Tuesday, January 08, 2013


I’ve worked for years in emergency psychiatric care.  People come to me because they have been dangerous due to mental illness.  That can mean dangerous to themselves or to others, and sometimes “dangerousness” stretches as far as self-care: wandering in the street, not eating.  But in both the first two categories, harming self or harming others, guns are often involved.

I’ve met a lot of people who have threatened to shoot someone, and some who actually have.  It is sometimes part of my job to call family, police, or neighbors and try to figure out whether there was actually a gun to start with, whether someone has removed it, whether the police have taken custody of it.  I am very familiar with that sickening feeling, hearing someone’s story and thinking “Oh crap.  This person should absolutely never be allowed near guns.”

One category of people I work with are seldom gun-people.  Social workers, psychologists, psychiatrists, and the various rehab groups don’t hunt and don’t tend to have been in the military. They are more likely to come from urban or suburban backgrounds.  Whether they got their deer this year never comes up. The other hospital staff, the nurses and psych techs, the environmental services and dietary folks, the medical records and administrative people are more like the general population, some hunters, some not.  The professional staff think that gun ownership is itself a worrisome sign.  They say they don’t, and many go out of their way to be understanding and recognising cultural differences and forcing themselves back from passing judgement.  But it’s clear what they think.  They say stuff that offends the others, but the others are pretty used to it by now and shrug it off

So yes, mental health professionals might be too quick to pathologise gun ownership, but it’s not like they don’t have lots of personal examples of people who shouldn’t own guns. They do look down on gun-owners, though many see the cultural aspect and try very hard (and some quite successfully) not to. Plus, confirmation bias being what it is, you can’t realistically expect them to change that.  I support gun rights, but I sure see some folks that make you think we’ve got to find some way to get the guns away – and there’s not always a law covering it.

Here are the (somewhat random) parts most people don’t know:

You should be more worried about what mentally ill people in crisis are going to do with their cars than their guns. A lot more.  Some of that is greater availability, and that people spend many more hours holding a steering wheel than a pistol.  But greater safety per minute used isn’t really the point, because that increased time is part of everyday life and isn’t going to change.  Given that greater danger, what do you want to do about that?  Remember that you want people who have been in crisis to be able to resume normal lives, going to work and visiting relatives, getting themselves to appointments, living where they like. So sketch out a mental-health/dangerous driving statute if you can, just to see the possible obstacles and difficulties.

Now understand that it’s much the same for guns.

Second, there is a federal law that prohibits any person who has been involuntarily committed to a psychiatric institution from acquiring a firearm. Two problems.  There is no enforcement mechanism set up, because no one wants to give gun sellers or local police access to confidential medical information, for good reasons of privacy.  It gets sticky, and there is no national registry of the involuntarily committed.  Next, that word “acquiring” looms large.  What about guns already owned?  What about borrowing your brother’s rifle to hunt or target shoot? What do you do when Sam says he wants to shoot someone and has access to a gun, but next day says he was lying, that he’s never owned one and has no friends who have them? Where do you search?  How were you planning on wording that warrant when it’s not illegal to own that gun?

Third.  People who had a suicidal crisis are often extremely willing to turn in their guns and have already done so by the time they talk to us.  They are relieved.  “I called my wife and told her to get both guns out of the house - give ‘em to anyone.  I never want to go through that again.”  People who were threatening others are less likely to do this.

Fourth, even with all those people who scare the bejeesus out of me, we have very little gun crime in NH – and a lot of what we do have is coming up out of Lynn, Lawrence, Lowell, and Haverhill, MA.  That caught me by surprise when a friend who went to become one of the prison psychologists told me that a lot of our prison population were not NH residents. He said almost half, though I can’t back that up.  So even our low rate of gun crime is inflated.  Yet NH is a high gun-owning state.  The words of Howard Dean come to mind, when he was explaining his state to national Democrats. “You have to understand that this is Vermont, where even liberals own 2-3 guns.”  There’s some other reason – something other than legislative strictness and mere possession – that drives actual violence.  I have my theories.

Fifth, some gun owners are yahoos.  So what? Give me measurables.  It does strike me as weird that people would want more advanced weaponry.  I immediately grasp the argument that “they really don’t need that.”  But you can also hear people say “They really don’t need those big SUV’s.” “They really don’t need…” those  jetskis, more miles of hiking trails, expensive cars, hundred choices of shampoo, video games, free condoms – you get the picture.  You have to be able to show, not just hypothesize or imagine, that there is some ill effect that requires intervention.  As far as I know, that isn’t there.  Gun laws don’t seem to move the dial much one way or the other.

Sixth, based on no knowledge other than history, I predict that the Obama administration will (perhaps already has) propose sweeping legislation that includes the entire wish-list of gun control advocates. He’s not an incrementalist.  (Washington in general prefers comprehensive solutions for several reasons, all of them bad.)  Using a crisis to manipulate people’s emotions is SOP.*  It will be called reasonable, so that opposnents can be accused of opposing even reasonable measures. I may even approve of portions of it myself or at least, approve of the intent while remaining suspicious of the execution - and actual, not-always-unintended, real world result.

*It will be argued that Republicans sometimes do the same thing.  Yes, and especially those who have worked for the government a long time.


Sam L. said...

I have here a big A-MEN! on your #6. You have called it.

SJ said...

About medical privacy and government records: I think the VA-Tech shooting was a case in which the young man should have been reported to the FBI for inclusion on the "do-not-allow" portion of the NICS.

If he had been properly reported by Virginia authorities in 2005, he would not have been able to (legally) purchase a gun in 2007.

Don't know if all those problems were fixed, but they did get a lot of attention in the State of Virginia, and some attention at the Federal level, immediately afterwards.

However, you still point out the core problem of medical privacy.