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Mass Murderer Psychobabble Misses Gun Policy Point

By Allen Frances, MD | August 3, 2012

In his recent New York Times piece, David Brooks1 provides a psychological analysis of mass murderers, concluding that “the crucial point is that the dynamics are internal, not external. These killers are primarily the product of psychological derangements, not sociological ones.” He goes on to make the astounding claim that better relationships and treatment can help prevent mass killings.

Brooks’ naive psychobabble allows him blithely to dismiss the role of public policy. He would have us focus our attention on the mind of each individual mass murderer, ignoring the issue of why the US consistently produces so many mass murderers. 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. Brooks misses the point of both disciplines when he so ardently embraces a psychiatry he doesn’t understand and so casually dismisses a sociology that actually can provide important data.

(MORE: Mass Murders, Madness, and Gun Control)

Psychiatry has no way to predict mass murder and no way to prevent it. Many mass murderers never see a mental health worker before going ballistic. Even those who do are as impossible to identify as needles in a large haystack. Violent thoughts are not uncommon among psychiatric patients, but vanishingly few will ever act on them. Future mass murderers are far too rare to be selected out of the crowd before the deed is done. Psychiatry can do wonders in treating psychiatric disorders but strikes out in predicting or preventing violence. Brooks is misinformed to offer treatment as a solution—his other suggestion (better relationships) is even more fatuous.

Sociology first became a valuable informant of policy more than a century ago when Émile Durkheim noted the statistical predictability of rates of suicide and violence and their systematic variability in different countries. It is impossible to predict which specific individual will kill himself or others (and certainly to say when and how), but it is easy to predict how many people will kill themselves or others in each country in any given year.

There is no indication that psychiatry can change the statistics of violence or the proclivity of the violent. We need to look instead to sociological data and their policy implications. Statistics tell us that we have a saturation of extraordinarily deadly weapons unparalleled in our own history and unique in the developed world—and simultaneously that we also have the highest rates of gun-related injuries. The burden of proof is on those who want to refute the seemingly obvious causal connection and to deny its policy implications.

Brooks’ command of facts is as weak as his theories. According to Brooks: “People are trying to use the Aurora killings as a pretext to criticize America’s gun culture or to call for stricter gun control laws. This doesn’t happen after European or Asian mass killings.” He ignores the fact that after the 1996 Port Arthur mass murder, a conservative government in Australia overcame strident opposition (especially among its own conservative constituents) to replace lenient gun control measures with tight and effective ones. And Brooks should know that people in other developed countries don’t have to soul search about a gun culture because they don’t have one and don’t have to call for stricter gun control laws because they are already in place.

Homicide is as old as Cain. The capacity to kill had clear survival value, is built into the human genome, and will never be completely eliminated. But killing can be enhanced or contained depending on public policies. People will always find ways of killing people, but the number killed depends on the number and nature of the weapons available to the potential killers. It is a statistical numbers game and we stack the odds against the victims when we allow the killers easy access to semiautomatics and thousands of rounds of ammo.

Brooks should stick to expressing his policy views (he supports gun control) and drop any attempts at amateur psychologizing. His observations would be silly, but harmless, were he not such an influential voice. As it stands, Brooks facilitates the existing suppression of a serious policy discussion on gun control that allows a mindless spread of ever more destructive weaponry. 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.

Reference
1. Brooks D. More treatment programs. New York Times. July 23, 2012. http://www.nytimes.com/2012/07/24/opinion/brooks-more-treatment-programs.html. Accessed August 2, 2012.

 

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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.

Article Comment Pages: 1 2 Previous


Related content

POINT: The Case for Gun Control

COUNTERPOINT: Gun Control and the Second Amendment

Mass Murderer Psychobabble Misses Gun Policy Point

Mass Murders, Madness, and Gun Control






 
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