We're not doing enough to prevent violence

When the tragic massacre of 13 people occurred on “college night” at a country music dance hall in Thousand Oaks, Calif., much of the nation was shocked, not only because the event itself was horrendous, but because it came so closely after another massacre at a synagogue in Pittsburgh. That one left 11 people dead and occurred in the context of a series of 16 pipe bombs being mailed to prominent Democrats, CNN and critics of President Donald TrumpDonald John TrumpTrump administration eyes proposal to block jet engine sales to China: report Trump takes track to open Daytona 500 Brazile 'extremely dismayed' by Bloomberg record MORE.

It was the 307th mass shooting in the U.S. on the 311th day of the year, which averages a deadly incident almost every day so far this year.  

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According to Gun Violence Archive, 328 people died and 1,251 were injured in those 307 incidents, defining them as incidents in which four or more people are shot or killed, not including the shooters.

Certainly, mass shootings are on the rise. However, the scale is still miniscule compared to single-victim homicides, which comprise more than 90 percent of the 19,103 murders over the course of a year in the United States (52 murders per day)

A 2017 study of 115 mass murderers has found that their profiles are not very different from individual murderers: they are heavily male, relatively low in educational attainment and likely to possess a previous criminal conviction. Unemployment, social isolation and military experience also play a role.

Questions that are commonly asked such as a mass shooter’s “profile” become less answerable given the broad spectrum of potential motivations and idiosyncratic situations. Focusing on mental illness is also misleading, since a majority of people with mental disorders do not engage in violence against others and most violent behavior is due to factors other than mental illness.

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To try to predict violent behavior in individuals is a fool’s errand, since when and how violence occurs is almost accidental, depending largely on situational factors, state of mind, social support, the immediate environment and access to weapons. Long-term probability trends based on fixed characteristics are somewhat more reliable. Rates of violence in society, on the other hand, are almost entirely predictable and preventable.

This is what the World Health Organization has shown through its reframing of violence as a public health problem that can be understood and solved through scientific research. As a result, there is an enormous amount we now understand about violence.

We know through ecological studies, for example, that social, cultural, economic and environmental factors are far more reliable predictors of violence than individual factors and that cleaning up our socioeconomic and political environment does far more to prevent violence than all the police, prisons and hospitals we can muster.

The WHO and two United Nations bodies documented how 133 countries changed policies, instituted laws, offered services and implemented prevention programs to reduce global homicide rates by 16 percent in 12 years. Many of these programs focused on overcoming political barriers to investing in prevention rather than taking the more popular route of responding to crises after they have happened.

Based on this and other research, it would not be an exaggeration to say that the United States has followed the exact opposite course of what was necessary to prevent violence. One of the most potent and consistent predictors of violence, across multiple studies, is inequality — so much so that societal violence rates rise and fall almost identically as the levels of economic inequality.

Yet, a year ago, the U.S. passed tax laws that funnel billions of dollars from the poor to the super-wealthy, causing enough concern for the United Nations to do a special report on how these policies were endangering the 40 million Americans living in poverty.

Culturally, it has glorified punishment and further violence by building more prisons. We have become the leading incarcerator in the world. We have become a nation where the average citizen is five to ten times more likely to die by homicide than people in other developed countries.

Politically, we have chosen a leader who uses his powerful office to lay the groundwork for a culture of violence, which risks giving rise to epidemics of violence. The recent Pittsburgh synagogue shooter’s words echoed the president’s portrayal of a group of South American refugees as “invaders” who were “committing genocide to his people.”

The pipe bomber’s van was plastered with stickers that showed reverence for the president and crosshairs of a gun over pictures of his opponents. These are only the most sobering examples of the violence that is being instigated. The true extent of the violence is hidden and will likely never be fully attributed.

What can the growing frequency of high-fatality mass shootings, with four of the biggest mass shootings in five decades happening in 2018, tells us? First, an overwhelming proportion of these are homicide-suicides. Most violence scholars know by now that the different types of violence are not unrelated. A group of us learned that those trends become much clearer when we combine different types of violence and look at them together, such as suicides and homicides.

The context of violence in all forms has led to the following conclusions: Violent crime has dropped significantly since the early 1990’s — when unemployment rates also dropped dramatically, but it will be counteracted by the fact that a drastic rise in suicide rates accompanied the rise in unemployment rates in 2008.

Either the faulty “scholarship” on violence that panders to a popular desire for reassurance, or the political rhetoric that claims violence in our cities is “the highest it’s been in 45 years” and thus needs to be met with more violence, promotes the status quo. What we need is a new awareness that violence is fully understandable and preventable at very little cost — and we need only to have the political will to do it.

Bandy X. Lee, M.D., M.Div., is a forensic psychiatrist at Yale School of Medicine and project leader on violence prevention for the World Health Organization.