Psychiatrists Explain Why Disarming the 'Mentally Ill' Won't Prevent Mass Murders

Two articles published today in Mayo Clinic Proceedings question the effectiveness of trying to prevent mass shootings by keeping guns away from "mentally ill individuals." The longer essay, by forensic psychiatrists Ryan Chaloner Winton Hall and Susan Hatters Friedman, notes that people on both sides of the gun control debate tend to agree that restricting the rights of people diagnosed with mental disorders is a sensible response to massacres like those in Tucson, Aurora, and Newtown. Yet it is hard to see how such crimes could be prevented by improving the background check system that aims to enforce the federal ban on selling guns to people who are involuntarily committed or adjudicated as "mentally defective":

Even if the Brady law is fully implemented and expanded, questions remain regarding whether it would have been able to prevent school shootings like the ones that have occurred. Many times, individuals already own guns by the time they would meet criteria to be added to this list, and the waiting period does not seem to be a deterrent or obstacle because most school-based or mass shootings are planned in advance. Furthermore, shootings such as those at Columbine High School in Littleton, Colorado, and Sandy Hook Elementary School in Newtown, Connecticut, would not have been prevented because the individuals obtained the guns from family and friends.

Mass shooters generally do not have psychiatric histories that would disqualify them from gun ownership under current law, meaning they would not be stymied by background checks even if the records were complete and they had no alternative way to obtain firearms. But Hall and Friedman argue that expanding the category of people disqualified by a psychiatric assessment would undermine civil liberties while doing little to improve public safety. New York's SAFE Act, for example, requires mental health professionals to report patients they believe may harm themselves or others so their guns can be confiscated. This year Florida's legislature considered a bill that would have required "health care providers with direct knowledge of an individual’s mental health status and propensity for violence to provide identifying information to law enforcement for inclusion in the automated database of persons prohibited from purchasing a firearm." The bill asserted that "prohibiting persons who have mental illness from having access to firearms is an important state interest." National Rifle Association Executive Vice President Wayne LaPierre, who after the Newtown massacre demanded "an active national database of the mentally ill," seems to agree.

As I noted at the time, that would be a pretty big database, since survey results indicate that nearly half of all Americans will qualify for a psychiatric diagnosis at some point in their lives. Maybe LaPierre has in mind an especially dangerous subset of the mentally ill. But which one? "The condition that may most commonly come to mind when the public refers to mental illness and guns is schizophrenia," write Hall and Friedman, but data from the National Comorbidity Survey indicate that "the mental illnesses actually most likely to result in increased threatening behavior with a gun are bipolar disorder type 1...and drug dependence...both potentially fluctuating, unpredictable states." In a major study by the MacArthur Foundation, "a diagnosis of major mental disorder was correlated with a lower violence risk."

A companion editorial by Mayo Clinic psychiatrist J. Michael Bostwick notes that a Swedish study found that "individuals discharged from psychiatric hospitals with severe psychotic or affective diagnoses did have 3.8 times the odds of committing [violent] crimes than did their non–mentally ill countrymen," although "their number relative to the general populace was so low that only 1 in 20 violent crimes could be attributed to them." Similarly, American studies have "estimated a 2- to 4-fold increase in the risk of violence by individuals with schizophrenia but only a 3% to 5% population-attributable risk."

Both essays note that even if people who receive certain diagnoses are more likely to commit acts of violence than the general population, the vast majority of them do not. According to the American Psychiatric Association, "96% of people with serious mental illnesses never act violently." Any attempt to prevent all of them from owning guns would be highly inefficient as well as unfair (and unconstitutional, given the weakness of the public safety rationale). And as both essays emphasize, psychiatrists not only admit they are bad at predicting which individuals will turn violent; they insist upon it, lest they be held liable for their failure to prevent future crimes. Hall and Friedman quote a 1983 decision in which the U.S. Supreme Court observed that "neither petitioner nor the APA suggests that psychiatrists are always wrong with respect to future dangerousness, only most of the time." Research suggests even that assessment is excessively generous

Bostwick says he was inclined to disagree with Hall and Friedman's assessment when he was asked to comment on their article but was persuaded that the mass shootings they discuss "were not and could not have been prevented by more restrictive gun legislation." He also agrees that "a diagnosis of mental illness...does not justify stripping Second Amendment rights from all who carry such a diagnosis, most of whom will never commit violent acts toward others." Bostwick urges his colleagues to reject "the fallacy that they can predict gun-related tragedies" as well as "the passive and simplistic dogma that guns are evil and should simply go away." He adds:

[Hall and Friedman] have resoundingly dispelled any lingering belief I might have entertained that laws designed to keep firearms from the mentally ill can prevent horrific school shootings such as those in Arizona, Colorado, and Connecticut or killings on military bases such as the recent Washington Naval Yard massacre. They have convinced me that firearms are here to stay and that wishing them away serves neither my patients nor myself.

More on the limitations of the mental health solution to gun violence here and here.

[Thanks to Mark Sletten for the tip.]

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  • Fist of Etiquette||

    So what you're saying is the only sensible solution is to confiscate all civilian firearms. I guess we better start documenting who has what now, then. Which means background check legislation comes back into play. See? It all circles back around to an eventual national gun registry.

  • Jquip||

    Nah, that would be one of those infringement things.

    Correct thing to do is to abridge or remove the Rights of any citizen, if any politically favored citizen says so.

    "The patient exhibits signs of pathology as demonstrated by a minority viewpoint on the morality of fiat currencies. Thus the patient should be restrained from the exercise of rights covered in the 1st, 2nd, 4th, 5th. As well as the protections offered by the 13th."

  • SweatingGin||

    Might as well station a NSA officer in their house to make sure they don't have any other verboten activities planned.

  • The Rt. Hon. Serious Man, Visc||

    It's almost as if 'common sense' is a bullshit politician's word that means nothing, objectively speaking.

  • Austrian Anarchy||

    Sheldon Richman has written some good stuff on this topic. Especially the aspect of how the mental health professionals themselves don't even know when someone is dangerous or not.

  • Being Waterboarded||

    Clearly this means we should ban guns in their entirety (except for gov't officials, of course).

    I wonder what will happen when they head to the small, backwoods towns scattered throughout this country to confiscate the guns? I cannot see anything going wrong...

  • Sevo||

    "Sheldon Richman has written some good stuff on this topic. Especially the aspect of how the mental health professionals themselves don't even know when someone is dangerous or not."

    So has Thomas Szasz.

  • Austrian Anarchy||

    I believe Richman interviewed Szasz too. Should be on YouTube.

  • mr lizard||

    Isn't Team Blue still pulling the political bodies off Hill GC?

  • ||

    The BAN BONER crowd doesn't actually give a shit about preventing shootings or stopping "mentally ill" people from getting guns. This is just another way for them to incrementally ban guns or make them harder and harder to purchase. They have been stymied by the Supreme Court in terms of total or sweeping bans, and so they flock to dubious lists that can prevent certain people from getting guns, because at least it's a step closer to removing guns from the public, and has the benefit of being incredibly nebulous and impossible to define (just like "assault weapon"; imagine that), which is just what they want.

  • Hospital||

    Yeah god forbid we have the gun murder rates of Germany, or some other "socialist" country with strict gun laws and consequently much lower per-capita gun crime rates (even excluding suicides, which I agree is bullshit to include in an effort to inflate gun crime numbers).

  • Francisco d Anconia||

    Gun murder rates are worthless. Compare crime rates in general. Guns in the hands of the citizenry will reduce incidences of other crime.

    You conveniently overlook the benefits of owning firearms.

  • ||

    Why bother to respond to someone who seems to think murders with a gun are somehow different than murders of any other kind? They're obviously either stupid or mendacious, or they suffer from Tulposis.

  • Francisco d Anconia||

    I prefer Tulpa's Syndrome. We can call it TS for short.

  • Adam330||

    Is that a form of mental illness?

  • Calidissident||

    You use this word "consequently." It does not mean what you think it means

  • Robert||

    Ban boner? I hope not!

  • Boisfeuras||

    Even if the Brady law is fully implemented and expanded, questions remain regarding whether it would have been able to prevent school shootings like the ones that have occurred. Many times, individuals already own guns by the time they would meet criteria to be added to this list, and the waiting period does not seem to be a deterrent or obstacle because most school-based or mass shootings are planned in advance.

    That is because preventing massacres is not the purpose of these laws. And when the next one occurs, they will demand the next law.

  • Rich||

    In a major study by the MacArthur Foundation, "a diagnosis of major mental disorder was correlated with a lower violence risk."

    That's OK. We'll have "an active national database" of *everyone*.

  • SweatingGin||

    Luckily, we just *need* to have that database as part of providing healthcare!

  • Jordan||

    Dat smile. Can't unsee...

  • playa manhattan||

    That dude doesn't look crazy at all...

  • Robert||

    I love, love that look. It's so...fun. It's contagious. Cops should arrest more people just to get us more mugs like these. And they're public domain!

    Smiley Guy (the bald one, you know) looked comforting, with an air of indomitability that says everything's going to be all right. James-Holmes-mugshot.jpg by contrast is for if I'm already in a pretty good mood and says anything's possible, let's go! The only thing beating it for enthusiasm is Lobster Girl, whose name unfortunately reminds me of the sideshow freak, Lobster Boy.

  • Jesus H. Christ||

    Based on that photo, it seems obvious he is bat-shit crazy. Of course, in most cases, that doesn't mean dangerous.

  • playa manhattan||

  • Paul.||

    Holmes worked as an intern at the Salk Institute for Biological Studies where he was assigned to write computer code for an experiment. Holmes, who was described by his supervisor as stubborn, uncommunicative and socially inept

    So how did he stand out from the other software programmers?

  • Paul.||

    Two articles published today in Mayo Clinic Proceedings

    But what about the Artisan Mayo Clinic?

  • Paul.||

    Oh, and I'm beginning to like the mugshots of our most recent mass killers. Not because I find them pleasing, but precisely because I find them so disturbing. That the photographs themselves say so much about how crazy these dudes are.

  • Robert||

    Out of context, I bet you wouldn't find them disturbing, but pleasing, as I do. Come on, how can ya not want to party with that guy?

  • Robert||

    But now that I look again, a little too faggy for best partying.

  • Paul.||

    "the mental illnesses actually most likely to result in increased threatening behavior with a gun are bipolar disorder type 1...and drug dependence...both potentially fluctuating, unpredictable states."

    As someone who was formerly married to someone with bipolar disorder, I can certify this as true.

  • ||

    Not to mention bipolar people tend to have a predilection for...drug dependence. Double whammy!

  • The Rt. Hon. Serious Man, Visc||

    The trick is to keep the bipolar people on the depressive side.

    You're much less likely to hurt yourself or others if you are on a low rather than a high.

  • Tulpa (LAOL-VA)||

    Er, depressed people do often hurt themselves.

  • The Rt. Hon. Serious Man, Visc||

    Right, but in bipolar people suicide and destructive behavior tends to occur during manic episodes when the subject feels energy and a drive to engage in harmful or self-destructive behavior.

  • playa manhattan||

    You got threatened with a gun during the course of your marriage?

  • SweatingGin||

    Meh, who hasn't had a crazy ex girlfriend come at them with a knife?

  • SweatingGin||

    ... And that didn't follow at all. Guess it was the conversation in my head.

  • Tulpa (LAOL-VA)||

    I heard Eva Braun could be a handful.

  • Brian D||

    Just make desiring to own a firearm an indicator of mental illness. Problem solved.

    /proglodyte

  • The Rt. Hon. Serious Man, Visc||

    I wonder about that, though. You can't read an anti-gun thread without the majority of progtards calling you a 'gun nut' or a 'gun fetishist'.

    They honest to god think that if you own guns and don't agree with their view of regulations you must be crazy and dangerous.

  • Tulpa (LAOL-VA)||

    You realize you just called them "progtards" while chiding them for conflating political positions and mental diagnoses?

  • The Rt. Hon. Serious Man, Visc||

    I don't actually think they are retarded. They genuinely think ownership of a gun means you suffer from masculine insecurities or false consciousness.

  • Tulpa (LAOL-VA)||

    But you're assuming the fact that they use the term "gun nut" implies they think you're a nut.

  • SweatingGin||

    Warrantless searches of my safe will surely make me stop saying 'progtard'

  • SweatingGin||

    Good friend of mine is a progtard. He spent about the six months before Newtown talking about getting a gun.

    Now he talks about how he knows he can't trust himself with one.

  • ||

    So, as always, it's projection. These people need help.

  • Tulpa (LAOL-VA)||

    I'm loving you guys making psychiatric diagnoses based on political positions, while complaining about other people making psychiatric diagnoses based on political positions.

  • ||

    Point to where I'm complaining about that, you blithering idiot. Oh, and saying someone suffers from projection because they project their own feelings of being unsafe with a firearm onto others has nothing to do with "making psychiatric diagnoses based on political positions", you abject moron.

    You just get stupider every day, don't you. I think you have a Progressively Stupider Every Day disease. Let's call it Tulpa's Syndrome.

  • Warty||

    Tulposis is a terrible curse. Let's have a telethon.

  • SweatingGin||

    I'm in for the Tulposis Tulpathon.

  • ||

    Would that be Cystic Tulposis or Multiple Tulposis?

    We're gonna need to call Jerry Lewis. I'll do it. HEY LADY

  • Tulpa (LAOL-VA)||

    You have no evidence he's projecting.

    He doesn't trust himself with firearms. That's all we know for sure, though one could guess from the "progtard" designation that he doesn't want others to have them either. That still doesn't mean he's projecting.

    That's like saying that a death penalty opponent is projecting, because he also doesn't trust himself to make the decision to kill someone.

  • ||

    Watching the inexorable decline of someone suffering from Tulposis should be tragic and sad, but really it's just hilarious.

  • JW||

    IT'S TULPUS.

  • Francisco d Anconia||

    Well, well, well...Tulpa's trying to start an argument about nothing.

    Go figure.

  • Robert||

    Isn't that introjection rather than projection?

  • Tulpa (LAOL-VA)||

    Maybe he can't. Gun ownership isn't for everyone.

  • Restoras||

    I hope he doesn't drive.

  • The Rt. Hon. Serious Man, Visc||

    Ask him why he drives since he's much more likely to drive under the influence than go on a shooting rampage.

  • Tulpa (LAOL-VA)||

    I assume you know this person? Otherwise how the hell would you know that?

  • SweatingGin||

    I don't argue politics with him anymore. I realized, if no one else is listening (audience might have their view changed), I'm only doing it to make him feel bad.

    That, and it's far too likely to escalate to a shouting match.

    What's the thing Progressives hate more than Republicans? Libertarians.

  • Hyperion||

    Progtards don't trust themselves with anything, which is why they are progs. They need the government to make even the most minute decisions for them, or they are uncomfortable.

    Later when they get what they want and don't like the decisions that are being made for them, they will whine and cry, and it will be tough shit.

  • SweatingGin||

    If someone else makes the decision for you, you don't have to be responsible for the consequences.

  • sarcasmic||

    Yep! That's what freedom is all about! Freedom from consequence! So long as you don't do anything without asking permission or obeying orders like a good slave, you're not responsible! Freedom is slavery!

  • Tulpa (LAOL-VA)||

    "The condition that may most commonly come to mind when the public refers to mental illness and guns is schizophrenia," write Hall and Friedman, but data from the National Comorbidity Survey indicate that "the mental illnesses actually most likely to result in increased threatening behavior with a gun are bipolar disorder type 1...and drug dependence...both potentially fluctuating, unpredictable states."

    Addiction to illegal drugs is already a separate bar to gun ownership under federal law. It's also dirty pool to assume LaPierre and others limit "major mental illnesses" to schizophrenia just because that's the term that people immediately think of. Presented with the symptoms of bipolar 1 or antisocial personality disorder, "the public" would comfortably conclude that the patient was crazy and potentially dangerous.

    In a major study by the MacArthur Foundation, "a diagnosis of major mental disorder was correlated with a lower violence risk."

    Probably because the majority of such diagnoses are for major depression, which is understandably negatively correlated with violence against others. NYS is obviously going to far, in many ways. But there's a happy medium between that and letting schizophrenics walk the streets armed. But involuntary commitment, as opposed to mere disorder diagnosis, indicates that the person in question is a danger to himself or others. I mean, bulimia and agoraphobia are both psychiatric diagnoses

  • Robert||

    I assume you mean bulimia nervosa, rather than bulimia in general. Then again, maybe that could be one too.

  • Hyperion||

    The statist don't need to pass any more bills to achieve taking away your 2nd amendment rights, or any other rights they want to take away.

    They have already passed the only law that they will ever need again. It's called the ACA, and has nothing to do with health care.

    They will now be able to achieve any control of your behavior that they desire, through a massive array of 'penaltaxes' that the IRS will extract directly from your paycheck or bank account.

    Smoke: Penaltax

    Drink: Penaltax

    Overweight: Penaltax

    Too much sodium: Penaltax

    Have guns: Penaltax

    Don't vote Democrat: Pentaltax

    This is what's coming, and with it, they will restrict your rights, when and how they desire, simply by depriving you of most or all of your income.

  • Brian D||

    But they'll scream the loudest when the Republicans pass the "Get an abortion/gay marriage = Penaltax" law.

  • Hyperion||

    I don't think you are being serious, but neither was I about voting Democrat being a penaltax.

    But when you vote for tyranny, you don't get to choose what's in it when your team isn't in charge. This is the derptitude of the progs.

  • Cytotoxic||

    The supremos ruled that the Penaltax can only be so high that it doesn't actually cause any pain to the payer.

  • Hyperion||

    Did they define 'pain'? Is that a restriction on the amount of income you are deprived of, and if so, what's that amount? Or is it anything short of having your toenails all ripped out with pliers?

  • SweatingGin||

    If you still get an Obamaphone and EBT, the Penaltax isn't a Penalty.

  • Tulpa (LAOL-VA)||

    Cigarettes and alcohol already have sin taxes.

    And I'm not sure which part of the decision in question says the govt can tax you for exercising a constitutional right.

  • sarcasmic||

    Uh, I believe the ACA allows for higher insurance rates for politically incorrect activities like smoking or drinking.

    For a moment I actually thought you were trying to add something of substance to the conversation! Oh, silly me. You were moving the goalposts while attacking a straw man, otherwise known as Tulpafying the thread. Never mind.

  • Tulpa (LAOL-VA)||

    Uh, I believe the ACA allows for higher insurance rates for politically incorrect activities like smoking or drinking.

    A free market would "allow" for that, too. Your beef is what exactly?

  • sarcasmic||

    Your beef is what exactly?

    The ACA does not allow insurance companies to charge for preexisting conditions, but it does allow them to charge 50% extra to insure smokers. Even if they aren't sick.

    That amounts to a penaltax on smoking, because there's no way smokers will cost that much more to insure over their shorter lifetimes. It's a way to recoup losses from not being able to charge extra for preexisting conditions.

    And what it really amounts to is a way for the government to micromanage your lifestyle by dictating what the insurance companies can or cannot charge for, based upon political considerations instead of economic ones.

    I don't know if you're obtuse, stupid, or dishonest, but the end result is the same.

  • Tejicano||

    "I don't know if you're obtuse, stupid, or dishonest, but the end result is the same."

    Can't it be all the above?

  • sarcasmic||

    I'm starting to think he's retarded.

  • Tulpa (LAOL-VA)||

    So if the insurance companies were "allowed" to charge you more because you injected yourself with random hypodermic needles you found in the dumpster, that would be even more unlibertarian?

    That amounts to a penaltax on smoking, because there's no way smokers will cost that much more to insure over their shorter lifetimes.

    That's very questionable. Smokers start getting sickly earlier in life than nonsmokers. All those folks carting around O2 tanks can't be cheap to "insure" either, which would explain why smoking has raised rates for individual health insurance long before ACA.

  • Hyperion||

    Who forces you to buy insurance in the 'free market'?

  • Hyperion||

    In the free market, if you smoke, and the insurance company finds out, and they say, hey we're going to double your rates, then you have the right to tell them to fuck off and do without insurance.

    That's the difference. It's that simple.

  • Tulpa (LAOL-VA)||

    Is there some sort of invisible part of my comment where I said I liked the individual man-date?

    In a libertopian paradise, if at the time of application for the policy, your insurer asked whether you smoked (as all of them would do), and you lied, you could be sued for fraud.

  • sarcasmic||

    You moved the goalposts, attacked a straw man, and otherwise Tulpafied the thread by bringing up sin taxes in the context of the ACA turning insurance rates into a political tool. Tool.

  • Tulpa (LAOL-VA)||

    Smokers already paid higher rates for health insurance when buying individually, before ACA. I guess that's some sort of corporate conspiracy or something?

  • sarcasmic||

    Smokers already paid higher rates for health insurance when buying individually, before ACA.

    Not up to 50% as with the ACA that controls rates based upon political considerations! Are you daft? Fucking shit I will disengage. You can't be honest. Fuck off.

  • sarcasmic||

    I'm sorry. You're a tard, not a tool. Tools can be useful.

  • Francisco d Anconia||

    + 1 wedge (the simplest tool)

  • thorax232||

    More proof that the only defense against guns is guns. Checks and balances.

  • optimusratiostultum||

    of course confiscating all the guns won't work since the mass murderers (who are willing to plan ahead and put effort into their evil) will simply make bombs instead (many explosive recipes are easier to make than meth and its not like outlawing that actually deters meth heads)

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