New legislation in a number of states requires mental health professionals to assess their patients for the potential to commit gun crimes. For instance, New York state law mandates that mental health professionals report anyone who “is likely to engage in conduct that would result in serious harm to self or others” to the state’s Division of Criminal Justice Services, which then alerts local authorities to revoke the person’s firearms license and confiscate his or her weapons. Similarly, a recently passed bill in Tennessee requires mental health professionals to report “threatening patients” to local law enforcement.
Supporters of these types of laws argue that they provide important tools for law enforcement officials to identify potentially violent persons—and understandably so. US policymakers and the general public look to psychiatry, psychology, neuroscience, and related disciplines as sources of certainty in the face of the often incomprehensible terror and loss that gun violence inevitably produces. And to be sure, persons with mental illness who have shown violent tendencies should not have access to weapons that could be used to harm themselves or others.
However, the notion that psychiatric attention might prevent gun crime is more complicated than it might seem. New research undertaken by me and my colleague, Professor Ken MacLeish, warns of the potential pitfalls of such laws if they are unaccompanied by other community-based or antistigma interventions.1 We systematically reviewed the key psychiatry, psychol- ogy, public health, and sociology literature that addressed connections between mental illness and gun violence between 1960 and 2014. We also used our own primary source historical research on violence and mental illness, and American gun culture.2-4
Our review critically addresses 4 central assumptions that underlie many US political and popular associations between gun violence and mental illness:
• That mental illness causes gun violence
• That psychiatric diagnosis can predict gun crime before it happens
• That US mass shootings teach us to fear mentally ill loners
• That because of the complex psychiatric histories of mass shooters, gun control “won’t prevent” another Tucson, Aurora, Newtown, or Navy Yard
Each of these statements is certainly true in particular instances. At the same time, our research shows how these seemingly self-evident assumptions are replete with complicated and at times contradictory assumptions. At the aggregate level, the notion that mental illness causes gun violence stereotypes a diverse population of persons with psychiatric conditions and oversimplifies links between violence and mental illness. Moreover, notions of mental illness that emerge in relation to gun violence frequently reflect larger cultural issues that become obscured when mass shootings come to stand for all gun crime and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat.
Our research also shows how anxieties about insanity and gun violence are imbued with often unspoken anxieties about race, politics, and the unequal distribution of violence in American society. In the current American landscape, these tensions play out most clearly in differing cultural responses to, for instance, high-profile shootings in places like Newtown (where headlines located pathology in the perpetrator’s brain) and New York City (where news commentators wondered whether murderous actions were motivated by “black politics.”5)
Our analysis suggests that similar, if less overt, tensions suffuse discourses linking guns and mental illness more broadly, in ways that subtly connect “insane” gun crimes with often unspoken assumptions about “white” individualism or “black” communal aggression.
Ultimately, our research challenges psychiatry to think deeply about potentially untenable situations in which mental health practitioners become the persons most empowered to make decisions about gun ownership—and most liable for failures to predict gun violence—if these situations are not accompanied by larger reforms that address the social, structural, and indeed psychological implications of gun violence in the US.
Our findings appear in the February 2015 issue of the American Journal of Public Health.1 By way of a summary, the following 4 assumptions are examined.
Assumption 1: mental illness causes gun violence
The focus on mental illness in the wake of recent mass shootings in the US reflects a decades-long history of psychiatric and legal debates about guns, gun violence, and mental competence. Psychiatric articles in the 1960s deliberated ways to assess whether mental patients were “of sound mind enough” to possess firearms.6 Following the 1999 mass shooting at Columbine High School, psychiatrist Peter Breggin decried the toxic combination of mental illness, guns, and psychotropic medications that contributed to the perpetrators’ actions. After the 2012 shooting at Sandy Hook Elementary School in Newtown, psychiatrist E. Fuller Torrey claimed that “about half of . . . mass killings are being done by people with severe mental illness, mostly schizophrenia, and if they were being treated they would have been preventable.”7
Dr Metzl is Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society; Director of the Center for Medicine, Health, and Society; and Professor of Psychiatry at Vanderbilt University in Nashville, Tenn. He reports no conflicts of interest concerning the subject matter of this article.
1. Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. 2015;105:240-249.
2. Metzl JM. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press; 2011.
3. MacLeish KT. Making War at Fort Hood: Life and Uncertainty in a Military Community. Princeton, NJ: Princeton University Press; 2013.
4. Metzl JM, MacLeish KT. Triggering the debate: faulty associations between violence and mental illness underlie US gun control efforts. Risk Regul. 2013;25:8-10.
5. North A. When officers die and protesters get the blame. New York Times. December 23, 2014. http://op-talk.blogs.nytimes.com/2014/12/23/when- officers-die-and-protests-get-the-blame/?smid= tw-share. Accessed February 10, 2015.
6. Rotenberg LA, Sadoff RL. Who should have a gun? Some preliminary psychiatric thoughts. Am J Psychiatry. 1968:125:841-843.
7. CBS News. Preview: Imminent Danger. 60 Minutes. September 27, 2013. http://www.cbsnews.com/videos/preview-imminent-danger. Accessed July 23, 2014.
8. Appelbaum PS. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006;163: 1319-1321.
9. Centers for Disease Control and Prevention. Leading Causes of Death Reports, National and Regional 1999-2010. February 19, 2013. http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html. Accessed February 3, 2015.
10. Follman M, Aronsen G, Pan D. A guide to mass shootings in America. Mother Jones. May 24, 2014. http://www.motherjones.com/politics/2012/07/mass-shootings-map?page=2. Accessed February 3, 2015.
11. Swanson JW. Explaining rare acts of violence: the limits of evidence from population research. Psychiatr Serv. 2011;62:1369-1371.
12. Keers R, Ullrich S, Destavola BL, Coid JW. Association of violence with emergence of persecutory delusions in untreated schizophrenia. Am J Psychiatry. 2014;171:332-339.
13. Grohol JM. Violence and mental illness: simplifying complex data relationships. Psych Central. http://psychcentral.com/blog/archives/2007/05/02/ violence-and-mental-illness-simplifying-complex-data-relationships. Accessed July 1, 2014.
14. Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006;163:1397-1403.
15. Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012;47:487-503.
16. Lott JR Jr. More Guns, Less Crime: Understanding Crime and Gun Control Laws. 3rd ed. Chicago: University of Chicago Press; 2010.
17. Miller M, Azrael D, Hemenway D. Rates of household firearm ownership and homicide across US regions and states, 1988-1997. Am J Public Health. 2002;92:1988-1993.
18. The Editorial Board. Craven statehouse behavior. New York Times. March 14, 2014. http://www. nytimes.com/2014/03/15/opinion/craven-statehouse- behavior.html. Accessed February 3, 2015.
19. Metzl JM. When shootings happen, gender has to be part of the conversation. MSNBC. June 9, 2014. http://on.msnbc.com/TmbHlK. Accessed February 3, 2015.
20. FBI Hunts NAACP Leader. NY Amsterdam News. September 23, 1961.
21. Peters JW. Senate balks at Obama pick for surgeon general. New York Times. March 14, 2014. http://www.nytimes.com/2014/03/15/us/senate-balks-at-obama-pick-for-surg.... Accessed February 3, 2015.
22. Ruiz R. Life, death, and PTSD in Oakland: how violence and poverty are traumatizing the city’s youth. East Bay Express. December 11, 2013. http://www.eastbayexpress.com/oakland/life-death-and-ptsd-in-oakland/Con.... Accessed February 3, 2015.
23. Hiday VA. The social context of mental illness and violence. J Health Soc Behav. 1995;36:122-137.