Gunfire In the Streets

 

True crime television is very big in the United States right now.  It is well produced and, in most cases, more engaging than typical fictional crime dramas.  Much of it shows real time police work with body cam and camera crew footage.  It gives a generally good presentation of police officers and detectives including demands of the job and their disclosure of the emotional toll and empathy for crime victims.  A cross section of police departments are sampled and they represent themselves very well.  I have been consistently impressed with their degree of professionalism and approaches to solving crimes. 

The striking part of these videos is the level of violence on the streets of the US and what the police have to contend with.  There seems to be a pattern of reactivity that many people have that leads them to try to evade the police or physically resist their efforts to detain them at all costs.  These aggressive confrontations often occur for trivial reasons.  A common example is a routine traffic stop that turns into a high-speed chase and multiple collisions or a single high impact crash.  The person apprehended has suddenly gone from a misdemeanor crime or traffic ticket to multiple felonies and jail time. 

Nowhere is the escalation more evident than firearm related crimes. I have seen many of these situations where the first action taken by the offender is to open fire on the police.  Open the car door and start shooting.  Pull off the covers in bed and come out shooting.  Wrestle with two officers in close proximity to your girlfriend, get loose, grab a gun, and start shooting. Hole up in your house or apartment and when the police show up start shooting through the windows and walls.  I saw one episode where 96 rounds from an assault rifle were fired though the apartment walls at police officers on a stairway (they did not fire a single shot).  And all of that gunfire took less than a couple of minutes.

Any reader of this blog knows that I support reasonable gun laws, abhor the current trend to maximize the number of guns on the street, and see easy access to guns as a major public health problem.  I also dispel the conventional political wisdom on guns as only being problems in the hands of the mentally ill or people taking antidepressants.  Gun violence in this country is directly proportional to high gun density and lax gun laws.  True crime TV quickly reveals that the primary equation for gunfire on the streets is an angry young man with access to firearms.  I have seen about a hundred of them interviewed on these shows. Most have no clear explanation for what happened.  They uniformly regret that it did happen – mostly because the consequences they are facing. And nothing would have happened if there was no easy access to handguns.  What would have been a fistfight became a gunfight with somebody dead and somebody in prison for the rest of their lives.

Although, the sampling for the shows is undoubtedly biased toward the sensational – I decided to take a look at what has been researched and written about in terms of gunfire on American streets.  For context I have posted the tree stump from outside the Spotsylvania Court house.  At least it was in that spot when it was sawed off by gunfire during a battle in the Civil War in 1864.  It was subsequently sent to the Smithsonian where it is displayed today.  For scale, historians estimate that during the three-day Battle of Gettysburg – 6 - 7 million rounds were fired from small arms and 50,000 artillery shells were fired from 630 cannons.  The combined weight of the bullets, shells, and gunpowder was about 569 tons.  That is a lot of gunfire considering the standard military rifle of the day was a single shot musket that fired a Minié ball. 

One of the main questions I thought about was how much gunfire exists on American streets today with much more liberal gun laws and firearms with high-capacity magazines.  How would a typical day on American streets compare with the Civil War figure?  Globally we know that Americans purchase about 15.5 -22.7M firearms (rifles, shotguns, handguns) per year over the past 5 years. According to a 2017 estimate from Small Arms Survey, US citizens held 393.3M legal and illicit firearms or about 120.5 firearms for every 100 citizens.  The next closest country was Yemen with 52.8 per 100 citizens.  No other high-income countries had more than 40 firearms per 100 citizens.  

Incredibly the government is prohibited by law from collecting data and statistics on ammunition purchases so it is typically estimated from financial reports.  According to those estimates, Americans purchase about 10-12B bullets per year. That is 1600 times the number of rounds fired in the bloodiest battle of the Civil War.  For a weight comparison, the metal projectiles from 10B 9mm rounds would weigh 82 Tons, the full cartridges 132 Tons.  Of course, within that number there are people who may fire thousands of rounds at a gun range and some people who may not fire a single round every year.  Some rounds will be fired from illegal firearms. Some rounds will be fired during hunting.  Is there any way to estimate how many gunshots may be a direct danger to the public?

There are several sources of information.  Public health statistics offer indirect data on the end results.   There are about 132 firearm related deaths per day.  40% are homicides and 57% suicides.  The remaining gun deaths are from accidental deaths, police shootings, and undetermined gun deaths.  Beyond that another 200 people are struck by gunfire each day. A total of 320 people per day are struck by gunfire in the US and killed or wounded.  For comparison during Vietnam War (1965–1973), an average of approximately 20 American soldiers were killed and 53 were wounded every day.

It is difficult to impossible to find valid estimate of all gunfire in the US on any given day.  Several sources extrapolate from 30M recreational shooters and 10M hunters hunting and shooting at target ranges every day.  That us typically in the range of millions of rounds fired each day.  Using the most conservative figure for ammunition purchased, that figure might be as high as 27M rounds per day across all settings (gun ranges, hunting, fatal and non-fatal shooting).  Acoustic detectors of gunfire are deployed in only 100 cities in the US. Some files of gunfire detection are publicly available but as difficult to read CSV files.  There is some controversy about whether these systems lead to more traffic stops in minority areas and I cannot locate any national estimates from these devices.  Two studies have documented that about 88% of acoustic detected gunshots were unreported to the 911 systems.   Some authors have also included celebratory gunfire as another source of gunfire on the streets.

As a physician interested in public health and reducing gun deaths – the only way any of this makes sense is political interference.  Gun extremism is a problem in this country.  It has been a progressive political force for the past 40 years.  It is the most likely reason for a lack of tangible data on total rounds of ammunition sold per year in this country or even more basic information about total gunfire occurring at all crime scenes in the US every year.  At every crime scene, all of the expended shell casings are marked, numbered and photographed by location.  Collecting and reporting that data to a central location would be an easy job in this era of information, even if it would be an underestimate (not all firearms eject expended cartridges). 

There is only access to the end result – gun deaths and injuries.  The politics is such that we have become desensitized to it – even though the rate of gun violence in the US is higher than the casualty rate in the Vietnam War.  That was a war that was protested as unnecessary, but nobody is protesting the unnecessary gun violence in this country.  It is being sold at the highest levels as the price we all must pay for the hallowed Second Amendment.  

If you watch true crime TV like I do – pay attention to the senseless gun violence. Pay attention to how much gunfire occurs and the setting.  Pay attention to what the veteran police officers say about it.  Most of those shows do a good job of showing the impact it has on families and the police officers. 

And ask yourself why we can’t do better.   

 

George Dawson, MD, DFAPA

 Image Credit:

This is an image of a tree stump that resulted when the tree was sawed off by small arms fire during a Civil War battle.  The details of that battle are from where it resides in the Smithsonian Institute.  

"Until May 12, 1864, this shattered stump was a large oak tree in a rolling meadow just outside Spotsylvania Court House, Virginia. That morning, 1,200 entrenched Confederates, the front line of General Robert E. Lee's Army of Northern Virginia, awaited the assault of 5,000 Union troops from the Second Corps of the Army of the Potomac. Twenty hours later, the once-peaceful meadow had acquired a new name, the Bloody Angle. The same fury of rifle bullets that cut down 2,000 combatants tore away all but twenty-two inches of the tree's trunk. Several of the conical minie balls (bullets) are still deeply embedded in the wood. Unusual objects of war, such as this tree stump, come to symbolize the horror and heroism of a great battle. Originally presented to the U.S. Army's Ordnance Museum by Brevet Major General Nelson A. Miles, the stump was transferred to the Smithsonian in 1888."

 

References:

1:  Carr J, Doleac JL. The geography, incidence, and underreporting of gun violence: new evidence using ShotSpotter data. Incidence, and Underreporting of Gun Violence: New Evidence Using Shotspotter Data (April 26, 2016). 2016 Apr 26.

2:  Hansen JH, Boril H. Gunshot detection systems: Methods, challenges, and can they be trusted?. InAudio Engineering Society Convention 151 2021 Oct 13. Audio Engineering Society.

3:  Kaufman EJ, Wiebe DJ, Xiong RA, Morrison CN, Seamon MJ, Delgado MK. Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017. JAMA Intern Med. 2021;181(2):237–244. doi:10.1001/jamainternmed.2020.6696

2009–2017: ~120,232 firearm injuries/year, or 329 every day — comprising 34,538 deaths (~95/day) and 85,694 ED visits for nonfatal injury (~235/day)

4:  Kaufman EJ, Song J, Xiong R, Seamon MJ, Delgado MK. Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020. Ann Intern Med. 2024 Sep;177(9):1157-1169. doi: 10.7326/M23-2251. Epub 2024 Jul 30. PMID: 39074371.

2019–2020: the burden rose to an average of 1 firearm injury every 4 minutes and 1 firearm death every 12 minutes — ~252,376 total injuries with 84,908 deaths over the two years (~346 injuries and ~116 deaths per day).

A key public-health caveat is that these figures capture people who are shot and wounded or killed, not all rounds fired — there is no comprehensive national surveillance system that counts total gunfire or nonfatal, uninjured shooting incidents; nonfatal shootings and firearm uses "far outweigh" homicides and suicide deaths

5:  Koper CS, Baas G, Taylor BG, Liu W, Sheridan-Johnson J. Validating open-source data on fatal police shootings against self-reports from a national sample of police agencies. Inj Epidemiol. 2025 Oct 21;12(1):68. doi: 10.1186/s40621-025-00625-6. PMID: 41121442; PMCID: PMC12538985.

The Only Gun Legislation In the Past 30 years Is Nothing To Get Excited About

 

The only thing more annoying than seeing self-congratulatory legislators not solving another problem is when they discuss their rationale for their latest decision.  That was in full view on CBS This Morning Today as Tony Dokoupil interviewed four senators Chris Murphy (D), Thom Tilis (R), John Conryn (R), and Kyrsten Sinema (I).  In the interview Sen. Murphy suggests there is evidence that “the law is starting to have some impact” according to “criminologists”.

But what is the evidence?  A summary of the bill is available at this link and it is more readable that the final version on the same web site. One of the provisions was enhanced background checks for gun purchasers 18-21 years of age.  That has resulted in 230 denials. Sen. Tilis commented that 107,000 people between the ages of 18-21 applied to purchase a gun and therefore only 0.2% were denied. No comment on the negatives of putting another 100,000 guns out on the street. I tried to find data on the NICS database but it is not available for 2022.  We don't know if a 0.2% denial rate is an exception or if it is expected.  This report states the overall denial rate was 3.92%.  He goes on to say he is proud of the fact that they have passed the “biggest investment in mental health” in history and “we all agree that behavioral health had to be the foundation of everything we did.”  

Hold on Senator! Granted I am only a psychiatrist and not a behavioral health expert – but this seems like bullshit to me. The federal government and their cronies in behavioral health managed care have been rationing services while making massive profits for the past 30 years. It is as likely that your funding intervention will have as much impact as it did on the opioid epidemic.  It also happens to be a gun extremist narrative to divert attention from the primary problem of far too many guns.

Senator Sinema suggests that “every single person” who picks up a firearm and engages in mass violence is mentally disturbed.  If that were true (and it is not) – the suggested funding through the usual channels will not impact mass shooters. Mass shooters are a product of gun extremism. They see politicians every day talking about guns as the solution to many problems. Stand your ground laws that encourage both gun violence and exoneration of the gun user. They see people being shot and killed or shot at for trivial reasons.  They see indignant gun extremists claiming that “the government” wants to kick your door down and confiscate your guns – even though with the massive number of guns in this country it is physically impossible.  They see armed “militia” intimidating state legislators on their own capitol grounds. They see social media threats about the use of arms. Most importantly – they see daily mass shootings in the United States and nobody doing anything about it. Politicians seem to blame the victims, in some cases the police, or globally “wrong place-wrong time.” You do not have to be mentally ill to be confused or driven by those messages and emotion.

Most notably – there continues to be no background checks for all gun buyers and no assault weapons ban.  There was some joking about not being able to agree on a definition of an assault weapon.  That is a basic definition and it has been defined by Congress in the past but it appeared to be off the table for this crew.

Dokoupil makes a point that violence in America seems to drive legislation and maybe the tradeoff for a Second Amendment is that there will always be violence in America. He cites examples of gangsters in the 1930s and violence in the 1970s with riots and radical politics.  That is a good sound bite but it ignores the fact that there has been no gun legislation through the past 30 years of gun violence and this anemic bill was the result of a level of gun violence that should have been an embarrassment for any legislator.  He misses the obvious point that even in the Wild West (see Tombstone Ordinance of 1881), you had to check your gun when you came into town and post-World War II we had decades of common sense gun legislation that did not involve the massive carrying of firearms.  During those decades – nobody under the age of 21 could own a handgun, guns were used for hunting, and the Second Amendment was interpreted the way it was written.  During those decades the NRA was focused on gun safety and hunting rather than flooding the streets with guns. 

There was some rhetoric about how an extreme mass shooting incident led to the bipartisanship necessary to pass this mediocre bill. First off - that is an extremely high bar.  How many catastrophes does it take to move Congress?  The answer is obviously hundreds. Secondly, it is obvious that partisanship was alive and well right in the room.  None of the Senators could even touch the assault rifle issue? Assuring the rights of people refused firearm purchases was a higher priority?  Gun extremism is alive and well and as long as one party finds it necessary to fan the culture war flames - very little movement would seem possible and that is exactly what we have seen for decades.  

The gun extremism of one political party and their judges is the current problem. An atmosphere of unabated gun extremism is unlikely to have any desired effect on mass shootings, gun homicides, gun suicides, or accidental deaths. I have attached a few paragraphs on what gun extremism is below. This is my definition. I have written about potential solutions in the past – but clearly people would rather listen to the clear thinking of their elected officials instead.

 

George Dawson, MD, DFAPA

Previous Posts:

Likely and Unlikely Causes of Mass Shootings

Another Note on Gun Extremism - An Appeal to Grandparents

Gun Extremism Not Mental Illness

Elements of Gun Extremism

1:  Misinterpreting the Second Amendment:

The culture war political party and their judges ignore the text of the Amendment which is simply:

A well-regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

Gun extremists ignore the preamble that gives the rationale for the right to bear arms and instead isolate the clause about the right to keep and bear arms and generalize it to the entire population and any firearms.  The well-regulated Militia in this case is every states National Guard.  Arms in those days were muzzle loaders that could fire 2 rounds per minute if you were an expert contrasted with 45 rounds per minute from an AR-15 semiautomatic rifle. A fully automatic AR-15 can fire 700-900 rounds per minute. Courts have taken additional steps to say that gun permits can be superfluous and that anyone requesting one should be issued one – with rare exceptions.  Local legislatures have gone ahead with permitless carry and concealed carry laws.

In debating gun extremists, a common argument is that it is protection from tyranny and that is why the Amendment is there.  When I suggested that using weapons against the US government was treason, a famous gun advocate suggested “it would depend on who won.”  Clearly there is nothing about tyranny associated with the amendment.  Gun extremists favor lawlessness and insurrection.  Their judges do as well.

2:  Putting everyone at risk:

One of the famous gun extremist arguments is that more guns results in less crime.  That is clearly not the case and the number of defensive uses of firearms does not have a significant impact on crime.  In the meantime, there are more gun suicides, homicides, accidental deaths, mass shootings, and deaths from the impulsive use of an available firearm in the US than any other high income country.

3:  Increased risk with handguns and assault rifles:

Before the gun extremism culture took over – guns in the US were used for hunting and target shooting. Some people thought they were necessary for self-defense but they were clearly in the minority.  The NRA ran Hunter Safety Courses to teach safe use of hunting firearms.  Gun extremism is a result of the culture wars approach to American politics. When one party realized they did not have much to run on they decided to make a few things up.  Gun extremism was one of those results.   Gun extremism has resulted in the proliferation of handguns and assault rifles.  Both of those weapons are designed for shooting people not wildlife. Gun extremists try to minimize the role of assault rifles by claiming that they are not fully automatic like the military version but they can still release a flurry of high velocity rounds capable of penetrating many walls – as fast as you can pull the trigger.  That is not a hunting firearm.  No need for a lot of physics - just recall that the kinetic energy of a mass is a function of the square of its velocity.  Weapons with high muzzle velocity like assault rifles will have much more energy to damage the target.

4:  Increased risk with permitless carry:

 As the gun extremists became more radical there was a progression of loosening of gun regulations.  Initially to carry guns in public you had to have a permits. In many states that required an application and background check from a county Sheriff.  For a concealed carry permit, training was required. Continued radicalization has resulted in the abolition of many of those laws so that you can purchase a handgun and carry a concealed handgun without a permit or training.  You just must meet minor age criteria. It is obvious that this is the goal of gun extremists across the USA.  Permitless carry will make every community more dangerous. Just ask your local men and women of law enforcement. 

5: The idea that gun carriers are supermen or superwomen:

In other words if you meet criteria to carry a gun - you are by definition responsible and do not make any mistakes leading to the loss of life or injury. Epidemiology teaches that just having a gun on the premises greatly increases the likelihood of death by accidental injury or suicide. Every year hundreds of police officers are injured by accidental discharge of their firearms and they have more extensive and ongoing firearms training than typical gun owners, especially in this era of vanishing qualifications. The obvious political goal of gun extremists is to eliminate any qualifications except for age and possibly (if a NICS check is run) a history of felony crime or domestic violence.   

6:  The new era of shoot first ask questions later:

There have been many incidents in the news of people being shot at and in some cases killed for ringing a doorbell or accidentally driving down the wrong road. In well televised road rage incident, a man fires several rounds from a semiautomatic handgun through his own windshield at a car he mistakenly thought had fired a gun at him.  Not a thought about how far those bullets travel and who else he might hit on a busy freeway. Is this the kind of country we want to live in?  This is the country we currently have courtesy of gun extremists. 

7:  All we have to do is enforce existing laws:

This is a favorite of gun extremists as they continue to roll back existing gun laws. They also use the slogan "If guns are outlawed only outlaws will have them."  That slogan is obviously flawed at two levels.  First, nobody has ever suggested outlawing guns and as I pointed out earlier - it is physically impossible at this point.  Secondly, nobody seems to consider where outlaws get guns. A large source is theft from legal gun owners. About 380,000 guns are stolen in 250,000 incidents in the USA each year.  In other words, one of the largest sources of illegal guns in the hands of outlaws is legal guns from legal gun owners.   Keeping the streets flooded with guns keeps that process going. 

Image Credit:  Thanks to Rick Ziegler.

 

Guns In Psychiatric Hospitals - Texas Has The Worst Possible Idea

Almost on cue, USA Today came out with a story at about the same time that I responded to a post about secure environments in psychiatric hospitals.  My response provided a specific reason why these places need to be a firearm free environment and why armed peace officers sitting at bedside or in the hallway are not really more of a deterrent to criminals with goal directed aggressive behavior or patients with mental illness who have aggressive behavior.  My personal experience with firearms in psychiatric settings is fairly extensive.  It varies from visiting a primary care physician in his office early in my career and being shown a closet full of firearms turned into him to working in settings where mental health professionals or law enforcement professionals were killed by the use of a firearm.  It has occurred in both inpatient settings and outpatient clinics.  Even without firearms I have worked on inpatient units with highly aggressive individuals that on several occasions basically rioted and took control of the hospital unit until enough law enforcement staff came on the scene to restore order.  In one situation an entire unit was disrupted by one individual and law enforcement had to be called.  Against this backdrop, I was more than a little puzzled by new legislation in the state of Texas that allows visitors to carry weapons on units in Texas psychiatric hospitals.  

The USA Today article states that although staff and patients are not allowed to have weapons, visitors are now allowed to openly carry firearms.  Signs suggesting that these weapons need to be left in cars or concealed needed to be removed.  A hospital spokesman quoted in the article makes the understatement of the year by saying that it is generally not a good idea to expose hospitalized patients to weapons of any kind.  Even police officers entering these hospitals do not carry in weapons, probably because it is standard police protocol to not carry weapons in an environment where there are large numbers of potentially aggressive people with impaired judgement in close proximity.  In my previous post, I also point out that firearms are not a deterrent to people who are aggressive and have severe impairments in judgment or see them as a means to escape or perpetrate violence. Law enforcement officers involved are also not able to maintain a high enough level of vigilance to prevent an unexpected attack. A hospital environment is not generally a very stimulating environment. There may be a significant amount of background noise, but there are not a lot of events that require focused attention - like very low frequency aggressive events.

The best protection against these events are physical barriers to protect people from the aggressive person and maintaining a therapeutic environment with multiple interventions to reduce violence. The barriers include jail cell units where incarcerated patients who need acute medical treatment can be transferred to and entire 18-20 bed units that specialize in treating aggressive men. In the case of open units, staff must be available and out there with the patients to provide therapeutic interactions and also frequent assessments. In this era of the electronic health record, it is common to see people sitting in unit offices charting on computers all day long. That is not an approach that optimizes the therapeutic environment. The units themselves have to be staffed with people who are comfortable dealing with aggression and who know how to address it. The environment has to be secured against contraband weapons and drugs and all material coming into the unit needs to be searched. Metal detectors are also employed to detect any weapons coming into the unit.  I have also witnessed incidents where visitors have become physically aggressive and threatening to staff.  One of the logical flaws of gun advocates is that anyone who is licensed to carry a firearm always acts in a rational manner.  You don't have to be a psychiatrist to see that as an unrealistic statement.

The real problem in visitors carrying weapons into a psychiatric facility is the potential adverse impact on individual patients who are being treated there.  To cite a few examples:

1.  Patients with a history of trauma and in some cases post traumatic stress disorder.   These patients are hypervigilant and scanning the environment for the slightest hint of danger.  What would appear more dangerous than a person walking in with a gun?

2.  Patients who constantly expect to be harmed or killed - paranoid patients.  During inpatient work it is common to have many people with this problem.

3.  Suicidal patients who may have those thoughts under fairly good control until these see a highly lethal method within arms reach.

4.  Aggressive patients who may have been involved with weapons prior to admission and immediately gravitate towards anyone carrying a weapon.

There are more examples, but in our society guns are powerful symbols.  Any powerful symbols tend to be amplified in many predictable and unpredictable directions by psychopathology.   The other unappreciated fact is that there is a psychological environment in any hospital setting.  That environment is the conscious and unconscious product of every staff person, patient and visitor in that facility.  Unless that environment is actively managed for safety and affiliative rather than confrontive interpersonal communications there is the potential for major problems.   Carrying firearms into a psychiatric facility is more than a bad idea.  It is an inexcusable use of a psychiatric facility for political purposes at the cost of a therapeutic environment.

In order to get more details about this legislation and the positions of Texas psychiatric organizations I sent an e-mail to the Texas Psychiatric Federation - a website that lists Texas Society of Psychiatric Physicians, the Texas Academy of Psychiatry, and the Texas Society of Child and Adolescent Psychiatry as the major professional organizations in the state.  I am interested in getting feedback on the positions that these organizations are taking as well as the position of the American Psychiatric Association.  I delayed posting this for a few days but so far have not received a reply.  I will post information in the comments section as it becomes available.

Every psychiatric professional organization and every psychiatrist should know what is wrong with this picture and demand safe and therapeutic hospital environments for our patients.
.


George Dawson, MD, DFAPA


References:

Rick Jervis.  Texas allows guns into state mental health hospitals.  USA Today August 8, 2016.
http://www.usatoday.com/story/news/2016/01/08/texas-open-carry-psychiatric-hospital/78522138/


Attributions:

The graphic at the top is downloaded from Shutterstock via their Standard License Agreement and is copyrighted by Bob Orsillo.

A Gun In The Snow

A colleague of mine was out for a walk today.  It is a brisk winter day in Minnesota.  There is about 6 - 8 inches of snow cover.  He was walking across the street and found this handgun laying there.

He took a picture of the gun and called the police to pick it up.  They were there in 20 minutes.

My views on violence and gun violence are fairly well known. My recent position has been that arguing with gun advocates and the pro-gun lobby in Congress is futile.  But when I saw this posted on Facebook with the accompanying story I couldn't help but think: "Guns are so common they are falling on the ground like wallets."  Only a fool believes that this level of gun availability does not result in death and injury of all kinds including accidents, suicides, and homicides.  Only a fool believes that with this level of gun availability it is possible to prevent guns from ending up in the hands of people who are not competent to use them.  I live in a state that passed a concealed carry law that  is basically the right to carry a concealed firearm.  It passed a few years ago by tacking it on to unrelated legislation.  The gun and holster look like a common one that is sold to those who complete a brief concealed carry course.  The main argument of the concealed carry contingent was that they were supermen of sorts.  There was literally nothing that would compromise their judgment if they were carrying a handgun.  Since then there have been a number of incidents involving concealed carry owners showing that in fact problems happen.  In the most notable incident a concealed carry owner opened fire on an undercover police officer.  I think it is safe to assume that there are probably at least as many lapses of judgment involving concealed weapons as there are driving automobiles.  The main difference is that people spend more time driving.  The reporting of these incidents is not transparent and that is typical of much gun legislation.

On a worldwide basis, small arms fire is a leading cause of death and disability.  I had the opportunity to see how some of that was transacted when I lived in Africa for two years.  In travelling as little as 100 miles there were frequent roadblocks at times.  The intent of the roadblocks was not clear but each roadblock was manned by police or paramilitary personnel and everybody was heavily armed.  The American friend that I most frequently traveled with told me about a time he got out of his car to ask if there was a problem.  One of the police officers pushed the barrel of a machine gun into his chest and prodded him back to his car.  He previously served in a country where a fellow volunteer accidentally drove through a police checkpoint because there was nobody around.  It appeared to be abandoned.  He made it a short distance before he was shot through the head by soldiers out of sight up on a hill.

In the US, besides the obvious problems with the legal availability of firearms there is also the issue of the black market and stolen firearms.  Since 1994 an average of 232,000 firearms are stolen every year and 80% of those are not recovered.  Stolen guns account for 10-15% of the guns used in crimes.  The majority of guns used in crimes are purchased by proxy or so-called straw purchase sales including other tactics like diversion of guns to criminals by licensed gun dealers.  There are several common sense changes that can occur in firearm policy that might make a difference in the sheer number of firearms in the general population and their availability to criminals.

This week marked another school shooting.  It marked the anniversary of the Sandy Hook Elementary School shootings.  In practically every school shooting easy access to firearms is a major part of the problem.  There are clear models for what happens to firearm deaths when some restrictions are placed on their access.  Fareed Zakaria has a new feature Global Lessons on Guns on his Sunday news program GPS.  Last Sunday he reviewed gun policies in Japan.  Getting a license to have a firearm in Japan is very difficult.  The authorities need advance information on where it will be stored and they need a detailed floor plan of the residence where it will be stored.  In a country of 130 million people there were a total of 4 firearm homicides last year.  By contrast, in the United States with a current census of 317 million people, there were 31,672 firearm related deaths (see Table 1-1 and 1-2).  The example from Japan is also interesting because it looks at the issue of violent video games.  They are played at a higher rate in Japan than the U.S. and it obviously had no impact in the context of extremely limited gun availability.

Even though I think there are better approaches for psychiatry to focus on than strictly gun policy and confrontations with a pro-gun lobby we need a basic level of awareness that current gun laws in the US are probably not what the Framers of the Constitution intended.  I think they would be as shocked as anyone if they found a gun in the street.  They would be equally shocked to find out that 7 times as many Americans die every year as a result of firearms than died in the Revolutionary War.  (see Table 1)

George Dawson, MD, DFAPA

Psychiatric care versus gun control - an expected outcome

Just in case you are keeping score the Senate voted down some modest gun control proposals last week.  The issue of coming together over mental health care to address one of the dimensions of mass shootings also did not happen.  In the political calculus, it makes sense that if legislators did not fear the gun control lobby they had a lot less to fear from a mental health lobby ambivalent about dovetailing improved mental health care with gun control.

The pro gun advocates especially the NRA have always underscored the idea that they support law abiding citizens having access to firearms.  Their mantra for years has been that if there are more obstacles to law abiding citizens getting guns then only criminals would have them.  Never mind the significant number of accidental deaths every year and the fact that firearm suicide is consistently greater that firearm homicide in this country.  That detail is not lost on psychiatrists interviewing patients who have told us that they were impulsively looking for a gun to kill themselves and the only thing that prevented it was a background check and a waiting period.  The main provision of the attempted legislation was an extension of background checks.  If the pro gun lobby believes that it is protecting the right of law abiding citizens to purchase firearms, there should be no problem at all with universal background checks.  That should cut across all venues where firearms are bought and traded.  I have not heard a single rational explanation for voting down extended or universal background checks.

Reaction to the failure of this legislation was as swift as the Sunday morning talk shows.  Bob Scheiffer interviewed family members of the victims of the Sandy Hook incident on Face the Nation.  They were clearly upset about the vote in the Senate as captured in this quote from Neil Heslin father of 6 year old Jesse Heslin one of the victims of this incident:

"....As simple as a background check, putting aside the assault weapon ban or limitation or control, it's just a stepping stone of the background check with the mental health and the school security. I think the most discouraging part of this week was to, after the vote, to see who voted and who didn't vote, support it, and realize it's a political game. It was nothing bipartisan about it, at all. And we aren't going to go away. I know I'm not. We're not going to stop until there are changes that are made."

In the vacuum of no discussion of the vote against the bill or partisan rhetoric, very little was said in the press about the money behind the vote.  OpenSecrets.org did an excellent job of showing that like most things in American politics it looks like a significant factor.  Their research clearly shows that the pro-gun lobby can outspend the gun control lobby by as much as 15:1 with most of the money going to Republicans.  There are a couple of things working against the pro-gun lobby and all of that money - public support for common sense gun measures like background checks is at an all time high.   The second factor is difficult to say out loud but in American culture you can depend on it.  There will be more incidents and the pro-gun solutions (armed guards in schools, keeping the guns out of the hands of criminals and the mentally ill) are not really solutions.  The pro-gun lobby has demonstrated that they do not take that task seriously.

George Dawson, MD, DFAPA

Senate Blocks Drive for Gun Control.  NYTimes April 17, 2013.

S. 649 Roll Call Vote