The recent mass murder at Marjory Stoneman Douglas High School in Parkland, Florida, has shocked us all, not only because this one incident was so horrendous, but also because it was only one of an apparently endless and increasingly frequent series of mass murders in our country. As psychiatrists who have devoted our careers to studying the causes and prevention of violence, we would like to summarize what we have learned to help reduce the frequency and scale of lethal violence.
The first point to emphasize is that only 1 percent of murder victims in America are killed in mass murders (defined as those in which four or more people die), according to the Bureau of Justice Statistics. More than 90 percent are killed in single-victim homicides. So if we wish to reduce the toll of violent deaths in America, we need to give more attention to the overall murder rate, in which most of the deaths occur one at a time.
Many politicians continue to attribute the cause of almost every mass murder to mental illness. We know that is not true of murders in general, only 1 percent of which are found by the courts to have been caused by mental illness. That is, only 1 percent of those who commit homicide are found to be “not guilty by reason of insanity.” But this is also not true of the much rarer mass murderers. One study concluded that only about 22 percent of those who commit mass murders suffer from serious mental illnesses; the vast majority, or 78 percent, do not. A 2016 research study concluded that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness. As one researcher stated: “If you focus on mental illness, all you get is a huge number of false positives.”
Mental health professionals have an entirely separate system of assessing risk of violence, which has nothing to do with evaluating mental illness. If mental illness were a major cause of either individual or mass murders, then the nations of Western Europe should have the same murder rates we do. After all, their rates of mental illness are essentially the same as ours. But our individual murder rates are often 5 to 10 times higher than those in the European countries, and our rates of mass murder are astronomically higher.
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While individuals with mental illness are more likely to be victims than perpetrators of violence, certain symptoms, especially when severe and occurring in combination with antisocial, paranoid, narcissistic or borderline personality disorders, can predispose to violent behavior, especially when the individual is experiencing, or has experienced, severe trauma or stress. So it is of course important to attempt to identify and assess those who have characteristics that make them vulnerable to committing an act of violence, and to provide whatever degree of support or restraint they may need in order to prevent them from doing so – whether or not they meet the diagnostic criteria for any given mental illness.
Many people have noticed that the young man who committed the recent mass murder sent out multiple “red flag” warnings on how dangerous he was, and have lamented the fact that those in the community did not intervene in such a way as to restrain him from acting on his violent impulses. It is important to recognize these signs in individuals and to intervene where appropriate. But far more effective is to take action before any of those signs appear, and the best way to do that is through public health approaches. Primary prevention through policies that improve social, cultural, and economic conditions, not to mention reducing access to guns, is far more effective than all the police, doctors and hospitals combined, and intervening only after tragedies have struck.
There is overwhelming evidence that the rate of gun ownership in any population correlates with the rate of gun deaths in that population. For example, U.S. states that have significantly higher rates of gun ownership also have higher rates of homicides, suicides and “accidental” gun deaths. Countries’ rates of gun ownership almost exactly correlate with their rates of gun deaths, with the U.S. as a complete outlier in both. One gun shot is estimated to be seven times more likely to cause a death than one stabbing by a knife is. That is among the reasons that guns are virtually always the weapons that cause mass murders: You can kill far more people more quickly with a gun than you can with a knife or any other readily available weapon.
But don’t guns protect their owners from the violence of others when they are used for self-defense? According to the F.B.I., in 2015 private citizens with guns committed 268 “justifiable homicides” to defend themselves from someone they perceived as dangerous to them. But during that same year, the National Center for Health Statistics reported that 489 Americans died from “unintentional firearms deaths,” many of whom were children. And it has long been known that guns in the home are far more likely to kill those who live in the home – whether from suicide, domestic violence, or accident – than they are to kill or disable any home invader.
Another argument against tighter gun control – that the private ownership of pistols or rifles could protect us if our government, armed with bomber planes, tanks and nuclear weapons, became a dictatorship – is too ludicrous to be worth discussing. The only realistic means of warding off dictatorship in this country is to support and vote for politicians who are prone to keeping the rule of law and constitutional principles such as the freedom of speech and press, separation of powers, due process of law, and protection of the public – and to hold them accountable if they don’t. If we cannot exercise our civic responsibility to safeguard that, then no amount of private gun ownership will help us.
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