Keep Your Sight on Target

(from nydailynews.com)

(from nydailynews.com)

Attempts to blame guns for mayhem are unfortunately frequent. In a recent Politico articled Laura Kiesel cites a number of reports of violence committed with guns. Unlike many authors, she calls for a more careful examination of factors that may lead to such shootings. This focus on those who commit acts rather than the means they use is commendable.

She blames “toxic masculinity”, and presents data showing that—no surprise—men are more violent than women. She notes in particular that 86% of domestic violence perpetrators are men.

It is certainly true that men are more often violent than women.  It is broader than this, however. Developmental research consistently shows that boys are more aggressive than girls, and the tendency for males to be more violent than females is evident in chimpanzees and gorillas. One study Kiesel cites showing men being more violent also points to genetic and other biological factors that account for this. However, in addressing biology she focuses unduly on levels of testosterone in adulthood, which is a small part of male/female differences.

Kiesel observes that being male is more strongly associated with committing violence than is any mental health diagnosis. She argues for a minimal role for mental health problems in violent behavior by noting that although women are more likely to have a mental health diagnosis, they are less likely to behave violently. She observes that “female sex is actually considered a protective factor against becoming a perpetrator of serious violence.”

Despite the importance of biology, she surmises that “societal influences probably play a larger role in violence than any biological factor”. She raises, for example, such concerns as “entitlement” and “intersectionality.”

This is inconsistent with the material she presents earlier in her paper suggesting that “women live through the same experiences, from childhood abuse to stressful life events, at rates similar to or even higher than men.” If societal factors predominate, then by this reasoning women should behave more violently than men.

She suggests that men commit violence because setbacks of one sort or another threaten their masculinity. One might also believe that women who commit violence may do so in response to similar threats to their identity.

Other logical problems are to be found in the Kiesel paper, including slipping into talk about “gun violence” as though guns were somehow an actor rather than a tool. This is odd, since the focus of her discussion is the actors’ characteristics, and particularly their gender.

The use of “gender” rather than “sex” raises an issue as well. “Gender” is currently used to imply social and psychological identification, while “sex” is used to refer to biological factors; one of the reports she cites addresses in detail genetics, brain anatomy and so on.

She devotes considerable space to the role of mental illness in violence. While the link between mental illness and acts of violence is not strong, her discussion makes clear how difficult it is to know what diagnosis a perpetrator might qualify for.

 She talks about “serious” and also “definitive” mental illness, although she provides no definition of these terms. Indeed, they have no generally accepted meaning in psychiatry. She allows, however, that substance abuse is definitely linked to violence, a fairly solid finding.  But it’s complicated—men are more likely to be substance abusers.

Another shortcoming of Kiesel’s report is that she begins by rehashing information from episodes of mass killings. This is a misplaced emphasis—not only does it play to emotionality but it takes away from serious discussions of violence in a number of the reports she cites. She accepts as fact that “mass shootings” occur more often in the United States than other places. To believe that, any consumer of international news would have to ignore reports from Syria, Afghanistan, Nigeria—and who know where in the future. The significance of “mass shootings” in the U.S. is minimal in our overall murder rates for decades. And this, despite the fact that there’s been no decline in the ratio of men to women!­­­­­

Given Kiesel’s appropriate emphasis on people who commit violent acts, rather on the means they use, what follows? The great majority of people (even men!) are not violent.  A more productive approach would be to study biological and psychological factors, along with social context, that influence why a particular individual is liable to commit a violent act. This sort of understanding would allow us to consider interventions that could reduce the likelihood of individuals turning to violence.

 

Tom E Gift, MD

—Thomas E. Gift, MD is a child and adolescent psychiatrist practicing in Rochester, New York, an associate clinical professor of psychiatry at the University of Rochester Medical School, and a Distinguished Fellow of the American Psychiatric Association.

All DRGO articles by Thomas E. Gift, MD