In the resurgent national debate regarding gun violence, the overriding focus -- understandably -- has been on homicide. I am aware of no discussion regarding suicide and guns. And yet the Center for Disease Control estimates that in the U.S., there were approximately 37,000 suicide fatalities in 2012, of which about 19,000 were from self-inflicted gunshot wounds, resulting in an estimated 50 million in medical and occupational costs to society, and inestimable damage and despair for the surviving families and loved ones. Tragic, though not heinous, 19,000 is more than double the 9,000 homicides by gunfire. A closer look at the characteristics and methods of suicide reveals a glaring similarity as well as a critical difference when compared to homicide.
Whereas the NRA would have us believe that the solution to our alarming homicide rate is more good-guy guns and greater accessibility, that argument has been refuted beyond dispute when it comes to suicide. A recent landmark review by the Harvard School of Public Health begins with, "Every study that has examined the issue to date has found that within the U.S., access to firearms is associated with increased suicide risk." Based on hard scientific data, the unanimous verdict is in. Period.
From a multitude of statistics, I will cite a few that seem especially revealing:
- In rural America, where guns are a far more accessible part of the culture, people ages 10-24 are twice as likely as their urban counterparts to commit suicide, overwhelmingly by gunfire.
- 1.1 million people attempted suicide in the U.S. in 2012. A suicide attempt by gunfire is nearly always fatal. Only one in sixty suicide attempts by all other means combined is fatal.
- A 2012 study found that suicide has surpassed auto accidents as the leading cause of injury-related death in the U.S. Gunfire is the fastest growing method.
- A 2007 study compared 39 million people from the 15 states with the highest gun ownership versus 40 million people from the 6 states with the lowest gun owner prevalence. There were 9,749 firearm suicides from the high-prevalence states versus 2,606 from the low-prevalence states. Both groups had approximately 5,000 or so non-firearm suicides.
- The oft-quoted study of sweeping gun control regulation in Australia, following the 1996 mass murder of 35 people by a lone gunman, resulted in a 65 percent annual drop in suicides by gunfire with no increase in suicide by other methods. A successful gun buy-back program reduced the rate still further by as much as 74 percent. These results only slightly exceed the drop in homicides by gunfire (59 percent), again with no increase in homicide by other methods.
Although statistics can be misleading, the universal consensus is reminiscent of similarly damning studies that demonstrated the irrefutable link between cigarettes and cancer. As NRA point-man Wayne LaPierre likes to say, a gun is only a tool. Precisely the point. Just as a jackhammer is an infinitely more effective device than a household hammer at breaking up concrete, a gun is indisputably more effective in the business of killing oneself than all other methods combined. Uncontained accessibility sets the stage for tragedy to occur.
But there is a critical difference in suicide versus homicide by gunfire. Improving mental health care availability would likely have a very significant impact on lowering suicide rates as opposed to virtually zero positive effect in preventing homicides. In previous posts, I have insisted that the notion of profile-predict-and prevent strategies as a way of curbing mass murders is nothing more than a comforting illusion. Chasing a mirage. A counterproductive distraction and waste of resources that plays right into the hands of the NRA leadership. Many of the recent mass murderers were known to have severe emotional problems ranging from the predatory psychopath to the floridly psychotic. Many had been in psychiatric treatment of some sort.
Over the course of my 35-year career, working with over a thousand patients and supervising the treatment of scores of others, there is only one instance I can recall of an individual who revealed passing thoughts of taking out a contract on the parents of his former girlfriend. His reference was fleeting and, in my judgment, not credible. We were able to talk this through, he grieved his loss and moved on. Had I rushed to the phone to report him to the authorities, the therapy would have been over, his anger would have become much worse, and any propensity for actual violence would have been exacerbated.
The number of people who seek therapy because of explicitly homicidal urges is virtually non-existent, although many seek help for problems with rage, uncontrollable temper, alienation and bitterness, often with very successful therapeutic outcomes. But it is simply impossible to predict reliably whose rage will combust into homicidal action. In my personal experience, three young males stand out who would not have surprised me if had they exploded and actually killed someone, yet there was never anything explicitly homicidal revealed, nor did anything tragic occur.
The story is very, very different when it comes to people who feel like life is not worth living. They regularly come for help when it is available. The success rate is extremely high. Clinicians who work with severely depressed people hope to be fortunate enough to make it through their careers without a patient committing suicide. But even with suicide, it is impossible to predict with any certainty who will leave the office and take their life.
I have lost one patient to suicide a few years ago. I was thoroughly stunned and shocked, as was the medicating psychiatrist. We both viewed the person as virtually immune to suicide for a variety of reasons I will not go into. Of the hundreds of suicidal people I've worked with, this person I considered one of the least likely to act. I was dead wrong. As with homicidal behavior, there is good clinical judgment, but no reliable way of predicting.
For suicidal people, access to guns is lethal; access to mental health care is life-saving. Similarly, access to guns increases the risk of homicide. But in stark contrast, expanding mental health services with the goal of profile-predict-and-prevent, essentially for the purpose of psychiatric incarceration, will make matters far worse.
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