On gun violence and mental health

December 28, 2012

The Newtown slaughter has reached the hearts of everyone. The country knows that something about our wars, our weaponry, and the saturation of guns in America, our movies and video games based on self-justified killing are a recipe for periodic shock and grief over pointless murders. No other nation in the world has all these elements in place.

Another variable is the stress that is endemic to our land. The frequent high drama of the media shapes the tone of our environment. Change in America is so frequent that nothing can be counted upon. The recent wrenching changes in the economy have sorely tested the spirit of our citizenry. The only vocational directions that seem safe are based upon sickness, and breaking of the law. Even if one can find a “good” job, health and retirement benefits are evaporating. My married children would like to consider having third children, but the cost of childcare, or the cost of a three bedroom apartment in New York City are prohibitive.

Getting married is too steep a financial/emotional commitment for many, and so our population is growing older. Optimism is difficult, anxiety is normal. World research indicates that although Americans have the highest percentage of the world’s resources and goods by far, they are less happy or satisfied with their lives than many other nations. This all translates into stress. And stress can alter the mental health of families and individuals.

This brings me to my concern over putting undue reliance on mental health to solve the national symptom of gun deaths. It is no “silver bullet.” While it is true that 55 percent of gun deaths are suicidal, the rates of household gun violence are drastically increased if there is a gun in the home. In recent media discussions around deaths by firearms I hear seemingly solid citizens claiming that although they have a shotgun and two pistols in their home,”We are not the problem.” This implies a static picture of mental health; people with no familiarity with psychological problems feel exempt from it.

The reality contradicts that sense of denial. Schizophrenia often occurs when a young adult is newly on their own.  Depression can visit in sudden and unpredictable ways, as can fear or anger. And all of the mental health conditions associated with mass killings are exacerbated by stress. No family or individual can be exempt from these emotions or the situations which promote them. Those conditions are endemic in our land: a difficult divorce, a cheating spouse, loss of a child, savings wiped out, loss of a home, litigation, sudden unemployment, loss of a vocation, accidents, sudden illness, loss of health insurance, etc.

Often the perpetrator did not have a clinical profile or history prior to the situation, stressor, or crisis that pushed them over the edge. No one has guaranteed immunity to such a downturn in mental health.

I have worked in mental health for over 35 years. I was a long-term consultant in a shelter for woman, and also worked with men in domestic violence groups. I later ran therapy groups for people with problems with violence or temper control. This population can be frightening to a therapist or an agency. Legally a provider walks on eggshells. It is not like such clients cannot be helped so that the percentage of outbursts can decline, but professional programs and practitioners for such intense work are scant.

Also the focal population who need such help is generally adverse to mental health treatment and rightly do not trust the promise of confidentiality. They fear incarceration or psychiatric hospitalization as our laws require. They often do not want medication - how can it be forced or monitored? Some are people hearing voices of fear or anger, or people who store significant hurt or rejection; many are isolated loners and very mistrustful. They can be very private, and use intimidation to keep others at a distance. Anger, aggression, and paranoia grow under such conditions. These are often independent souls, who trust no one, certainly not “the system”.  Rarely do they choose treatment, and, if they are referred by agencies, they count the days or drop out. Certainly, many are very intelligent and would tell us what we want to hear just to end the charade. Psychological insight or discussion of emotions or relationships is not in their skill sets. Their rights to choose are constitutionally protected. Forced mental health treatment is generally unproductive. If a fearful society starts sending all those alienated or marginalized persons, and/or found to be “suspicious” for therapy, practitioners will be overwhelmed with a high percentage of false positives - those who raised an alert but were not actually dangerous.

In a number of high-profile cases mental health workers had some contact with the person prior to their heinous aggression. Finally, I must question the ability of the professionals to accurately predict who, when, and if violence would occur.

I am not saying that mental health should not play a part in a complex and sophisticated attempt to modify gun carnage, Mental health will not, however, be the panacea.  The resources are currently not in place, and that the population of concern is very difficult to identify and treat under existing conditions.

Eric Kafka, Ph.D., psychologist

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