Guns? Mental Health? Really? Let’s Talk About Psychopaths

It is touching that Wayne LaPierre, the compassionate CEO of the National Rifle Association, has expressed concern for the mental health of his fellow citizens. Let’s take this comical pose seriously for a moment, and imagine just how we might improve psychiatric health services in a way that would diminish the obscene rate of gun violence in America.

Try this out, for instance, as a thought experiment. The health authorities approach their local survivalist — who lives in a modest bunker trimmed with barbed wire and stuffed with semiautomatics — and they propose to examine him for symptoms of clinical paranoia.

Now, let’s assume that these health officials escape alive. Will the NRA get behind their efforts to treat this man, who — according to any acceptable professional diagnostic — is mentally ill?

His large and bristling collection of devastating weaponry might itself be taken as evidence of looming psychosis, but is the NRA really going to argue that it’s not healthy for one person to own that many assault rifles?

The gun lobby is not only uninterested in mental health care, but I assure you: they can be counted on to resist any real efforts to improve it.

A sincere proposal for solving the gun crisis by concentrating on mental health would include a provision of this sort: that we check briefly into the background of a gun buyer, to see whether he or she has ever been ticketed for standing naked on the roof and screaming at black helicopters. Or expelled from Disneyworld for setting fires. That kind of thing. But here, you see, medical concerns infringe upon the right to bear arms. (Yes, that sounds a touch ridiculous, but I assure you that we’ll encounter that argument, loudly and immediately).

Oh, and who is going to pay for the improved medical infrastructure required to improve psychiatric services? The state? That would require something in the way of taxation. More: it would require an ideological bent congenial to subsidized medical treatment. Members of the NRA have not proven overwhelmingly friendly to Obamacare, and are not — generally speaking — cheerleaders for new and higher taxes.

Should we perhaps tax guns and ammunition to pay for collective mental health care? Try floating that concept in a casual conversation at a gun show.

The gutting of America’s mental health system was accomplished, unsurprisingly, by a man remembered fondly by Wayne LaPierre’s constituency: Ronald Reagan. The Mental Health Systems Act of 1980, prepared at the behest of Jimmy Carter, was not unflawed. Nevertheless:

The act was considered a landmark in mental health care policy. The key to the proposals included an increase in funding for Community Mental Health Centers and continued federal government support for such programs. But this ran counter to the financial goals of the Reagan administration…. So, the law signed by President Carter was rescinded by Ronald Reagan on August 13, 1981.

Ronald Reagan, unlike Wayne LaPierre, was honest and consistent here. The goal was to reduce federal spending and trim social programs, and an effective overhaul of the mental health system is a fantastically expensive proposition.

The mentally ill, you see, are not a small fraction of society. The NIMH provides sobering statistics: In any given year, “about 6 percent, or 1 in 17 … suffer from a serious mental illness.” If you want to include minor mental disorders, we’re talking about 26 percent of the population.

Dr. Michael Bader details precisely what we’d have to do now “if we took seriously what conservatives are hypocritically proposing.” Should you be interested in the minutiae of medical policy — Wayne LaPierre certainly isn’t — I urge you to read Dr. Bader’s excellent piece. You don’t have to. Rest assured that he convincingly demonstrates that “it would involve the greatest expansion of government involvement in the lives of Americans in the history of the republic.”

Not insignificant here is the issue of patients’ rights. The treatment of mental health is — like it or not — a service that often has to be imposed upon the patient. Here is where I in fact agree to an extent with the mindset embraced by the libertarian gun lobby: we should not be throwing citizens into psychiatric hospitals without due process, and forcing medication upon people without careful legal guidelines. Curtailing individual liberty is a truly dangerous business, and you don’t want to do it unnecessarily.

I’m sure Wayne LaPierre has considered all of this as well. But that’s okay, because he doesn’t expect this gambit to influence mental health policy in any substantial way. It’s a deflection strategy. A feint.

The mental health ruse on the part of the NRA and its apologists is in fact interesting, examined as a species of trickery. Online behavior presents us with a pertinent category: the internet has become middle-aged, and in its collective experience has generated all sorts of new genres, including wondrous variations on a certain foundational type — the troll.

Trolling has become subtle, and one of the more elegant methods of subverting debate is “concern trolling.” This is where you pretend to be deeply concerned about something that concerns you not in the slightest, so that you can undermine the conversation, derail it, and ultimately destroy it.

The NRA’s professed concern for mental health — as opposed to metastasizing gun cancer — makes this organization perhaps the largest and most efficient concern-troll collective in the nation.

Decent people do care about mental health issues, of course — profoundly — and LaPierre has tricked a great number of these people into thinking that the treatment of mental illness is crucial to the containment of gun violence. He has managed to convince them that this in fact trumps such concerns as the grotesque proliferation of civilian weaponry.

This is how concern trolling works: the troll appeals to one of our more admirable attributes — the human propensity to care — in order to further an agenda that is the opposite of admirable.

Do the mentally ill commit homicide? Yes. They do. In America and elsewhere. The difference — and do we really have to say this, yet again? — is that the mentally ill in America have far easier access to vastly more guns, so they kill in much greater numbers.

This truism should not have to be stated. That’s the point of truisms. Except that hundreds of thousands of Americans have decided that this risibly obvious truth is in fact false.

Moreover, to concentrate upon mental illness is to trivialize the moral dimension of the gun debate, and to neglect the great number of people who are very much an issue here, and are not mentally ill.

Joe Nocera in the New York Times gets it precisely wrong: “Anyone who goes into a school with a semiautomatic and kills 20 children and six adults is, by definition, mentally ill.”

Actually, no. Anyone who kills children is, by definition, evil.

Even if the killer is mentally ill, he is almost certainly evil to some extent as well. This medicalizing of moral categories is pernicious. Here again I am in sympathy with the conservative position — or what should be the conservative position. Scientism tends to be a disease of the left, which is always trying to find banal material explanations for matters that might just elude CAT scans. Whereas the right, in general, is more likely to conclude that people who do bad things are in fact bad people.

This is simplistic, of course: lots of leftists think very much in terms of good and evil individuals. Still, the tendency is something we associate more with, say, Churchill than Marx.

Here is where guns again pervert the debate. Only when it comes to matters like shooting children do American conservatives shy away from suggesting that someone is doing something evil because he is an evil person. No, it’s because he’s diseased.

This is often partially true, of course. Adam Lanza appears to have suffered from some species of mental illness, although nobody has convincingly provided an explanation for the causal link between this and the slaughter in Newtown. (No, Asperger’s syndrome is a neurological condition — not a mental illness — and does not correlate with murderous tendencies.) Depression is being discussed. And yes, shooters are often severely depressed, but so are 14.8 million American adults — some 6.7 percent of the population. Most of those afflicted are law-abiding citizens, and stigmatized enough as it is.

Is this a workable method of dealing with the gun crisis? Curing depression, an intractable condition that we’re already doing everything we can to alleviate? Even if we could demonstrate a meaningful correlation between violent crime and severe depression — which we can’t — it’s not really a practical approach.

We find a much more obvious link between mental illness and gun violence in Jared Lee Loughner, the mass shooter who attempted to assassinate US Representative Gabrielle Giffords, and killed six others. Diagnosed with schizophrenia, Loughner had to be forcibly treated with antipsychotic drugs for over a year before he was even competent to stand trial. (He should almost certainly be spending the rest of his life in a hospital for the criminally insane — not a prison — but that’s a separate issue.)

Some 2.4 million American adults are schizophrenic: about 1.1 percent of the nation. Schizophrenia does indeed correlate with violent criminal behavior. A rigorous epidemiological meta-study, however — which examined the analysis of statistics from Britain and America — concluded that: “The proportion of societal violence attributable to schizophrenia is small…. (It) consistently falls below 10%.”

If we wish to find a significant correlation, we have to turn to a form of insanity that is not in fact a mental illness. Yes, this is a paradox. Here we encounter a hugely complex issue, not just medically but morally. The causal connection is unambiguous, however: it is a condition responsible for a great number of homicides, including virtually all serial killings, as well as the massacre at Columbine.

Let’s talk about psychopaths.

Prior to the term “psychopath,” these people were often deemed “morally insane.” Or were said to suffer from “madness without delirium.”

Now, what’s interesting about psychopathy is that moral insanity is a fair definition. Moreover, its diagnosis is debated tortuously by experts in the medical community: it is of pressing interest to psychiatric theorists.

And, furthermore, it is not a mental illness.

This last bit is arguable, but the world’s leading expert in this condition, Dr. Robert Hare at the University of British Columbia, has said:

I don’t feel comfortable calling it a disease. Much of (a psychopath’s) behaviour, even the neurobiological patterns we observe, could be because they’re using different strategies to get around the world. These strategies don’t have to involve faulty wiring, just different wiring.

Don’t get me wrong. Psychopaths are monstrous people, and Dr. Hare certainly recognizes this. He in fact seems to fall back on moral categories (perhaps unwittingly), in the absence of medical typology: “True saints, completely selfless individuals, are rare and unnatural too, (Hare) points out, but we don’t talk about their being diseased.”

Thanks to Dr. Hare’s diagnostic test — the PCL-R (Hare Psychopathy Checklist-Revised) — we are now much better at identifying these people. Eric Harris, one of the killers at Columbine, was almost certainly a psychopath. Serial killers are probably all psychopaths. It is an ugly, ugly phenomenon:

People who are psychopathic prey ruthlessly on others using charm, deceit, violence or other methods that allow them to get with they want. The symptoms of psychopathy include: lack of a conscience or sense of guilt, lack of empathy, egocentricity, pathological lying, repeated violations of social norms, disregard for the law, shallow emotions, and a history of victimizing others.

Quibbling about this category — whether it is simply evil, or a mental illness, or both — is not really what’s pertinent here. What’s pertinent — what lays this matter to rest, in terms of the gun debate — is that psychopathy is incurable.

There is no treatment.

Even less heartening: “Several studies have shown that existing treatment makes criminal psychopaths worse. In one, psychopaths who underwent social-skills and anger-management training before release had an 82 percent reconviction rate. Psychopaths who didn’t take the program had a 59 percent reconviction rate.”

Moreover, there is no viable legal remedy: you can’t simply lock all of these people away. It has been proposed, yes, but in ways that would not appeal, to put it mildly, to the NRA:

The United Kingdom… is in the process of creating a new legal classification called Dangerous and Severe Personality Disorder (DSPD). As it stands, the government proposes to allow authorities to detain people declared DSPD, even if they have not committed a crime. (Sample text from one of the Web sites that have sprung up in response: “I was diagnosed with an untreatable personality disorder by a doctor who saw me for ten minutes, he later claimed I was a psychopath…. Please don’t let them do this to me; don’t let them do it to anybody. I’m not a danger to the public, nor are most mentally ill people.”)

Despite the absence of such a policy in American and Canada, many of these people have in fact already been locked up: “In a typical prison population, about 20 percent of the inmates satisfy the Hare definition of a psychopath, but they are responsible for over half of all violent crime.”

On the other hand, many are out there in the world, sometimes doing surprisingly well. If you wanted to preemptively imprison America’s psychopaths, you would probably have to decimate Wall Street. “Hare has said that if he couldn’t study psychopaths in prisons, the Vancouver Stock Exchange would have been his second choice.”

Approximately one percent of the general population would qualify as psychopaths, according to the PCL-R. The ones who have not been imprisoned — and there are a vast number — may well be managing your stock portfolio. Or standing beside you at the firing range. Or doing routine maintenance of that semiautomatic, after brushing up on the Second Amendment.

What have we discovered here? I remind you: the point of this exercise was to take Wayne LaPierre’s cynical advice seriously. Responsible and even thoughtful people are doing just that. Hey, the man has good ideas: if we address medical issues, rather than the availability of guns, then perhaps we can cure the slaughter of children with semiautomatic weapons.

As long as we don’t look too hard at what this would entail.

We would be attempting to preemptively cure millions of Americans whose homicidal tendencies cannot be identified. Or we would be taking unconstitutional steps to force a cure upon those whose tendencies have been identified, even though the great majority of them will never commit an offense: citizens suffering from schizophrenia.

Of course, we could target a group we know to be truly dangerous: psychopaths, who are responsible for over 50 percent of violent crime. These are people who — whether or not we wish to classify them as mentally ill — are almost certainly incurable.

It is a fool’s errand, but the man who would send us on it is no fool. Wayne LaPierre knows full well that this expensive and time-consuming idiots’ ballet would nicely divert resources from actual solutions, the ones that might keep guns from flowing efficiently onto the streets. The NRA receives its funding from two symbiotic groups: the people who make guns and ammunition (the NRA’s “corporate partners”), and the people who buy guns and ammunition (the NRA’s members). So keeping that flow robust is everything. And the mental health ruse of course insures that we ignore an entire category of criminal, whose buying habits are crucial to the health of the gun market, and hence to the NRA’s bottom line: vicious people who are neither psychopaths nor mentally ill.

By all means, let’s put intelligence and will towards ameliorating the mental health crisis in America. There is no question that a national effort to treat schizophrenia more effectively would benefit both patient and society: it would greatly remedy homelessness, for instance, even if it would have only a minor effect upon the rate of violent crime. This kind of project is not inexpensive, as Dr. Bader points out above, but it is a matter central to our humanity, and an issue of urgent public concern. We can start by making a list of organizations whose expertise and intentions would accord perfectly with a civic project of this nature.

And if we’re truly credulous — okay, witless — we’ll put the National Rifle Association on that list.