Mental Illness and Political Violence: Reckless Rhetoric, Weapons, and the Media
Mental Illness and Political Violence: Reckless Rhetoric, Weapons, and the Media
The recent mass murders in Arizona are the latest in our country's epidemic of horrible, hate inspired crimes. The 24/7 media punditry and political spinning has been disappointingly off point in a way suggesting that once again we will learn nothing from our mistakes and that such tragedies will continue to recur with distressing frequency. Three possibly interacting causal theories have been offered:
1.The killer is severely mentally ill and acted on a variety of delusional beliefs that converge on the notion that the government exerts a malign influence on him and on our country. His potential for violence was accentuated by drug use.
2.He was also responding, at least in part, to the vitriolic, violent and inciting discourse and conspiracy theorizing that has become increasingly acceptable on talk radio and the internet.
3. The tragedy was facilitated by the killer's easy access to automatic, assault weapons that can kill promiscuously and rapidly.
Talk show hosts and apologists for the aggressive political discourse have jumped on the first hypothesis ("the killer was an isolated and unpredictable crazy man, who is really apolitical") and the airwaves and print have been filled with psychiatric testimony linking mental illness and violence. Much of what has been said in this regard badly misses the point and diverts attention from correctable problems that cry out for correction.
While it is never wise to diagnose at a distance, it seems a fairly safe bet that the murderer in this case does have a severe mental illness and has also abused drugs. Indeed, both are definite risk factors for violence-- but it must also be strongly emphasized that violence is an issue for only a tiny fraction of those with severe mental illness and the mentally ill are responsible for only a tiny fraction of violent crime.
This brings us to the real question that must be addressed. Why is it that ours is the one developed country experiencing this epidemic of repeated mass murders? To blame this episode (and its many similar predecessors) solely on the mental illness of the perpetrator ignores the fact that the rates of schizophrenia and drug use are similar across the developed world. If our people are not sicker than people elsewhere, what is it about our society that makes it more likely to provoke such tragedies?
The most obvious answer is that we are armed to the teeth-- too often with rapid-fire assault weapons that can promiscuously and within seconds kill dozens of innocent victims. Reasonable people can certainly disagree about the general right to bear arms, but it seems clearly absurd to allow the sale of such automatic weapons and condone their current easy availability even for those with severe mental illness. Since there is no way to legislate mental illness out of existence, we must focus on what we can control. We need a more rational policy regulating who can have guns and what kinds of guns are acceptable.
Then there is the increasing violence of political attacks. Free speech has too often deteriorated into violent and inflammatory speech-- just the kind most likely to incite and enable those made vulnerable by the poor judgment and impulsivity that occasionally accompany mental illness. Reckless political discourse is equivalent to lighting a flame to kindling. It is irresponsible for those who provide the spark then to blithely disavow the flame. All responsible leaders must disavow the cheap-shots, the demonization of opponents, the smears, the violent denunciations,and the outright threats.
A safe society must be a civil society.
Marking opponents with a gun scope and other similar acts of political theater can unwittingly become an incitement. Reckless speech is especially risky for those who are vulnerable to suggestion because mental illness renders them liable to take literally what may have been meant figuratively. Public figures must accept that the mentally ill inevitably form part of their audience and may possibly enact their provocative statements.
The media and the internet also have much to answer for. The 24/7 lurid coverage of violence inadvertently promotes imitation. Even more culpable is the conscious selection as media stars of the most reckless voices- promoting a degradation of civility and the encouragement of verbal abuse which can increase the risk of physical violence. Media ratings have obviously been given priority over our national safety.
So let's not take the easy way and again simply blame the mental illness in the individual-- without trying to correct the societal context which promotes its most tragic expression. Other countries have people just as crazy as ours, but they are much less likely to experience repeated mass murders. The carnage will continue unless we find our way toward a reasonable compromise on gun control, a more measured political discourse, and a responsible media.
Thank you, Harold Maio. I see this "the"mentally ill quite often on the Internet, although it is not so common in my language, Norwegian, as it is in English. Since I myself have a mental health problem, I sometimes ask people if they include me when they talk about this "group". Sigrun Toemmeraas
mental health acitvist
I also think it raises the issue of accessibility to good mental health care for any and all who need it--which is many of us at some point in our lives. Traditionally, mental illnesses have not been treated on a par with 'physical' illnesses. And that has been a huge problem. To often there is still stigma against seeking help as well. And, for some mental illnesses, there can be a sense of denial about the illness itself (certainly not in all cases). Families, spouses and institutions that may have concerns for someone may find themselves with their hands tied as far as I can tell...once age 18, it can be very difficult to get help for someone that may not want it. And, this is certainly not all people with a mental illness...but some. So, a question for me is, how can we better support families, loved ones and institutions get help for their people who may need it but not want it? And, I totally agree with your other points about guns, drugs, etc. Sigrun...an additional note to you. No one should be referred to as a 'mentally ill person', but a 'person suffering from a mental illness'. I think there is a subtle, but profound, distinction in wording.
Where is the evidence that the individual charged with the assault was influenced in any way by "reckless speech"? It seems to me that the "reckless speech" has been by those who have blamed the Internet, talk radio, and various political commentators in the absence of any evidence.
Kudos to Dr. Frances for "telling it like it is"! I reached very similar conclusions in my own essay on the Tucson shootings.
http://psychcentral.com/blog/archives/2011/01/11/the-arizona-shootings-a...
Re: the need for mental health services (which are being cut in states across the nation), some intriguing data emerged from the classic MacArthur study of violence in discharged patients with psychiatric disorders.
Controlling for age, gender, race, education, marital status, substance use, diagnosis, and prior violence: the MacArthur study found that, within the 2nd 10 weeks after discharge, violence of any kind occurred in 14% of discharged patients who did not attend outpatient
therapy; in 9.5% of those who went to treatment once per month; and in 2.9% of those who went once per week. The comparison rate of violence for the community was 4.6%. Thus, the "no treatment"discharged patients had a "violence" rate of about 3 times that of the comparison group in the general community; whereas those who had at least one
treatment session per week had a lower rate of violence, than that observed in the surrounding general community.
The take-home message: left untreated, mental illness is associated with increased risk of violence; when treated weekly, the risk actually drops to below the average in the surrounding community. The caveat here is that subjects were not randomized for study, so we can't be assured that those with equally severe pathology were being compared from group to group. Also, violence in the surrounding community may differ from region
to region in the U.S. [Source: Dr. John Monahan, lead author of the MacArthur study; personal
communication, 1/21/11]
Finally, I join Al Frances in calling for more civility and
courtesy in the way we speak and communicate with one another, as I try to suggest elsewhere on this site [see "The Eight-fold Path for Internet Ethics"].
Best regards, Ron Pies MD
P.S. Harold Maio's point about "the" mentally ill is well-taken.
As someone posted above, where is the evidence that political discourse tipped this over the edge? Have there been studies of some sort? Maybe have been, I would just to know what they are. But since the author is assuming political speech can incite violence, why only single out "talk radio"(which means conservatives) and "talk show hosts" (which could mean conservatives and liberals but in the present climate means conservatives) along with the internet (which I suppose is both liberal and conservative)? Why not mention Congressmen? Remember the liberal Representative from Florida who said opponents of Obama's health care plan wanted old people to just go home and die? Or how about former governor and Democratic Party Chairman Howard Dean who said he "hated" Bush? It probably was not the author's intent (I certainly hope it was not) but this article reinforces those on the left such as the columnist Paul Krugman who are quite consciously using the incident to try to blunt the momentum of the recent election. Greg Smith, MD
Dr. Francis made at least four statements that are factually incorrect. Fully automatic assault weapons that "kill promiscuously and rapidly"are not available to the general public for sale. The Left uses the term "assault weapon" to describe semi automatic rifles that look like M16 rifles to frighten the generally uniformed public into thinking these are machine guns to advance their victim disarmament goals. Second, there have been mass killings all over the world, mostly done by governments who murdered 100 million people in the 20th century by genocide. These goverments first disarmed their people by "gun control." Thirdly, "gun control laws which disarm victims increase crime. The crime rate in every county in this country and and every country in the world is inversely proportional to gun ownership rates as is reviewed in John Lott's book "More Guns Less Crime." Psychiatrists should stick to what they know and not misuse their position of respect and knowledge to advance a Left Wing political agenda. Lastly, I have listened to talk radio for 20 years and have never heard "vitriolic, violent and inciting discourse and conspiracy theorizing" talk referred to by Dr. Francis. Who is he referring to?
Rick Robertson, MD
Re: rational gun control: I would encourage all PT readers to see the diagram in today's New York Times, correlating firearms per 100 people and number of homicides, in various countries. The link follows. The notion that guns keep us safe is one of the pernicious ideas that fuel the unconscionable rate of gun-related suicide and homicide in this country. If that is a "left-wing" point of view, I am happy to stand behind it, both as a physician and as a citizen. --Ronald Pies MD
http://www.nytimes.com/imagepages/2011/01/21/opinion/21blowimg.html?ref=...
Re: the NY Times diagram: it actually shows percent of homicides by firearms, vs. number of firearms per 100 persons, in various countries. The U.S. is at the top of the graph.
For a rational perspective on gun control, please see the commentary by Dr. Wintemute in the NEJM:
"Gun violence is often an unintended consequence of gun ownership. Americans have purchased millions of guns, predominantly handguns, believing that having a gun at home makes them safer. In fact, handgun purchasers substantially increase their risk of a violent death. This increase begins the moment the gun is acquired - suicide is the leading cause of death among handgun owners in the first year after purchase -
and lasts for years."
from: "Guns, Fear, the Constitution, and the Public's Health" Garen J. Wintemute, M.D., M.P.H.
N Engl J Med 2008; 358:1421-1424April 3, 2008
Thank you for an excellent article. I applaud your accurate and sensitive treatment of the mentally ill. It is so nice to see an article containing subject matter pertaining to those with this illness treat them fairly without demonizing and accusing them of being the culprit in any violence case.
If we legalized drugs, gambling, and prostitution, we would be able to tax them enough to have money to spend on mental health care...
for politicians.
Dr. Pies' response to Rick Robertson, MD:
I thank Dr. Rick Robertson for referring me to the Kates & Mauser paper, which I intend to read very thoroughly. I agree with Dr. Robertson that we need to understand the data in an objective manner, and I want to assure him that my allusion to "a rational perspective"on gun control was not intended to characterize opponents of gun control as "irrational". Since Dr. Robertson does not regard the New York Times as a reliable source of information, and as having a "left wing bias", I feel obligated to point out that the journal that published the Kates & Mauser paper is a student-edited publication sponsored by the Federalist Society, and describes itself as the "….leading forum for conservative and libertarian legal scholarship." Incidentally, the graph to which I referred readers
http://www.nytimes.com/imagepages/2011/01/21/opinion/21blowimg.html?ref=opinion
was not produced by the NY Times, but by the United Nations Office on Drugs and Crime-though somehow I suspect that Dr. Robertson will not be greatly reassured by that.
I respect Dr. Robertson's 45 year interest in second amendment issues, and I would like to clarify that I have no agenda calling for repeal of the second amendment, or for the "disarmament" of the general public. I accept the fact that there is a circumscribed "right to bear arms". Nonetheless, I believe that our woefully inadequate firearms laws are contributing to exorbitantly high rates of gun-related homicide, as well as to gun-related suicide-surely, a prime concern of psychiatrists. I am hoping to prepare a comprehensive editorial addressing these issues--and I can assure Dr. Robertson that I always do my "homework"!
In the mean time, I would encourage readers to read carefully the editorial in the April, 3,2008 New England Journal by Dr. Garen Wintemute MD, MPH. (available on line at www.nejm.org/doi/pdf/10.1056/NEJMp0800859]. Dr. Wintemute is a professor of emergency medicine and director of the Violence Prevention Research Program at the University of California, Davis, School of Medicine, Sacramento. Here are a few conclusions from his Op-Ed:
"Permissive policies regarding carrying guns have not reduced crime rates, and permissive states generally have higher rates of gun-related deaths than others do."
"Living in a home where there are guns increases the risk of homicide by 40 to 170% and the risk of suicide by 90 to 460%. Young people who commit suicide with a gun usually use a weapon kept at home, and among women in shelters for victims of domestic violence, two thirds of those who come from homes with guns have had those guns used against them."
I join Dr. Allen Frances in calling for reasonable restrictions on firearms sales. In my view, this should include restrictions on violent individuals with a history of involuntary commitment to a mental health facility; and on those expelled from college or high school by reason of violence or violent threats. I also favor eliminating high capacity ammunition clips and magazines, as well as semiautomatic firearms with the ability to accept a detachable magazine containing more than 10 rounds (cf. Violent Crime Control and Law Enforcement Act, H.R. 3355, Pub.L. 103-322).
I believe that such restrictions are indeed "rational", and will not prevent the legitimate exercise of second amendment rights, self-defense of one's home or store, hunting, etc. Of course, such regulations will never eliminate all homicides, or all gun-related violence, such as that related to drug trafficking. We also need to ensure that those with severe psychiatric disorders who present an immediate danger to themselves or others, but who refuse treatment, receive mandated, court-ordered care. Finally, as I argue in my blog1, we must increase the availability and affordability of mental health care in the U.S. and examine other factors in our society that increase the risk of violence.
Ronald Pies, MD
1. http://psychcentral.com/blog/archives/2011/01/11/the-arizona-shootings-a-recurrent-american-tragedy/
Dr. Pies has referred to a New York Times article that is "rational"regarding gun control. Is anyone who disagrees "irrational?" The New York Times is hardly a reliable source of information. The New York Times Left Wing bias is so well established by the Media Research Center and others that I won't make further comment. As scientists we have a duty to understand the data before forming a conclusion. Here is a link http://www.saf.org/journal/19/KatesMauser.htm to an article published in Harvard Journal of Law and Public Policy showing the highest murder rates occur are in countries where guns are banned. The highest murder rates in the US are in areas with the most repressive gun control, e.g. Chicago, Washington, DC. The Times article refers to gun related murders, not just murders. They do this since if they just looked at the overall murder rate, they could not advance their victim disarmament agenda. In Australia and England, crime and murder rates have skyrocketed following "gun control". Remember, most of the US murder rate is due to the drug trade so "gun control" won't change that. I've been involved in second amendment issues for 45 years and the evidence supports that providing people with an effective means of self defense saves lives and prevents rape, assault, robbery. I respectfully ask readers to do their homework before jumping on an emotional bandwagon. Thanks!
Rick Robertson, MD
Would someone be kind enough to post links supporting the assertion that "rates of schizophrenia and drug use are similar across the developed world."(quoted from original article above) I've read this, in regard to schizophrenia, but never in regard to drug use. It seems that definition of "drug use" would be rather difficult, across cultures. Would it include prescribed drugs that make life tolerable for some, or only illegal drugs? How much "use" qualifies? Even schizophrenia might be hard to pin down, say in cultures where hearing spirit voices is not considered aberration.
Please provide evidence that "reckless rhetoric"contributed in any way to the shootings. Until the accused shooter can be interviewed in depth by a forensic psychologist or psychiatrist, any statement that "reckless rhetoric" played a role in his motivation is pure speculation. Bob Morris MD
Mr. Smith, does everything have to be evidence based these days before we consider its merit? Does it not make sense that if someone with anger issues listens enough to the mean spirited, vitriolic talk of some of the pundits out there, he or she might find the drive to do the unthinkable?
Does everything have to be evidence based these days before we consider its merit? Does it not make sense that if someone with anger issues listens enough to the mean spirited, vitriolic talk of some of the pundits out there, he or she might find the drive to do the unthinkable? DS
Those readers interested in following up on my comments to Dr. Robertson are referred to the Op-Ed below. http://pn.psychiatryonline.org/content/46/7/6.1.full?sid=99b315be-88af-4579-a84e-591e0bd0d0f6 Best regards, Ron Pies MD
It is as irresponsible to reference a "the" mentally ill as a "the" Jews. Harold A. Maio, retired Mental Health Editor