A natural experiment.

May 31, 2022

[Audio version here]

          Researchers look for “natural experiments” to study the causal effect of a single variable. A famous natural experiment was conducted by physician John Snow who created a map of a cholera outbreak in London in 1854. People who lived in the same neighborhood experienced wildly disparate rates of cholera infection. By conducting an observational study, Snow determined that proximity to water pumps supplied by the Southwark Water Company was the most predictive variable of cholera infection. (Southwark drew water from the River Thames below London’s sewage outlets.) The handles were removed from the Southwark pumps, and the cholera epidemic in the neighborhood near the pumps subsided.  

          Is America’s epidemic of mass killings a “gun problem” or a “mental health problem”? Australia’s experience with banning assault rifles provides a rough natural experiment. In 1996, an Australian man walked into a tourist area of Port Arthur, Australia, and killed 35 people with a semi-automatic assault rifle. Australia immediately passed the National Firearms Agreement (NFA), which banned automatic and semi-automatic rifles and established a mandatory buyback program. In two years, Australia removed more than 600,000 prohibited weapons from circulation. The buyback program removed 20% of the firearms in circulation in Australia—but left 80% of guns (still legal) in the hands of Australian citizens.

          In 2011, Harvard researchers David Hemenway and Mary Vriniotis reviewed research on gun deaths in Australia before and after the NFA buyback of semi-automatic assault rifles. They found that in the 18 years before the buyback program, there were 13 mass killings in Australia, but in the 14 years following the mandatory buyback program, there were 0—as in “zero”—mass killings in Australia. See Vox, Australia confiscated 650,000 guns. Murders and suicides plummeted. As reported in Vox,

The average firearm suicide rate in Australia in the seven years after the [NFA] bill declined by 57 percent compared with the seven years prior. The average firearm homicide rate went down by about 42 percent.

Hemenway and Vriniotis write, “the drop in firearm deaths was largest among the type of firearms most affected by the buyback. Second, firearm deaths in states with higher buyback rates per capita fell proportionately more than in states with lower buyback rates.”

          Did Australia have “gun problem” or a “mental health” problem causing mass killings before 1996? The “natural experiment” of Australia’s ban of certain firearms strongly suggests that the availability of assault rifles, not mental health issues, was causing mass killings. I acknowledge Australia’s experience is not an exact match for the gun problem in America and that critics motivated by partisan politics can find distinctions and limitations in the comparison. But any honest researcher would acknowledge that the natural experiment in Australia says something powerful about the causative nature of assault rifles in mass killings.

          Like Australia, America has a gun problem that causes mass killings, not a mental health problem that causes mass killings. Nor does America have a “gun safety” problem. America is awash in weapons designed to kill as many people as possible in the shortest time possible. That is the problem. But we have been bullied and cowed by Republicans and the gun lobby to mince around the root cause of mass killings in America: guns.

          Charles M. Blow addressed his weariness with the need to speak obliquely and in code about America’s gun problem. He writes,

          When I hear Democratic politicians contorting their statements so it sounds like they’re promoting gun ownership while also promoting gun safety, I’m not only mystified, I’m miffed.

          Why can’t everyone just be upfront? We have too many guns. We need to begin to get some of them out of circulation. That may include gun buybacks, but it must include no longer selling weapons of war to civilians.

          I will not entertain the fantasy that America can confiscate guns from current owners. But we might be able to ban future sales of assault rifles and ammunition designed to shatter and tumble on impact. More importantly, regardless of whether we can rid ourselves of assault rifles, we must speak honestly about the problem. America does not have a mental health problem. It does not have a gun safety problem. It has a gun problem. Recognizing that truth will help fashion remedies that work, rather than directing our efforts to surrogates or proxies for the gun problem.

          But we must not limit our willingness to speak plainly and honestly about the problem of guns. As Jennifer Rubin writes, Democrats, the media, and Biden must stop using coded language that obliquely refers to “polarization” in America. We are not suffering from polarization. We are faced with an imminent threat from one political party that sees democracy as the problem. Rubin writes,

          Democracy’s survival demands that mainstream media prioritize candor about the nature of today’s GOP over fake balance in political coverage. And it needs pro-democracy politicians to rise to the occasion with exacting, truth-based language — not to fuzz up the stark reality of a democracy imperiled by one political party.

          We have a challenging road ahead—both with guns and the defense of democracy. Do not allow Republicans to control how we speak about existential threats to our safety or our nation. Guns are the problem. To fix that problem, we must control guns through bans, restrictions, licensure, civil liability, and criminal liability. Growing anti-democratic authoritarianism is the problem, not “red state / blue state” political divisions. To fix the anti-democratic authoritarianism in the GOP, we must stop treating those who seek to destroy democracy as legitimate participants in the democratic process.

          We must begin to speak plainly—say what we mean, and mean what we say. Then we can talk truthfully about the problems we face.

Republicans don’t care about mental health—except as a scapegoat for mass killings.

          After the Uvalde massacre, Governor Greg Abbott shed crocodile tears in his first press conference. He claimed that the increase in mass killings was due to mental health problems. But Texas is doing everything it can to limit the availability of mental health services. Abbott wanted to bus persons detained at the border to Washington D.C. but needed money to pay for the bus transportation. Where did he find the money? Abbott removed $211 million from the state’s Health and Human Services Commission—which is responsible for the state’s mental health programs. See Catherine Rampell in Washington Post, Opinion | Republicans blame mental health issues for gun violence. So where’s the money for care?

          Greg Abbott does not give a damn about mental health care. Per Rampell (above), Texas is ranked last among 50 states in the availability of mental health care services. Moreover, Texas is one of a dozen states that refuse to offer expanded Medicaid (subsidized by the federal government). Medicaid “is the country’s single largest payer for mental health services.”

          Aside from not caring about people in need of mental health services, Abbott and other Republicans unfairly stigmatize people with mental health issues by blaming them for the epidemic of mass killings in America. That narrative is false and hurtful. A reader sent a link to a Substack blog by Craig Calcaterra titled Cup of Coffee: May 26, 2022. The blog focuses on baseball, but toward the end of the May 26th post, Calcaterra turns to his family’s experiences with “mental health difficulties.” Calcacterra’s candid discussion of his family’s mental health difficulties is worth reading in its entirety, but he includes the following points about mental health and guns:

• Only 3%–5% of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population;

• Republican budgets frequently slash mental health care, either directly or indirectly. Republicans have routinely, as a matter of policy, have proposed and/or enacted billion or even trillion-dollar cuts to Medicaid, Medicare, and Social Security Disability Insurance.

• The mentally ill are far more likely to use guns on themselves than on other people, and when mental illness and deadly violence coincide, ready access to a gun is a major risk factor for suicide.

• Psychological factors that are not mental illnesses — things like hostility, aggression, anger, alienation, misogyny — are far more likely predictors of violence than depression, anxiety, bipolar disorder, and other mental illnesses.

          As I wrote last week, America (like all other nations) has millions of citizens with mental health issues. We should provide appropriate support and care for them—as we should for any person suffering from a medical condition. But trying to address mental health services through the lens of “gun safety” does a disservice to the children of Uvalde and Americans who need mental health care.

          If we have any hope of decreasing mass killings in the US and improving healthcare, we should speak candidly about both issues rather than using one (mental health issues) as an excuse to avoid talking about the other (too many guns).

Concluding Thoughts.

          I am struggling to catch up with the many other pressing issues that confront us. It may take a week for me to circle back to the significant matters that readers want to discuss. Again, I recommend the Comments section to the newsletters for your review. (Click on the “comment icon” next to the “like / heart” icon.) The Comments include smart, passionate, and thoughtful observations about today’s news by readers of the newsletter. The Comments also highlight the conflicting mix of anger, frustration, and renewed commitment coursing through our hearts and minds during this confusing period in American history. If you are feeling alone or isolated or wondering if anyone else feels the way you do, there is a good chance that other readers have something to say that will resonate with you.

          There is an increasing sense of frustration among Democrats with their leaders in the Senate and the White House. The urge to direct that frustration at Biden and Schumer (among others) is understandable. That urge may be unfair because both face constitutional and electoral roadblocks that prevent them from achieving the immediate solutions that many Democrats desire.

          But both Biden and Schumer have failed the initial test of leadership after Uvalde. It pains me to say this, especially about Joe Biden, whom I admire greatly. But Biden and Schumer have manifested a sense of resignation and exhaustion over the problem of mass killings in America. As one commentator wrote, it is not enough for Joe Biden to be “eulogizer-in-chief”—an important role that he discharges with grace and empathy. But both are missing the urgency of the moment, failing to understand the rage Americans feel about an endless slaughter of innocents. If they will not (or cannot) capture that rage and channel it into generational change, they should step aside and deputize others to lead on this issue.

          I hope Biden and Schumer can recover from their slow start in response to Uvalde. The upwelling of commitment and determination in response to Uvalde can be converted into majorities in the House and Senate that support gun control. If that happens, we can finally begin to enact laws to address America’s gun problem head-on.

           Talk to you tomorrow!