Headlines have reached one consensus about the policy implications of the shooting in Tucson, Ariz., this past weekend.
"How can we prevent crazy people from getting guns while still protecting the Second Amendment?" poses a lively Yahoo! debate.
"Ten Rampages by Mentally Ill People Who Bought Guns That Can Teach Lawmakers What to do Next," blares a Phoenix New Times blog posting.
Americans often squirm around these two topics — gun control and mental illness — but have little trouble finding agreement when they intersect, as they appear to have in the attempted assassination of Congresswoman Gabrielle Giffords. At the very least, we can all agree to keep guns out of the hands of unstable people, right?
Attempting to do so, though, has never particularly proven to improve public safety. And if anything, says Paul Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University, channeling so much attention toward the mentally ill distracts us from the much larger problem of gun violence and further stigmatizes the mentally ill who are rarely responsible for it.
Federal gun laws have singled out the mentally ill since 1968, although for decades the states charged with implementing the ban rarely enforced it. Some were cowed by political opposition to the appearance of "gun control." More often, states didn't have the money or the technical resources to keep track of the people "adjudicated as a mental defective" who were to be excluded from gun ownership.
Then there was another problem.
"Nobody was quite sure what that meant," said Appelbaum, a past president of the American Psychiatric Association.
Also excluded were people who had been "committed to a mental institution" — another imprecise standard. What exactly constitutes a "mental institution"? Does voluntary admission to one count? Separate state laws produced yet more definitions.
After nearly 30 years, the 1993 Brady Bill for the first time narrowed the federal language, and another decade later, the Virginia Tech shooting dramatically boosted state participation in background check databases. Today, federal law excludes: people who have been adjudicated as a danger to themselves or others, or as mentally unable to manage their own affairs; people who have been involuntarily committed to a psychiatric facility; people found not guilty of a crime by reason of insanity; and people deemed mentally unfit to stand trial.
Still, the words "mental defective" are used in federal regulation.
"The term's problematic in at least two ways," Appelbaum said. "One is it has a pejorative ring to it. 'Mental defective' sounds like something you call somebody you don't like on the street. Secondly, it is not a term that has a precise meaning. Are we talking here about people with mental retardation? People who've suffered brain injury? People who have psychiatric disorders? Who are we talking about?"
Today, gun laws that target the mentally ill — alongside convicted felons — are founded on a series of assumptions: that people with mental illness are particularly dangerous, that legislation restricting their gun ownership will lead to decreased violence, and that this strategy will make a difference in the overall safety of society.
Such laws also assume that the background-check system is an effective means in the first place of keeping guns out of the hands of any type of dangerous person.
"In a society like ours where firearms are so prevalent — there are more handguns than there are people in the U.S. today — that seems like a highly dubious proposition," Appelbaum said. "People who really want guns are arguably likely to be able to get them whether they are covered by this statute or not. It's an empirical question as to whether this actually works in keeping guns out of anybody's hands, or at least very many people's hands."
The best data Appelbaum has found, which dates to the late 1980s and early '90s, also suggests that, at most, 3-5 percent of violent acts in the U.S. are attributable to serious mental illnesses as a risk factor — and most of those acts don't involve guns. More recent studies in England and Sweden suggest that number for violent acts may be as low as 1-2 percent.
"To say that another way, if no one with a mental illness committed a violent act, we would still have 95-97 percent of the baseline level of violence," Appelbaum said. "However you cut it, it looks as though we're just talking about the tip of the iceberg in terms of problems of violence in our society, which raises the quite reasonable question as to why we're so focused on the mentally ill?"
Not only is that focus a distraction, he adds, but it comes with the significant downside of further stigmatizing people with mental illness and confusing the public as to the notion that mental illness is a significant cause of violence in this country.
"To take an approach which has substantial costs — the states are spending a lot of money on these databases — and implement it without any evidence suggesting that it's likely to be effective, and in fact a good deal of inferential reason to believe that it's not likely to be effective," Appelbaum said, "is simply not good public policy."