Whatever went wrong with Virginia’s gun background check system or the Navy security protocols or the neurons in Aaron Alexis’s delusional and angry brain, none of that matters now to the 12 souls who were tragically killed on Sept. 16, 2013. They are gone. They don’t care about balancing gun rights and public safety. They don’t care about Thanksgiving this November. They won’t be there.
Heartbroken family members of the victims of the Navy Yard shooting do care, and so should the rest of us. But we should also care about the 85 other people who were shot to death the same day in the United States – and the 85 who are shot every day, many by their own hand – according to Centers for Disease Control and Prevention data.
Why is this happening?
Dr. Jeffrey Swanson
The root causes of our national gun violence epidemic are many and complex, but it seems easier these days to blame one thing: mental illness. After all, what person in their right mind massacres strangers?
In one news clip, Dr. Janis Orlowski, chief medical officer at Washington Hospital Center, told a TV anchor: "If we just had better mental health care in this country, you wouldn’t be interviewing trauma surgeons like me."
According to a national poll conducted earlier this year by Johns Hopkins Bloomberg School of Public Health, a majority of adults in the United States support increasing government spending on mental health screening and treatment as a strategy to reduce gun violence (N. Engl. J. Med. 2013;368:1077-81); National Rifle Association members and gun-control advocates agree on very little, but there is that.
Of course we need better mental health care in America. The public mental health system is a disaster in most states – fragmented, ineffective, overburdened, and underfunded. An estimated 3.5 million people with serious mental illnesses are going without treatment every year. But they are not the nub of the violence problem.
Mental disorder is responsible for about 4%-5% of violent incidents in the United States. If we cured schizophrenia, bipolar disorder, and major depression overnight, 95% of violent acts toward others would still occur. A person with mental illness is far more likely to be a victim of violence rather than a perpetrator.
When we include suicide as part of the gun violence epidemic, mental illness is a much stronger causal factor. Suicides account for 61% of all firearm fatalities in the United States – 19,393 of the 31,672 gun deaths reported by the CDC in 2010. Suicide is the third-leading cause of death in Americans aged 15-24 years, perhaps not coincidentally the age group when young people go off to college, join the military, and experience a first episode of major mental illness if it’s bound to happen.
More than half of suicides involve guns, and most victims had identified mental health problems and a history of some treatment. "How did they get a gun?" is an important question to answer. "Where was the treatment, and why did it fail?" might be even more important.
Suicide attempts with a gun almost invariably succeed, because they are almost always aimed at the brain at close range, and there is seldom anyone around to call 911. In contrast, the majority of victims of other-directed firearm violence survive. They are often disadvantaged young people left to struggle with lifelong disabilities in places where hope runs thin. The burden of their care and lost productivity are a big part of the $170 billion price tag for gun violence in America.
How about profiling mass shooters – can we thwart the next mass shooting? Profiling multiple-casualty killers is not difficult. Predicting them in advance is almost impossible. Most of them are young and male. They tend to be angry and socially isolated. Some of them have delusional beliefs. Some use illicit drugs, drink too much alcohol, play violent video games, and are preoccupied with weapons. Should we round up all the angry young men who fit this description? Lock them up and treat them?
The problem with that strategy is that the description also applies to tens of thousands of young men in America who would never perpetrate a mass shooting in a million years.
Dr. Marvin Swartz
Could the problem have something to do with unregulated guns? The average crime rate in the United States over the past 50 years is very similar to that of Canada, the United Kingdom, and most Western European countries. But our homicide rate is several times higher than the average homicide rate in those countries. We don’t have an exceptional crime problem in America. We do have an exceptional murder problem. The reason for that, in part, is that we have approximately 310 million firearms in private hands in the United States. Lots of people in other countries get angry and hurt each other and commit crimes, too. But here, we do it with guns; more people die.