June 23, 2022

The basic bipartisan agreement among senators to ensure a filibuster-proof deal to reduce mass gun violence includes billions of dollars of mental health investments, such as expanding nationwide mental health and addiction services.

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What do mental health and mental illness have to do with mass murders and increasing violence in society? Virtually nothing, we would argue. 

Having mental health “experts” look at many people to determine who is a threat is an exercise in futility.  There has never been a major study that indicates that such experts can discern who is dangerous or not dangerous better than laypeople.

Our late colleague and friend, psychiatrist Dr. Thomas Szasz, spent sixty years of his life pounding home the chasm between mind (behavior) and disease (physical cell abnormality).   

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We are addressing here the issue in light of the almost ubiquitously reckless and irresponsible use of the terms “mental health” and “mental illness.”  Pundits and those social scientists considered experts on the matter use the terms mental health and mental illness as if they are causal agents which account for why people act in socially desirable and undesirable ways. In fact, they are usually terms only of inference, implying good/bad and socially valued/disvalued thinking, opinions and conduct. 

Szasz and his supporters submitted that neither empirically exists: mental illness nor mental health. They are both metaphors, metaphors masquerading as medical realities.  Diagnoses of mental illness are subjective judgments of behavior. Diagnoses of real disease, such as those made by pathologists and used in nosology, are made on the basis of cellular abnormality. The latter is objective;  the former is subjective. 

That is to say, mental illness and mental health are value judgments, not medical/scientific assessments. As Szasz always asserted, disease is something physical, something a person has, like leukemia, whereas mental illness refers to alleged reasons people do bad or wrong actions.  The terms refer to everything and therefore distinguish nothing. 

The American Psychological Association this year argues that “prior research suggests that approximately two-thirds of public mass shooters exhibit signs of mental illness… and that even the most ‘mentally healthy’ perpetrators could be recoded as having signs of mental illness or suicidality…” None of these “signs” is anything but behaviors, not physical symptoms of disease. 

Regardless, mental health and mental illness remain most of current liberal and conservatives’ go-to explanations for virtually all impossible-to-stop anti-social phenomena.  This is mainly due to frustration; what if there is no way to lessen the criminal population, especially in violent cities?

Yet, regarding mass murders, surprising as it may be, the generally psychiatrically focused left has a few — just a few — dissenters.  The Psychiatric Times wrote unambiguously, “The fact of the matter is that ideology, racism, and perceived injustice trump mental illness in many of these cases. To put it bluntly, racism is not mental illness.”  This incongruous admission is no doubt due to the Left’s unwillingness to excuse perceived racism, which it finds everywhere.