Let’s treat the real problem

To the Editor:

I am writing regarding the recent mass shooting tragedy in Lewiston that has affected so many. As a physician (practicing in Lewiston/Auburn), a hunter, and a strong supporter of the Second Amendment, I would like to offer my personal insights and potential solutions to reducing such horrors in the future.

Before my 36-year career in Emergency Medicine and Occupational Medicine, I studied Psychiatry for one year after medical school. Although I did not pursue a career in psychiatry, the knowledge gained was, nonetheless, highly beneficial.

We do not have a problem that can be solved by attempting to take away guns. It has been estimated that there are well over 300 million guns legally owned by U.S. citizens, so, expecting to effectively put that genie back in the bottle is grossly unrealistic, even if we tried. Changing the magazine in a semiautomatic handgun takes about 1-2 seconds.

Take away AR-15 weapons and those with murderous intent, will simply use handguns instead. Rather, the issue that needs to be addressed is the national epidemic of mental illness and I believe that there may be relatively simple and effective ways to deal with this. I am sure we can all agree that other than war, drug cartels, and gang-on-gang conflicts, anyone who commits mass murder of innocent civilians, is not mentally well.

First, it is critical to understand that there are many types of mental illnesses; some are considered highly treatable, and others are not. I am not addressing common, treatable, often temporary conditions like anxiety, situational depression, and the other so-called “mood disorders”.

The issue at hand is the category of “thought disorders”, also referred to as “major” mental illnesses, which are almost always permanent conditions; schizophrenia is a common example of psychosis. Psychosis is, by definition, the group of conditions characterized by the individual being out of touch with reality, often accompanied by auditory hallucinations and unfounded paranoia.

Many psychotic disorders are, indeed, manageable with medications, but the underlying condition is virtually never “cured”. This group of patients remains functional and safe only when faithfully taking their medications. Therein lies the stumbling block – the vast majority of people with major mental illnesses intermittently choose to stop taking their prescribed medications.

If the reports are accurate, the Lewiston shooter had a psychotic disorder, i.e., hearing voices telling him to kill people. Mentally well people do not commit such horrendous acts.

In the practice of Occupational Medicine, I am often ethically and legally mandated to place concerns for public safety above the rights of the individual. A very common example is not giving medical clearance to commercial drivers who represent a significant risk of harm to the public; indeed, we medical providers are required to report these cases to the Federal Motor Carrier Safety Administration.

Although well-intended, blanket medical confidentiality for individuals who suffer from psychotic disorders, needs to be reconsidered. I would propose legislation requiring all medical providers, on a national basis, to be required to report to a single federal agency, such as the ATF, anyone and everyone who has been diagnosed with a psychotic disorder.

Such individuals, because of the very high risk of relapse, as discussed above, should never be granted the right to own firearms. Public safety demands that their rights be subservient to the public’s right to live in a safe environment.

When I go to purchase a firearm, my gun dealer calls the ATF to get clearance that I am okay to possess it. I am fine with universal background checks before any firearm purchase. I have nothing to hide. Contrary to the “slippery slope” argument, there is no defensible rationale for opposition to background checks.

An automobile can be a lethal weapon. For the sake of the public’s safety, we are all required to demonstrate that we can effectively operate a motor vehicle – so why should ownership and use of a lethal firearm be any different?

On the local state level, in addition to universal background checks, Maine needs a red flag law with “teeth”, rather than a yellow flag law that lacks universal enforcement. However, this will only work effectively when medical providers are required to report all psychotic disorders to a central federal database to be accessed only by authorized gun dealers and law enforcement officers.

We can no longer continue to just restrict weapons from persons who actively present as an imminent danger to themselves or others. Currently, law enforcement is often hindered from protecting the public, because they must meet the imminent danger criterion before they can act. Any person with a diagnosis of psychosis should be seen permanently as an imminent danger to the public.

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