The Tragedy of Access to Lethal Means

The Tragedy of Access to Lethal Means

The loss is overwhelming. The suffering and anguish palpable and unfathomable. The sense of utter despair and desolation incomprehensible to those of us fortunate enough to not have experienced such a heinous act. At present I would suggest that the people of Newtown, Connecticut are best served by family, friends, and the supportive silent presence of others to commune and witness their pain and sorrow. Often times, with a tragedy of this magnitude, it may even be too early for consoling. The desolation is too raw and profound. Grief, loss and bereavement heal within the confines of a loving and compassionate community.

Much has been written about the connection between severe psychiatric illness and violent behavior. As a Board Certified Psychiatrist and Systemic Family Therapist I would like to add my voice to those of Charles M. BlowGail Collins and Nicholas D. Kristof who echo Rabbi Harold S Kushner, as I paraphrase, Now that this terrible tragedy has occurred what are we as a society going to do about it? How do we make the agony of a loss beyond meaning matter?

A psychiatrist’s primary responsibility is to ensure safety. When psychiatrists evaluate individuals for dangerousness, defined as the probability of future violent behavior towards self or others, best clinical practice recommendations include assessment of risk factors, protective factors and access to lethal means. Unfortunately, there is often a failure to assess the individual’s “access to lethal means” and provide “lethal means counseling.” Clinicians need to both complete a thorough assessment and methodically focus on the management of risk.

Although no psychological test or interview can uniformly predict future violence there is one modifiable factor that can decrease the risk of death – reduction of easy access to lethal means. Reducing easy access to lethal means is life saving. If highly lethal means are made less available it stands to reason that less people will be killed. Assessing an individual’s access to lethal means and taking steps to restrict this access are necessary components of psychiatric outpatient evaluations and treatment planning.

We can prevent and reduce death by removing or eliminating the means and the methods that individuals at high risk may use to murder other people. Lethal means counseling and lethal means restrictions for high risk individuals can save lives. Psychiatrists cannot predict with any degree of accuracy who may become a murderer, but society can protect against these types of tragedies by limiting easy access to lethal means for high risk individuals. The common causative and modifiable factor in the deaths at Columbine High School, Virginia Tech, the immigration center in Binghamton, New York, Fort Hood, Texas, the movie theater in Aurora, Colorado and now at Sandy Hook Elementary School was easy access to lethal weapons by high risk individuals.

Our hearts and prayers are with the families and friends of the children and staff of Sandy Hook Elementary School and the greater community of Newtown, Connecticut. Let us honor the dead by taking the initiative to light the way for others.

 

Please feel free to ask any questions or to comment in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here (http://www.familyfocusedsolutions.com/contact/).

You are encouraged to forward this blog to anyone who would be interested in reading it.

 

Ronald B Cohen, MD, PC www.familyfocusedsolutions.com Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
RBCohenMD@FamilyFocusedSolutions.com
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6 comments

  1. Dr. jim sellner, PhD.,DipC. on December 21, 2012 at 11:22 pm said:

    Hi Ron,
    Looks like the members of the NRA might be insane or at least delusional!?
    Regards
    jim

    • Ronald B Cohen, MD on December 22, 2012 at 4:55 pm said:

      Hi Jim,

      A formal definition of psychosis includes an alteration in relationship to reality, impairment in reality testing, a distorted perception of reality and reconstruction of an alternative, delusional reality such as the belief that more guns in the hands of more people would not result in more murder and death. Another definition is ”Psychosis is a psychiatric classification for a mental state in which the perception of reality is distorted. Persons experiencing a psychotic episode may experience hallucinations, hold paranoid or delusional beliefs, experience personality changes and exhibit disorganized thinking. This is sometimes accompanied by features such as a lack of insight into the unusual or bizarre nature of their behavior, difficulties with social interaction and impairments in carrying out the activities of daily living.” Finally a third definition states that “Psychosis is a loss of contact with reality that usually includes: False beliefs about what is taking place or who one is (delusions) and Seeing or hearing things that aren’t there (hallucinations).

      Applying these criteria I would have to conclude that you are correct.

      Regards,

      –Ron

  2. Josephine Venezia on December 22, 2012 at 5:02 am said:

    Dear Dr. Cohen:

    So well said and I totally agree. Thank you for sharing it and allowing to forward it, as it would be very useful for others to read.

    Regards,
    Josephine Venezia, LMSW

    • Ronald B Cohen, MD on December 22, 2012 at 4:59 pm said:

      Hi Josephine,

      I would be honored to have you re-post my thoughts. Please reference and acknowledge the source.

      Here is a shorter version if that would be helpful.

      Much has been written about the connection between severe psychiatric illness and violent behavior. As a Board Certified Psychiatrist and Systemic Family Therapist I know that unfortunately no psychological test or interview can uniformly identify who will perpetrate future violence. However, we can prevent and reduce death by removing or eliminating the means and the methods that individuals use to murder other people. Reducing easy access to lethal means is life saving. If highly lethal means are made less available it stands to reason that fewer people will be murdered

      Psychiatrists cannot predict with any degree of accuracy who may become a murderer, but society can protect against these types of tragedies by limiting easy access to lethal means. The common causative and modifiable factor in the deaths at Columbine High School, Virginia Tech, the immigration center in Binghamton, New York, Fort Hood, Texas, the movie theater in Aurora, Colorado and now at Sandy Hook Elementary School was easy access to lethal weapons.

      Our hearts and prayers are with the families and friends of the children and staff of Sandy Hook Elementary School and the greater community of Newton, Connecticut but our thoughts and conscience must be addressed to our lawmakers at every level of government. The issue is clear; the time for leadership and integrity is now. Let us honor the dead by taking the initiative to light the way for others and prevent another Tragedy of Access to Lethal Means.

      Regards,

      –Ron

  3. Marvin Glassmann on December 25, 2012 at 3:37 am said:

    FYI It has been reported that approximately 60% of the NRA do not support the extreme party line of the executive group. The NRA is not much different from the tobacco industry. Primary concern is profit, lethal outcome is totally irrelevant. Keeping all lethal devices from psychotics and psychopaths sounds like a pretty tall order as is prediction of probable future acts. I believe research has shown that prediction is not much better than chance.

    • Ronald B Cohen, MD on December 25, 2012 at 5:16 pm said:

      Hi Marvin,

      Right you are. It is essentially impossible to predict who will commit a violent act whether in the office or in society at large regardless of diagnosis or emotional distress. Prediction of dangerousness is an inexact science and clinicians should focus on the management of risk not the measurement of risk factors. While risk evaluation is not prediction, limiting access to lethal means is life saving. Contrary to the mistaken belief of the NRA, guns, especially semiautomatic assault weapons, DO kill people. I’d have to ask if the majority of the NRA membership do not support the views of the executive group why are they still the executive group? Thanks for the comment.

      Regards,

      –Ron

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