It wouldn’t be a post-mass shooting news cycle without the renewed calls for social workers and therapists to do more to gently guide potential mass murderers off the path of murdering dozens of people.
This idea fails on a number of levels. It links murderous violence with mental illness in a way that countless mental health professionals and individuals with mental illness have identified as stigmatizing, empirically false, and unhelpful. It is legally and economically untenable, as there is no way to mandate people to counseling just for owning lots of guns and being angry, and there is insufficient funding for such a large expansion of social work services. (There is insufficient funding for the social work services we have now.)
It is not based on any research showing that mental healthcare can help prevent this type of violence. It is ethically preposterous, expecting untrained, underpaid social workers to place themselves in the literal line of fire. It neither addresses the root cause of the problem (toxic masculinity) nor provides the type of bandaid solution that actually stops the bleeding (effective gun control legislation).
It’s just a way for people to feel like Something Is Being Done. Except it isn’t.
There’s a reason why the National Association of Social Workers and the American Psychological Association consistently support effective gun control legislation. That’s because people who actually work in this field rather than armchair-quarterbacking it understand that there’s only so much we can do to prevent violence given that there will always be people who are determined to commit it. For starters, a social work-based mass shooting prevention program is practically impossible for three reasons:
1. Therapy cannot work if you do not want to change anything about yourself and do not have any internal motivation for doing so.
American mass shooters typically demonstrate what sociologists call “aggrieved entitlement“–they think they’re owed something and they think it’s the rest of the world that’s the problem. Even if you somehow forced such a person into therapy, all they’d do is talk about how everyone has wronged them, and any suggestion the therapist makes about changing their own behavior just makes the therapist part of the problem, too.
Olga Khazan sums up the research in The Atlantic:
While improving access to mental-health care might help lots of suffering Americans, researchers who study mass shootings doubt it would do much to curb tragedies like these. According to their work, the sorts of individuals who commit mass murder often are either not mentally ill or do not recognize themselves as such. Because they blame the outside world for their problems, mass murderers would likely resist therapies that ask them to look inside themselves or to change their behavior.
Even clients who are mandated to therapy by the courts or, less formally, by a partner or parent have some sort of internal motivation for change, even if it’s “to get my PO off my back” or “because my girlfriend said she’ll leave me if I don’t.” They may be resentful, especially at first, but they understand that they’ll need to change something about themselves to achieve their other goals. And in my professional experience, these clients will not stick to treatment or benefit from it if they don’t end up finding their own reasons for being there. Forcing someone into counseling is rarely effective. It’s mostly something our institutions do in order to be able to sign a form stating they did.
This is something I really wish more laypeople understood. Therapy is not surgery. It’s not shoving a pill down someone’s throat. You can force someone to come to a therapist’s office and sit in it, but you can’t force someone to receive therapy.
And I can tell most laypeople don’t understand this, because every time this topic comes up, I have to watch strangers on Twitter accuse licensed mental health professionals of being “incompetent.” It’s absurd. It’s like accusing a mechanic of being incompetent because they can’t fix a car you refuse to bring to their fucking shop.
2. You cannot mandate someone to counseling who hasn’t broken a law or endangered themselves or others.
Many of these commentators glibly waving away the idea of effective gun control legislation say that we should somehow “identify” these potential mass shooters and send them to counseling. I’ve already explained that they won’t go voluntarily (or use the time for anything other than complaining about the rest of the world if they do), so that only leaves court-ordered treatment.
This is a complicated legal area and I am emphatically Not A Lawyer, but speaking from my experience and professional knowledge, here are the types of mandated clients I’ve seen: 1) clients who are required to receive mental health treatment as a condition of probation; 2) clients who are required to receive mental health treatment in order to regain custody of their children after a case has been opened with child protective services; and 3) clients who are ordered into treatment by the courts when there is “substantial risk” to themselves or others because of an untreated mental health condition.
In practice, that “substantial risk” has to be extremely high for a white person to be forced into treatment. For a person of color, it is much lower. For clients who are truly mentally ill, this whole painful and drawn-out process tends to make them even more suspicious of everyone around them who claims to want to help, and rarely seems to lead to effective long-term care or recovery.
And what would be the red flags? An obsession with vengeful violence and amassing tons of weapons? Good luck proving to a court in this country that that qualifies as a “substantial risk” to anyone’s life. That’s what we expect of white men.
Even if it is legally possible to get someone like Stephen Paddock into treatment, I highly, highly doubt that treatment would’ve done anything to prevent that shooting. In fact, I can see many ways it could’ve made it worse.
3. Not all mental health conditions are treatable, let alone curable.
Even if we assume that mass shooters like Paddock have a diagnosable mental health condition–a tenuous claim at best–we cannot assume that mental health treatment would’ve been effective.
First, a little primer on diagnostic categories.
The previous version of the DSM, which was replaced by the DSM 5 in 2013, used five “axes” to categorize diagnoses. Axis I was basically “all psychological diagnoses besides personality disorders and intellectual disabilities.” Axis II was–you guessed it–“personality disorders and intellectual disabilities.” Broadly speaking, axis I disorders are treatable. Axis II disorders are not.
Personality disorders are different from other mental illnesses in that they are typically present from a very early age and continue for the rest of the person’s life. Until they’re diagnosed, people with personality disorders typically have no idea that they may be mentally ill and rarely think of themselves that way even after diagnosis. They may be distressed by the ways in which their disorder affects their lives, but they generally attribute this to the faults of others/society.
There are three personality disorders that most often come up in the media or in conversation: narcissistic, antisocial, and borderline. Of these, borderline is the only one that’s really treatable in any meaningful sense. It’s certainly the only personality disorder I was ever taught to treat, and I have many clients with it who make huge improvements–again, because they tend to want to change. They’re unhappy as they are.
Clients with narcissistic or antisocial personality disorder are generally considered untreatable. When I attended a training on these disorders a few years ago, the presenter–a psychologist who worked for years in prisons and in private practice–emphasized that the only somewhat effective strategy is “behavior management.” You can probably imagine what that means, and it only really has any meaning inside an institution.
It’s important to remember that personality disorders are not, like, A Thing in the same way that diabetes and cancer are A Thing. They are categories that we created to help describe our social world. The idea of even having these categories at all is a pretty controversial one in the mental health treatment community despite their inclusion in the DSM, because many of us don’t believe that we should be in the business of designating certain personalities as disordered (or “normal”). While it’s clear that there’s something “wrong” with people who meet the criteria for diagnoses like antisocial personality disorder, it doesn’t really make sense to refer to these people as “mentally ill,” despite how much the public may want to.
So, we’re stuck. The men who fit the mass shooter profile are extremely unlikely to want therapy or benefit from it. There is probably no way to force them into it, and almost no chance it would be effective that way. And whether or not they are diagnosable with anything in the DSM, there are plenty of things that can be “wrong” with someone’s personality that may not be alterable at all.
So you can see why it’s extremely frustrating to hear, over and over again, that rather than enacting common-sense legislation or having an open conversation about the way we define masculinity in our culture, we should rely on social workers and other mental health workers to save us from this.
It’s not just that it’s impractical and not evidence-based. It’s the suggestion that we’re somehow not doing our jobs, or that our job descriptions should be expanded. Now, in addition to treating mental illness, reducing substance abuse, helping people with criminal backgrounds reintegrate into our society, assisting people with disabilities with squeezing themselves into our capitalist workplaces, teaching neglectful parents the skills they need to parent safely, finding safer homes for abused children, finding housing for the chronically homeless, advocating for people who have difficulty finding their way around institutions like courts and hospitals, educating the public about health and safety, deescalating situations involving people in crisis, supporting people through aging, illness, or hospice, conducting research, writing policy, lobbying lawmakers, organizing communities, and any number of other critically important tasks that get thrown our way because nobody else wants to do them–now we’re also expected to “personally disarm” potential mass shooters.
What, pray tell, the fuck?
I love my job, and my profession. Although I don’t personally do all of the things I listed above–no social worker does all of them–I think those are all crucial aspects of social work, and they all need to be done.
But more and more I feel that social workers are just the people we turn to when we’ve fucked up our society and want someone else to take the responsibility of fixing it.
We wouldn’t need to help people with disabilities force themselves into the workforce if our society had adequate support for them, or if workplaces were more flexible. People with criminal backgrounds wouldn’t need so much help if employers didn’t fucking refuse to give them a chance the vast majority of the time. There wouldn’t even be nearly as many people with criminal backgrounds if not for the so-called war on drugs and racist policing and sentencing practices. People wouldn’t need social workers to help them navigate the impossible thicket of Social Security, Medicaid, Medicare, SNAP, HEAP, and whatever if we would just fucking institute universal basic income. There wouldn’t be nearly as many homeless people to house if not for all of the above. Delete institutionalized racism from our country’s history entirely, and you’d be surprised how many so-called “social problems” would diminish right along with it.
Sure, we’d need social workers even in a pretty ideal society, and that’s fine and good. There will always be mental illness, substance abuse, child neglect, and so on. But what’s happening right now is that too few social workers are being paid too little to deal with problems that are way, way too big for our profession. That’s true of poverty, homelessness, and crime, and it’s especially true of mass shootings assisted by weapons that should never have been legally sold to anyone who isn’t defending themselves from a fucking zombie apocalypse.
Right now, the existence of the social work profession is just an excuse for almost everyone else to do diddly squat about social problems because don’t worry, a woman (88% of social workers are women; African Americans have about twice the representation in social work as they do in the general population) with no protection besides a cell phone and a crisis deescalation training certificate will handle this middle-aged white man with 20 semi-automatic weapons in his hotel room.
I know you’re going to ask what my solution is, if social work isn’t it. Look: I don’t have a solution. Because not only is my specialty mental health, not violent crime (the two have relatively little to do with each other), but I also don’t think that the solution is going to come from my profession, at least not single-handedly. This is a political problem, this is an economic problem, this is a cultural problem, this is a sociological problem.
Some smart people say that the research* on gun control shows it doesn’t work. Plenty of other smart people say that it shows that it does. Part of the problem is that you can’t fully research the impact of policy without instituting the policy, and looking at other countries or smaller political units isn’t going to help. Sure, Australia can’t tell us exactly how gun control will work here, but neither can Chicago.
What is absolutely certain is that violence has always been, and will always be, a feature of every human society. The meanings, conditions, and extent of the violence may differ, and certain factors may increase or reduce it, but it’s going to happen.
There was a time when it happened mainly with fists, knives, swords, or pistols. Lately it has been happening with rifles modified to be able to fire 90 shots in 10 seconds.
Back then, if a dude got mad and stabbed someone with a knife or challenged him to a duel, nobody called in social workers to solve the problem. (Not least of all because they didn’t exist.) Now when a dude gets mad and is able to murder 58 people and wound over 500 more almost instantly, we’re suddenly supposed to fix it.
I don’t know how to fix it, and I don’t think any of my colleagues do either, and if it’s all the same to you, I’d like to live long enough to see an end to this absurdity.
- Also relevant is the fact that the 1996 Dickey Amendment to the federal omnibus spending bill bans the CDC from using its funds to “advocate or promote gun control,” which in practice has severely limited its ability to research whether or not gun control works at all. This amendment has been opposed for years by the American Academy of Pediatrics, the American College of Preventative Medicine, the American Psychological Association, and the National Association of Social Workers.
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