As the gun control debate continues down its path of media soundbites, Twitter one-liners, and passive aggressive comments, are we missing the real issues? After any tragedy, we attempt to find out why this happened and what we can do to stop it from happening again. With school shootings, both sides of the aisle resort to a predictable monologue of guns versus everything else. Several months ago, we addressed many of the gun control proposals in light of all of the school shootings and which proposals would have helped or would have done nothing.
Today, I want to look past all the elephant and donkey rhetoric and attempt to see a root cause to the problem. Why has the number of school shootings increased drastically in the last 20 years? Well, first of all, that myth is false, according to James Alan Fox, Professor of Criminology, Law, and Public Policy at Northeastern. Fox claims that schools are actually safer now than they were in the 90’s, and that school shootings aren’t actually on the rise at all.
"The difference is the impression, the perception that people have," Fox says — and he traces that to cable news and social media. "Today we have cell phone recordings of gunfire that play over and over and over again. So it's that the impression is very different. That's why people think things are a lot worse now, but the statistics say otherwise."
My research for this article challenged my preconceived notions as a political contributor, as well as a healthcare professional. While attempting to prove my theory that we need more mental health treatment in America, I came across several studies that potentially implicate some psychotic medication for an increase in violent tendencies. I and these studies do NOT say that some anti-psychotic medications cause violence, but there was a significant correlation between their use and an increase in violence.
Several school shootings have been carried out by people who had a history of known or suspected mental illness, many of which could have likely been stopped had someone spoken up and given the individual access to mental health treatments. Ironically, these studies show that some of the treatments, especially for MDD (Major Depressive Disorder), could increase the likelihood of someone committing violence to themselves or others.
So, what is the deal? Well, research has shown that specifically in males ages 15-24 who were treated with an SSRI (Selective Serotonin Reuptake Inhibitor), there was a relative risk of 6.6, indicating a statistically significant increase in violence. What is interesting is that this increased risk of violence is only statistically significant on a low dose of SSRI’s in this age range for males. This means you can’t conclude that SSRI’s cause and increase in violence because those who take moderate to large doses do not have an increased risk of violence.
We also aren’t dealing with every SSRI on the market, only about 5 of them. Specifically, Prozac (fluoxetine), Paxil (paroxetine), Luvox (fluvoxamine), Effexor (venlafaxine) and Pristiq (desvenlafaxine) are implicated in several studies as causing an increase in violence as well as suicidal thoughts. It is hypothesized that the medications can cause a state of numbness in some individuals, creating an “I don’t care” attitude that can be observed in many who commit acts of violence. This is also associated with an increase in suicides amongst the same population.
All that being said, please don’t read into this as “never take anti-depressants” or all medicine is bad for your mind. That in no way is my conclusion, and in no way is it the conclusion of all the studies that have been done. What it does say is that using certain circumstances, caution must be taken when making decisions about initiation of mood-altering substances. I would suggest that great care must be taken if starting a young adolescent male on an SSRI, including avoiding the 5 drugs listed above, as well as considering the risks versus the benefits to beginning a young male adolescent on one of these medications.
Sometimes, the best intentions to help can end up backfiring and causing more problems. Throwing pills at a problem is usually never the appropriate solution. We need to approach mental illness from a multi-faceted point of view, including potentially using medication, but adding other therapies, such as cognitive behavioral therapy and others. Fortunately, one of the biggest deterrents we have at our disposal is friends and family. If you see someone who is acting irrationally, or doing things that aren’t normal, say something. Don’t be the person who reflects on a major act of violence and say, “Yep! I knew he was gonna do that.” Be a part of the solution.
So, what do we do about this? Is mental health really relevant in the non-existent epidemic of mass violence and shootings? Absolutely it is! We need to implement a broad range of treatments and make them widely available to those in need. We need to be less quick to jump into shoving a pill down someone’s throat and consider the consequences of those treatments. Unfortunately, sometimes the only way to see some of these effects is to do post-market surveillance on medications, meaning bad things have to happen before we know why.
There are a lot of perpetrators of mass violence lately who have been taken in to custody, unharmed. These people need to be studied in depth to see their motivations, thought process, mental illness attributes, and actions to help us learn what actions and steps we need to take to help reduce the number of events. HIPAA (Health Insurance Portability and Accountability Act) will likely be a hindrance to many of these efforts, especially in those who are deceased as there is no chance they will be able to consent to the release of their medical records. Congress will need to act to amend the HIPAA protections to allow this to be studied in greater depth.