Psychology/Psychiatry

Stopping Mass Murderers Would Be Easy If Psychiatrists Were Psychics

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A front-page story in today's New York Times notes how difficult it is to predict which of the country's many weird or troubled people will be tomorrow's Adam Lanza:

No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.

That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.

But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.

"Anytime you have one of these tragic cases like Newtown, it's going to expose deficiencies in the mental health system, and provide some opportunity for reform," said Richard J. Bonnie, a professor of public policy at the University of Virginia's law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. "But you have to be very careful not to overreact."

The gun control law signed yesterday by New York Gov. Andrew Cuomo, for instance, requires "mental health professionals" (including psychiatrists, psychologists, social workers, and nurses) to report any patient/client whom they think "is likely to engage in conduct that would result in serious harm to self or others." Based on that report, that person may lose his Second Amendment right to keep and bear arms. In addition to the constitutional issues raised by this provision, there are practical problems. It is not hard to see how this requirement might "backfire." As I suggested yesterday, it may deter troubled gun owners from seeking help, exactly the opposite of what mental health reformers say they want. Or it may discourage them from being candid about their problems. And if the motivation for the reporting requirement is preventing mass shootings, why include people who might harm themselves? That casts a pretty wide net:

"The way I read the new law, it means I have to report voluntary as well as involuntary hospitalizations, as well as many people being treated for suicidal thinking, for instance, as outpatients," said Dr. Paul S. Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University's medical school. "That is a much larger group of people than before, and most of whom will never be a serious threat to anyone."

That is true even of people diagnosed with schizophrenia, the vast majority of whom do not commit violent crimes. Furthermore, mass murderers typically receive such diagnoses (often rendered at a distance by op-ed pundits) only after they've committed their crimes. Mental health reforms based on the premise that psychiatrists can predict the future are bound to fail, violating the civil liberties of many harmless people in the process. As Northeatern University criminologist James Alan Fox, an expert on mass shootings, observes, "People cannot be denied their Second Amendment rights just because they look strange or act in an odd manner."