Friedman's statement that ‘most people who are violent are not
mentally ill, and most people who are mentally ill are not violent’
remains apposite, but recent US gun killings inevitably reawaken the
debate. In a moving editorial in the New England Journal
of Medicine, Malina and colleagues compellingly compare gun
lobbyists to a cancer growing in the mutated cells of the psychological and
sociological make-up of the United States. What is the contribution of
mental health to this problem? Estimates suggest it might have impacted the
trajectory of 3–5% of the approximately 33 000 US gun deaths in 2013. Sadly,
one imagines that psychiatry had a far bigger role in terms of the
subsequent psychological impact on their relatives, witnesses of the
violence, and the further 84 000 who survived such assaults that year.
Against the backdrop of halting convulsions towards legislative change, the
authors reason that mental healthcare cannot be held responsible for what
they label the impossible task of identifying anyone who might conceivably
start shooting others.