COMMENTARY

Mass Distraction: Equating Mental Illness With 'Evil'

James L. Knoll IV, MD

Disclosures

February 14, 2013

In This Article

Distractor 3: Gun Laws Focusing on Mental Illness Will Effectively Prevent Mass Shootings

In December 2007, the Senate passed HR 2640, which gave states permission to create systems for reporting the names of individuals prohibited from possessing or purchasing firearms, including people who have been involuntarily committed to psychiatric hospitals.[28] It should not escape attention that the act's title states it is an improvement to the "National Instant Criminal Background Check System (NICS)" (author's emphasis). HR 2640 used denigrating language when it described persons "adjudicated as mental defectives." This was despite the National Alliance of Mental Illness (NAMI) expressing concerns, not the least of which was the bill's broadly discriminatory effect, with no attempt to address treatment for mental illness in any way.[29] The practical problem was that the 2 categories used in the gun control act were persons found not guilty by reason of insanity, and persons who had been civilly committed. These specific categories "speak to perceived riskiness (not always riskiness to others) at the time of a past crime or hospital admission but do not speak clearly to future risk."[30]

Well over a decade later, the mechanics, practicality, and effectiveness of the NICS remain uncertain at best and unreliable at worst. The current state of affairs reveals that "state statutes vary widely in terms of the definitions of, and reporting requirements relating to, prohibited persons with mental illness or substance abuse."[31] Indeed, states "vary widely" in how they approach NICS-related mental health cases, how they are evaluated, how they are decided, and how effectively they are reported. But the important facet of the NICS system to consider is that it focuses on individuals who have a history (often in the distant past) of being involuntarily committed, who then attempt to buy a firearm -- legally. Thus, the law focuses on those persons with SMI who follow the rules. How many would-be mass murderers, filled with rage and self-destruction, will have a history of prior civil commitment, and then attempt to legally purchase a firearm to perpetrate their mass homicide-suicide? I do not feel too exposed in predicting that the answer will either approach or equal zero.

Recalling the very low percentage of violent acts that are attributable to SMI, and that most of these acts do not involve guns, "the contribution to public safety of these laws is likely to be small."[32] It is also the case that imposing these special laws requires resources and funding, all for a speculative, unproven system. A more sensible method, noted by Appelbaum and Swanson,[33] involves state statutes that allow "firearms to be removed from persons in emergency situations, when the risk of violence is heightened," regardless of whether the person has a mental illness. This may be a rational option to pursue while awaiting more data points from the research. The small amount of research on firearms seizure laws does suggest that "seizure by police was rarely a result of psychosis; instead, risk of suicide was the leading reason."[33] Thus, for more reasonable and less distracted approaches, there is the option of having law enforcement seize firearms based on the individual's behavior as opposed to their psychiatric diagnosis.[34,35]

Conclusion

The behavior and motives of mass murder need to be distinguished from mental illness. To view these two as always causally related is to allow distraction to frighten reason from her propriety. It also runs the risk of strengthening the old, primitive notions of mental illness as sinful and evil. Surely, the debate on gun control was inevitable for the United States, but I believe it can be accurately viewed as going after the symptoms and not the disease. Indeed, the debate might be more productive if it focused on what it is about our relatively recent cultural changes that have contributed to this present state of affairs. In particular, one helpful area of discussion might be America's attitudes toward violence, which has historical roots going back several hundred years. This will not be an easy exploration, but certainly a valuable one.

Acknowledgements

The author would like to thank Ron Pies, MD, for his thoughtful insights and advice.

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