Welcome to Autism and The Human. I’m Limbic Noodle. This week I will be talking about gun violence and mental illness. I encourage you to take care of yourself first if you don’t have the spoons to listen at this time. There are so many things I would like to say to you about mental illness and gun violence. I have too much to say and will have to leave much of it unspoken if I hope to make at least one coherent point. I want to talk to you about why mentally ill people are seen as threats to social safety, how media and politicians reinforce this misconception, and how it is acted upon to put the rights of disabled people at risk. I wish to talk about how mental illness has been proposed as a method of predicting gun violence and how these proposals further put the rights of disabled people at risk without offering any legitimate increase in social safety. I want to remind listeners that I use identity-first language. That is why you will hear me say “Mentally Ill People” rather than “People With Mental Illness” or “Autistic” rather than “Person With Autism.” I have explained my choice to use Identity First Language in previous episodes. If you wish to hear my reasons, I suggest you go back and listen to episodes one and two before you proceed to listen to today’s episode.
With that, I would like to get into it.
Last week I told you I felt strange, as a Canadian, talking about the gun violence that is a never-ending part of the American news cycle. At that point, I thought Uvalde would be the freshest example of senseless slaughter. Of course, it did occur to me that there could easily be more incidents in a week. I’ve stopped approaching these events as if they will be the only ones in an extended period, the worst, or the last. There no longer is a single place in the United States of America where I would be shocked to find out something like this happened. There’s no event I think above being marred by an event like this. As an outsider looking in, nothing and nowhere is left in that country that feels safe. I’m not suggesting mass casualty events haven’t or couldn’t happen in Canada. I’m also not saying these things to insult people who are already injured. I have nothing but sympathy for what Americans are enduring, being held hostage by a minority who value the right to have guns more than people’s ability to feel safe in their communities, country, and homes. As an outsider, I might typically leave the speaking on this subject to other people. However, I can’t stand by and say nothing while mentally ill people are scapegoated for a problem that starts and ends with guns.
Each year there are approximately 32,000 people killed by guns in the United States of America. For perspective, there were 155 gun homicides in Canada in 2014, 179 in 2015, 233 in 2016, 267 in 2017 and 249 in 2018. These numbers only account for firearm deaths that were deemed homicides. A statistic for 2020 puts the total gun deaths in Canada at 767. Unlike the previous statistic, this accounts for homicides, accidents and suicides. The 32,000 number for the United States of America needs similar dismantling into smaller categories of death. About 19,000 of these deaths are self-inflicted. There is no clear indication in the source material of how many of them might have been accidents. Jeffrey Swanson et al. presented these numbers in “Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy” (Swanson et al. 2015). They said an additional 74,000 are injured in nonfatal gun incidents yearly.
I have watched the increasing gun violence in the United States of America and the subsequent framing of the issue with alarm. The problem is often dichotomized into an argument about ‘Dangerous Guns versus Dangerous People.’ Even more alarming than this dichotomization is that it is starting to disappear, turning into ‘Dangerous guns AND Dangerous People.’ Don’t get me wrong: Anyone who takes a gun and shoots people is dangerous. The problem is that isn’t what is meant when people say “Dangerous Person.” They aren’t acknowledging the danger of putting these weapons in the hands of people, not knowing who among them are capable of this violence. It attempts to create a class of persons separate from the rest of humanity that can be identified and labelled as “Dangerous.” It is a call to define what “Dangerous” looks like and create monitoring systems for these “Kinds of People.” This describing and segregating process seems to always begin with mentally ill people.
“Mental Illness” is used so broadly as to lose meaning, made more apparent by experts such as Jeffrey Swanson seeming to spit in the face of the prevailing narratives about mental illness being causally linked to gun violence, when they are only stating facts. Swanson said, “If you look at the statistics, a small minority of even the mass shooters have one of the major mental disorders that impair the ability to regulate mood and perceive reality. The rest of them tend to be angry, isolated young men who marinate in hate and have access to this killing technology” (Spivey, 2022).
How experts like Swanson define mental illness and how the general public perceives it is not the same.
The disconnect comes from a natural inclination to believe, or maybe the better word is to hope, that most people are not capable of violence, especially not at the scale we’ve seen with these mass shooting events. Swanson said, “When mass shootings occur, people naturally think it must be at the hands of someone ‘not in their right mind.’…And that gets overgeneralized and reinforced in the media” (Pallarito, 2022).
Jonathan Metzl addresses three central assumptions in “Mental illness, gun violence, and (misguided) policy interventions.” These assumptions are that mental illness causes violence, psychiatric diagnosis can predict gun crime before it happens, and U.S. mass shootings teach us to fear mentally ill loners (Metzl, 2015). Metzl said that at the aggregate level, the idea that mental illness causes gun violence stigmatizes a diverse population of persons and oversimplifies links between gun violence and mental illness.
Metzl said, “Moreover, notions of mental illness that emerge in relation to gun violence frequently reflect larger cultural issues that become obscured when mass shootings come to stand in for all gun crime and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat…anxieties and gun violence are imbued with oft-unspoken anxieties about race, politics, and the unequal distribution of violence in American society” (Metzl, 2015).
Michael Stone, a forensic psychiatrist at the Columbia College of Physicians and Surgeons, wrote a book about the personalities of murderers. He said that a fifth of mass killers have a severe mental illness. Stone said, “The rest had personality or antisocial disorders or were disgruntled, jilted, humiliated, or full of intense rage” (Khazan, 2017).
I am sure some of you are thinking, “Yeah, but isn’t an antisocial disorder an extreme mental illness?” A criminologist from Northeastern University, James Alan Fox, said the data collected by Stanford Geospatial Center indicates 15 percent of indiscriminate mass shooters had a psychotic disorder, and 11 percent had paranoid schizophrenia (Khazan, 2017). The difference between what you might have asked yourself about why an antisocial disorder isn’t being called a serious mental illness and what Stone, Metzl, Swanson and others call severe mental illnesses demonstrates the disconnect between the general public’s perceptions and the knowledge of experts.
Khazan wrote of Fox, “After studying mass shooters for decades, he’s concluded that the killers have more mundane motivations: revenge, money, power, a sense of loyalty, and a desire to foment terror” (Khazan, 2017).
If revenge, money, power, a sense of loyalty, and a desire to foment terror were determined to be the top indicators of the potential for gun violence, how many of you would be eager to have the general public screened for gun violence potential using these indicators? Would people be calling for their name to be put on a list based on having expressed a desire for revenge on social media? I imagine people would be urging restraint.
As mentioned, Michael Stone maintains a database of people who have shot four or more people. Michael Rosenwald explains that Stone breaks mental illness into two categories. He said, “In the first category are those with schizophrenia, delusions, and other psychoses that separate them from reality and who are suffering from serious mental illness that could be helped with medical treatment. In the second are those with personality, antisocial or sociopathic disorders who may exhibit paranoia, callousness or a severe lack of empathy but know exactly what they are doing” (Rosenwald, 2016).
The press, politicians, and the general public conflate personality, antisocial or sociopathic disorders with serious mental illness. This isn’t always motivated by a calculated and callous desire to reinforce the pro-gun agenda. J. Reid Meloy said, “I think it’s the human inclination to explain behaviour that is frightening and tragic as the result of mental illness, because it’s hard to understand that individuals do not have to be mentally ill to do something frightening and tragic” (Rosenwald, 2016).
We can’t imagine someone being able to tell the difference between reality and fantasy or right and wrong and be able to choose to massacre people. Therefore, we decide that anything that makes a person different from the standard definition of “The Human” also makes you more likely to perpetrate violence. That doesn’t make us right. In the meantime, mentally ill people are stigmatized, demonized, and placed in danger.
It doesn’t help that the literature is inconsistent about how mental illness is defined. Konnikova (2014) said:
one has to start with the complexities of the term ‘mental illness.’ The technical definition includes any condition that appears in the Diagnostic and Statistical Manual of Mental Disorders, but the D.S.M. has changed with the culture; until the nineteen-eighties, homosexuality was listed in some form in the manual. Diagnostic criteria, to, may vary from state to state, hospital to hospital, and doctor to doctor. A diagnosis may change over time, too. Someone can be ill and then, later, be given a clean bill of health: mental illness is, in many cases, not a lifelong diagnosis, especially if it is being medicated. Conversely, someone may be ill but never diagnosed. What happens if the act of violence is the first diagnosable act? (Konnikova, 2014)
What alarms me about what Konnikova wrote above is that many mass shooters in the United States of America are being killed rather than arrested. This makes posthumous assumptions of mental illness pass without much challenge.
So what are some ways mental illness has been defined in academic literature? Silver and Teasdale (2005) used an approach where they stratified individuals by the severity of mental illness. Schizophrenia or major affective disorders were considered the most severe, while phobias, somatic, eating disorders, and panic were considered less severe.
Casiano et al. 2008 looked at mental illness in two ways. The first was to look at individual mental disorders such as depression, bipolar disorder, and PTSD. The second was to examine mental conditions such as mood, anxiety, and impulse disorders. They found that only PTSD was significantly associated with gun violence when looking at individual mental disorders, and only impulse control was significant when looking at categories (Lu & Temple, 2019).
Swanson et al. (2006) used the Diagnostic and Statistical Manual-III criteria to define mental illness. Swanson has said in many different sources in the works cited for this episode that most people with mental illness are not dangerous, and mental illness has no predictive significance for gun violence. Swanson has said that mentally ill people are far more likely to be the victims of violence than the perpetrators. Swanson did stipulate several circumstances that could negatively affect the likelihood of a mentally ill person committing gun violence but said these were the same aggravating factors for society as a whole (Konnikova, 2014)
This podcast is called Autism and The Human, and I will do my best to ensure every topic covered relates to autistic people. The subject of gun violence and mental illness is no exception. Autism is a diagnosis found in the Diagnostic and Statistic Manual. Autistic people also frequently have comorbidities such as depression, anxiety, panic, etc. To provide context for how many people would be affected by gun and personal rights restrictions being based on a D.S.M., I should point out that alcoholism also is a diagnosis in the Diagnostic and Statistical Manual. While many people might shrug their shoulders and quietly think that they are alright with authorities keeping a closer eye on autistic people, I have to wonder if those same people would feel that way about alcoholics. Would they think their name as an abuser of substances should appear on a list? Or if they have depression? Anxiety? Gambling addictions? An eating disorder? ADHD?
If you are thinking to yourself that most of those do not correlate with gun violence, what I am trying to tell you is that schizophrenia doesn’t either. Alcoholism has a more proven correlation to gun violence than schizophrenia.
The Autism Self Advocacy Network has contributed to the discourse around gun violence and mental illness. They have isolated some common themes and facts from the research. One echoes what I already said about Swanson’s findings, that after adjusting for aggravating circumstances that equally affect the public, mentally ill people are not significantly more likely to commit violent crimes than anyone else. They also found that alcoholism is a mental illness more likely to contribute to violent crimes than mental illnesses typically considered severe or dangerous. They found that people discharged from psychiatric facilities are not more likely to commit violent crimes than anyone else living in the neighbourhoods where they go to live. The statistics are very closely related, indicating that social factors are far more likely to affect the likelihood of committing violent crimes than mental illness. ASAN found that once you accounted for social factors that equally affected the general population, mentally ill people were at no higher risk of committing gun homicides or self-inflicted gun violence than anyone else.
Furthermore, ASAN stated that mentally ill people were far more likely to be killed by guns at the hands of law enforcement officials. A 2016 article entitled “The Counted” in The Guardian attempted to catalogue every shooting committed by law enforcement in the United States of America over a given period and found that one in six people killed by police had a mental disability (ASAN, n.d.). Another American newspaper, the Washington Post, recorded police-involved shootings from 2017 in a database. They found that 25% of the people who were shot by police that year had a mental disability. Finally, ASAN said, “The Ruderman Foundation hypothesized that 30-50% of people assaulted or killed by police officers have disabilities (particularly mental health disabilities), and that their disabilities are rarely mentioned in media reports of these incidents” (ASAN, n.d.).
This is particularly true for autistic black people. For example, there was the shooting death of Elijah McClain in Aurora, Colorado. “I’m just different,” he tried to tell the police before they shot him. Even black people close to autistic people are put in danger, as demonstrated by the police shooting of Charles Kinsey, who was a black caretaker of an autistic man. The behavior of Kinsey’s autistic client was what drew the negative attention of the police, but it was ultimately Kinsey’s black body the police deemed threatening.
ASAN (n.d.) said, “In general, according to the Bureau of Justice Statistics (BJS), people with any disability are 2.5 times more likely to be the victims of any crime than people without disabilities. They are also more likely to be the victims of violent crimes” (ASAN, n.d.). A 1999 study of people who had spent time in a psychiatric facility showed they had been victimized by violent crime at a rate of two and a half times more than the general population. A different study conducted using data collected from mental health agencies showed an even higher rate of victimization, at eleven times more likely (ASAN, n.d.)
Jeffrey Swanson has been part of foundational studies of mental illness and gun violence in homicide and suicide. In a paper titled “Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy,” Swanson et al. (2015) said that public perception of mental illness concerning gun violence is a huge obstacle to effective changes in policy being made. Swanson et al. (2015) said, “A 2013 national public opinion survey found that 46% of Americans believe that persons with serious mental illness were “far more dangerous than the general population.” Data from the 2006 General Social Survey suggest that Americans perceive persons with schizophrenia as particularly dangerous” (Swanson et al., 2015).
This perception has resulted in people desiring social distance from schizophrenic people. Swanson said public perceptions and attitudes towards mental illnesses are essential because people support public policies based on what they believe to be true. If they believe mentally ill people are more likely to commit violent crimes with guns, they will support public policy that seeks to restrict the liberties of mentally ill people (Swanson et al., 2015).
Empirical evidence of the relationship between violence and mental illness was limited before the 1990s. The first large-scale epidemiologic study on the matter was published in 1990. This was a study conducted by the National Institute of Mental Health Epidemiologic Catchment Area (ECA), which measured violence using an index of survey questions that asked about specific abusive behaviour concerning specific defined mental disorders found on the D.S.M. It had some fascinating insight into violent behaviour. It found the prevalence of minor or severe violence among people with schizophrenia, bipolar disorder, or major depression was about 12% overall. However, the 1-year population attributable risk of violence for mentally ill people dropped to 4% when substance abuse was not present as a comorbidity.
Swanson et al. (2015) said:
The ECA results implied that even if the elevated risk of violence in people with mental illness were reduced to the average risk in those without mental illness, an estimated 96% of the violence that currently occurs in the general population would continue to occur. The ECA study also found substantially increased risk of violent behavior within particular demographic subgroups of participants—specifically, younger individuals, males, those of lower socioeconomic status, and those having problems involving alcohol or illicit drug use; these risk factors were statistically predictive of violence in people with or without mental illness (Swanson et al., 2015).
I will say this again: The statistical evidence shows a slightly elevated likelihood of seriously mentally ill people committing violent acts. It also shows a more significant portion of mentally ill people will not commit violent acts. In addition, the statistical evidence demonstrates that the slightly elevated risk is often present for the same reasons it would be present for the general population—complex social problems caused by many other things than mental illness (Swanson et al., 2015).
One of the best-known studies that followed the ECA was the MacArthur Violence Risk Assessment Study (MVRAS). This study confirmed the significance of substance abuse as comorbidity. Swanson et al. (2015) said that patients discharged from psychiatric facilities who only had a mental illness without a comorbid substance addiction were no more likely than anyone else in their communities to commit violence. Again, the two statistics paralleled each other closely. In other words, the social conditions of the respective neighbourhoods the patients called home were directly related to their increased risk of committing violence. However, the same was true of every individual living in those neighbourhoods. The reason was the same as well. This increased risk stemmed from trauma (Swanson et al., 2015).
Van Dorn et al. confirmed many of the same findings of the ECA using data collected from the National Epidemiologic Survey on Alcohol and Related Conditions. This study found a lower rate of violence than the ECA: 2.9% for mentally ill people who didn’t have a substance abuse comorbidity committed violent acts in a year, compared to 0.8% for people who were not mentally ill and did not have a substance abuse problem (Swanson et al., 2015). While this is a significant relative risk, despite the low absolute risk of violence, Swanson et al. point out that a clinician asked to use mental illness as a predictor of violence would still be wrong most of the time (Swanson et al., 2015).
Swanson et al. (2015) point out a series of population studies from Nordic countries and Australia, which also demonstrated a small but significant line between mental illnesses and violence. Like the other studies, two diagnoses had higher odds of violence—substance abuse and antisocial personality disorder. Swanson et al. (2015) said, “Assuming causality, population attributable risk fractions for violence range from 2% to 10% for psychoses, around 20% for personality disorders (including antisocial personality disorder) and between 20% and 25% for alcohol and drug use disorders” (Swanson et al., 2015).
Again, all the empirical studies conducted on gun violence and mental illness since the 1990s have come to similar conclusions. While there is a slightly increased risk of mentally ill people carrying out violence, the elevated risk becomes negligible when social factors and substance issues are considered.
Swanson et al. (2015) said:
With respect to the correlates and hypothesized mechanism that may lead to violence in people with mental illness, some scholars have theorized that social and economic risk factors such as poverty, crime victimization, involvement with illegal drugs and drug markets, early life trauma exposure, and ambient neighborhood crime largely account for the apparent link between mental illness and violent behavior toward others (Swanson et al., 2015).
Swanson et al. (2002) found that “mentally ill people who didn’t have substance abuse issues, who weren’t maltreated as children, and who didn’t live in adverse environments have a lower risk of violence than the general population” (Matthews, 2019). Swanson said that if any one of these factors alone is added to mental illness, the risk of violence doubles. If any two are added, the risk doubles again. If any three exist, the risk triples. Of course, this causes the correlation between mental illness and gun violence to be exaggerated. Many mentally ill people were also maltreated as children, have substance abuse issues, and live in adverse environments. In fact, our society guarantees that disabled people without inherited wealth or well-paying employment live in adverse conditions because any social support they get from the government is insufficient to provide any better. When violence occurs, people immediately blame the mental illness rather than the social problems that are more causally related. For the Republican party that labels any measures to promote social wellness as socialism and labels socialism as undesirable in all respects, it probably seems much easier to sacrifice an entire segment of society than to do anything that might be seen as giving away something for free, even if it helps save lives.
Swanson et al. said that subjects who had antisocial behaviour that predated the onset of psychotic illness were about twice as likely to commit violent acts. However, the violent acts had very little correlation with their psychotic symptoms such as delusions or hallucinations. In fact, they found that violent acts were connected to early life victimization and trauma (Swanson et al., 2015).
While Swanson et al. repeatedly state there is very little causal correlation between mental illness and homicidal gun violence, the picture changes when talking about self-inflicted gun violence. Suicide accounts for 61% of gun-related deaths each year in the United States of America. It is the third leading cause of death in the U.S.A. for people aged 15-24 (Swanson et al., 2015). Swanson et al. said, “Population attributable risk proportions for suicide associated with mental disorders are in the range of 47%-74%” (Swanson et al., 2015). Unsurprisingly, many of the same aggravating factors play a role in self-inflicted gun violence that factored heavily into gun homicides.
Swanson et al. (2015) said:
many studies have reported that concurrent substance abuse and specific psychological symptoms, such as hopelessness, also have strong links with suicide. In those with psychosis or bipolar disorder, concurrent depressive symptoms increase risk. However, one of the clearest findings in the suicide literature is the substantial contribution of environmental factors—notably including the availability of lethal means such as firearms. New research demonstrates that household gun ownership in the United States makes a strong independent contribution to increased suicide risk, above and beyond the effects of other covarying risk factors for suicide (Swanson et al., 2015).
One could correctly state that restricting mentally ill people from accessing guns would reduce the rate of self-inflicted gun deaths. Beckett (2014) said:
If you were to back out all the risk associated with mental illness that’s contributing to the 300,000 people killed by gunshot wounds in the last ten years, you could probably reduce deaths by about 100,000 people. Ninety-five percent of the reduction would be from suicide. Only 5 percent would be from reducing homicide. Mental illness is a strong risk factor for suicide. It’s not a strong risk factor for homicide (Beckett, 2014).
So it is true that reducing the guns mentally ill people had access to would lead to a reduction in self-inflicted gun violence, but the same would be valid for the general public.
Don’t get me wrong. I am all for restricting everyone’s access to guns. My problem rests in limiting only part of society based on faulty perceptions. When the process of implementing a partial restriction might involve some people being placed on a list that could impact all aspects of their lives, causing further stigmatization and marginalization, I object vehemently.
Since I’ve landed upon the subject of regulations and lists, I think this is a perfect moment to talk about real-world impacts that have resulted from the “Dangerous Guns versus Dangerous People” narrative and from the general perception that mentally ill people are the “Dangerous People” in this scenario.
Metzl said that insanity is the only politically sane place to discuss gun control (Rosenwald, 2016). Statistics demonstrate that one thing left and right-leaning Americans can agree upon is fearing mental illness. ASAN (n.d.) said, “A 2013 Gallup poll revealed that up to 80 percent of Americans believe that the failure of the mental health system is in some way to blame for gun violence, with 48% of responders believing the system affected gun violence ‘a great deal’ and 32% believing it affected the outcome ‘a fair amount” (ASAN, n.d.). The media reinforce this belief. A study that examined 400 news stories on mental health published between 1995-2014 showed the majority of them portrayed mentally ill people with violent acts or the potential for violence. This shared agreement to believe a misconception, even if not done intentionally or maliciously, has impacted the choices made by the two major political parties of the United States of America.
One of the only things Trump’s administration did was justified in repealing, in my opinion, was an ill-conceived gun policy created in the Obama administration. You heard me correctly. Trump got one thing right. However, he got it right for the wrong reasons. He then tried to follow up with something that would have been infinitely worse.
When I say he got one thing right, I am referring to the ill-conceived gun policy that restricted gun ownership for Social Security beneficiaries who had a psychiatric disability and used a “Representative Payee” to manage their finances (Ne’eman, 2018). The Obama administration framed this as a step forward in gun regulation that bypassed the recalcitrant Republicans in Congress. The rule targeted people who use a representative payee for gun restrictions, acting like this kind of regulation would have stopped any of the mass shootings.
Ne’eman (2018) said:
The rule required the agency to send names from its database of certain people receiving disability benefits who had a ‘representative payee’ to the National Instant Criminal Background Check System (NICS). That a federal database of people prohibited from purchasing a gun…More specifically, the new rule singled out people who use a representative payee and possess a mental impairment. People affected by the rule could have a range of mental disabilities from dementia to autism to agoraphobia (Ne’eman, 2018).
I’ve already said I don’t mind the idea of everyone being restricted from owning guns. However, I do care about creating a rule that puts disabled people on lists when there is no solid connection to public safety. There is no proven connection between a person needing a representative payee and that person being an increased risk to public safety.
In 2013 the National Council on Disability wrote to Joe Biden’s Task Force to Curb Gun Violence, pushing back against the rule that would link the Social Security Assistance representative payee database with the criminal-background-check system (Ne’eman, 2018). Ne’eman says that a coalition of 11 major disability rights organizations issued similar warnings to the Obama administration around the same time (Ne’eman, 2018).
People use a representative payee for many reasons. Sometimes they simply find paying bills and managing budgets taxing. Ne’eman (2018) said:
The determination that someone should have a representative payee is very different from the determination that someone should be involuntarily hospitalized, a process that does include an evaluation of someone’s risk to themselves and others. I and many other advocates who worked against the representative payee rule have no issue with reasonable restrictions on gun ownership for people in this latter category (Ne’eman, 2018).
You might be questioning why I care whether individuals who use a representative payee are restricted from gun ownership if I wish for everyone to be limited. As I’ve already said in one way or another, it isn’t keeping the guns that I care about. I am pro-restrictions for everyone. I care about a precedent being set to restrict the rights of disabled people, especially when the restriction is imposed based on faulty data and conclusions.
Ne’eman (2018) said:
These concerns are rooted in discrimination that people with mental disabilities face in other areas of life, such as parenting and voting rights. People with mental disabilities often face an assumption of incapacity. Their advocates and lawyers often have to fight to overturn assumptions that certain diagnosis, or a determination of need for support in one area, should lead to a loss of rights in an unrelated area. These advocates feared that using the representative payee database for prohibiting gun purchases might constitute a ‘thin end of the wedge’ for loss of more important rights down the road (Ne’eman, 2018).
Ne’eman states that advocates pointed out the risk to employment some people faced. Ne’eman (2018) said that the regulation allowed people to use the program “regardless of the legal competency or incompetency of the qualified individual” (Ne’eman, 2018). The warnings given by the disability community that this precedent presented a danger of being extended were almost immediately born out. The short-lived alliance between disability advocates and the NRA ended abruptly when the NRA collaborators proposed the creation of a national database of the mentally ill (Ne’eman, 2018). Ne’eman (2018) said, “Led by Rep. Tim Murphy (R-PA), who has since resigned, they introduced legislation to strip people with psychiatric disabilities of HIPAA privacy protections, limit legal aid to the community, and drastically expand coercive treatment” (Ne’eman, 2018).
In 2017, Metzl said that new legislation in several U.S. States required mental health professionals to assess their patients for the potential to commit gun crimes (Metzl, 2017). Metzl (2017) said:
Supporters of these laws argue that they provide important tools for law enforcement officials to identify potentially violent persons, and perhaps understandably so. U.S. policymakers and the general public look to psychiatry, psychology, neuroscience, and related disciplines as sources of certainty in the face of the often incomprehensible terror and loss that gun violence inevitably produces. And undeniably, persons with mental illness who have shown violent tendencies should not have access to weapons that could be used to harm themselves and others (Metzl, 2017).
As we reel from the almost constant gun violence in the United States of America and growing incidents of mass shootings, it’s alarming to hear someone suggest they are in any way rare. Still, this is what Metzl (2017) suggested. Metzl said that scholars such as Swanson, who studies violence prevention, contend that mass shootings are statistically rare acts of violence, at least when it comes to using statistical modelling and predictability to prevent future incidents (Metzl, 2017).
At the beginning of this episode, I mentioned the perceptions of how mental illness is defined compared to how professionals and experts describe it. I explained the disconnect that happens between the two and how this reinforced the myth that gun violence is correlated with mental illness. The same kind of disconnect could be happening with how people understand the concept of prediction.
Metzl (2017) said:
This is not to suggest that researchers know nothing about predictive factors for gun violence. However, credible studies suggest that a number of risk factors more strongly correlate with gun violence than mental illness alone. For instance, alcohol and drug use increase the risk the violent crime by as much as seven-fold, even among persons with no history of mental illness. According to Van Dorn, a history of childhood abuse, binge drinking, and male gender are all predictive risk factors for serious violence. Miller and colleagues found that homicide was more common in areas where household firearms ownership was higher. Availability of guns is also considered a more predictive factor than is psychiatric diagnosis in many of the 19,000 American completed gun suicides each year (Metzl, 2017).
Metzl (2017) warns when public policy focuses on trying to build “Common Evidence” on “Uncommon Things,” it reduces the opportunity to create “Common Evidence” from “Common Things.” This includes correlative evidence “about substance abuse, domestic violence, availability of firearms, suicidality, social networks, economic stress and other factors” (Metzl, 2017).
On the face of it, the expectations of these proposed regulations places the burden on clinicians to use their expertise to predict which mentally ill people have the potential for violence. I say this is a danger on the surface because my inner cynic senses the intent is not for psychiatrists to put much effort into a discernment process. What I mean is that I believe the objective is to create an indiscriminate database that flags anyone with specific diagnoses. After all, they only ask psychiatrists to predict who among their mentally ill patients might be considered a risk. They only ask for creating regulations to put mentally ill people on databases. Marital conflicts, financial problems, grief, and disputes with co-workers are all risk factors. There is widespread resistance to having regulations like red flag laws enforced, which might consider these factors.
In a 2013 paper in the journal “Homicide Studies,” James Alan Fox said:
Revenge motivation is, by far, the most commonplace. Mass murderers often see themselves as victims—victims of injustice. They seek payback for what they perceive to be unfair treatment by targeting those they hold responsible for their misfortunes. Most often, the ones punished are family members (e.g., an unfaithful wife and all her children) or coworkers (e.g., an overbearing boss and all his employees) (Khazan, 2017).
These red flag laws would allow those in a position to observe dangerous risk factors and behaviours, such as friends and family, to make reports that might restrict the people exhibiting these signs from owning or possessing guns until a more thorough assessment could be made.
My inner cynic says resistance to these measures is the result of the convenience of prejudice. In this case, society’s willingness to come together in their shared fear of mental illness makes mentally ill people an expedient scapegoat. People are not so willing to blame those who are experiencing marital conflicts, financial problems, or disputes with co-workers.
In any case, Metzl (2017) says the following about how these regulations burden mental health experts in counter-productive ways:
As such, agendas that hold mental-health workers accountable for identifying dangerous assailants puts these workers in potentially untenable positions because the legal duties they are asked to perform misalign with the predictive value of their expertise. In this sense, instead of accepting the expanded authority provided by current gun legislation, mental health workers and organizations might be better served by identifying and promoting areas of common cause between clinic and community, or between the social and psychological dimensions of gun violence. Connections between loaded handguns and alcohol, the mental-health effects of gun violence in low-income communities, or the relationships between gun violence and family, or socioeconomic networks are but a few of the topics in which mental-health expertise might productively join community and legislative discourses to promote more effective medical and moral arguments for sensible gun policy than currently arise amongst the partisan rancor (Metzl, 2017).
I already said that Trump got it right when he repealed the Obama administration regulation that those who had a representative payee be registered on the NCIS. I also said that he got it right for the wrong reasons. This is proven true by what he went on to say and do. Trump said, “This is also a mental illness problem. These are people that are very, very seriously mentally ill” (Matthews, 2019). Texas Governor Greg Abbott supported Trump saying, “Mental health is a large contributor to any type of violence or shooting event” (Matthews, 2019).
Matthews (2019) rejected Abbott’s position with words we’ve already heard from Jeffrey Swanson:
Abbott is wrong: the share of America’s violence problem (excluding suicide) that is explainable by diseases like schizophrenia and bipolar disorder is tiny. If you were to suddenly cure schizophrenia, bipolar, and depression overnight, violent crime in the U.S. would fall by only 4 percent (Matthews, 2019).
Trump made one of the most vigorous pushes for mental illness to be used as a predictive tool. As an autistic person, I have specific reasons I found Trump’s proposal particularly disturbing, which I will get into shortly.
The New York Association of Psychiatric Rehabilitation Services Inc. (2019) reported how Trump’s administration was considering a proposal to monitor people with mental illness for the potential of future violence (New York Association of Psychiatric Rehabilitation Services Inc., 2019). The proposal was coined SAFEHOME or Stopping Aberrant Fatal Events by Helping overcome Mental Extremes. The Suzanne Wright Foundation and Bob Wright prepared the proposal after Ivanka Trump approached them with the suggestion of extending their concept for the Health Advanced Research Projects Agency (HARPA) to include mental health monitoring. The Suzanne Wright Foundation first proposed HARPA in 2017. It was conceived after Bob Wright’s wife died quickly after her cancer diagnosis. Bob Wright believed that better monitoring of risk factors and signs might make the outcomes of specific diagnoses possible (Swanner, 2019).
On the one hand, I have to think that Bob Wright and the Suzanne Wright Foundation responded the only way they felt was available to them when approached with the request from Ivanka Trump, at least if they wished to remain in favour with Trump. They scrambled to throw together an ill-conceived proposal to expand the purview of HARPA to monitor mentally ill people. On the other, I find the source of the proposal particularly alarming.
Bob and Suzanne Wright created Autism Speaks, a corporation most autistic people consider a hate group. This organization has an extensive database of autistic DNA and names of autistic people. I can’t help wondering if it occurred to Bob Wright how easily he might double-tap the Autism Speaks database to create a database of people who pose the potential risk of violence to satisfy Trump. To be fair, that is not what Bob Wright or the Suzanne Wright Foundation said would happen. They claimed all the data collected would be voluntary. Again though, my inner cynic whispers to me. After all, the data given to Autism Speaks was voluntary, at least on the part of parents of autistic people, if not the autistic people themselves.
The New York Association of Psychiatric Rehabilitation Services Inc. (2019) said:
Talks about HARPA were reopened as Trump was assuring the NRA that he would not pursue universal background check regulation to prevent mass shootings, and doubling down on previous claims that people with mental health challenges are the primary cause of shootings—suggesting to reporters last week that the U.S. should institutionalize mentally ill people to prevent violence. Among other initiatives, this new agency would reportedly collect volunteer data from a suite of smart devices, including Apple Watches, Fitbits, Amazon Echos, and Google Homes in order to identify ‘neurobehavioural signs’ of ‘someone headed toward a violent explosive act.’ The project would then use artificial intelligence to create a ‘sensor suite’ to flag mental changes that make violence more likely (New York Association of Psychiatric Rehabilitation Services Inc., 2019).
It astonishes me that anyone could believe artificial intelligence in the form of a sensor suite could be better positioned to recognize risk factors in individuals better than the people in their lives. It amazes me that people prefer empowering artificial intelligence to “report” risky behaviour rather than people with a vested interest in an individual’s well-being. It shocks me that people do not want universal background checks but shrug off the names of mentally ill people placed in databases and asked to wear devices that track and record their biometric data. After all, red flag laws might impair the rights of human beings deemed less expendable than mentally ill people. Better to impair the rights of mentally ill people by making them wear tracking devices, institutionalizing mentally ill people en masse, and putting their names on databases that might impact their rights for the rest of their lives.
It is infuriating to see mentally ill people targeted this way based on faulty data and fear. The truth is that violence in the United States is not statistically worse than in most other countries. Matthews (2019) said:
According to the United Nations Office on Drugs and Crime’s collated government data, the crime of assault was rarer in the US in 2014 than it was in Australia, Frace, Ireland, or the Netherlands. The assault rates in Belgium and England/Wales were more than double the US rate. Some of that is due to differing assault definitions, but scholars generally agree that for most offences, US crime rates are pretty normal (Matthews, 2019).
So what is the difference? Some people would have us believe the difference is that mental illness is more prevalent in the United States of America. They would have us believe poor access to mental health care causes more homicides but not more physical assaults (Matthews, 2019). The difference is not mental illness. It is guns.
Matthews (2019) said, “Sure enough, international data shows that countries with higher gun ownership rates have more gun deaths. And similarly, US states with higher gun ownership levels see more gun deaths, including gun homicides” (Matthews, 2019).
All of this is even more outrageous when one understands there are no accurate means of using mental illness to predict the potential for violence. I already said that studies and evidence have demonstrated that any clinician who tried to use mental illness to predict violence would be wrong the vast majority of the time. Even the United States of America Department of Defense agrees with this position. In 2012 a Department of Defense task force prepared a report called “Predicting Violent Behavior.” Appendix 13, otherwise named “Prediction: Why it won’t work,” was particularly interesting.
Appendix 13 of the DOD report concluded that while there may be pre-existing behaviour markers that are specifiable, they are of low specificity and would result in an abundance of false alarms. They stress a prevention focus is far more valuable and effective than a prediction focus. The DOD report (2012) said:
Suppose we actually had a behavioral or biological screening test to identify those who are capable of targeted violent behavior with moderately high accuracy (something we in fact do not have at present). Table 4 represents the predictive accuracy of such a test applied in two modes—one aggressive and another more conservative—in a screening application to a hypothetical military base with a population of 10,000 military personnel. The population includes ten individuals with extreme violent tendencies, capable of executing an event such as that which occurred at Ft. Hood. In the aggressive mode, the test is strict enough to correctly identify 80% of those capable of extreme illicit violence. Accordingly, it identifies eight of ten individuals we wish to detect, but also falsely implicates 1,598 personnel who do not have these violent tendencies, i.e., who are “normal,” but we would have to invest enormous resources in further examining all 1,606 of those identified to find the eight bad apples, and currently we have no method of doing so…In the “conservative mode,” the test protects the normal, non-violent personnel. Only about 39 personnel would fail the test, but eight of the ten extremely violent people would “pass” and be allowed to continue on to potentially act out their aggressions and commit a truly violent act (Department of Defense, 2012).
The Department of Defense (2012) said they could not overemphasize that there is no scientific basis for an instrument that would screen for potential future violence. No such tools are even close to being accurate in the testing phase. This is as close to saying that Bob Wright and the Suzanne Wright Foundation foundation were full-of-it as the Department of Defense is likely to get.
In short, it is at best a waste of time and money to try to use mental illness as a predictor of gun violence. At worst, it is discriminatory and grossly violates the rights of a vast segment of society. I hope that I have made a clear point that mental illness is a far less valuable tool to predict the potential for future violence than social factors, and even they are unreliable. The most effective means of predicting the potential for gun violence is the ownership or easy access to guns.
That’s all I have for you this week. Thank you for listening. Keep looking for me on your chosen podcast platforms on Mondays, at least until the end of July. I have decided to take time off in August to enjoy some family time before jumping back into finishing my Master of Education Thesis. I am projected to defend my thesis in December. I will try to release at least one episode per month between August and January. I will pick up a regular routine once I finish my thesis in December.
Look for me under @LimbicNoodle on Twitter. On Facebook, I have a page called Autism and The Human. I was accused by Facebook and Meta of misleading people into liking my Page and engaging with it. They wouldn’t tell me what the accusation was based upon. Since they wouldn’t tell me how I was supposedly tricking people by misrepresentation, I came to the conclusion it was based on ableism. I think someone went to my page looking to have their negative paradigm of autism reinforced. I think they got angry when that didn’t happen. My other theory is that someone went to my page and decided they could act as the arbiter of my disability, deciding I wasn’t really autistic. Either way, I think Facebook and Meta sided with them. I shut that page down. I did open another one, but I am really pretty over the idea of a Facebook page if I can’t promote it.
You may find my WordPress under Autism and The Human with Limbic Noodle. That is where I put my transcripts and works cited. This week’s transcript and works cited will take a couple of extra days than normal.
Until next week, Keep On Noodling.
Remember to Like, Follow, Subscribe, Review and Share. Thanks again.
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