The following article is an overview of some of the astronomical number of considerations in mental health, and how they are related to violence and criminal behavior. The understanding of mental health and criminal behavior, as presented very often in the media, is very misleading and comes with a host of unintended ill- consequences. We tend to over-simplify the issue of mental health in our society not realizing just how broad and complex it can be. The variables and exceptions to human behavior are too numerous and far too complex to completely list here; therefore this is not an exhaustive piece, however I hope to bring some awareness of some of these issues through this article.
In the wake of the media frenzies and public outcry over tragic, high-profile killings and terrorist acts involving firearms, the dialogue in the United States is beginning to shift towards “gun violence is a mental health issue”.
It is tempting to absolve violent criminals of their wrongdoing by finding something to blame – economic circumstances, religious oppression, the number of bullets in their gun, the gun-manufacturer or dealer, mental illness, drugs, discrimination...anything other than the individual making the choices – partly because it gives us a sense of control as a society. We tell ourselves that if we can fix the things that “made” them do what they did, then we can stop bad things from happening, and we then have the illusion of control over our world. It's a nice lie to tell ourselves but that comes with devastating consequences.
Unfortunately, politicians love to tell us that they can stop all bad things from happening to us. They love to say things like “If we can stop just one death, it will be worth it,” yet many more people continue to be harmed, and we need to stop more than just one. Two- hundred plus years of such promises, and trillions of dollars spent, have not eliminated the tragedies in our world that are born of human choices.
And they never will.
Now, we are being told that mental illnesses are to blame for the tragedies in our world – that if we can test for, find and fix mental illness, keep guns out of the hands of the mentally ill, and give mental health exams to gun-owners, THEN we will be safe and all will be well. Not only is this not true, it is impossible. I hope to illustrate the complexities of psychological assessments as they relate to violent crimes, as well as dispel some of the myths that pervade our fast-food, instant-gratification world on the issues of mental health and criminal behavior.
First, “mental illness” is pretty much universal and there isn't really any way to escape it. Nearly all of us are going to experience it or are going to be exposed to it. For example, almost everyone is going to experience some form of depression in our lifetimes in varying severities. Some may experience depression so severe that they are unable to get out of bed, associate with friends or family, or take care of themselves in even the most basic ways, while others may sadly commit suicide. People can be depressed over family troubles, financial issues, professional difficulties, psychiatric disorders (e.g. dysthymia, bipolar), as a product of substance use, the death of a family member or a pet, seasonal affect disorder, physical illness or disability...pick a reason! The causalities of mental illness are widely varied, as are the severities, and even the outcomes as numerous as the people who have it. Don't forget other issues like anxiety or Post Traumatic Stress Disorder (PTSD) that are experienced by so many of our police, first- responders, veterans, victims of violent crimes and world tragedies, or even those who live in high-crime areas. There are hundreds of mental illnesses and literally trillions of combinations of illnesses with other life-factors (e.g. culture, gender, environment, intelligence, stress, nutrition, age, etc.) such that mental health deals with more variables and possibilities than are even calculated in a NASA space launch.
Mental illnesses aren't static over the course of a lifetime. Some illnesses (e.g. PTSD, substance related disorders) stem from life events, and other illnesses seem to onset at certain ages (e.g. schizophrenia, dementia). There is not really an “I was born this way” in mental health. None of us are the same at forty years old as we were at three years old, and none of us are at ninety years old the same as at forty. We all evolve, have life- changing experiences, and make choices that affect our biology and psychology. Some illnesses and issues are temporary. Others improve over time with medical advances and treatment. Some stay the same while the world around them changes, making the interactions of the illness different over time, while others worsen and are terminal – all of this making the issue of simple testing at any single point to guarantee public safety impossible. Let's say that an individual takes a mental health exam and is perfectly healthy, walks out into the parking lot immediately after, and witnesses a tragic accident that permanently traumatizes them making the test they just took invalid. Or they leave their test only to have some crisis at home that permanently impacts them. Now, I'm not saying that this is going to happen, or is even likely to happen, but things like this do happen regularly in our world. Screening alone can't and won't catch everything because life and time do not stand still.
Additionally, you have the first three considerations in mental health, especially forensic mental health, that are 1) people lie, 2) people lie, and 3) people lie (and number 4, people lie about lying). Most people don't want to see a psychologist, and if they do, they usually want to present themselves in a favorable light. Even when they are being completely honest, and unless they have the ability to remember everything and are omniscient, you are still only getting their side and impression of the story leaving lots of room for inaccuracies even unintentionally. Throw in the issue of someone having a low IQ, and then their interpretation of events and understanding of the questions on the tests becomes a whole new ballgame – some tests can't be used at lower intelligence levels, and administering a different test isn't going to give you the exact same results. Add in an illness that can affect perceptions (e.g. depression or even having done damage from drug use) and you will get an unreliable report. This isn't meant to be pessimistic or cynical about human nature or psychology. But the reality is that we like to be in charge of how others see us even when we don't have anything to hide, and our perceptions aren't as clear as we would like them to be. There are some things that are going to be quite obvious, but getting the back-story and supporting details to clarify what you're seeing clinically can be its own challenge, especially when working with criminal behavior (e.g. a seemingly manic presentation can be the result of a psychiatric disorder (Bipolar), substance use or even stress). Those details are critical in order for an evaluation to be of any usefulness.
If someone wants to commit a crime, but we want to use mental health screening to predict who is going to commit a crime so we can stop them, why would they be honest in taking a test that would expose them? If someone did commit a crime, why would they want to admit to anything by taking a mental health test that's going to make them look worse and help seal their own case against them? The mental health files at the prisons and the state mental hospitals are stacked with test results of offenders/patients who lied or got bored during the test and started filling out random answers. You can't make them be honest. Even if you could, the stress and resistance that would result would invalidate any test results you obtained, making the results useless. Further, if you live in a society that has the ability to coerce every single human being to honestly take a psychological test against their will, you're going to have bigger problems than wondering if someone has criminal intentions with a gun.
Despite the safeguards that even the United States government has to screen and monitor its most trusted individuals' mental health and behavior there are still traitors and criminals operating at the highest levels of government undetected, at times with catastrophic consequences. So, if it is impossible to make background checks and mental health screenings work infallibly in the most tightly controlled organizations in the world, why would we expect it to work among everyday citizenry with even less control? These are not the thoughts we want to have about our world and security, but it's reality. Historical background checks and mental evaluations are limited in their effectiveness to predict behavior because “past performance is not necessarily an indicator of future performance.” Who knows what might change a person's mind tomorrow? These are only records of the past.
In terms of a mental health assessment to screen for criminal intent, it will never be covered by something like a quick, free, ten question Facebook quiz in the privacy of your own home. The whole premise behind criminal behavior is deception and breaking of rules. Comprehensive tests, such as those used by government agencies for security clearances take years of training to learn to administer and interpret, are very lengthy, and are very costly. The government's most trusted positions require extensive interviews across a variety of settings and with multiple clinicians to begin to get a big enough picture of the individual's life and psychology for the testing to be useful – but going back up to the Federal Government's having criminal individuals in its own agencies, there are still no guarantees even with all this that there will be no problems.
But, what if we only screened those who want to own guns? Well, again, if they don't want to take the test, don't want to be honest, decide to get their gun another way, manufacture one or use a different type of weapon, what good is your test? But let's say that we did decide to just give mental health exams for gun owners and if they have mental health issues they can't own one - assuming we wanted to run a test to actually screen for criminal intent and mental ability, rather than just seeking to declare people mentally unfit for gun ownership. Where are we going to get the money to pay for that on the scope of American gun-ownership? Especially seeings how your test results in some cases might not be valid long after getting them (going up to the examples above). Would you make the gun-owners pay for it....so that you now just made firearms ownership a privilege of the wealthy or the lawless, leaving the poor unable to afford to protect themselves from the lawless who use guns, and make this an issue of discrimination, while claiming we need to help the poor and oppressed? Those who most need personal protection are very often going to have mental health issues that arise from living in places where they are unsafe. We see a lot more anxiety, depression and PTSD issues just from living in high crime areas. Mental health issues from these settings may span generations, with mental health test results often taking on racial tones based on geography and economics, making the results appear politically incorrect in many cases. This is going to affect public support and perceptions about the efficacy and validity of your tests, as well as the lives of people being tested, and may actually do more harm than good in cases like this.
For example, we would expect some trauma with a rape victim, in the form of depression, anxiety, and PTSD at the very least. Yet, telling a rape victim that she isn't mentally sound enough to own a firearm to protect herself because she has an illness from being raped is not helpful. There are very many cases where owning a firearm would be therapeutic, help the victim regain confidence, heal from a sexual assault, and not “be a victim” anymore. Meanwhile, there are those for whom exposure to firearms, even in a safe setting, may be traumatic for one reason or another – yet having the opportunity to be exposed to, and utilize a firearm in a safe setting can be therapeutic for some individuals (though firearms should not be a substitute for social skills, relationship skills, or using wisdom and discretion to avoid situations and developing lifestyles that increase personal risk). There is no one single answer on this issue that is going to fit everyone. But we need to be aware not to project our own psychology on everyone around us in a one-size-fits-all attempt to cure society's ills and thereby unintentionally cause more problems.
Now, I've heard the word “paranoid” thrown around by politicians and activists to describe the “gun lover” crowd for wanting to protect themselves. Simply desiring to own a firearm for protection does not meet the psychological definition of paranoia. Paranoia is irrational, tends to be bizarre and even delusional, like thinking that people wear black to send you a coded message that you're going to be hauled off, or that people put padlocks on unused lockers to warn you that you're going to be locked away. Would you want people who purposely or even ignorantly misuse the word “paranoid” in charge of deciding whether you are mentally sound and writing government policies for you? Desiring to be safe, and not a repeat victim, is healthy, and is at the root of natural selection and evolutionary theory – so why would we want to stop that? Realistically, there are threats in our world. Statistically the probability of being a victim to violence can be low or high depending on where you live and how you live. Being prepared for it, and living in a society that promotes and enables preparation, reduces those statistical probabilities (“...if we can save just one life...”).
To say that the “mentally ill” shouldn't have guns...well, if we're going to use “mental illness” as the basis for denying gun ownership, then there isn't a human being alive who could ever have a gun (or do a lot of other things). We could categorize illnesses and severities and deny on that basis, but then we are back to honesty/reliability in testing – which aren't infallible. We also have to realize that many with profound illnesses (e.g. schizophrenia) function in our world quite well. We would be stigmatizing people and creating classes of mental wellness, and mental health practitioners would be under pressure to be dishonest in their assessments to keep people from being denied their rights or to even help them be safe in some situations. If we decide to deny rights to people simply on the basis of having ever been an inpatient in a psychiatric facility, then what incentive do we give if people are going to lose rights for seeking help, especially if the help is effective? So we talk about wanting to improve the mental health system, and then essentially “punish” people for trying to get better and make a better life for themselves and put them in a negative category again. I wish I could say that the government and psychology field were completely honest and ethical, were infallible, and that psychological evaluations could never be used to harm anyone now or ever. Many of us in the mental health profession are concerned about increased government involvement in mental health because of the potential for misuse of client records and test results. Additionally, when people have privacy concerns they tend to be less honest about the issues they need to work on, so increased government intrusion is only going to hamper progress rather than help. The integrity, usefulness, and confidence in the system decreases as it stops being about “mental health” and more about politics. Again, we find ourselves at somewhat of an impasse.
But those aren't the types of mental illnesses we are talking about, are we? What about the disorders that “make” people commit mass murder? Do people want to do these things, or is something like drugs or mental illness “making” them do it? What about the psychopaths? Let's get to the real issue, right?
We first have to dispel with the notion that people are “made” to do things – in the sense that if we find the thing that “makes” them do what they do, then there is something else that will “make” them stop, or do the opposite. As in, if they have (X) mental disorder, they are going to rob a bank – and by finding that mental disorder we can now prevent the crime. There isn't any one thing that “makes” people do anything. I know that's what we all want, the straight-up answer – “what made them do (x,y,z)?” (going back to the beginning). But in our quest for answers, we have to beware that we don't oversimplify the problem, and we need to ask the right questions.
Can people have a break from reality where they commit a violent act and not really understand or know what they did? Absolutely (e.g. blacking out from alcohol). In that case we would also look at their comprehension before they drank so much alcohol, and usually they knew they were being irresponsible – though people who are this irresponsible aren't likely to freely admit it. However, I've seen some people who embody sociopathic traits so severely, and whose behaviors appear so compulsive and are so dangerous, that they should never be released to the public (and probably never will be). I've seen others who were under the influence of illicit substances who didn't stop their behavior even when they have been shot by a firearm. Meanwhile, others seemingly out of control, only stop their behavior at the threat of harm to themselves, and in some cases, their own death. Ascertaining whether they were actually disassociated from reality can be very challenging, especially when you consider that the nature of criminal behavior is dishonesty. Most criminal offenders want to claim that the illness or drugs (or their friends, or circumstances, etc.) made them do what they did and the crime they committed isn't their fault, and that “all of this is just a big misunderstanding”. Far more often than not, there is an awareness that violent crimes are wrong. If not that, then it is known that there is going to be some opposition to it - a clue that you shouldn't be doing it and that doesn't require a PhD. Claiming a disassociative break from reality by criminals as an excuse for their crimes is so ubiquitous because they don't want to face the reality that they are responsible for what they have done – or the consequences. Just because someone claims they don't remember what they did, doesn't mean automatically that they are even telling the truth (in my professional experience, overwhelmingly they do remember) nor does it mean that they were under compulsion to do something they claim they didn't want to do, but did. It is, in the criminal mind, always someone or something elses' fault, and they see themselves as the real victims.
This is why the Department of Corrections focuses so heavily on choices in rehabilitation and mental health: the choices leading up to, during and after the offense - and helping offenders recognize that they are responsible for their lives and nobody else. Blaming anything other than the individual choices (e.g. the look of the gun because it had a handle on the front of it, or Saturday Morning Cartoon violence) for violent crime is never going to give us the results we want, or even address the real issue: that people make choices and do what they want to because they want to, even through the fog of mental illness. While we might wish to say in some cases “they don't understand what they are doing!” I would point out that the types of crimes I'm talking about ( I'm not talking about things like compulsively alphabetizing the soup cans in the grocery store or repeatedly entering into destructive marriages – I'm talking about things like school shootings and murders) are so obviously wrong, with so many opportunities to change directions and so many warnings that precede the act, that it is very difficult to dismiss these acts as a complete lack of awareness and of automatic/compulsive behavior on the parts of the perpetrators.
Are there people who truly don't know right from wrong? Absolutely. But far exceedingly more often than not, in my experience working with offenders, this is an excuse used to escape responsibility even at the lower levels of intelligence and higher severities of illness. We need to be sure not to make the exception the rule. They aren't likely to admit that they knew right from wrong, especially if it means reducing or escaping the consequences for their actions, or their attorney thinks they have a better case blaming something else.
There are concerns over psychotropic medications and their relationships to violent behavior, with some suggesting that people using medications shouldn't be allowed to use or possess firearms. Simply taking a pill does not automatically make one at risk for committing suicide or shooting up a shopping mall, no more than having a mental illness of any sort will. Hundreds of millions of Americans, even with severe mental illnesses, take psychotropic medications with improved lives and functionality and never violently harm another in their lifetime. Medications do come with warnings, and require skill and judgment to use, just like everything else in our world. There are differing levels of capability and responsibility of the people who live in our world with some requiring more help than others. Yet we have to remember from Basic Statistics 101, that correlation between events (e.g. take a pill, commit suicide) does not equal causation. While it is tragic when we see people commit suicide, or harm others while on medication, solely blaming the pills for the outcome shows an alarming lack of insight into the nature or scope of the issues. It would be a fallacy to lump a fully functional user of a psychotropic medication for schizophrenia into the same category as a murderer in prison who is diagnosed with a mood disorder, simply on the basis that they both take a pill, or have an illness. It would be yet another mistake to compare a psychotropic medication to an illicit drug on the basis that they both alter behavior and are ingested, and conclude that they are both dangerous – and yet, so often these are the leaps of logic that pervade our society.
Similarly, there are assertions being made that the mere presence of firearms makes people “likely” to violently harm others – there's that notion again: “Make”. Criminals love to blame things for their choices, and our society unfortunately caters to their mentality with how often this mantra is taken up. Three things we look at in human behavior are means, motive, and opportunity. A firearm is not the only means of harming another human being, neither is opportunity to harm absent without a firearm. Actually, the vast majority of deliberate violent harm to humans occurs sans firearms (e.g. assault). While I was a military police officer, I was stationed in a country that, for the most part, has banned firearms (Japan). I have been personally attacked in the line of duty with a variety of items ranging from beer bottles and butcher knives, to being nearly brained with a turkey platter, and had countless people swing at me with a fist. I've also seen people permanently disabled and nearly killed by such weapons. If someone genuinely doesn't want to commit a violent crime, they aren't going to even if they have the tools. If someone wants to do something horrific, they aren't going to be stopped even if they don't have the tools – they will make them or get them somehow. In my professional experience of dealing with criminal violence, in the cases where firearms were criminally used, the firearm wasn't the only factor: i.e. they weren't living the Ward and June Cleaver dream life in Pleasantville, a gun somehow enters their life, and suddenly they become irresponsible murderers who disassociated during the whole killing spree and suddenly didn't understand morality. The firearm has always been just one variable in a long list of variables (e.g. impulsive behavior, anger issues, substance use, ideology) to where even if the gun wasn't present, you still had a lot of issues that were going to lead up to something negative if continued. Going back to the American mentality: we love to blame because it gives us a sense of control and absolves us of responsibility, yet we miss the bigger picture. Removing guns from violent or dangerous people doesn't change the fact that they may be violent or dangerous.
Well meaning people like to look at other countries' laws as a solution for the United States' issues. We can't transpose one country's laws, culture, history, and social norms onto another and expect it to function equally well, no more than we would transpose religions onto someone as a solution for behavioral problems – i.e. “you are now Evangelical Wiccan, PRESTO! Your problems are solved!” Japan, as an example, is a very homogeneous nation – an island! - with an extremely different set of values, history, and social pressures that shape their society to be what it is in regards to crime and guns (and everything else). Japan is only a fraction of the size of America, with only a fraction of the different cultures, races, histories, and subsequent issues that are spread all over America. Simply changing our laws to be “like Japan” or any other country ignores the millions of other variables, factors, and forces that make up the system. It is ironic that in America, where we focus so much on diversity and individuality, how often we look over at our neighbors and think that we can be “just like them” by simply copying their laws, and expect an immediate change in society. This doesn't work very well at the individual level, and it certainly isn't going to work better when you start doing it with entire countries.
Lastly, we need to explicitly state and recognize that “harm is harm”. Tragically, we tend to overlook some crimes because they aren't as unpopular (e.g. female sex offenders) and we drop millions of dollars to campaign against sensational crimes (e.g. violence with guns). We thereby tacitly justify some crimes with our lopsided responses and cherry-picking activism. Yet there are a lot of similarities in the thinking that allows someone to steal, as allows someone to molest a child, as allows someone to open fire with a gun in a mall – namely a disregard for others and a justification and rationalization of the decision to do so. There are a lot of commonalities in the trauma that is experienced by an assault victim as there is a theft victim – such as a feeling of powerlessness, fear, mistrust, and anxiety. Rape at gunpoint is not worse than it is at knife-point than it is while sedated. Robbery by someone on drugs with a baseball bat is not better than robbery by someone with a gun. In my role as a counselor, I don't ever have victims saying “I was raped but they didn't use a gun, therefore I have no issues and don't need to see you” though I do get a lot of criminal offenders who say things like “I didn't use a gun or a knife, therefore she shouldn't be complaining.” (Male rapists often simply physically overpower their victims and don't need a gun to carry out the act – especially when we consider that they select victims based on vulnerability). The tools used aren't the issue, neither is the “severity” of the harm - the issue is that people choose to inflict harm, and harm is harm.
In the end, issues of violence and criminal behavior don't start overnight, nor will they be solved overnight by background checks, mental health assessments, or simply removing the objects used to harm. As a society we need to work to embrace and promote those measures that improve mental health and decrease criminal behavior - stable families being one of the most effective. Unfortunately it can take generations of work to develop functional families and break destructive cycles. Healthy, intact families have been in decline for several generations in America as government programs and political promises have often become the inept, absent surrogate. We keep inventing new programs, blaming objects and spending more money to solve society's ills, when what most effectively works has already been discovered, and is being targeted, undermined and destroyed on multiple fronts and even by many well-meaning government programs and policies: the family. Seeing a counselor for issues is great, but without an effective support system outside of the counselor (the best is a healthy family – which alone eliminates a ton of issues), the ability to change can be quite limited, and in many cases, may be impossible. All those things that require warning labels and a bit of wisdom and judgment to use so they help rather than hurt you? The best way to learn is from parents who take the time to guide and instruct who were guided and instructed themselves as children. A lot has changed for the worse in our world, but many things have changed for the better and I believe that if we wanted to and were determined to, the destructive tides we face can and will be turned. But it isn't going to happen through government testing, banning, or blaming.
(Professional Note: Issues of criminal behavior and psychology have
their own special considerations and dynamics apart from family or
clinical psychology. Despite the good intentions and
concerns of those in the healthcare and mental health community, many
suggestions I've seen on these topics, despite their accomplished careers and
credentials (e.g. Ph.D., MD, Psy.D.), reflect a
lack of specific and focused experience in the forensic field, and would
often perpetuate issues or create new ones. It needs to be recognized
that there are many specialties in the healthcare industry, most of
which aren't aimed at the dynamics and focus of criminal behavior
and issues. Because of the very high risk of harm, when working with
criminal issues and policy, we need to consult with those specifically
experienced and focused in that field).
