Mass Murderer Psychobabble Misses Gun Policy Point

by Ronald Pies | August 04, 2012 10:07 PM EDT

Re: "Gun control shouldn't be shouted down, or lobbied away, or rationalized with pop psychology. We need a sustained and serious debate on how best to deal with the public health problem of violent death, not wishful thinking."

Right you are, Al! Thanks for being a clear and brave voice in the wilderness (or should I say, "in the Wild, Wild, West"?). I have detailed comments on your earlier piece (7/30) re: the need for sensible regulations on semi-automatic weapons and high-capacity clips.

At the same time, I would not underestimate the role of proactive psychiatric assessment, not in "predicting"violence--that is not really the issue here--but in determining that someone with a serious psychiatric disorder is in a high-risk category; i.e., is statistically more likely to commit a violent act. A classic "red flag" profile would be someone with untreated or poorly-responsive, active psychosis; a past history of violent acts; co-morbid substance abuse; recent threats of violence (albeit not directed at a specific person, which would activate a Tarasoff-type warning); and easy access to firearms or other lethal weapons.

In principle, such individuals who refuse voluntary psychiatric treatment may be candidates for so-called "outpatient commitment" or court-mandated outpatient treatment.(1) This is not appropriate for all patients with serious psychiatric illness, and does have the potential for curtailing civil liberties. Moreover, the research is not yet clear in showing that outpatient commitment prevents violent acts, though it appears to reduce victimization of the patient (2) (Let's recall that those with serious psychiatric illness are more likely to be victims of violence than perpetrators of it).

Of course, as Dr. Frances rightly argues, none of this should serve as an excuse for legislative inaction, with respect to passing sensible gun and ammunition regulations. Nor should the outpatient commitment option replace more broad-based reform of our mental health care system, so that more individuals have access to comprehensive, voluntary care.

These issues notwithstanding, I believe that--when properly adjudicated--individuals with a high propensity for violence may benefit from proactive, outpatient psychiatric treatment--before they get hold of lethal weapons and act on their violent impulses.

Regards,
Ron Pies MD


1. Appelbaum PS, Thinking Carefully About Outpatient Commitment. Psychiatric Services 2001; doi: 10.1176/appi.ps.52.3.347


2. Kisely SR, Campbell LA, Preston NJ. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD004408.

by adrian sondheimer | August 07, 2012 10:29 AM EDT

Thank you, Dr. Frances. Hopefully, at least some psychiatric thinkers are able to keep their heads straight about the gun issue, and are willing to articulate well what would seem to be matters that ought to be clearly understood and not subject to obfuscation.

by george moses | August 17, 2012 12:01 AM EDT

"There is no reason to assume that we have the highest gun death rate in the developed world because we have more deranged people-it's just that our potential killers are so much better armed."Allen Frances, MD

The Federal Fireams Act of 1934 regulated the sale & ownership of machineguns by private citizens. Prior to about 1932, anyone could own one. When I was young, every hardware store sold rifles, shotguns & pistols. There was no paperwork. I remember looking at flyers I got through the mail, advertising guns I could buy. I only had to say I was 18 years old & send a check. Today, I can go to any one of dozens of "trader days" through out my state & buy any "assault rifle" I want. New York City & Washington, DC have had oppressive gun control laws for decades. So, why does my state have a much lower violent crime & murder rate than they do?
Dr. Frances should stick to expressing his medical views and drop any attempts at amateur policy setting (he supports gun control).
George Moses, D.O, M.A., F.A.P.A.

by Ronald Pies | August 17, 2012 10:13 PM EDT

Before we dismiss the "amateur"policy makers among our colleagues, perhaps we ought
to ponder the bleeding nightmare the "professional" policy makers have created for us.
I mean, of course, the craven legislators who would do anything to avoid the ire of the NRA
lobby, whose leadership continues to dictate the firearms policies of this country (often
in opposition to the views of their own membership). Let's just review for a minute where these policies
have left us:

1. The U.S. has the highest per capita gun possession rate in the world, at about 90 guns for
every 100 citizens (Small Arms Survey 2007 by the Geneva-based Graduate Institute of
International Studies)
2. The United States has a homicide rate 6.9 times higher than those in the other high-income
countries, driven by a firearm homicide rate that was 19.5 times higher; for 15-24 year olds, the firearm homicide rate in the United States is 42.7 times higher than in the other high-income countries
[Richardson & Hemenway, J Trauma. 2011;70: 238-243].
3. The US firearm suicide rate is 5.8 times higher than those in other high-income countries
(Richardson & Hemenway, J Trauma. 2011;70: 238-243)
4. Across the U.S., the "gun-show loophole" allows buyers to purchase from unlicensed sellers
without having to go through a criminal background check.
5. According to Fairfax City Police Chief, Richard J. Rappoport--past president
of the Virginia Association of Chiefs of Police--"A person can go on the Internet using the
pseudonym 'Fred' and arrange to buy a semiautomatic weapon from someone using the pseudonym
'Sam' and meet in a dark parking lot and money exchange hands and weapons exchange hands."
[http://www2.timesdispatch.com/news/virginia-politics/2012/jun/27/tdmet02-law-enforcement-
officials-back-closing-the-ar-2015984/]

When it comes to firearms regulations, I, for one, am ready to consider "amateur" policy makers, like Dr. Frances.

Ronald Pies MD

by kimberly cay | August 21, 2012 2:14 PM EDT

My thoughts articulated by Rick Robertson | August 07, 2012 7:49 PM EDT

Unfortunately, brilliant psychiatrists continue to put on display their ignorance of the Second Amendment and its history. The Second Amendment is not about hunting or even defending your home from armed intruders although that is certainly a fringe benefit. The founders of this great nation came here to escape tyranny and religious persecution. So, not surprisingly, the First Amendment to the Constitution is about religious freedom and the Second Amendment, about the defense against tyranny. The situation in Colorado was tragic and heartbreaking. However, when individuals "go off", they kill people in the dozens. When governments "go off", they kill people in the millions. Between 50 and 100 million people were killed in the 20th century after being disarmed by their own governments in the name of "gun control", the most famous being Germany. Germany was the most educated and technically advanced country in the world at the time and yet murdered 20 million of its own people after disarming them the less than 70 years ago.

Even today people are being murdered all over the globe, people who have no ability to fight back. As far-fetched as it may seem to some, it can happen here as we are neither more moral nor civilized than the Germans in the 1940s. People in government are people and not automatically more trustworthy than your neighbor. ... The best way to stop tragedies like the one in Colorado is an armed citizenry since the only way to stop a bad man with a gun is a good man with the gun. All mass shootings in this country have occurred in "gun free zones."

I will send as much money as I can afford to political candidates and politicians who support the Second Amendment so that I can decide what kind of gun I own and how much ammo I can buy. Rick Robertson, MD