The first article of this series, “Connecticut: The Storm Fizzles, Part I,” was posted two weeks ago. The second part, Connecticut: The Storm Fizzles, Part 2was posted last week. The Sandy Hook Advisory Commission’s report that is the basis for these articles is available here. This final article of the series discusses the final portion of the mental health section of the Commission’s report, wherein we learn that mentally ill people aren’t violent, but put a gun anywhere near a sane person, and “gun violence” is going to ensue. And as we learned in the last article, mental health professionals not only can’t predict who is going to do violence, they can’t be blamed for not being able to do that.
A substantial portion of the mental heath section is devoted to the idea that stigmatizing mental health issues must be eradicated because it causes virtually every problem imaginable, and many not. Consider this bit of neophyte psychoanalysis:
Although it is unclear exactly what role stigma played in the Lanza household, it seems likely that the stigma attached to mental illness and the behavioral health system affected the family‘s choices and internal dynamics as well as its interactions with the community. Stigma may have informed his mother‘s decision to withdraw A.L. from treatment at Yale. Stigma almost certainly contributed to the isolation that both experienced. According to the recent report issuing from the Office of the Child Advocate, Ms. Lanza may have both overestimated and underestimated her son‘s social, emotional, and behavioral health challenges. On the one hand she created and perfected what the Yale Child Study Center‘s evaluating psychiatrist dubbed a ―prosthetic environment‖ that unwittingly undermined her son‘s healthy development and enabled his progressive alienation from the community of his peers. Ultimately he became so isolated that he eschewed live human contact altogether. On the other hand, she may have failed to appreciate the full and increasingly alarming extent of his social and emotional impairments. Out of concern for his welfare she narrowed her own world dramatically to accommodate her son, thereby cutting both of them off from potential support structures. The stress and shame of parenting a deeply troubled child may have made it impossible for Ms. Lanza to ask for help in those final years. Nothing in the record before the Commission suggests that offers of assistance were forthcoming. Pervasive stigma compounds the stress and shame that many families experience, and this experience may encourage family members to retreat still further from potential social supports. The Child Advocate‘s report notes emphatically that stigma can impede the sort of successful family engagement strategies that are critical to the effective care and support of children with emotional, developmental and behavioral challenges.
Notice the weasel words. It’s unclear what–if any–role stigma played in the Sandy Hook killer’s family, but it seems likely it did. somehow or other, just, you know, because. Stigma may have caused this or influenced that. “Stigma almost certainly contributed to the isolation that both experienced.” And how do we know? Because the Child Advocate report suggested that the killer’s mother “may have both overestimated and underestimated her son‘s social, emotional, and behavioral health challenges.” She may have been a three headed alien from the Crab Nebula, but we don’t know that either.
So stigma may have had some role in Sandy Hook; there is no actual evidence of it. But the Commission is sure it may have.
Considering the report’s overall approach to firearm ownership, this might seem an odd inclusion:
In addition to exacerbating negative attitudes toward people with psychiatric illnesses, media coverage that places mental illness at the center of debates over gun control may irresponsibly distort the issues by suggesting that access to firearms by individuals with mental illness constitutes a significant factor in overall rates of gun violence [p. 143].
However, this observation is made in the context that irresponsible media stories stigmatize mental illness, relegating gun ownership to a secondary, distracting issue.
The Commission spent considerable space, in by far the largest portion of the report, speaking to their worry that people might link mental illness with societal violence:
No significant correlation exists between most psychiatric illness per se and violence, including gun violence, in our culture. This is true even for severe psychiatric disorders, such as bipolar disorder and major depression [p. 167].
Yet it is impossible to avoid talking about the mental health implications of tragedies such as the Newtown shootings for a number of reasons. Despite the widespread assumption that anyone who could commit an act like this must be mentally ill, reviews of mass murders committed over the past three decades suggest that many perpetrators would not qualify for a diagnosable mental illness [p. 168].
But leading studies clearly suggest that, under most circumstances, people living with mental illness are no more violent than the general public. Such studies repeatedly find that a mental illness diagnosis is a weak predictor of violent acts, defined broadly to include hitting, throwing objects and engaging in physical fights as well as using weapons. A diagnosis such as depression, anxiety, bipolar disorder, or schizophrenia alone tells us almost nothing about a person‘s likelihood of committing acts of violence toward others. For psychiatric patients who are not currently psychotic, there is most likely no more risk of violence than for the average person [p. 170].
OK, so we can’t blame mentally ill people for violence because they’re really, really not violent, honest. But how do guns figure into this? After all, the Commissions wants substantial bans and restrictions. You won’t be disappointed, and you knew this was coming all along, didn’t you?
We also know that rates of gun violence in general, and particularly gun fatalities, correlate strongly with higher rates of gun ownership. Whereas the United States has both extremely high rates of gun ownership and high rates of firearm-related deaths, Japan and the United Kingdom have very low gun ownership rates and correspondingly low rates of gun-related deaths. In a recent study evaluating the relationship between rates of gun ownership and deaths by firearms across twenty-seven developed countries, researchers found ‘a significant positive correlation between guns per capita per country and the rate of firearm related deaths, with Japan being on one end of the spectrum and the US being on the other.’ Their statistical analysis identified a far weaker correlation between rates of mental illness – estimated by looking at major depressive disorder – and gun deaths, and no significant correlation at all between rates of mental illness and general crime [p. 173].
The Commission would have us believe that there is virtually no correlation between mental illness–human belief, thinking and action–and deadly violence, but the mere presence of guns–inanimate objects–is another story. Keep in mind several facts: correlation is not causation. It merely indicates two trends–if reported correctly–appear to be moving in the same general direction. Most people die in bed, therefore there is a high correlation with mattresses and death, but only an idiot would imagine that means anything more than that most people are lying down when they die, and most people prefer to lie down on a bed.
Comparing firearm issues across societies is a matter of comparing apples and elephants. There is no way to do it accurately. Despite having more firearms in private hands than at any time in history, overall violence and accidents involving guns are at all time lows in America. There are few Swiss homes where fully automatic, government issued military arms and ammunition are not present, yet crime involving those firearms is rare. The Japanese and British have truly draconian gun laws, but criminals have no difficulty obtaining guns and other weapons. And the Commission is wrong. As John Lott has conclusively proved, more guns to do not lead to more crime, quite the opposite. Traditionally Democrat-controlled cities across America such as Chicago and Detroit, which essentially disarm the law-abiding, have enormous rates of criminal violence involving guns.
Firearms have no magical power to compel people to misuse them, yet this is exactly the Commission’s implication:
As the Child Advocate‘s report observed, ―[t]he conclusion that access to guns drives shooting episodes far more than the presence of mental illness is inescapable [pp. 172-173].
The report packages 20/20 hindsight, marketing it as a predictive virtue:
A person‘s prior history of violence is the best predictor of future episodes, and each additional episode enhances the predictability of the next one. Measures that ensure earlier treatment of psychosis and continued treatment in the community would likely prevent at least some violent acts [p. 180].
And for that they went to medical school? The more often people are violent, the more likely they are to be violent in the future? Brilliant deduction, Sherlock! Obviously, treatment of such people might help to prevent future violence, but people who are obviously, repeatedly violent tend to be pretty–obvious.
And what’s the point? The Commission is making the point, repeatedly, that mental health professionals can’t be blamed for not identifying mass shooters before they start shooting. Despite all the recommendations for hugely intrusive laws and policies, and treatment and bureaucracies and the increases in taxes and government power that would entail, they know–and there were a number of mental health professionals on the Commission–they can’t predict or prevent mass shooters. And they make that plain:
Mass fatality incidents such as those that have occurred over the past few years in Newtown, Aurora, Tucson, the Washington Navy Yard, Fort Hood, TX, and – most recently – Isla Vista, CA remain extremely rare, despite their prominence in the media. Although their incidence appears to have increased in the past several years, such events still account for only one-tenth of 1% of all firearm-related homicides in the United States [p. 181].
Yet the reality is that mental health professionals are ill-equipped to make specific predictions of violence with any accuracy. Such predictions differ from assessments of risk that equate with the general condition of ―dangerousness‖ (being at significantly higher risk than the norm).
According to Dr. Michael Norko, Director of Forensic Services at Connecticut‘s DMHAS and Associate Professor in Yale‘s Department of Psychiatry, ‘[w]e can determine current dangerousness reasonably well, for clinical purposes, when the danger is due to psychiatric conditions.’ (Norko, M. (April 12, 2013). Testimony to the Sandy Hook Advisory Commission.) In other words, clinicians are skilled at identifying which patients currently pose a danger to themselves or to others and at devising ways to manage risks related to psychiatric conditions. But testimony before the Commission from forensic psychiatrists and others makes clear that no one has yet devised a reliable method for predicting future violence – who will and will not be violent, when violence will occur, or what the targets of that violence might be [pp. 181-182].
So it was the Sandy Hook shooter, who showed no prior signs of violence, who was not violent, who had no police record, and who had substantial mental health treatment opportunities, who could not have been identified as a danger, despite the recommendations of the Commission, recommendations that will require huge amounts of money, the establishment of enormous mental health bureaucracies, and massive intrusion into the lives of citizens. This is what the report suggests, yet it appears to contradict itself:
The Commission heard testimony from law enforcement officials and others, including an expert school security consultant who worked for the United States Secret Service, suggesting that profiling tends to be inaccurate and far more likely to create stigma than to avert harm. An influential report compiled by the Secret Service in collaboration with the U.S. Department of Education on school shootings carried out between 1974 and 2000 specifically determined that ‘[t]here is no accurate or useful profile of students who engaged in targeted school violence [pp. 182-183].
The Commission’s report tells us essentially nothing useful. We have no way of profiling potential school shooters. Mentally ill people aren’t violent, but if people have a record of violence in the past, they might be violent in the future. Even so, mental health professionals can’t predict who is going to be violent, and can’t be held responsible for that inability.
So. What are the Commission’s recommendations, apart from spending wheelbarrows full of cash on security measures, mental health programs and intrusive bureaucracies they admit can’t work? They recommend banning and restricting guns in ways that would have had no effect on the killer at Sandy Hook or elsewhere. They recommend harassing and annoying the law-abiding, people who are a danger to no one.
All of that work and energy and–I’m giving them the benefit of the doubt–good intentions, and that’s the best they can do, because not one of them, despite their degrees and qualifications and intellects were smart enough to ask and answer one simple question: what do we do, when all the programs, the caring, the bureaucracies and feel good measures have failed? What do we do when a gunman is shooting his way into a school? How do we save the lives of the children and staff?
We save those innocent lives by allowing willing teachers and staff to be armed with concealed handguns. We provide training. We widely publicize the fact that the schools are no longer victim disarmament zones, and that any attempt to harm children will be met with gunfire.
I could have told them that. I guess I just did.