Truth or Consequences: Talking About Violent Death in America

For decades, Americans were able to tune into a popular game show, “Truth or Consequences,” that began with inane questions that contestants could not readily answer. This led to some zany consequences. I raise this ridiculous entertainment spectacle in connection with a serious topic: violent death in America. Why? Conversations on this topic today are commonly started with ignorant questions.

“Why did he do it?” is the question newscasters commonly ask following the latest act of mass murder. It is also the question people ask about acts of suicide. Unfortunately, the public does not understand that this is a highly uninformed question. We need to help people see the misdirection involved with this question, as well as the consequences of politically motivated answers to such questions.

There are many dimensions to violent deaths, including the means by which people commit such violence. The national debate about gun violence is quite important, but not a focus here. The focus instead is on the lack of sophistication the public and the media share in their inquiries into violent deaths. The focus is on the failure to advance that discussion despite scientific advances.

The question — why did he do it? — suggests naivete. The questioner would seem to be unclear about how to begin analyzing such an atrocity, and possibly expects a simple, direct explanation. Behavioral healthcare experts have not been successful in moving this conversation to a more advanced level. This is not for lack of sophisticated models on the risk of violence, but for the absence of a common language all can understand.

Good question for another time

When I hear news about a recent homicide or suicide, I often begin to think about what happened based on my diagnostic training. It is important for authorities to ultimately get clarity on diagnostic questions, but I am focused here on the important first questions rather than deeper clinical questions. They are for a later time. We fail today with the initial reaction to these tragedies by the public and the media. We frame the problem incorrectly.

Behavioral healthcare experts on a local and national level need to develop the communication skills to guide a productive, clarifying discussion in the wake of violent deaths. They need to resist entertaining detailed diagnostic questions and instead reinforce the basic facts about mental illness, substance abuse and human violence. The first two categories are clinical, while the third is non-clinical, far more pervasive, and historically driven by a variety of group and religious affiliations.

Basic myths need to be dispelled. Mental illness is not monolithic. Mental illness is not bizarre or unusual. Mental illness is not hopeless. Approaching a discussion from the non-clinical direction is also important. People have been violent toward one another since the beginning of human existence, and the carnage of wars, crime and community violence requires no lessons in mental illness. Intense tribal beliefs about self and others have been more determinative.

Suicide receives less media coverage than murder, whether the killing involves one or more victims. The single most important myth regarding suicide is the idea that people kill themselves due to a wave of misery that lacks historical context for that person. In all cases, the public and the media search for simple, comprehensible motivations. The most confounding variable for that search is the reality that alcohol and drugs can serve to blind, motivate or empower the violent actor.

A time for truth

There are proximate causes of events. A man may commit murder upon being fired from a job or being rejected by a partner. This is important but not actionable, in the sense that we cannot prevent people from losing jobs or loved ones. It may help us understand this person’s violence in a very limited way, but this fact exists within the larger reality that millions of people with the same stressors never take such action.

Mental illness could be the larger context for violent behavior. In this regard it is important to start a discussion by focusing on the most common and the most destructive conditions, depression and psychosis. There is little to be gained by bringing the entire DSM into a general discussion of mental health and violence.

People with depression are no more likely to commit violence than other members of the public. In fact, depression tends to leave people in a sad, lethargic and unmotivated state, not one conducive to violence against others. On the other hand, psychosis can promote violence to the extent that people lose touch with reality, nurture paranoid, vengeful fantasies, and view acts of violence as making sense in some distorted view of the world.

Suicide is not a choice that comes out of nowhere, despite often seeming that way to family and friends who know the person best. Nearly half of people who commit suicide had a prior diagnosis of a mental disorder, and studies show that 90% displayed symptoms of a mental health condition before ending their lives.

Consequences of misconceptions

Some view murder as an inherently insane act. In fact, it exists within a comprehensible context, of either mental illness, substance abuse, human (non-clinical) aggression or some combination of these. Each occasion should prompt a discussion of which factors best account for the act. Precision is often not possible, but the goal is to assess the relative weight of each category.

Suicide is best understood as connected with symptoms of mental illness, fueled at times by substance abuse. The proximate cause can often seem minor or non-existent, but this is often best understood in the context of a lifetime of suffering. There are frequently warning signs for violence, both toward self and others, and while this should not be used to castigate survivors, it is possible for friends, family and professionals to defuse many crises.

The important point is to put the larger issues in perspective. While behavioral healthcare executives should be volunteering to speak to the public through the media about these tragic events, they should not worry about arming themselves with statistical data and talking points for related controversial debates. If we don’t help the public understand the basic issues articulated here, then we are exposing ourselves to bad policy decisions on mental health and the prevention of violence.

As experts in this area, our communication goals should be to ensure all citizens are armed with basic knowledge. Our passion and expertise will shine through more forcefully in clarifying these basics than in cloaking ourselves in the security of complex data and theory. We are currently stuck in a game of uninformed questions and politically motivated answers. There is little truth, but consequences are foreseeable.

Ed Jones, PhD, is senior vice president of the Institute for Health and Productivity.