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Bioethicist: We need to treat violence as public health issue

The mass murder of 20 children and six adults Friday in Newtown, Conn., has provoked yet another round of recrimination, finger pointing and breast-beating. Was the shooter mentally deranged? If there was more gun control, would this have happened? Did violent video games play any role? What we fervently want as we continue to reel from a story whose misery seems to know no bounds is to find a clear cause - a reason why this happened - so that we can fix it.

We hope to see something in all the stories, analyses, commentaries, Facebook postings and Twitter speculation that gives us the reason behind what happened and thus a guarantee that if we understand and act on it then no 6 year old or her parent need to worry ever again what might happen at their school. We hope that no college, hospital or mall will ever again have a reason to practice drills for "shooters" and no play or movie-goer grow anxious over who has snuck into the theater with evil intent.

But, there is no simple answer. We have ourselves to blame for where we find ourselves in terms of mass shootings. Our culture is too far down the road of tolerating and even extolling violence. We do so in our popular entertainment, we permit the mass marketing of violence to young kids, and we thrill to it in too many of our sports. A lot of people make a lot of money selling violence. I doubt that will change.

Nor will the easy availability of guns. We have been well aware of the cost of easily obtained high-powered guns for a long time.  Even if we move toward tighter gun control laws and seek to reduce access to automatic weapons and ammo, which I favor, we have so many guns in circulation that these efforts are too little, too late. Will deaths fall if killers are not armed as if for combat with automatic weapons and full body armor? Yes. But, will ready access to automated weapons, guns and this kind of equipment disappear any time soon in America? I am afraid not.

So what are we left with as a way to construct a response to Newtown and all the Newtowns before it? I think we need to rethink how we think about violence in the situation in which we find ourselves — armed to the teeth in a very violent society that is nervous and full of fear. The only way to reduce risk in such a tinderbox is to give up a bit of liberty.

First, make the discussion of violence a public health priority. Ask health care workers to talk about the threat of violence in all its forms as a huge public health problem — from suicide to domestic abuse to mass murder. Insist that doctors and nurses talk about guns and weapons with their patients noting their risks and the need for safety handling and storage when they are present.

Ditch efforts, such as Florida’s, to prohibit these discussions. Take the stigma out of talking about the possibility that someone you know will may be prone to violence and offer clear directions about what to do about that.  Let prying in the name of health into what is now deemed private be the accepted norm.

Second, fix the broken mental health system. Not all who are violent are mentally ill.  And mental illness is not always a reason not to hold someone responsible for their actions. Still, no one with a kid who has a mental health problem, and I mean no one, has ready access to competent mental health assistance.  Ask parents who have a kid with anorexia, compulsions, a personality disorder or schizophrenia how easy it is to get services and you will quickly get an unhappy earful.  

If you have a heart attack in any American town or city you can expect an ambulance within minutes. If you or someone you knows has a mental breakdown or ongoing drug abuse why cant we expect the same rapid response and treatment capability? We also need more incentives for doctors, nurses and social workers to specialize in mental health. The nation needs fewer dermatologists and allergists and a lot more psychiatrists and psychologists.

Third, start to screen kids in school — all schools --  for signs of problems involving violence be it bullying, domestic abuse or social isolation. We screen kids for hearing and vision problems but looking for early signs of mental illness is somehow off-limits. A kid can be labeled as at risk of diabetes but not suicide or violence. A bit of screening and some early counseling for those found to be at risk of violence is not going to lead to the thought police controlling the next generation of Americans.

As much as we want it there is no quick fix for Aurora, Columbine, Newtown, Virginia Tech, West Nickel Mines and the scores of other school, mall and public building massacres America has seen over the past two decades. Given where we find ourselves, the fix means giving up a smidgeon of liberty to better protect safety. It means seeing violence as a public health problem that is just as real as swine flu or obesity. It means committing to a hard societal slog from a very bad place to something a bit better.


Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

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