Below is a transcript of a quick reaction to the most recent shooting in Pittsburgh:
As America mourns for the victims of the Pittsburgh synagogue shooting, it might be comforting at least to know what is the mental health profile of a mass shooter. What can we look for? Recent studies, however, suggest that if we were to suddenly eradicate bipolar disorders, schizophrenia, and major depression, violence would be reduced by only between 2% and 19%. In fact, those with severe mental illness are much more likely to be the victims rather than the perpetrators of violent crime.
In one study where psychiatrists made predictions about which inpatients in mental health units were likely to commit violence within the next year, their predictions were a little better than the flip of a coin, just about 50-50. In other words, when it comes to our deepest questions, the ones about the origins of evil and violence, the explanations of science may offer no advantage over the constellations of religion and spirituality.
For MedPage Today, I am Morgan Campbell.
Comments:
Firstly, the standard of care is not prediction, but rather reasonable anticipation or foreseeability of dangerous behavior. Secondly, “severe mental illness” is not limited to acute illness, such as decompensating schizophrenia or major depressive illness. Long term absence of psychological health, as defined in paranoid and antisocial personality disorder phenotypes, is deeply ingrained, tending to be chronic, and generally refractory to treatment. It is here that social, and clinical, indices of suspicion must remain high.
— jamie fields
There seems to be a correlation between domestic/relationship violence and mass shooting. Has this been studied?
— Bailey Lee
“Recent studies, however, suggest that if we were to suddenly eradicate bipolar disorders, schizophrenia, and major depression, violence would be reduced by only between 2% and 19%.” and “In one study where psychiatrists made predictions about which inpatients in mental health units were likely to commit violence within the next year, their predictions were a little better than the flip of a coin, just about 50-50.”
There’s part of the problem right there. IF educated people can’t tell the difference between 2%-19% and 50%, then there’s no hope for any solution.
Here’s a better question: Mass shooters get all the attention but gang violence and domestic violence kills multiple times more people than mass shootings. Go to where the money is (Willie Sutton ) and try to solve those crimes at the same time if not first.
— M Elward
There is a disconnect between the title and the content. It is true that we cannot well predict “violence” in many cases. That is different than prevention or profiling of potential “mass shooters.” What seems to be clearly true is that certain mental health issues predominate in mass shooters. Mass shooting and general violence are sad but in some ways significantly separate issues, in terms of prevention.
— Russell Copelan
All good points. Important to remember that “prediction”, whether five year survival following DX of CHF, or predatory violence, attenuates with time “within the next year.” Also, “If educated people . . .”; According to the Council on Behavioral Health, 1.CMS discontinued emergency psychiatry training many years ago, so whose training the trainers?; 2. A significant percentage of psychiatrists no longer accept insurance or see the most severely ill; and 3.Fifty-five percent of U.S. states have a severe shortage of general psychiatrists, 95 percent a severe shortage of child psychiatrists. To paraphrase Yogi Berra, “It has gotten late early.”
— Andrew Johnstone
While I applaud the goal of intervention by trying to predict who might be at risk of such a crime, the parallels if the person were an arsonist instead of a shooter might give us pause.
If periodically arsonists set fire to high-rise buildings, would we ONLY focus on either trying to analyze the personalities of currently known psychiatric patients, or all depressed individuals, or would we ONLY focus on trying to figure out which brand of matches or lighters they used, and try to somehow restrict the sale of those…?
No – we would ALSO be sure that the buildings that were potential targets of such activity were equipped with proper fire-detection and fire-stopping equipment, and that the occupants knew how to use those things. We would make sure each floor had working smoke detectors, sprinkler systems, fire extinguishers, and operate on the principle that intervention DURING the event may be necessary, given the likelihood that our prior-restraint interventions are likely to fail.
But when it comes to atrocities carried out with firearms, we completely ignore the idea of intervening DURING the event, and base our ‘rational’ discussion of stopping a violent criminal via trained and armed personnel, much less ‘ordinary citizens’ with concealed-carry licenses, on our vast experience as physicians with firearms – either watching movies, working in Emergency Rooms, or serving in the military, NONE of which help us make decisions advising public policy on concealed carry licensees being prohibited in certain areas.
That is no more logical than prohibiting fire extinguishers in high-rise buildings for fear that irresponsible individuals might misuse them and hurt other people.
‘Gun-Free Zones’ contribute to the problem, and we need to address that…!
— Russell Copelan