Many years ago, a man I was seeing in therapy decided he wanted to take up a new hobby: high explosives. The state he lived in licensed purchasers of dynamite and other incendiaries only after a background check. He wanted to know: Would I write a letter declaring him fit to blow up stuff in his backyard for fun?
Aside from the fact that this was how he wanted to pass the weekend, I didn’t have any reason to think otherwise, so I gave him the note. He got the license. A few years after he stopped seeing me, I had occasion to visit him at his office. He had all his digits and limbs and, to my knowledge, had committed no antisocial acts with his legally obtained explosives. My note attesting to his mental health was framed on his wall.
I’ve been thinking about this guy recently, ever since our politicians’ imaginations have fastened upon background checks as the solution to our gun problems. I’ve also been thinking about a couple of other patients. One of them, a middle-aged professional, a ramrod-straight retired Marine, father of a little girl, faithful husband, the kind of man who buys a special lockbox just for transporting his weapon between home and gun club. The other: a 27-year-old hothead, an absentee father who never met a drug or a woman he didn’t like. His idea of fun was riding his motorcycle between lanes on the interstate at 100 mph, and he was the proud owner of (by his count) 37 guns. In the three years prior to arriving at my office, he’d been fired from four jobs, arrested for six or seven driving offenses and a few drug charges, and helped to bury three of his friends who met untimely and violent ends.
No one asked me which of these two men I’d rather was a gun owner, let alone which one ought to have a firearms license. But I know what my answer would have been. Or I would have known until about a year ago, when the ex-Marine, inexplicably and without warning (although he’d just been put on an antidepressant as part of a treatment for chronic pain), sat at the base of the tree holding his favorite deer perch and shot himself in the mouth. Meantime, the hothead has cooled down. He’s been with the same woman for two years and the same job for one. He sees his son faithfully twice a week. He’s sold his motorcycle and more than half of his guns, and become obsessed with bodybuilding and responsibility. The transformation is not complete—he’s still dead certain the government wants to come to his house and confiscate what’s left of his arsenal, for instance—and I can’t take too much credit for it. He’s pursuing the pleasures of self-control with the same manic intensity as he once chased adrenaline. But I’m not all that worried about his guns anymore, and I’m really glad no one asked me if he should have them.
Because one thing they don’t teach you in therapy school: how to tell the future. Clinicians can assemble a story out of the ashes of a person’s life; we might even be able to spot what we think are the seeds of catastrophe, but we generally do that best in retrospect. And that’s why, if one of us insists he or she knows for sure what’s coming next, you should find another therapist. It’s also why, to the extent that background checks involve people like me, it wouldn’t do much more than reassure politicians that they are doing something about gun violence without simultaneously threatening their National Rifle Association ratings.
But wait a minute, you may be saying. Don’t mental-health workers have a whole huge book of diagnoses to turn to that can help you assess a person’s fitness to own a gun? No, we don’t. We have the book, of course, the Diagnostic and Statistical Manual of Mental Disorders, which is about to come out in its fifth edition. But while some of those disorders seem incompatible with responsible gun ownership, even a diagnosis of a severe mental illness like schizophrenia or bipolar disorder isn’t a good predictor of who is going to become violent. Indeed, only about 4 percent of violent crimes are committed by mentally ill people. We are not going to diagnose our way to safety.
There’s a reason for this. A diagnosis of a mental disorder is only a description of a person’s troubles. A neurologist presented with a patient suffering loss of coordination and muscle weakness can run tests and diagnose amyotrophic lateral sclerosis or a brain tumor. They can explain the symptoms and predict with some accuracy what will happen as the disease takes its expected course. The 200 or so diagnoses in the DSM, on the other hand, explain little and predict less. Until the book contains a diagnosis called Mass Slaughter Disorder, whose criteria would include having committed mass slaughter, it’s not going to offer much guidance on the subject, and, obviously, what guidance it provides is going to come too late.
With the mentally disordered, as with all of us (and let’s remember that in any given year, something like 30 percent of us will meet criteria for a mental disorder, and 11 percent of us are on antidepressants right now), there is no telling what will happen next. No matter how many diagnoses are in the DSM, and no matter how astutely they are used, they will not tell us in whose hands guns are safe. The psyche is more unfathomable, and evil more wily, than any doctor or any book.