Crime, Guns / Firearms, Health Care / Medicine, Politics, Violence

What We’re Not Talking About When We’re Talking About Guns

In Washington, D.C. on Monday, Aaron Alexis gunned down twelve people. As if designed to preempt the scripted reactions of those who fight for an anemic interpretation of the Second Amendment, the Navy Yard massacre included no assault weapon. Alexis committed his crimes in a virtually gun-free zone. His background had been checked in order to gain the active security clearance he held prior to the shooting. While I’m usually game for a good discussion of the proper limits of the Second Amendment, that alone cannot sensibly be the focus here.

Neither is the matter so simple as switching the sound bite of choice from “gun control” to “mental health and gun control.” Most states, as well as the feds, already substantially limit lawful access to firearms by the mentally ill. Even Texas does.

If the law can deprive felons of their Second Amendment rights, gun control measures that restrict the rights of entire classes of potentially dangerous citizens are not off the table. Even as a conservative, my defense of your individual right to bear arms stops right about when you start having auditory hallucinations. But it’s long past time to start responding to horrors like what occurred this week at the Washington Navy Yard with less talk about guns and more talk about mental illness . . . .

Aaron Alexis

Some facts about Aaron Alexis, the Navy Yard gunman, to get clear on first:

(1) Contrary to some initial news reports, Alexis did not use an AR-15 assault rifle. Rather, he used a shotgun, which he brought with him, and a pistol he appears to have taken from an armed guard at the Navy Yard. So, arguments about banning “military-style assault rifles” don’t fit this particular — still tragic — narrative.

(2) Alexis had a Secret security clearance. More than a simple criminal background check, the procedure requires a few months to a year of investigation. So, the usual arguments about basic background checks for gun ownership preventing tragedies of this sort don’t fit this narrative either.

So, what does fit? What changes to law and policy can we talk about in the aftermath of this week’s tragedy?

We need to have some tough conversations about identifying severely mentally ill individuals, treating them for those conditions involuntarily if necessary, and warehousing them, if absolutely no other therapeutic option remains. Historical precedents teach that these issues can be easily mishandled. That fact, though, does not mean that we don’t need to do our best to handle them properly now.

We must also have some uncomfortable conversations about pharmacological treatment of mental illness and the liabilities that come with prescribing drugs that may affect individual patients in difficult-to-predict ways.

As a general rule, I believe in better living through science. As a slightly more specific rule, I believe in not-being-batsh*t-crazy through science. I wholeheartedly endorse responsible use of medication to treat depression and the like. Many people I love would not be here if it weren’t for medication that keeps them well. But we’d be foolhardy not to consider the fact that Aaron Alexis was prescribed a drug and not closely monitored for its effects.

Alexis had sought treatment for insomnia at two Veterans Affairs emergency rooms in the past month. Both times, doctors prescribed him trazodone, an antidepressant frequently used to treat major depressive disorder and, as in Alexis’s case, sleep disturbances. Both times, he reported to doctors that he was not depressed or anxious and was not thinking of harming himself or others. Although he was instructed to follow up with a primary care physician, he apparently elected not to do so. Neither that self-report nor his failure to follow up are unusual for individuals in the throes of mental illness.

Trazodone is generally safe and widely prescribed, but some studies have reported low doses of trazodone inducing psychosis, albeit rarely. For example, one patient studied developed “auditory hallucinations with threatening voices, agitation, stupor, negativism, and delusions” shortly after being prescribed the drug. Alexis apparently suffered from similarly troubling symptoms leading up to the massacre on Monday. Whether trazodone was partially to blame for his state of mind, we’ll never know. However, even those possible consequences might not have been so catastrophic had Alexis been closely monitored by a physician while adjusting to the drug.

A significant problem in mental health care, as well as the laws that govern it, is that many sufferers of mental illness either do not seek treatment or do not follow through on treatment prescribed. I have personally witnessed two friends descend into paranoid schizophrenia during the years that I knew them. In each case, the sufferer was a man in his twenties, intelligent, academically accomplished, artistically gifted, and previously well-adjusted if a bit quirky. I watched each of those men go from psychologically normal to detached from reality. Thankfully, in each case, people around them urged them into treatment, and both have gone on to live healthy, happy lives, while doggedly following their treatment plans. They are among the fortunate few.

While most states have involuntary commitment laws of some sort, the application of those laws often requires concerned family or friends to diligently pursue that option against the mentally ill person’s protests and through a multitude of legal hurdles. The de-institutionalization movement of the 1960’s, while well-intended, has left our nation’s public psychiatric hospitals with 90% less capacity than when the movement started. Typically, much of the severely mentally ill population receives sustained treatment only after they have committed a crime.

We need better ways of legally categorizing mental illness, better ways of identifying which types of mentally ill persons are likely to threaten the safety of others, and better ways of equipping authorities and families to intervene early on. If this means contemplating the reversal of the deinstitutionalization trend, so be it. Better to contemplate that than to contemplate another Navy Yard tragedy.


Tamara Tabo is a summa cum laude graduate of the Thurgood Marshall School of Law at Texas Southern University, where she served as Editor-in-Chief of the school’s law review. After graduation, she clerked on the U.S. Court of Appeals for the Fifth Circuit. She will be working at the Center for Legal Pedagogy at Texas Southern University during the 2013-2014 academic year. She looks forward to a career of teaching and writing about, but never practicing, law. You can reach her at tabo.atl@gmail.com

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