Monday, December 17, 2012

Guns, Pesticides, and Mental Illness: WHO will do something?

As I sift through the commentary on the tragedy in Fairfield County, there seem to be two camps. One group blames guns and the other, mental illness. One group calls for gun control and the other for more resources for mental health. This is a ridiculous dichotomy. We should do something about both, but we get mired in a debate about our Constitutional right to bear arms and don't seem to know where to begin when it comes to mental health.

James Fallows makes a strong case for why we must do something about guns. He talks about an incident in China last Friday and makes his central point: fewer people died from somebody who was just as crazy as the mixed-up 20 year-old boy from Newtown. Take away the guns and fewer people will die, fewer families will be torn asunder.

There are plenty of countries--from Greenland to Russia to Myanmar--where the murder rate is much higher than in the US. In fact, most of southern Africa and northern South America far outstrip the US. Murder rates are not necessarily linked to access to guns, but getting rid of guns will result in fewer deaths in the United States.

My former colleague, Lindsay Hanson, posted a Gawker story from a mother with a child who is monstrously violent. It is a sad reminder of how many seemingly innocent people suffer when their children go astray or turn out to have a bit of the devil in them. This mother's piece was moving, but it was the first, insensitively-worded, raw, hard-hitting comment in the comment section that really stuck with me:
I won't deny, I can't deny, that there is a crisis in mental health care in the US. However, if it was just a question of mental illness, then 33 of the 66 mass shootings the author refers to would have been committed by women. One 1 [sic] was. That undermines the author’s entire argument that the primary cause of these types of events is mental illness.
If you have a child that you know is capable of committing mass murder you have a responsibility to contain them by whatever means are necessary. Your child assaults you? Press charges. Medicate them. Even if it turns them into a zombie. Have them committed to a mental institution. Even if it's a shi**y one. Can't get them into one? Lock them in their bedroom. Surrender them to the state. They threaten to kill themselves? Let them. Because one day they will kill you. And your other children. And perfect strangers.
Just because all the choices are shitty it doesn't mean that you don't have choices. Pick one. Do something because they are your responsibility. And for f**k sake, don't own firearms.
This fellow's comment is a display of the incivility and lack of compassion that some people think contributes to the violence of our society and the breakdown in civil communication; however, he is all very clear about some basic facts:
  • In America, if a child is not 18, the parent is responsible and must take that responsibility seriously even if it means taking draconian steps. [The Gawker-mother has, by all accounts, tried to do what she can. This commenter seems to discount how debilitating her sense of helplessness is. She asked the hospital on an intake form for help! Society owes these families some measure of intervention, too. It may not take a village, but few parents would be able to manage a Michael on their own.]
  • Keeping guns in this woman's household would be akin to giving nuclear weapons to Hamas--one cannot be sure what would happen, but it is a not a risk worth taking.
  • Mass shootings are not only about mental illness.
It is only this last observation that I find interesting and rather haunting. So, then, what is the label that we should ascribe to their behavior? If it is not a result of mental illness, what is it a result of? Why are men so much more likely than women to engage in these desperate, public acts of gun violence?

Taking Away Guns Won't Lower Suicide Rates; Would Lower Accidental Deaths

Guns are not just dangerous as murder weapons; they are implicated in thousands of accidents every year and in thousands of suicides. In terms of suicide, though, it can be argued that if you take guns away, people will resort to other means. In 2009, the British medical journal The Lancet identified Lithuania, Finland, Latvia, Hungary, China, Japan and Kazakhstan as all having exceptionally high rates of suicide, 20 per 100,000 people or higher. (As an aside, I do wonder why the Estonians are the only Baltic State not on The Lancet's list.) In Japan, there are only a handful of murders with firearms each year, but people find a way to kill themselves.

China's suicide rate is amongst the highest in the world. Pesticides are China's smoking gun when it comes to taking one's own life. Pesticide ingestion was implicated in 62% of suicides in China between 1996 and 2000 (around 175 000 cases per year), according to the World Health Organization. In the United States, firearms were used in more than half of all suicides; hanging (23%) and poisoning (18%) lagged far behind as second and third. See also Miller M, Azrael D, Hepburn L, Hemenway D, Lippmann SJ. The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002. Injury Prevention 2006;12:178-182; doi:10.1136/ip.2005.010850.

The way to tackle suicide rates is not to control guns. This is a mental health and cultural problem.

Accidental death or unintentional death (the fifth leading killer in the US after such things as cancer and heart disease) claimed 118,021 Americans in 2009. Automobile accidents and poisoning were the causes most responsible, followed by accidental falls, fires and choking.
The nation’s accidental death rate has been gradually creeping higher and is up 12 percent compared to the lowest rate on record, in 1992, according to a report released by the National Safety Council.
The independent, nonprofit group warned that if the trend continues, the nation could surpass the all-time high of 116,385 accidental deaths, set in 1969.
From 1969 until 1992, the rate of accidental deaths — a number adjusted for population growth — steadily declined. The council credited seat belts and air bags in vehicles, smoke detectors in homes and stiff drunken driving laws with reducing deaths.
But ground is being lost because of increasing rates of falls among the elderly and accidental overdoses from legal and illegal drugs , said Alan McMillan, CEO of the National Safety Council. Meanwhile, deaths from workplace accidents and car crashes have been fairly stable.
If we want to attack accidental death rates, getting rid of guns is not going to be as effective as waiting for the last of the Baby Boomers to fall downstairs and to more effectively address our (legal and illegal) drug problem. Taking poisons off the market and implementing public transportation options that reduce automobile accidents are the real public policy fixes that we need.

While controlling guns is not the only thing we must do and is not an effective fix for some problems, it is hard to reason that we ought to tolerate the status quo.