cycle, where they are unable to improve their circumstances because they haven’t been given the mental and material werewithal to do so. If a good fraction of schizophrenics are homeless and / or live in poverty because of this – a dimension not mentioned by the studies –, then the statistics describing the correlation between mental illness and violence make a lot more sense. I’m sure even “normal” people would be more violent if they were subjected to such dire circumstances (substance abuse being a big one). I believe that this is the crux of DeBoer’s argument – we have to understand that the connection between mental illness and violence exists because of our failure to acknowledge and address it. Even if we may not like the idea, mental health is something that should be considered not only when dealing with individual cases of violent crime, but also with sweeping systemic change.

In summary, I believe that neither source is 100% correct. Even if DeBoer was a bit quick to jump to conclusions with the data from the Treatment Advocacy Center, I agree that we have been ignoring the realities of the country’s mental health infrastructure for far too long. Blaming mental health for gun violence does stigmatize it, but that does not mean that it should not be considered. On the other hand, though the arguments about gun violence and mental health may be steeped in political tribalism, we cannot ignore that policy changes are necessary. The trick with gun violence and mental illness, then, is to assume complexity. Take everything with a grain of salt. In fact, you should bring around with you a mountain of salt. I wish everybody could look at life with this lens, but DeBoer is right: it is human nature to oversimplify and jump to biased conclusions. This is the commonly touted truth of unconscious bias: our brains process about 11 million pieces of information every second, but only about 40 of those are handled by conscious, rational thought. And so, it is necessary to challenge all preexisting notions and initiate discussions, which is what this blog is about. I’m not trying to be right; I’m trying to be thoughtful. That is, in essence, thinking about thinking.

mkahmon

I'm a high school student dedicated to stimulating conversation around mental health.

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