Map of life expectancy at birth from Global Education Project.

Saturday, May 28, 2022

Mental Ilness

Among all the ridiculous deflections, excuses, and illogic Republicans use to repel any suggestion that there should be gun safety legislation, one of the most plausible sounding is that a causal factor in firearm violence is mental illness. Of course, they don't actually support increasing funding for behavioral health care or addressing social determinants of mental illness, so it's just hypocrisy. However, it is also not so plausible after all.


A common estimate is that about 20% of the population has a diagnosable mental illness, and it is also estimated that the prevalence in mass shooters is similar. But the concept of mental illness is pretty muddled anyway. Officially, a "mental illness" is an entity described in a book called the DSM-5, which originally stood for Diagnostic and Statistical Manual but it doesn't really have statistics and nobody calls it that any more. For the vast majority of these entities, however, determining whether somebody has THE DISEASE is purely a matter of judgment, based on subjective criteria. Two diagnosticians confronted with the same subject will often make different diagnoses, and the same person may have changing diagnoses over time. It is entirely possible for two people to have the same diagnosis who have no symptoms in common, and in fact who have opposite symptoms -- e.g. insomnia/excessive sleep, hyperactivity/lethargy. The dirty secret is that psychiatrists have no idea what specifically is going on in the brain that might correspond to the diagnoses they make, and they have no idea how the drugs they prescribe work, to the extent they do at all.


You might say that anybody who commits mass murder is mentally ill, because their behavior is markedly abnormal, and as far as I'm concerned that's a reasonable position. However, it is also useless, because it's tautological. There is no way to predict who will commit these acts, and it's probably as much a function of their social environment and immediate experiences as it is baseline facts about their brains. For example, racially motivated mass murders require a social environment of racism as well as whatever is "the matter" with the perpetrator.


However, whether you want to call it a specific disease or not, there are a lot of people in chronic emotional distress, and people who have difficult regulating their behavior so they can live successfully, and these largely (although not entirely) overlap. They can benefit from counseling, and in some cases empirical use of medications (although probably not as many cases as there are prescriptions), and even more from supportive social environments. There are investments we can make that will help. Whether these will result in fewer mass shootings, however, is highly speculative.

5 comments:

Don Quixote said...

There is absolutely no justification for 18-year-olds to be able to buy guns. They can't have a beer legally, after all ...

There needs to be a permanent ban on weapons that can be used as automatics, and a ban on automatic weapons.

Cervantes said...

I think to be precise you mean semi-automatic weapons. It is currently illegal in the U.S. to manufacture or import fully automatic weapons, although existing ones are grandfathered in. It is not actually difficult to illegally convert a semi-automatic, but it isn't really necessary. Semi-automatic weapons are perfectly adequate for mass murder, and there is no reason why civilians should be allowed to own them.

Innocent Bystander said...

In Australia, a forced ban and confiscation of guns happened. A 2016 JAMA study on the matter found no statistically significant change in the trend of the country’s firearm homicide rate following the law’s passage. The authors also noted that the decline in firearm suicides post-ban could not clearly be attributed to gun control since non-firearm suicides fell by an even greater magnitude.

https://jamanetwork.com/journals/jama/fullarticle/2530362

Following enactment of gun law reforms in Australia in 1996, there were no mass firearm killings through May 2016. There was a more rapid decline in firearm deaths between 1997 and 2013 compared with before 1997 but also a decline in total nonfirearm suicide and homicide deaths of a greater magnitude. Because of this, it is not possible to determine whether the change in firearm deaths can be attributed to the gun law reforms.



Cervantes said...

You have selected a single study out of a multitude of analyses that have been done on this subject. This study makes a very conservative conclusion, because it is indeed very difficult to draw causal inferences from an interrupted time series analysis, which is what this is technically called. The results are consistent with the claim that the gun law reforms contributed to reduced firearm deaths but it isn't considered proven. That a similar action in England had the same result, however, does greatly increase our confidence in the causal inference. Most important, cross sectionally there is a strong correlation between national prevalence of gun ownership and gun injuries and deaths. However, if you actually read my post I am saying that there is also a more complicated story.

Innocent Bystander said...

I would turn to economists to straighten this out and not three guys in the public health and psychology arena, who have admitted, have no real evidence. That was the point. There is no evidence.

So, how much did the Gun Control Act of 1968 reduce homicides? How'd the 1994 assault weapons and large capacity magazines ban help?

The mistake here is by focusing only on the weapons used myopically misses the real problem of homicide rates. While over the years, more and more gun control laws were enacted and, at the same time, homicide rates increased. Does this echo the War on Drugs where more laws didn't do jack squat?

Focusing on the weapons only might actually be detrimental by taking attention away from the bigger picture.