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Friday, April 1, 2011

Mental Illness and Political Violence

DSM5 in Distress

The DSM's impact on mental health practice and research.

Mental Illness and Political Violence

The role of reckless rhetoric, automatic weapons, and the media

The recent mass murders in Arizona are the latest in our country's epidemic of horrible, hate inspired crimes. The 24/7 media punditry and political spinning has been disappointingly off point in a way suggesting that once again we will learn nothing from our mistakes and that such tragedies will continue to recur with distressing frequency. Three possibly interacting causal theories have been offered:
1) The killer is severely mentally ill and acted on a variety of delusional beliefs that converge on the notion that the government exerts a malign influence on him and on our country. His potential for violence was accentuated by drug use.
2) He was also responding, at least in part, to the vitriolic, violent and inciting discourse and conspiracy theorizing that has become increasingly acceptable on talk radio and the internet.
3) The tragedy was facilitated by the killer's easy access to automatic, assault weapons that can kill promiscuously and rapidly.
Talk show hosts and apologists for the aggressive political discourse have jumped on the first hypothesis ("the killer was an isolated and unpredictable crazy man, who is really apolitical") and the airwaves and print have been filled with psychiatric testimony linking mental illness and violence. Much of what has been said in this regard badly misses the point and diverts attention from correctable problems that cry out for correction.

While it is never wise to diagnose at a distance, it seems a fairly safe bet that the murderer in this case does have a severe mental illness and has also abused drugs. Indeed, both are definite risk factors for violence- but it must also be strongly emphasized that violence is an issue for only a tiny fraction of those with severe mental illness and the mentally ill are responsible for only a tiny fraction of violent crime.
This brings us to the real question that must be addressed. Why is it that ours is the one developed country experiencing this epidemic of repeated mass murders? To blame this episode (and its many similar predecessors) solely on the mental illness of the perpetrator ignores the fact that the rates of schizophrenia and drug use are similar across the developed world. If our people are not sicker than people elsewhere, what is it about our society that makes it more likely to provoke such tragedies?
The most obvious answer is that we are armed to the teeth- too often with rapid-fire assault weapons that can promiscuously and within seconds kill dozens of innocent victims. Reasonable people can certainly disagree about the general right to bear arms, but it seems clearly absurd to allow the sale of such automatic weapons and condone their current easy availability even for those with severe mental illness. Since there is no way to legislate mental illness out of existence, we must focus on what we can control. We need a more rational policy regulating who can have guns and what kinds of guns are acceptable.
Then there is the increasing violence of political attacks. Free speech has too often deteriorated into violent and inflammatory speech- just the kind most likely to incite and enable those made vulnerable by the poor judgment and impulsivity that occasionally accompany mental illness. Reckless political discourse is equivalent to lighting a flame to kindling. It is irresponsible for those who provide the spark then to blithely disavow the flame. All responsible leaders must disavow the cheap-shots, the demonization of opponents, the smears, the violent denunciations, and the outright threats. A safe society must be a civil society.
Marking opponents with a gun scope and other similar acts of political theater can unwittingly become an incitement.Reckless speech is especially risky for those who are vulnerable to suggestion because mental illness renders them liable to take literally what may have been meant figuratively. Public figures must accept that the mentally ill inevitably form part of their audience and may possibly enact their provocative statements.
The media and the internet also have much to answer for. The 24/7 lurid coverage of violence inadvertently promotes imitation. Even more culpable is the conscious selection as media stars of the most reckless voices- promoting a degradation of civility and the encouragement of verbal abuse which can increase the risk of physical violence. Media ratings have obviously been given priority over our national safety.
So, let's not take the easy way and again simply blame the mental illness in the individual- without trying to correct the societal context which promotes its most tragic expression. Other countries have people just as crazy as ours, but they are much less likely to experience repeated mass murders. The carnage will continue unless we find our way toward a reasonable compromise on gun control, a more measured political discourse, and a responsible media.

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