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By all means, let’s keep making progress on the prevention and treatment of mental illness. But let’s not kid ourselves. Mass gun violence is its own malady.
In addressing the spate of mass shootings, President Trump and the gun lobby have tried to deflect attention from our gun-crazy society and lax gun laws to the issue of mental health. After the El Paso Walmart killings, President Trump referred to mass shooters as “mentally ill monsters.” While this ploy may help bring needed resources to prevention and treatment of mental illness, it's a totally bogus story when it comes to explaining mass gun murder.
If you think about what has changed in the past several decades, there is no evidence that mental illness is on the rise. And other rates of violent crime have been declining for decades.
Rather, four things have changed, three of them having to do with guns. First, gun control laws are weaker; second, military-style weapons are more lethal and readily available; and third, magazines can carry more rounds of ammunition so that a killer can pull the trigger and just keep shooting.
One other thing has changed. The president of the United States identifies with violence and hatred.
On the mental health front, there is actually good news. Not only is serious mental illness more treatable and preventable than ever, but studies show little correlation between mental illness and mass shootings.
Dr. Richard A. Friedman, writing in The New York Times, summarized the major studies. One comprehensive piece of research found that some 80 percent of mass killers had no diagnosable mental illness. An FBI study found that just 5 percent of mass shooters could be considered psychotic.
A better diagnosis would be that they are haters. Were military-style guns not available, they could go right on hating, but not killing.
Stand-your-ground laws, meanwhile, make it all too easy for people to gun each other down in fits of rage over parking spaces. Without guns, they might scream at each other and resort to fists.
Modern life has far too much stress from multiple sources—the stress of not being able to earn a decent living; the stress of figuring out how to juggle kids and work; the stress of navigating an intimate relationship. But most stress isn't serious mental illness though it can indeed trigger violence.
Meanwhile, advances in the early diagnosis and treatment of mental illness are remarkable. One of the most impressive is the Portland Identification and Early Referral (PIER) program pioneered by psychiatrist William McFarlane in Maine in 2000, and now extended to several cities and states. (Disclosure: Dr. McFarlane is a cherished friend.)
The basic clinical insight of PIER is that if incipient major mental illness can be detected early, then young people at risk of a psychotic break can be spared that trauma and go on to live a normal life. PIER researchers found that it was the psychotic break more than the underlying risk of illness that was life-destroying.
After PIER was instituted in Portland, the incidence of major mental illness declined by 34 percent between 2001 and 2007.
The federal Substance Abuse and Mental Health Administration is now funding preventive services based on the PIER model in 21 locations across the country.
The strategy enjoys bipartisan support because Democrats think it's humane policy, and Republicans like the distraction from gun control.
By all means, let's keep making progress on the prevention and treatment of mental illness. But let's not kid ourselves. Mass gun violence is its own malady. It will decline only when we get serious about banning military weapons—and ending the preaching of hatred from the Hater-in-Chief in the Oval Office.
