Issue 29 / 8 August 2011

IN January this year, 23-year-old high school dropout Jared Lee Loughner opened fire with an automatic pistol at a “Congress on Your Corner” meeting in Tucson, Arizona.

He seriously wounded US Congress member Gabrielle Giffords, before killing six bystanders and injuring another 19 in a shooting spree that lasted less than a minute.

Roll on to July this year and 33-year-old Norwegian Anders Behring Breivik, acting alone, bombed an Oslo government building, which housed the Prime Minister’s office.

He then made his way to nearby Utoeya island and, disguised as a policeman, stalked and fired on teenagers attending a Social Democratic Labour Party retreat. The final toll was 77 innocent Norwegians slaughtered.

Australia has also witnessed this senseless slaughter with one infamous massacre forever etched in our national psyche — Port Arthur. In 1996, 28-year-old Martin Bryant shot dead 35 visitors to the mournful ruins of our convict past.

Such tragedies demand a considered response. We must ask if we are capable of both predicting and preventing such massacres.

Do the perpetrators of mass shootings share common personality traits and social attitudes, which may allow for their early identification and subsequent denial of access to firearms?

Our current understanding of the characteristics of mass murderers may be flawed, but it is all we have — they are invariably male, in their second to fourth decade, suffer from mental disturbances and social alienation, and have mostly chosen automatic firearms as their weapon of choice.

But an in-depth analysis of their mental and psychological traits remains problematic. This issue was explored in an article in the The Lancet titled: “Why are the mentally ill still bearing arms?” by Dr Jonathan Metzl, an expert in American culture, psychiatry and medical humanities at Vanderbilt University.

Metzl notes that when dealing with mass murderers, the media tends to focus on the conundrum of whether mental illness is responsible for the violence.

Indeed, immediately after the Arizona shooting, the New York Times speculated that Loughner was a schizophrenic and asked how society could more effectively treat the mentally ill who were increasingly becoming more disruptive. It has since reported that mental health experts have found Loughner does, in fact, have schizophrenia and they are trying to make him psychologically fit to stand trial.

But not all scholars support the notion that individuals with mental illnesses are more likely than anyone else to commit gun crimes.

Professor Paul Appelbaum, a Columbia University psychiatrist, in an editorial in the American Journal of Psychiatry, suggests that a far more important set of risk factors for gun violence in the US appears to be substance abuse and a past history of violence.

The crucial question is whether we can develop a reliable personality profile to effectively predict the likelihood of an individual becoming a firearm mass murderer.

And this question is critical. It requires a rigorous, collaborative global endeavour by forensic psychiatrists and other experts to develop criteria that will provide those working in the field with a broad cross-cultural personality prototype of mass murderers.

One can only hope that they may arrive at some common ground between competing ideologies and reach consensus.

But even then there may be difficulties. The medical profession may be reluctant to report such patients, as outlined in a recent letter in the BMJ. And there is always the might of the powerful gun lobby that assiduously protects the right to bear arms.

Whatever solutions should emerge for dealing with potential firearm massacres, this modern malady remains a serious public health problem.

It requires a concerted research agenda on an international scale. Otherwise this mindless and explosive human carnage of innocent bystanders will continue.

Dr Martin Van Der Weyden is emeritus editor of the MJA.

Posted 8 August 2011

One thought on “Martin Van Der Weyden: Carnage needs a health solution

  1. Bryan Walpole says:

    I like the idea, Martin (it started with Tarasoff vs Regents of Calif. in US, where we are ethically required to notify such people if they come to medical attention).
    But mostly they don’t ( Bryant had no mental health history) and a lot of people make outrageous allegations in times of stress (” I feel like blowing up the whole hospital” was once said to me by a disgruntled patient with BPD).
    Unnescessay locking up and infringement of our liberty may create more problems than it solves. Firearm and explosive restriction although not perfect does work, but maybe we need a more inclusive society, less of “me” and more about “us”. Horrid as Oslo seems, it pales when compared with the human misery from political violence seen in Somalia, Afghanistan.

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