What Should Parents Say About Mass Shootings?

The intolerable grief of mass shootings, in conversation with Sohaib Imtiaz, MD, MPH

A conversation (edited a bit and excerpted ) from this live conversation I had with my clubhouse-era friend, the Digital Doctor himself, on May 28th, 2022:

Sohaib:

Let's dive deep into the brain— what makes these incidents occur? Is it mental illness? What part does that play? what are some of the triggers for these kinds of events?

Owen:

I'm a child, adolescent, and adult psychiatrist by training. I have the distinct sadness to have lost a dear friend of the family in the sandy hook shooting.

I'm from Connecticut. My mom has run a Jazz Festival for years, and I lost a friend of our jazz family in the Sandy Hook shooting.

Back in 2017, I was interviewed in the Daily Mail for “what do you say to your kids about these awful events." I had some advice then, and I've had time to think about it more.

As health professionals, we're really in a difficult spot. We have to deal with not just what we'd like to be true, in changing the political tides, but what is true. There is human suffering. If we don't address it, people suffer more. If we don't address it effectively, we're not doing what we should to help.

I would argue that involves not just thinking about victims. It also requires thinking about how to help people who might be at risk of committing violence. It is really hard to figure out who will be in advance.

Once terrible violent things happen to lots of people, repeatedly, it’s time for health professionals to have something useful to say.

Dr. Sohaib Imtiaz, MD, MPH

Sohaib:

I'm really sorry for the loss. Mourning elementary school children is a very devastating and tragic.

It obviously affects a lot of us mentally. Especially, parents who have children going to school— it makes you feel vulnerable. It makes you think anything can happen at any point. I bet a lot of people are feeling that way.

What makes someone pick up a gun and just blindly shoot people?

Owen:

You don't actually need to know the details of this shooting, or of any of them, but if there are so many of them they blur into each other. What we know is something happens on repeat, now. It goes like this:

There is someone who feels aggrieved and usually, it's one person. Usually, they're male, they're usually white, in America at least.

And they will get access to a gun. Usually, it's the kind of gun that can shoot a lot of bullets. A new trend is wearing tactical body armor in the course of these shootings. Body armor makes it harder for authorities to take down shooters with their guns. Someone who feels bad. This is not something people do for their birthday, this is not fun. This is something you do for Anger or other negative emotions. So we don't even have to get into “mental illness.” I can just say that negative emotions play a really strong role in why anyone would shoot many people to death.

I'm certainly not going to mention the names of anyone who does any of this. One of the reasons it's become so common is because it's become a social trope for young and aggrieved people, this is the way that has, hundreds of times a year, become a way to express their rage.

I don't care why any of the rest of them did it specifically because I don't really feel like giving air time to those grievances. I can say people who are loved and people who are cared for and people who are supported— don't generally murder children.

This is not the kind of action we see from people who have strong social support. It is not an action chosen by those with a strong sense of self. How do we get to a place where more people feel loved? How can we help more people feel supported such that fewer people are allowed, through our neglect, to drift into a rage?

These are actions borne of profound unhappiness, despair, anger. This hurt is the fuel for these shootings, absent as much judgment as I can possibly withhold to try to understand.

But at the end of the day—literally every day—mass shootings are not a crime of the happy, joyful, or mindful. These aren't things done by people who have deep feelings of connection to others.

Because then of course you couldn't do these things in the first place.

Sohaib:

What are the contributing factors?

We want as many people to feel loved as possible, can we provide help, or access to help to prevent this?

Owen:

Having access to help is helpful for those who seek help. This kind of help, it’s for those who feel like help will be helpful and who have some trust in help.

Often, we have young people, as we saw in Uvalde, Texas, who didn't have someone they trusted. We had a shooter who trusted nothing other than his ability to get a gun and tactical body armor and inflict suffering.

And so we have this very strange situation—where we can't know who it's going to be. We can know it's highly likely to happen again.

As a physician, I'm someone who can make decisions about how health care is deployed at best. I can advise people who are making other kinds of policy decisions.

We have a pretty basic problem: the more people we have who feel adrift, unloved, uncared for, misunderstood, and enraged, the more likelihood is some of them are going to choose to express their rage with bullets. These crimes are easy to plan and carry out.

There's the time it takes to buy tactical body armor online— a mouse click, and it takes a day or two to get there.

We can't chalk all this up to the same kind of impulsivity we would for “snapping” or “drunk in a bar”— this is something, where the feelings involved, have let's say, happen over days to weeks. Sometimes, it’s even years longer to percolate. We know something about the kinds of problems that operate on those time scales.

Sohaib:

That's a brilliant place to start.

So do you often see these people almost signaling before they commit these types of heinous acts?

Owen:

The discussion around mental health is it almost entirely leaves out that personality is a dimension around which people’s behavior revolves.

Everything has been kind of compressed to the brand that is mental health. This is different from the medical discipline of psychiatry. It's certainly different from detailed ways of looking at personality disorders and personality impairment.

I look at individuals who have the kinds of profiles of shooters and I see personality impairments. Identity, self-direction, empathy, and intimacy functioning are impaired.

These impairments leave people with difficulty understanding who they are. They lack a good sense of what they're doing, and why. They have roadblocks in their connection to other people. They have problems with the ability to feel loved in their intimate relationships, assuming they have any they consider intimate.

Extreme impairment in intimacy functioning looks like someone who can't conceptualize relationships as doing anything but inflicting suffering or soothing pain. There are no shades of grey, just pain.

And when that's everything relationships become to you? This world of pain is a setup for real problems. This is only worse if you have concurrent impairment in self-direction. Self-direction is why you're doing what you're doing. Identity functioning is: who I am and how I make sense of that.

We can say that some people have more problems with these dimensions. We don’t even need to invoke a diagnosis to know this is problematic for some. Can syndromes or diagnoses play a role? Sure. But they aren’t needed to reach some kind of understanding.

I don't think we need to go all the way to “the mentally ill.” It’s easy to blame depression or a drug. Even absent that, we can understand:

What's happening here? There are people who feel horrible. It is not best described as sad, down, or anhedonic.

Those things are likely true. The inability to experience the minds of others and ourselves is a core issue.

What's real to people with severe impairments? Their feelings become very concrete. We see in some of the messaging from shooters is a need to be understood. They are willing to push the understanding of their pain so forcefully that they're willing to kill. “I need people to experience with shots the pain I feel.”

“I need to make my pain concrete and real” —otherwise, it can't be understood as real. This is a severe impairment in how to feel, and how to act.

Then we're freed up a little bit from the handcuffs of what are we going to do about treating depression. That is important but doesn't answer this particular set of questions about personality impairments.

How do we create systems where people suffering from their inability to feel connected can be understood? When you feel understood, you don't feel the need to act by pulling a trigger. That's the bottom line. I think there's a scaling of our empathy and compassion that's necessary. Parents having real conversations about their difficult feelings is an answer. Those conversations are a chance to feel feelings that are really difficult. Our kids are going to observe how we act, how we speak, and how we are curious about how they are feeling.

And that kind of interaction is exactly the kind of interaction that has kids grow up to not be murderers. This is what anxiety exists to protect us from, as an emotion. This is why we fear. If we don't, our children could die— there is no better use of fear than the fear of monstrous sadness armed with high-capacity magazines.

At the same time, it doesn't mean that I'm going to build a bulletproof box and my entire family is going to cower in it for the rest of my life.

As I mentioned in the beginning, connection and curiosity about the minds of others is the inoculation against wanting to annihilate them.

And if you want to pull your kids to home school you certainly can. I think talking to your kids about why you're afraid and letting them see you cope is more useful parenting than not doing so.

We talked talking about our thoughts and feelings with our children— which we can and should do regularly— that's how they learn to feel.

Observing us stumbling through our feelings and making that a little bit extra transparent is the antidote.

There are a lot of things I'm just completely powerless to prevent as a parent

And I can take reasonable precautions about x y and z but this isn't one of the things that's easy to avoid. A problem with homeschooling is that school is an important environment for kids.

I think taking school seriously is how we help social-emotional development.

Learning math is important. but learning not to shoot everybody else is more so. It doesn't matter how good you are at math when the skill is used for counting the dead.

As parents, we can talk about our thoughts and feelings — not only by getting it right, but when we get it wrong, talking about that also.

That ability to put feelings into words? It means we don't put bullets into the chamber of a gun.

—Owen Scott Muir, M.D.