Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control “won’t prevent” another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues 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.
Our brief review suggests that connections between mental illness and gun violence are less causal and more complex than current US public opinion and legislative action allow. US gun rights advocates are fond of the phrase “guns don’t kill people, people do.” The findings cited earlier in this article suggest that neither guns nor people exist in isolation from social or historical influences. A growing body of data reveals that US gun crime happens when guns and people come together in particular, destructive ways. That is to say, gun violence in all its forms has a social context, and that context is not something that “mental illness” can describe nor that mental health practitioners can be expected to address in isolation.
To repeat, questioning the associations between guns and mental illness in no way detracts from the dire need to stem gun crime. Yet as the fractious US debate about gun rights plays out—to uncertain endpoint—it seems incumbent to find common ground beyond assumptions about whether particular assailants meet criteria for specific illnesses, or whether mental health experts can predict violence before it occurs. Of course, understanding a person’s mental state is vital to understanding his or her actions. At the same time, our review suggests that focusing legislative policy and popular discourse so centrally on mental illness is rife with potential problems if, as seems increasingly the case, those policies are not embedded in larger societal strategies and structural-level interventions.
Current literature also suggests that 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. Mental health workers are in these instances asked to provide clinical diagnoses to social and economic problems.114 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.115 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, social, 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 among the partisan rancor.
Put another way, perhaps psychiatric expertise might be put to better use by enhancing US discourse about the complex anxieties, social and economic formations, and blind assumptions that make people fear each other in the first place. Psychiatry could help society interrogate what guns mean to everyday people, and why people feel they need guns or reject guns out of hand. By addressing gun discord as symptomatic of deeper concerns, psychiatry could, ideally, promote more meaningful public conversations on the impact of guns on civic life. And it could join with public health researchers, community activists, law enforcement officers, or business leaders to identify and address the underlying structural116 and infrastructural117issues that foster real or imagined notions of mortal fear.
Our review also suggests that the stigma linked to guns and mental illness is complex, multifaceted, and itself politicized, in as much as the decisions about which crimes US culture diagnoses as “crazy” and which it deems “sane” are driven as much by the politics and racial anxieties of particular cultural moments as by the workings of individual disturbed brains. Beneath seemingly straightforward questions of whether particular assailants meet criteria for particular mental illnesses lay ever-changing categories of race, gender, violence, and, indeed, of diagnosis itself.
Finally, forging opinion and legislation so centrally on the psychopathologies of individual assailants makes it harder for the United States to address how mass shootings reflect group psychologies in addition to individual ones.16 Persons in the United States live in an era that has seen an unprecedented proliferation of gun rights and gun crimes, and the data we cite show that many gun victims are exposed to violence in ways that are accidental, incidental, relational, or environmental. Yet this expansion has gone hand in hand with a narrowing of the rhetoric through which US culture talks about the role of guns and shootings.118 Insanity becomes the only politically sane place to discuss gun control. Meanwhile, a host of other narratives, such as displaced male anxiety about demographic change, the mass psychology of needing so many guns in the first place, or the symptoms created by being surrounded by them, remain unspoken.
Mass shootings represent national awakenings and moments when seeming political or social adversaries might come together to find common ground, whether guns are allowed, regulated, or banned. Doing so, however, means recognizing that gun crimes, mental illnesses, social networks, and gun access issues are complexly interrelated, and not reducible to simple cause and effect. Ultimately, the ways our society frames these connections reveal as much about our particular cultural politics, biases, and blind spots as it does about the acts of lone, and obviously troubled, individuals.