Guns and Suicide

February 22, 2013

Mass killings have been in the news recently, as I discussed in an earlier blog.  Suicide rates are also up dramatically, for a variety of reasons.  One of these reasons is posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) in returning veterans from the wars in Iraq and Afghanistan.  Another is a steady increase, over the past few decades, in the incidence of depression, especially among young people, in the United States.  Suicidal thinking is an important component in severe depression.  Some suicidal people engage in mass killings before killing themselves.

It is urgent that we devote more money and attention to the treatment of depression and PTSD, in order to reduce unnecessary deaths from both suicide and homicide.  The author utilizes dream revision therapy for PTSD, but the method is not yet widely known or practiced.  The author also prescribes antidepressant medications for people experiencing depression; some of these people are also suffering from PTSD.

Many people in need of antidepressants are not making use of them for one of several reasons: 1) lack of recognition, by themselves or their doctors, 2) lack of health insurance or ability to pay for treatment, or 3) refusal of treatment, due to concern about possible stigma associated with having a mental illness.  Two-thirds of gun deaths in the US are caused by suicide rather than homicide, as mentioned in a recent New York Times article.  Better mental health treatment is needed to reduce suicide rates in the US.

When I see a patient who is experiencing severe PTSD and/or depression, I ask if there is a gun in the house.  If they say yes, I then ask if they would be willing to have the gun removed from their control, ideally taken out of the house and placed in the care of a friend or relative.  A less preferred option is to have the gun locked up and the key placed under someone else’s control.

The problem with guns and mental illness is not that people with mental illness are “crazed”, but that they are impulsive.  Their emotions may be, at least temporarily, out of control.  If they feel sad, they can suddenly feel hopeless or worthless; if they feel angry, their anger can suddenly escalate into rage.  The increased emotional intensity may be quite brief, after which they would regain control.  The problem with a gun is that it is so decisive.  They might recover from an overdose of pills or a wrist cutting, but they are less likely to recover from a suicide attempt with a gun.

Clearly, someone who is intent on killing themselves may find a way to accomplish it.  My task as a psychiatrist is to try to make impulsive suicide more difficult and less likely.  If someone is consistently suicidal and I detect it, then I have the power to contact the police and have the person brought to the hospital for evaluation and possible 3-day involuntary admission.  Over the years I have undoubtedly saved many people’s lives by doing this.  Most people are grateful to be alive (eventually) after such intervention.  Many people recover from depression, and go on to live normal happy lives.  People with self-inflicted gunshot wounds involving the head or other vital organs do not generally have a good result.  The ready availability of a gun is an enormous risk for anyone with significant depression and suicidal ideation.  Anything we do to reduce this availability can be life-saving.