The Forgotten Gun Deaths—Suicides, Homicides, Domestic Violence

And yet again this country reels in agony of the mass shooting gun deaths of 17 high school students in Broward County, Florida. The definition of a mass shooting is four or more random deaths by gun not committed by religious zealots or terrorists. The debate is guns or mental illness or both. The man in Florida certainly had a mental illness by accounts of his life of major depression, rage personality disorder +/- bipolar disorder.

The literature accepts the figure that 50% of mass shootings are committed by people with untreated paranoid schizophrenia. In my own review of 14 of the most heinous mass shootings since the Texas Tower shooting in Austin, Texas in 1966 the figure was 57%.

What is not talked about regarding gun control is the shootings daily in the U.S. that occur one at a time and involve mental illness, suicides, and those that occur daily that do not involve mental illness at all. In today’s debate of the relationship between guns, suicides, homicides, domestic shootings, drive-by shootings, robberies and accidental shootings the dialogue is only about guns and mental illness as it relates to mass shootings or massacres or mayhem. Why? These others get no press.

The Centers for Disease Control records that half of all female homicide victims are killed by intimate partners. Most are committed by the male partner. More than half involved firearms. Restraining orders have no teeth. More than 1600 women were killed by a gun by a domestic partner in 2015. About 4000 women in total were killed by domestic violence. Just today the state of Oregon passed an ordinance that anyone issued a restraining order must surrender their guns. Hand guns are almost exclusively used and yet regarding gun legislation since the Parkland, Florida massacre all media is centered on long guns and in particular assault rifles.

This number may seem small but in 2016 and it appears it will be the same for 2017 there were 15,000 homicides in the U.S. Most were by guns—hand guns.

How about the disappeared, the mentally ill with predominately affective disorders who commit suicide. Who subscribes to the American Foundation for Suicide Prevention? Survivors and their families. In 2016 there were over 44 thousand suicides. That computes to 13 suicides per 100,000 population. Another way to look at the problem is that a suicide occurred every 12 minutes. 21 veterans returning from the Middle East commit suicide daily from PTSD. These statistics are prepared by the Centers for Disease Control and Prevention (CDC). (By way of comparison there were 37,000 motor vehicle deaths in 2016, 66,000 opiate related deaths.)

As for suicides Males outnumber females 4 to 1. By ethnicity whites had the highest suicide rates and American Indians and Alaskan natives were second. White males accounted for 70% of all suicides in 2014.

The most common method was by firearms (50%).

For many years the number of people with affective disorders likely to attempt to commit or successfully commit suicide in the course of a lifetimes was 1 in 8 or 15%. That figure has now been reduced by half with the advent of better medications. Although the incidence of suicide in the course of a lifetime with this disease has been reduced by half in the thirty years that lithium combined with newer drugs have intervened, an 8% lifetime occurrence is too high. This still computes to over eleven million over the lifetime of those afflicted.

Then there are people like me. I was diagnosed as bipolar II in 1973 over 40 years ago while in medical school. I have always been compliant with seeing psychiatrists and taking medications since diagnosed. I was lucky to have a gratifying career in nephrology for 37 years. I knew when I needed to take time off.

With all that compliance that did not get me out of the woods as far as a serious suicide attempt.

After driving home from a routine day in the office and hospital rounds in October of 2012 I called every member of my family from Modesto to San Francisco to Norway. No one answered. I was not sure what I was going to say perhaps because I had no reason to contemplate what I thought I was going to do. The days and weeks prior had been typical with the normal stressors. I felt neither depressed nor manic.

I reached up on top of the grandfather clock by the entry way door and brought down the .38-caliber Taurus five-shot revolver loaded with silver-tipped, hollow point bullets.

I shot my right lower leg. When the pain eased up, I looked down and saw arterial bleeding and bone. Then I shot myself in the left abdomen. “Blood pressure 57.” That is the last thing I remembered.

Right before the shooting, I had called 911 and told the woman who answered, “I’m going to shoot myself.” I even gave her my name and address. When she asked why, I said, “I don’t know why.” I also unlocked the door to the house. Did these actions show I wanted to die? No. Did I almost succeed? Yes.

I required three different surgical subspecialists in one sitting, one week in ICU and two weeks on the ward. Another surgical procedure was required four months later at a tertiary facility.

My psychiatrist asked me a bunch of questions. He concluded that despite four medications I had been in a “mixed state” of depression and mania at the same time. I was also dumbfounded to learn that most successful or serious suicide attempts are planned and carried out within one hour of conception.

Could my impulsive act been carried out without that gun? Could a domestic killing be caused without a gun? Could a drive-by shooting be caused without a gun? Could a lethal robbery be caused without a gun? Could a mass shooting be caused without a gun? Could a homicide be committed without a gun?

California is diligent about retrieving guns from felons and people with mental illness who have been hospitalized or committed an act. I sold my other guns after the shooting. Within six months two state marshals showed up at my door. They had a record of every gun I had ever bought complete with registration numbers, where purchased and when and I had to account for everyone.

An article in the New England Journal of Medicine and the Journal of the American Medical Association comparing Seattle to Vancouver between 1980 and 1986 showed that your chances of being shot were eight times greater in Seattle. Teenagers in families with guns in Vancouver were 10 times less likely to commit suicide. The chances of getting shot were 8 times greater in Seattle. These cities are comparable in size and other demographics and just 140 miles apart. The difference is gun control. For example in Vancouver and other Canadian cities an applicant for a gun must present a reason and a need for a gun. Self-defense is not a reason and possession of a gun is two years in prison.

Written by paul