The media is now filled with various statistics quoting the factoid that in over 200 days we have had over 200 mass shootings in the United States. Mass shootings are variously defined as a shooting incident in which three, or now more commonly the definition requires four victims by a perpetrator. The victims may be all in one site like the James Holmes Colorado theater shooting, or in more than one location where a shooter will shoot usually first members of his (recalling that most mass shooters are male), a spouse or estranges spouse or intimate partner, and then shoot members of the public at another location.

Most media sources noting this disturbing fact-trend-interval statistic, note that many of the shootings never attain national attention, and involve more understandable motives, gang-related violence, domestic violence only, shootings at directed, somewhat more understandable targets such as begrudged bosses etc. It is the more random, senseless mass shootings for which over and over we are drawn to. We humans like to have explanations and the ability to blame or affix guilt and causation.Theories of causation can be “nuts” by modern standards such as the reasoning behind the Salem Witch trials in which adolescent girls who swooned or were somehow connected with witchcraft and thought to be responsible for bad crops, disappearance of animals, sickness and all manner of unexplained events. If we still applied that sort of pre-scientific reasoning, a lot of harmless, and frankly in my biased opinion, practitioners of Wiccan would be burned at the stake all over the country. But even in modern times we have had our crazy, unsupported legends such as in the 1980’s when it seemed huge numbers of people had been somehow Satanically ritually tortured “in the woods,” and presented themselves publicly and privately as having suffered such. Alien abductions was also “big” in past decades, but in my mind, that seemed to die down after the radical and blistering satirical cartoon series “South Park” lampooned that goofball notion with the chubby screechy hyper-frenetic character of Cartman suffering from the famous “anal probe,” that had half the nation rolling on their living floors. After that I never saw a person claiming alien abduction as a psychiatrist unless they were clearly and thoroughly psychotically deluded, but such individuals were always grossly deluded about many other issues and ‘easy to spot,’ as sadly mentally disturbed.

But now we have much more serious phenomena occurring now on nearly a daily or weekly basis, that of mass shootings, with real harm to innocent citizens, families, and communities. The debate is now hotly enjoined over what is the biggest cause, mental illness or the massive availability of guns in this country. Experts are weighing in from all sides and justifiably so as this social question is serious and terrifying. Everyone now thinks sometimes twice about whether to go to a darkened public movie theater now. In my childhood, no one ever thought in those terms, not my parents or anyone else. All I thought about was my 25¢, a western or cartoon movie and the previews on Saturday afternoon in whatever town we lived in. Nowadays it is not uncommon for me to overhear my colleagues in my large hospital setting, debating whether or a not a certain because of its content, could possibly attract a mass shooter. No more scary teens being slaughtered by the camp’s lake by a hatch wielding madman, no more film noir (dark) thrillers with creepy characters and unexplained disappearances. A joke making the rounds locally and perhaps nationally is “no more dark Batman movies for my kids.” And I love Batman and always have though for years I have thought the movies have strayed from the spirit and feel of the comics.

I have a very unusual view of causation from my experiences as a scientifically educated person and specifically as a physicians and psychiatrist. I know that almost nothing has a single cause. That viewpoint, I know, sits poorly with a large segment of any population who needs either intellectually or religiously-culturally a simpler, singular view of the world, its problems, causes, interaction,s and solutions. Specifically as a psychiatrist, I “live in the world of ambiguity,” whether I am doing family therapy or psychopharmacological treatment of biologically psychotic person. Granted I am the first to admit that psychiatric residency training in the last two decades has overemphasized biological treatments to the detriment of a more comprehensive (many would use ‘wholistic’ instead of comprehensive) but I am old fashioned and still find it too “hippy-ish” from my years in Ann Arbor at the height of the hippie-yippie drug culture nonsense. Too many psychiatrists have lost the art of listening or being comfortable and personally able/socially adept enough to talk to patients at any length before whipping out the prescription pad and enshrining ‘the new medicine’ as treatment. I call them “medicine mechanics,” and mean it…

But back to family therapy. In that treatment paradigm and process the therapist is truly “in the crossfire.” Every family member of a family in serious enough distress to need help from an outsider, has a grievance, a beef, a clashing viewpoint, one or more conflicts with other members of the family and few members of “dysfunctional” or “hurting” families as I prefer to think of them, escaped the pathological process and even if they are quiet, overachieving, distant from the family, they still have been deprived of good emotional developmental fuel and have suffered role distortion and damage to the self and their senses of confidence, self-sureness, the self identity and all the other terms we use to try to encapsulate the “damaged self.”

The family therapist sits right in the middle of this inter-nicene war and gets shots at verbally from all sides as every member of the family tries to enlist the therapist in endorsing their position. Everyone gets mad at the therapist for switching sides, supporting one member when they have a valid point, and then feels betrayed when the therapist has to bring that same family member to look at their faulty issues, positions, blaming, projection of problems onto another and denial.

In family therapy there are so many “causes” to the family problems that with some families I had to keep written lists of the issues of each person, of each dyad, triad, the parental couple and even of extended family relatives such as aunts, uncles, and grandparents. I was not above requesting families have a distant grandparent come for the holidays and come into a session to track down an old, intergenerational issues. I recall having one grandfather come from overseas to spell out in detail the explanation to an issues that had plagued a parent and crippled the entire nuclear family. Talk about complex causation!

With regard again to the problem of mass shootings, it is clear there is no one cause. A recent news report from a television station in Indianapolis quoted a set of statistics from unnamed sources (no criticism intended)  that: “Experts say 26 percent of the population is mentally ill and 1 in 17 is severely mentally ill. 10 percent of the homicides are attributed to mental illness and 1 in 2 mass shooters displayed some overt signs of being mentally ill.” That is pretty impressive. At least one percent of the general populations in all measured societies are 1% schizophrenic and about 1.5% bipolar. These appear to be constants and do not vary much among difference ethnic groups and cultures. But nowhere else in the world is there as much gun violence exemplified by personal mass shootings as in the United States. The only kind of gun violence that comes close exceeds that of the United States are in disintegrated states that are embroiled in bitter, long-standing ethnic, religious civil wars such as Syria, Iraq, Lebanon, Chechnya, the Sudan and other such horrific chaotic (former) countries that are now completely lawless and it seems every male has a Kalashnikov machine gun waving it in the air and shooting it indiscriminately on any occasion related to the region’s unrest.

In other countries and cultures, where guns are strictly controlled there are still mass murderers. Mass murderers whether mentally ill or otherwise evil malignant personality disorders, likely have always been with us. Vlad the Impaler comes to mind. But t likely the modern phenomenon began in “Merry Old England,” home of one of sentimental favorite urban legends of literature, Charles Dickens’ The Christmas Story, with the never identified “Jack the Ripper.” He is rumored to have used a blade concealed in his dapper but deadly walking cane. In China just a few years ago, the stories leaked out that China was having a spate of unexplained “mass stabbings.” People would take kitchen or butcher knives and go into stores or of all places, children’s schools and start stabbing and killing as many persons as they could before being killed or subdued. This is the kind of point that the NRA would make in their stance that these crimes and phenomena cannot be blamed on guns alone and in that restricted sense they are correct. One fellow psychiatric wag friend of mine who shall remains unnamed, made a hilarious comparison Mort Sahl (a supremely good satirist of about 50 years ago for all you American culturally uninformed young readers–look him on YouTube clips, he’s worth the trouble), said that “The National Chinese Knife Associations” has lobbied successfully against the regulation and registration of large knives.”

I have found and long pointed to a not so old Michael Douglas movie, the 1993 movie “Falling Down,” in which he plays a defense worker, who goes beserk after a series of incidents on his way home from work and starts killing people in rage. Although most reviews characterize him as mentally ill, I saw him at the time the movie came out and still do as the angry loner who “can’t take it anymore and lashes out.,” almost a paradigm for the other predominant non-mentally ill mass shooters that we have today.

My last comment though in honesty must come from an attorney who was labeled in the news story link above as a member of the NRA. He made the telling point in a video clip quote that no law could stop this phenomenon. Unfortunately, he is right. Simplistic measures and answers will not solve what we are going through now. But societal wide measures must occur and many measures ranging for gun control of some sort to nonstop public educations campaigns on gun safety and violence, to even more research on the neurobiology of violence [remember Charles Whitman, the rifleman killer of University of Texas students from the famous Tower in 1966 who had a brain tumor?], early identification of persons at risk and more sophisticated treatment of nonpsychotic affective rage states must proceed with nationally agreed upon consensus or in a century future citizens will be viewing the same horrifying news nationally with no end in sight.

The ambiguity of such complex social problems that are this pressing, force everyone to abandon their favorite comfortable positions and move toward long-term, slow gradual efforts on many seeming unrelated fronts to reduce this modern plague.