Time to Turn Down the Rage Amplifier

“I think that mental health is your problem here. This was a very—based on preliminary reports—a very deranged individual, a lot of problems over a long period of time. We have a lot of mental health problems in our country, as do other countries, but this isn't a ‘guns’ situation.”

–Donald Trump, speaking in Tokyo, on the church shootings in Sutherland Springs, Texas on November 5, 2017.

319 days into 2017, we have had 391 mass shootings in the United States ¹.

That’s more than one each day this year. Sit with that for a moment.

I remember being 12 years old in the summer of 1984, and being indelibly marked when I learned of the mass shooting at a McDonald’s restaurant in San Ysidro, California, where a single gunman shot 40 people, of whom 21 died ². At the time, it was the single most deadly shooting in the US, a record which has been miserably eclipsed so many times in the 33 years since, to the point that many of us feel an agonizing anesthesia dolorosa—pain with numbness, at the news of yet again, another shooting.

The politicians, pundits, and press deliver this problem up as one for mental health providers to solve. It’s a convenient distraction from the difficult conversation about the ubiquity of guns in this country—almost as many guns as people at last count ^3,4. I am offended that my patients, people whose mental illness renders them far more likely to be victims than perpetrators of violence, should be scapegoated as the culprits in this situation ⁵.

WEIGH IN: Share your thoughts on this topic in the comment section below.

While there are some DSM diagnoses associated with a higher prevalence of violence⁶, there is no one diagnosis alone that predicts violence. To take the diagnoses that are associated with violence and decontextualize them from the circumstances of the patient and his/her presentation is to do a disservice to our patients and the society we are trying to protect.

A single diagnosis cannot clearly identify a person as a potential perpetrator of violence. As clinicians, we traffic each day in the realm of human emotions. And while it’s obvious to any clear thinker that we have a gun problem in this country, more importantly, it is also abundantly clear that we have an anger problem, particularly among the alienated, rageful white men, who are most often doing the shooting. It is this context of the patient’s circumstances and emotional presentation that we must attend to if we are to prevent violence.

Guns are rage amplifiers. They permit the indiscriminate dissemination of violence, not only to an intended target, but to anyone who is unfortunate enough to be in proximity when the bullets start flying. Increasingly, the rage seems to be nihilistic and arbitrary in whom it targets, with gunmen motivated to inflict maximal damage to any conveniently dense gathering of targets. I doubt that the Las Vegas shooter (I am intentionally omitting the names of the culprits so as not to glorify them) had a particular beef with country music fans, but rather, found a densely packed cluster of 20,000 potential targets as a target for his wholesale rage.

This is where we as mental health providers can be of assistance in staunching the bleeding. We need to be leaders in talking about the anger that drives these men to kill. We need to be talking about humiliation and how it metastasizes into rage in men who have been acculturated that it is more honorable to kill than to suffer a humiliation. We need to help our patients learn that not all disappointments are intolerable humiliations that justify a violent response. We need to teach young men that even when they are humiliated, they can endure the pain of shame without resorting to lethal retribution.

MORE: Preventing the Unpredicted Through Smarter Gun Policies

We need to be talking about a culture that permits violence against women to continue unchecked (witness the Texas shooter’s history of domestic violence against his wife and infant child or the UC Santa Barbara shooter’s internet polemics about feeling spurned by women on campus and how this justified his vengeance)⁷. We need to be talking about the dying gasps of white hegemony in this country before another angry young man expresses his rage on a congregation of African-American churchgoers, as happened in Charleston, South Carolina.

If this is to stop, we must not be lured into either/or frameworks for solutions. It is not a “gun problem” or a “mental health problem.” It is both and more. We need to reduce the stigma that men experience when asking for help with mental health problems. We need to turn down the rage amplifier with thoughtful, sensible restrictions on gun possession so that anger cannot so quickly be expressed with mass murder. And we need to look at the roots of the rage that is being amplified with bullets.

1. Mass shooting tracker. https://www.massshootingtracker.org/. Accessed November 15, 2017.
2. San Ysidro McDonald's massacre. https://en.wikipedia.org/wiki/San_Ysidro_McDonald%27s_massacre. Accessed November 15, 2017.
3. A minority of Americans own guns, but just how many is unclear. https://www.pewresearch.org/fact-tank/2013/06/04/a-minority-of-americans-own-guns-but-just-how-many-is-unclear/. Published June 4, 2013. Accessed November 15, 2017.
4. U.S. and world population clock. https://www.census.gov/popclock/. Accessed November 15, 2017.
5. Mental illness and violence. https://www.health.harvard.edu/newsletter_article/mental-illness-and-violence. Published January 2011. Accessed November 15, 2017.
6. Reuve ME, Welton RS. Violence and mental illness. Psychiatry. 2008;5(5):34-48.
7. Solnit R. Men Explain Things to Me. Chicago, IL: Haymarket Books; 2015.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, California, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.