Does Gun Violence, as in the Killing of the Children in Texas, Need to be Classified and Medicalized as a Social Psychopathology?


We need to focus on gun violence and control. Here’s what psychiatry can do.

gun violence



“The horror, the horror.”

- Colonel Kurtz as he dies at the end of the movie Apocalypse Now

Here it is once again, deja vu, another mass killing, this time especially heartbreaking because it was mainly of young children in a Texas elementary school. It has been almost a decade since 20 young children were killed in the Sandy Hook, Connecticut shooting. As of this writing, there have been 19 children and 2 adults killed this time.

One difference to note is that the shooter shot his grandmother before coming to the school. The grandmother may have had crucial information about the motivation of the 18-year-old gunman, who was killed. Reports are emerging that he was bullied early in childhood and became more violently hostile himself in recent years. Self-disclosure: I am a grandparent, too.

These high-profile shootings get plenty of media attention. What does not, and needs to, is the day to day killing of children by guns. The number of such children has increased during the pandemic, along with a surge in gun-buying. Various reports indicate over 1500 children younger than 18 were killed in homicides and accidental shootings in 2021, or about 5 a day on the average. Black children are way overrepresented.

Reports indicate over 200 mass shootings of any age in 2022. That is part of an overall crime surge of perpetrator and victim diversity.

There are plenty of guns in Canada and increasing gun violence, but they do not shoot each other at anywhere near the rates in our country.

The role of psychiatry in gun control has been debated. We do try to point out that it is rare for the mentally ill in treatment to commit gun violence. We are available for disaster responsiveness, to help the grieving and begin to process the ripple effects of the trauma.

A common interpretation is that guns represent a phallic symbol of real and imagined power. Men are the overwhelming perpetrators. Guns are a key part out our country’s founding and mythology, but there must also be some major vulnerability in human nature as the violent intraspecies history of human beings reveal. Other current examples include the current brutal invasion of Ukraine, and today is the 2-year anniversary of the killing of George Floyd.

What can I possibly add to the discussion and concern in this pop-up column? Here it is. I would classify gun violence as a social psychopathology, among others such as burnout, cults, racism, xenophobia, and even a general social breakdown in this century. I think that psychiatrists, along with other psychiatric professionals, should work on a classification of social psychopathologies to complement that of the individual psychopathologies in DSMs.

The annual meeting of the National Rifle Association (NRA) is scheduled for this upcoming Memorial Day weekend in Houston, Texas, while our APA annual meeting is just finishing. Ours focused on the social determinants of mental health, and there are many. However, in the daily reports to members, I did not hear of any focus on gun violence and control, which certainly has adverse mental repercussions.

Medicalization can lead to more research and treatments. We can bring more sense to something that is often called senseless. We have control of that. The NRA cannot stop us. This approach has not been tried. Why not?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

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