Guns and mental illness – The facts and consequences of using a blanket term so vaguely

Summary: Despite widespread propaganda, people with mental illnesses only commit 3-4% of all violent acts within the U.S in any given year. Mental health conditions are more strongly associated with suicide, not homicide. Restricting access to guns for those with mental health issues does not take into account those who already own guns and develop mental health conditions over their lifetime. Researchers say, given the climate of blame, people with severe mental health disorders may be dissuaded from seeking treatment.

Source: The Conversation

President Donald Trump called for reform of mental health laws on the heels of two deadly shootings that claimed the lives of at least 31 people and left a grief-stricken country in disbelief.

The president, saying that “hatred and mental illness pulls the trigger, not the gun,” also called for better identification of people with mental illness and, in some cases, “involuntary confinement” of them.

These sentiments are similar to comments that Trump and a number of other politicians have made previously. For example, after the Parkland shooting, which claimed the lives of 17 – 14 of whom were students – Trump said he thought due process for mentally ill people was not as important as making sure that they do not have guns.

“I don’t want mentally ill people to be having guns. Take the guns first, go through due process second,” Trump said.

In the past, mental illness has been scapegoated to deflect public outrage about access to assault rifles that can kill tens of people in a matter of minutes. During these heated debates, words such as “crazy,” “nuts” and “maniac” are used to describe the person who committed the act of violence, even before a medical diagnosis is released.

In this debate, many questions arise that those discussing mental illness and gun violence may not even think about: What do we mean by mental illness? Which mental illness? What would be the policies to keep guns away from the potentially dangerous mentally ill? Most of these questions remain unanswered during these discussions.

Specifically, no one suggests who will decide whether a patient with mental illness should not have access to firearms – would it be a psychiatrist, an independent forensic psychiatrist, a committee of psychiatrists or a judge? How about those who do not seek psychiatric evaluation and treatment? Should a psychiatric examination be integrated into the background check process for each person who wants to purchase a gun? As severe mental illness can start at any point in life, will gun owners need periodic psychiatric assessment (like a vision exam for renewing a driver’s license)? Who will pay for the visits?

As an academic psychiatrist, here’s my perspective on the complexities of this issue.

What is “mental illness”?

The term “mental illness” covers a wide range of psychiatric conditions that are addressed and treated by mental health professionals.

You may be surprised to know there are more than 200 diagnoses listed in the most recent version of Diagnostic Statistical Manual of Mental Disorders, which is released by the American Psychiatric Association. This includes conditions such as anxiety disorders like spider phobia, social phobia, social anxiety disorder, post-traumatic stress disorder, hair-picking, pathological gambling, schizophrenia, dementia, different forms of depression and personality disorders, such as antisocial personality disorder commonly known as psychopathy.

Mental illnesses are also very common: Nearly 1 in 5 people experience clinical depression during their lives; one in five experiences an anxiety disorder; 1 in 100 experience schizophrenia; and nearly 8% of the general population experience PTSD. People who have had higher exposure to trauma, violence and warfare, such as veterans, have higher rates of PTSD (up to 30%).

Now, when one suggests that gun access should be restricted for people with mental illness, do they mean all of these conditions? Or just some, or some in defined circumstances? For example, should we remove guns from all veterans with PTSD, or all people with social anxiety, or those who habitually pick their skin?

Needless to say that diagnosing these conditions mostly relies on the person’s report and the physician’s observation, and the ability to rely on their report is important.

When can a person be potentially dangerous to others?

Not all mental illness may be a risk of harm to others. In the majority of cases when a patient is involuntarily admitted to a psychiatric inpatient unit, it is not because the person is a risk to others. Rather, it is more often the case that the person is at risk of harming himself, as in the case of a depressed, suicidal patient.

In psychiatric disorders, concerns about harm to others typically arise in acutely psychotic patients with paranoid delusions that convince them to harm others. This may happen in, but is not limited to schizophrenia, dementia, severe psychotic depression or psychotic bipolar illness.

Substance use, which can increase the risk of crime or psychosis, can also lead to intentions to harm others. Other situations, when a person could be a risk of harm to others, are personality disorders with a high level of impulsivity or lack of remorse, such as antisocial personality disorder.

But the reality is that most people with personality disorders do not seek treatment and are not known to mental health providers.

It’s important to note that those with diagnosed serious mental illness, who are determined by a psychiatrist to be a serious risk of harm to themselves or others, already get admitted to acute or long-term inpatient care and are kept there until they are deemed not dangerous. Of course this happens only if they are brought in for psychiatric evaluation by others or law enforcement.

What are the facts?

Even among the 1% of the U.S. population with a diagnosis of schizophrenia, it is rare to find people who are a risk of harm to others or at risk of acting violently. Despite the widespread belief that a person with serious mental illness like bipolar disorder or schizophrenia can be dangerous, only 3% to 4% of all the violent acts committed in a given year in the U.S. are committed by people who have been diagnosed with commonly cited mental illness of schizophrenia, bipolar disorder or depression.

Also, these conditions are rather strongly associated with increased risk of suicide, not homicide. Furthermore, risk of violence among severely mentally ill declines in the absence of substance use. In other words, prevention and treatment of substance use can decrease the risk of violence in this population.

This shows a depressed man
As many as 1 in 5 people experience depression. The image is adapted from The Conversation news release.

Another fact to consider is that the prevalence of severe mental illnesses, is relatively similar across different countries, including those with much lower rates of mass murder than the U.S.

Finally, one has to keep in mind that the presence of a psychiatric diagnosis in a murderer, does not necessarily justify causality, as much as the weapon the person carries. In other words, because mental illness is so prevalent, a percentage of crimes are, statistically, going to be committed by people with a mental illness.

Consequences of using ‘mental illness’ so vaguely

I have previously discussed the negative impact of involving mental illness in politics. Every time mental illness is linked to acts of violence by the media or politicians, the highly charged emotions of the moment can impact those with mental illness and their families.

When “mental illness” is so vaguely addressed in gun debates, those with a mental illness without an increased risk of violence or impairment in judgment (such as anxiety or phobia) may avoid seeking treatment. I have often had patients who were worried that their diagnosis of depression or anxiety, although well-treated, might be used against them in court regarding child custody. I have repeatedly had to explain to them that their disorder does not provide grounds for justification of impaired judgment.

I personally believe it is common sense to limit everyone’s access to weapons with the potential of killing tens of people in a matter of minutes. Choosing who may or may not have access to them based on mental illness is, as I’ve outlined, very hard indeed.

[divider]About this neuroscience research article[/divider]

Source:
The Conversation
Media Contacts:
Arash Javanbakht – The Conversation
Image Source:
The image is adapted from The Conversation news release.

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  1. It’s incredibly important that we keep digging into this connection or the lack thereof. For example:

    • Eric Harris age 17 (first on Zoloft then Luvox) and Dylan Klebold aged 18 (Columbine school shooting in Littleton, Colorado), killed 12 students and 1 teacher, and wounded 23 others, before killing themselves. Klebold’s medical records have never been made available to the public.

    • Jeff Weise, age 16, had been prescribed 60 mg/day of Prozac (three times the average starting dose for adults!) when he shot his grandfather, his grandfather’s girlfriend and many fellow students at Red Lake, Minnesota. He then shot himself. 10 dead, 12 wounded.

    • Cory Baadsgaard, age 16, Wahluke (Washington state) High School, was on Paxil (which caused him to have hallucinations) when he took a rifle to his high school and held 23 classmates hostage. He has no memory of the event.

    • Chris Fetters, age 13, killed his favorite aunt while taking Prozac.

    • Christopher Pittman, age 12, murdered both his grandparents while taking Zoloft.

    • Mathew Miller, age 13, hung himself in his bedroom closet after taking Zoloft for 6 days.

    • Kip Kinkel, age 15, (on Prozac and Ritalin) shot his parents while they slept then went to school and opened fire killing 2 classmates and injuring 22 shortly after beginning Prozac treatment.

    • Luke Woodham, age 16 (Prozac) killed his mother and then killed two students, wounding six others.

    • A boy in Pocatello, ID (Zoloft) in 1998 had a Zoloft-induced seizure that caused an armed stand off at his school.

    • Michael Carneal (Ritalin), age 14, opened fire on students at a high school prayer meeting in West Paducah, Kentucky. Three teenagers were killed, five others were wounded..

    • A young man in Huntsville, Alabama (Ritalin) went psychotic chopping up his parents with an ax and also killing one sibling and almost murdering another.

    • Andrew Golden, age 11, (Ritalin) and Mitchell Johnson, aged 14, (Ritalin) shot 15 people, killing four students, one teacher, and wounding 10 others.

    • TJ Solomon, age 15, (Ritalin) high school student in Conyers, Georgia opened fire on and wounded six of his class mates.

    • Rod Mathews, age 14, (Ritalin) beat a classmate to death with a bat.

    • James Wilson, age 19, (various psychiatric drugs) from Breenwood, South Carolina, took a .22 caliber revolver into an elementary school killing two young girls, and wounding seven other children and two teachers.

    • Elizabeth Bush, age 13, (Paxil) was responsible for a school shooting in Pennsylvania

    • Jason Hoffman (Effexor and Celexa) – school shooting in El Cajon, California

    • Jarred Viktor, age 15, (Paxil), after five days on Paxil he stabbed his grandmother 61 times.

    • Chris Shanahan, age 15 (Paxil) in Rigby, ID who out of the blue killed a woman.

    • Jeff Franklin (Prozac and Ritalin), Huntsville, AL, killed his parents as they came home from work using a sledge hammer, hatchet, butcher knife and mechanic’s file, then attacked his younger brothers and sister.

    • Neal Furrow (Prozac) in LA Jewish school shooting reported to have been court-ordered to be on Prozac along with several other medications.

    • Kevin Rider, age 14, was withdrawing from Prozac when he died from a gunshot wound to his head. Initially it was ruled a suicide, but two years later, the investigation into his death was opened as a possible homicide. The prime suspect, also age 14, had been taking Zoloft and other SSRI antidepressants.

    • Alex Kim, age 13, hung himself shortly after his Lexapro prescription had been doubled.

    • Diane Routhier was prescribed Welbutrin for gallstone problems. Six days later, after suffering many adverse effects of the drug, she shot herself.

    • Billy Willkomm, an accomplished wrestler and a University of Florida student, was prescribed Prozac at the age of 17. His family found him dead of suicide – hanging from a tall ladder at the family’s Gulf Shore Boulevard home in July 2002.

    • Kara Jaye Anne Fuller-Otter, age 12, was on Paxil when she hung herself from a hook in her closet. Kara’s parents said “…. the damn doctor wouldn’t take her off it and I asked him to when we went in on the second visit. I told him I thought she was having some sort of reaction to Paxil…”)

    • Gareth Christian, Vancouver, age 18, was on Paxil when he committed suicide in 2002, (Gareth’s father could not accept his son’s death and killed himself.)

    • Julie Woodward, age 17, was on Zoloft when she hung herself in her family’s detached garage.

    • Matthew Miller was 13 when he saw a psychiatrist because he was having difficulty at school. The psychiatrist gave him samples of Zoloft. Seven days later his mother found him dead, hanging by a belt from a laundry hook in his closet.

    • Kurt Danysh, age 18, and on Prozac, killed his father with a shotgun. He is now behind prison bars, and writes letters, trying to warn the world that SSRI drugs can kill.

    • Woody __, age 37, committed suicide while in his 5th week of taking Zoloft. Shortly before his death his physician suggested doubling the dose of the drug. He had seen his physician only for insomnia. He had never been depressed, nor did he have any history of any mental illness symptoms.

    • A boy from Houston, age 10, shot and killed his father after his Prozac dosage was increased.

    • Hammad Memon, age 15, shot and killed a fellow middle school student. He had been diagnosed with ADHD and depression and was taking Zoloft and “other drugs for the conditions.”

    • Matti Saari, a 22-year-old culinary student, shot and killed 9 students and a teacher, and wounded another student, before killing himself. Saari was taking an SSRI and a benzodiazapine.

    • Steven Kazmierczak, age 27, shot and killed five people and wounded 21 others before killing himself in a Northern Illinois University auditorium. According to his girlfriend, he had recently been taking Prozac, Xanax and Ambien. Toxicology results showed that he still had trace amounts of Xanax in his system.

    • Finnish gunman Pekka-Eric Auvinen, age 18, had been taking antidepressants before he killed eight people and wounded a dozen more at Jokela High School – then he committed suicide.

    • Asa Coon from Cleveland, age 14, shot and wounded four before taking his own life. Court records show Coon was on Trazodone.

    • Jon Romano, age 16, on medication for depression, fired a shotgun at a teacher in his New York high school.

    It’s also important to realize that the gun is no more to blame for the actions of a homicidal maniac than the fork is to blame for an obese person’s weight. Both are inert tools that have been used for both good and bad throughout the ages. It’s 100% the person using them who is responsible for the actions performed with them.

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