Should mental health evaluations be required before the purchase of a fire-arm?

EDIT: This post was written hastily in response to something inflammatory posted on Facebook (isn't it always the case?) about the Aurora shootings. Please excuse errors and the gradual deterioration of my argument into a general anti-guns rant.

Regarding whether psych evaluations are necessary or indeed useful, I think we first have a to dispel a few myths and look at some data.

First of all is the way in which we psychologise extreme and disturbing acts that involve firearms, like mass murder. There's a great article here by a Cambridge Professor discussing how we tend to see Western murderers as lone, deranged individuals, but see non-Western murderers as acting on cultural influences (Islam, dictatorships, social deprivation etc.).
The reality in all cases West and East is it's a combination of many factors that we tend to ignore in favour of a simplistic analysis of motivations which helps us make some sense out of the chaos.

A recent Fox News article actually tried to blame failings in Psychiatry for not being able to properly understand and pre-emptively catch the aforementioned "lone deranged killers". Dr. Allen Frances, Chair of the Psychiatry department at Duke University and contributor to the upcoming DSM5 (the American bible of psychiatric illnesses) wrote an eloquent but pithy response to this kind of article explaining that we will never be able to find the needles in the haystack and we either need to accept Mass Murder as part of the American Way of Life, or we need to get in line with other industrialised nations and accept reasonable gun control laws.

Does that mean psych evaluations are useless? Not exactly. Up until now I've only been talking about mass shootings, which by default represent extreme exceptions in society, and sadly contribute to stigma and the false association between mental illness and violence.

The majority of murders in the US are overwhelmingly represented by firearms and are not carried out by mass murderers. Again, all these gun-related homicides aren't all caused by one type of person. It's certainly clear that most gun deaths happen in poor urban areas, and black teenagers appear to be most highly affected in terms of gun deaths, so that does help narrow down some of the social factors.
But from a purely psychological point of view, what lines can be drawn? We do know that a significant section of the criminal population may be suffering from mental illness (sometimes as a consequence of prison!). Furthermore, there is evidence that 64% of males and 50% of females in prison suffer from one form of personality disorder or another (in the UK), although the exact relationship between type of personality disorder and type of offence is unclear.

Additionally, we know that there is an association between violent offences and this narrow sub-set of psychiatric illness called personality disorders. Antisocial personality disorder is a fairly robust construct that can account for a lot of violent offending, and a recent large-scale study in Baltimore found that early disruptive behaviour and anti-social personality was predictive of later criminality (on the plus side, this was tempered by the introduction of a behaviour management program; remember season 4 of the The Wire?).

What I'm saying is that we're already well aware of some of the early signs and causal factors and there are (often under-funded) prevention programs in place to help avoid high-risk individuals from becoming violent, but again, it's a very complicated, multi-layered problem, and honestly, guns shouldn't have to be part of the equation.

Let's not forget though that guns don't just contribute to homicide rates; ready availability of guns in the household increase the risk of suicide in the home. Most states in the US actually ban the purchase of firearms for individuals who have a diagnosis of mental illness or have ever been hospitalised, but clearly it's not enough.

I don't know if mandatory psych evaluations would help or not, I do know that police have to take them before entering the force, and their gun is seen as an enormous responsibility, something that contrasts with my experience of walking into a Bass Pro shop in Oklahoma and seeing a large sign saying "Glock Giveaway!! 2 for 1!!".

I guess debates over mandatory screenings, and gun ownership in general relate to the wider notion of Isaiah Berlin's Positive and Negative Liberty.

Without going into too much detail, positive liberty represents the degree to which we have social representation (in other words, how democratic our society is), and negative liberty represents our ability to be left alone and do what we want, while still being held individually responsible for our actions (agency). Sir Berlin was more focused on negative liberty, as at the time the cold war had left the Western world feeling that any form of de-individualised mass movement could only lead to violent revolution.

I completely understand this concept and can largely agree, but in America the cultural history has strangely tied the notion of gun ownership tightly to this core principle of the Liberal conception of Freedom.

What provides a sense of agency about having a gun? Provided you're not a member of the Crips or the Bloods, you're probably a homeowner who feels that owning a weapon is a necessary part of home protection, leaving you and your family free to enjoy the fruits of liberty:

It's a well-known finding that, rather than confer protection, gun ownership increases the risk of homicide.

We don't have guns in the UK, or rather, we do have illegal guns in certain gangland areas near Manchester and London, but I've never seen one or been in a situation where I thought a gun might be necessary. Illegal guns are very difficult to come by as they are simply not manufactured and sold in a way that benefits the criminal underworld in Europe.

The police advise people in my neighbourhood that if someone breaks into your home, you should barricade yourself in one of the rooms of the house; intruders are mostly looking for stuff to steal, and that's covered by insurance. The best way to effectively deal with a violent situation is to get out of it. Charles Bronson most of us are not.

So as you can tell, I'm pro gun-control. I'm really anti-guns full stop, but I'm willing to meet halfway. Here's a study from Austria where guns are legal, comparing the homicide and suicide rates before and after the introduction of restrictive firearm legislation. The results speak for themselves.

And this cultural myth that America is simply a more historically violent nation and you simply can't compare it with other civilised nations? Need I remind you of Austria's history?

Aussies, Psychos, and Adam & Joes

This is a million times better than any of the film-based re-appropriation memes out there. It's also probably the only truly successful meme using footage of Tom Cruise that doesn't make fun of his Thetan obssession, but rather his trademark po-faced intensity:

Speaking of which, apparently Christian Bale took inspiration from Tom for one of his finest roles. Can you guess which one? No, not Velvet Goldmine:

It was, in fact, AMERICAN PSYCHO. Quote:

And then one day he called me and he had been watching Tom Cruise on David Letterman, and he just had this very intense friendliness with nothing behind the eyes, and he was really taken with this energy

Seriously, it's just a matter of time before these guys appear on-screen together and have a psycho-off

I find it wonderfully perceptive of Christian Bale to have picked up on the idea of "superficial friendliness, but nothing behind the eyes". This is a common description used for genuine psychopathy, a subject I could never tire from studying. The awesome Jon Ronson's new book sees his customary humanistic approach applied to the weird and terrifying world of psychopaths:

Psychopathy is considered a dangerous personality disorder, and while my jaded friends who've worked at Broadmoor may scoff, I do still find it shocking on some level that instead of serving the sentence one is given for a corresponding crime, claim to be coo-coo and you could end up in an institution for the rest of your life. This is because while a transient psychotic episode may (rarely) lead an individual to commit a violent crime, a personality disorder obeys the three P's:

Persistent – consistent and inflexible pattern of coping over time

Pervasive – can be seen across different situations such as work, family and social relationships, and not just specific to offending

Problematic – has negative impact for themselves and/or others

What that means is that you ain't gon' change, son. Which means that nobody knows what to do with you, which means that only "preventative measures" can be taken as a viable solution for your care i.e. the most fun you'll ever have from now on is brewing prison wine (I don't know if they do this in Broadmoor, it just seemed like a good moment to reference an excellent blog).

What's mildly chilling is that the Biomedical model of mental illness (i.e. all things CBT and prescription meds related) has gradually adopted this same approach to illnesses well beyond the scope of personality disorder.

I'm fairly new to clinical research in mental health, having come from an Experimental Psychology background (which is NOT the same thing), but I still find it shocking to think that a major assumption within current approaches to mental illness is that underlying all disorders are stable, enduring traits that cannot be changed. These underlying "vulnerabilities", may then create a higher predisposition towards developing affective or psychotic disorders.

This stems from personality research, which is somewhat poo-pooed in Experimental Psychology, but has become a dominant feature of modern Psychiatry, and purports that concepts such as the Big Five are stable over time and predictive of all kinds of social outcomes, despite mixed evidence here and there...

Modern evidence-based therapies thus concentrate not on changing the person, but rather helping them come to terms with who they are (or what they have, depending on your narrative), and learning to accept themselves while adopt compensatory behaviours that will hopefully limit their suffering and that of those around them. I acknowledge that CBT is designed to change cognitions, but this is not the same as striving towards changing fundamental aspects of the self (a dangerous term that no self-respecting psychologist would use for fear of ridicule by the empirical community, but that psychoanalysts bandy about willy-nilly).

I can't find a good reference that discusses these various points directly, thus undermining my argument, but this article certainly broaches the topic indirectly in that it is now apparently hard to distinguish between mental illness and personality disorder in the current approach to mental health.

Also, check out A Barefoot Therapist Speaks.

Obviously I'm massively generalising and what I'm saying is coming from someone who would very much like to enter the world of Psychiatry and become a practising clinician, so feel free to disregard/assassinate with logic.

It's also weird to think that a single academic's personality checklist has utterly dominated the field of psychopathy research for over 20 years.

In fact, as with many such things in academia, sadly, attempts to move the field forward are not always met with open arms.

Poorly referenced diatribes aside, I think I've gone quite off-track given that this all started with a funny video of someone doing an Aussie stereotype.

The video was actually made by Adam Buxton, one half of my fave comedy duo Adam and Joe, who sadly have ended their run of excellent podcasts (but have not been thrown in the bin/trash and forgotten about!).

No one understands our beardy man-love

Incidentally, the other, taller half of the duo, Joe Cornish, recently released his debut film Attack the Block, which I thought was very confidently directed and highly entertaining. I wonder whether the DVD release will suffer due to the recent London riots...(see my last post).

Ok, I've run out of steam, so I'll end by giving my Song Of the Day here.