Map of life expectancy at birth from Global Education Project.

Tuesday, June 17, 2014

More on gun violence

Lawrence Gostin, writing for the JAMA forum, makes many of the same points I did recently about the framing of gun violence as a mental health issue. Sure, most mass shooters have diagnosable mental illness but a) most mentally ill people are not violent, b) most gun violence is not mass murder (in fact it's only a tiny fraction), and c) the only good predictor of future violence is past violence. To remind us:

Although most mass killers are mentally ill, only a small minority of persons with mental illness is violent. Overall, only about 4% to 5% of overall violent crime can be attributed to persons with mental illness. At the same time, it is exceedingly difficult to predict violence based on a psychiatric diagnosis: psychiatrists’ predictions of violence are no better than chance. It is true that mental illness can be a risk factor for violence, but often only with comorbidities, such as alcohol or drug abuse. The latter are far more powerful predictors of violence than the diagnosis of mental illness. Still more powerful is a history of violence, particularly threatening or using a lethal weapon such as a firearm.
Like I said. Nevertheless, Gostin still wants to tighten the background check system so that people who have been committed to a mental institution can't buy guns easily. I'm not even sure what he means by that -- if you've ever been committed, you should lose your rights for life? If you're currently committed, you can't buy a gun anyway. Anyway, civil commitment is a somewhat arbitrary process and there is no evidence, certainly none that Gostin provides, that it is predictive of violence. After all, if psychiatrists' predictions of violence are no better than chance, why should their decisions to have people committed as a danger to themselves or others get any respect? His proposal is transparently self-contradictory.

He goes on to propose that people with a history of violence be banned from gun ownership. That makes more sense, but I despair of it working. The country is so awash in firearms that it is easy to obtain them illegally, and people who have been convicted of violent crimes do not have a proclivity to obey the law.

The only hope, it seems to me, is cultural change. People need to understand that guns are dangerous; having them around makes you far more likely to kill yourself or inadvertently kill someone you wish you hadn't than it makes you likely to somehow defend yourself; and the more guns there are in the environment, the more violent death there will be. Make it the cultural norm, what the cool people do, that if you have some good reason to won a gun, keep it locked in a safe and only take it out when you want to hunt or shoot at paper cutouts of Barack Obama or Trayvon Martin. Require licensing of gun owners based on taking safety training and passing a test, and registration of guns, just like motor vehicles. But saying Joe is allowed to buy a gun and Fred is not, just isn't workable.

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