COMMENTARY

Mass Shootings and the Ethic of the Open Heart

James Knoll IV, MD

Disclosures

December 20, 2012

In This Article

Mass Murder: Can It Be Prevented?

The reality is that mass murder cannot be "predicted" as such, particularly by persons outside the perpetrator's social circle.[45] Any hopes of prevention must rely on various approaches acting together to provide a widely cast safety net.[45] Yes, it's rare, but the fallout is profound, devastating, and long-lasting. I conclude that it is society that must first decide whether it cares enough to take meaningful action. I will forever advocate for better mental health services and improved access to care. However, at the present time, measures such as screening for prior psychiatric treatment (often in the distant past) among individuals who want to legally purchase firearms represents no meaningful intervention.[46,47,48]

Here I refer to the Brady Handgun Violence Prevention Act and relevant portions of the National Instant Criminal Background Check System (NICS). At the present time, this system is an inconsistent patchwork across the country, with different states handling the issue quite differently. There are many other problems with the NICS system, but they are beyond the scope of this article. However, suffice it to say that pouring precious resources into a system that evaluates anyone with a history of involuntary hospitalization (sometimes 20 years prior) who is also honest enough to go buy a firearm legally does not seem to me to be a meaningful intervention.

Experience has shown us that, at this point in time, the higher-yield interventions are:

  • third-party reporting of concerns or leaked intent;

  • sensible gun control laws; and

  • media responsibility.

Having already addressed the issue of third-party reporting with the example of Lammers' mother, I now turn to the perennial and contentious subject of gun control in the United States. It turns out that countries with less stringent gun control laws have been observed to have a higher risk for mass murder than countries with stricter laws.[49] In contrast, consider an Australian observational study done in the wake of a highly publicized 1996 mass shooting in Tasmania.[50] The study compared mass murders before and after Australia enacted gun law reforms that included removing semiautomatic firearms, pump-action shotguns, and rifles from civilian possession. In the 18 years before the gun laws, there were 13 mass shootings in Australia. In the 10.5 years after the gun law reforms, there were none.

Dr. Allen Frances (Chair of the DSM-IV Task Force) has framed the situation a bit more bluntly. He believes that we have only 2 choices: "Accept mass murder as a part of the American way of life...[or] Get in line with the rest of the civilized world and adopt sane gun control policies."[51] But Dr. Frances' latter option seems difficult for many to consider, let alone accept. Others, such as filmmaker/activist Michael Moore, have speculated that it is our deep-seated, long-standing fear that keeps us clutching at our guns.[52,53] I will not lay out here all of the debate but would only point out that there is "no other democracy on the face of earth that experiences this type of gun violence. We are the only free society that has yet to address this problem."[54]

Our rates of gun violence far exceed that of other countries. In a Time Magazine piece on gun violence in the United States, Fareed Zakaria noted that: "The gun-homicide rate per capita in the U.S. is 30 times that of Britain and Australia, 10 times that of India and four times that of Switzerland. When confronted with such a large deviation, a scholar would ask, Does America have some potential cause for this that is also off the chart? I doubt that anyone seriously thinks we have 30 times as many crazy people as Britain or Australia. But we do have many, many more guns."[55]

Given these associations, and the fact that at the present time psychiatry is largely impotent to "stop" or "predict" mass murder, what can be done? Perhaps confronting gun-related violence as a serious public health issue is a start -- for example, adopting sensible restrictions "such as eliminating the sale of semi-automatic weapons."[56] This is an approach that has already been advocated by both the American Psychiatric Association and the International Association of Chiefs of Police. But, of course, it must ultimately be society that decides to take this path. If and when it does, it will be critical for the regulations to be applied nationally or otherwise be doomed to failure: "A piecemeal approach to firearms regulation that affects only some cities or states cannot be expected to produce a robust effect on gun-homicides or mass shootings."[51]

The issue of media responsibility in helping to prevent mass murder has been highlighted since the Columbine and Virginia Tech tragedies. It became clear after these events that some perpetrators were, in part, motivated by the infamy they saw previous mass murderers receive via news coverage. Although some news media may be disinclined to admit it, they may be in the business of searching for "the right sort of madness" to capture the public's imagination.[57] This may involve exploiting violent and tragic acts carried out by mentally or emotionally disturbed individuals. In reality, it is a difficult task to report the occurrence of a mass murder in such a way that the public is adequately informed while withholding certain details (eg, numbers of victims, whether the offender was killed, etc.). Efforts to develop a universal reporting code have been recommended that would appropriately cover the tragedy and reduce the impact of the copycat effect.[58] Most recommendations involve ensuring that the perpetrator is neither glorified nor demonized. In fact, avoiding much emphasis on the perpetrator seems to be a good general rule. Rather, media should emphasize victim and community recovery efforts. I would add here that from what I have seen so far of the orthodox news media's coverage of Newtown, it seems that they are getting this message and are doing an exemplary job.

As a psychiatrist, I desperately wish that improved psychiatric care and access to treatment could save the day. I have little doubt that over the years, unsung mental health heroes have averted possible mass murder tragedies. Yet, it seems all too clear to me that this is simply not a problem that psychiatry can solve on its own. No one should expect psychiatry to do the impossible -- it already has its hands full with the possible. Therefore, I am suggesting 3 additional methods of prevention that should be seriously considered if we wish to confront the tragic phenomenon of mass murder: careful reflection on gun control laws, responsible media reporting, and acknowledging the heroism of individuals such as Tricia Lammerswith the hope that more will follow her compassionate, responsible example.

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