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Gun violence and mental health

http://www.vox.com/policy-and-politics/2015/12/4/9845434/tim-murphy-mental-health-bill-mass-shootings
The link is to a piece describing what appears to be a bipartisan bill to help mental health as one route to reducing America’s unique culture of gun deaths. In a moment I’ll reflect on some of the mental health issues involved. As a preface, though, I’ll note that funding for research on gun violence has been blocked for a long while, so we are working in the dark more than I would like. And remember the human tendency to lock on to one cause out of many. Whatever we focus on as the cause of gun death is only going to be part of the picture.
One other caveat. The huge, huge, huge majority of people with psychological disorders will not engage in gun violence. When someone such as the Virginia Tech shooter commits an atrocity it is easy to generalize from him to those with disorders in general. Don’t. The base rate of gun violence, while too high, is still tiny relative to the base rate of psychological disorder. What’s the likelihood that you had a meal yesterday if you were the president? What’s the likelihood that you were the president if you had a meal yesterday? Those two likelihoods are very different. So…even if we knew the likelihood that someone who committed a gun atrocity had psychological disorder we would not know the likelihood that someone with a psychological disorder will commit a gun atrocity. Folks with disorders are among the most stigmatized. They have some of the fewest resources to deal with stigma. Just don’t go there.
OK. Throat cleared.
Back in the 60’s laws were passed to deinstitutionalize those with disorders. Prior to that many, many more were treated in places far from home. That’s often not a great idea, so it made sense to instead have them treated in their communities. It would also in principle save money, since they could live at home. And we all like to save money. Two (of many) problems with this. First, deinstitutionalization was done on a massive scale when it would have been better to do it with pilot tests to find the glitches. This is a good case study for those of us who are more liberal–often there are unintended consequences of our well-intentioned ideas. It’s a really good idea to be very wary of these and to work hard to find them before we act. Second, money was supposed to be spent on community mental health centers to replace the more expensive in-patient facilities. But the system never came close to being fully funded. And Reagan did a chunk of his deficit reduction by gutting what little funding there was. There is good evidence that deaths rose as a result, including for the many Vietnam vets who ended up homeless. This is also a lesson for those who want to cut funding in some way. That funding has existed in a system. If you get rid of the old inefficient system it is quite possible that a new system will not come into being. No one wants to spend money. Consider the consequences of your spending cuts. There is no free lunch, including no free spending cut.
Bottom line–there are a lot of people with psychological disorders and without the resources to receive decent treatment. Rates of schizophrenia, addiction, severe depression, and the like are sufficient that you probably know someone, and likely someone you love, who has such problems. You, my friends, are among the wealthy–you have computers for instance. If not for the support of you, your family, that person’s family what would those you know with severe disorders do? OK, now reflect on the many for whom there is no support system. What sort of despair would they experience? What sort of anger? Imagine that they are remarkably virtuous. 99% never act out of the despair or anger. Imagine the other 1% are nearly as virtuous. They resist the temptation for years, but one day they snap. Perhaps you can think of the time that you have snapped the worst in your life, likely with far, far less provocation and much more support than the most isolated and impoverished. How many will die as a result of the snaps of those hardest pressed?
For the most part this will result only in the death of the person suffering. Suicide by gun is common, and more lethal than by many means. (I’ve seen the argument that people who want to kill will do so. Sometimes, sure, but often not. Often killing is done impulsively, and having easy and lethal means makes it much easier to act on the impulse. But I’ll not digress further into gun control and safe gun practices.) But sometimes the despairing and angry will kill others too.
Perhaps we could do something about that?
The proposed bill seems like a small step in that direction. The keys to improvement, in general, would seem to me to be providing easy access to treatment, reducing the stigma for seeking treatment, and improving treatment.
This will cost money. Many of the most in need do not have money for treatment because they have the problems that provoke the need. The scope of the problem dwarfs the ability of charitable organizations to handle it. Government spending seems the only approach that could be sufficient to the task of sufficiently expanding treatment.
It would help to spend money on effective treatments. Pharmaceutical companies do spend money, because they can turn a profit on the research. But many routes to treatment are difficulty to patent, so turn a profit. And these receive little research unless the government spends. And federal spending on treatment has drifted to a biological approach, reinforcing the trends of the for-profit folks. So this is a challenging issue in current times.
More access to treatment and more research on effective treatment are fairly direct steps to alleviating mental health issues and thereby to alleviate the gun violence that sometimes, if rarely, arises from mental health issues. I’m going to mention three other more distal steps.
First, can we ease the worst fiscal fears of our poorest? How much despair comes from working incessantly while on the brink, perhaps also afraid for the possibility one would no longer be able to care for one’s children?
Second, can we simply accompany others more? How much despair arises from loneliness, from thinking others have no time or patience or understanding for us? How much more true is this for those who are already struggling? How much can the odd and troubling ideas take root if we are alone?
Third, can we shift our perspective of what gives humans value? How much despair and anger arises from the sense that we have been deemed not worthy, that we have been dismissed as inferior? That can only happen if we have a view of human worth that is conditional. That people only matter if they are smart enough, wealthy enough, kind enough, thin enough, coherent enough, possessing the same religion, race, nationality, sexual orientation, gender identity, politics as us or some other. What would happen if we reflected on our own worth and concluded it was inherent in our existence? Perhaps the thought that we are worthwhile because we breathe? For the religious, perhaps the thought that we are worthwhile because the God that we worship loves us just as that Deity loves the person whom we most loathe? If we were to believe that might we not treat others somewhat differently, as no better nor worse in the most important sense than we are? And how might they react? How much despair and alienation would recede? It’s likely particularly hard to do this when we are so often dismissed by others. Nonetheless.
Perhaps our gun atrocity problems can serve as an opportunity to reflect on how our American culture has gone wrong psychologically, looking for worth in the wrong places. Perhaps it can serve as an opportunity also to reflect on those most in need and to ask whether we collectively can do something about it.
To my eye the gun violence that shows up in the US is only a symptom, albeit a terrible one, of something much larger.

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