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What if I told you there was an illness killing more than 30,000 Americans a year, with more than 80,000 becoming ill but recovering?  While some may recover completely, for many the repercussions are lifelong, with chronic pain, neurologic problems, and psychological issues.  It’s an unpredictable illness, striking both young and old.  While there are risk factors for being affected, many of those who die seem to merely have had bad luck

This illness affects some communities more than others, but crosses demographic boundaries.  And what if I told you that the federal government had banned research to try to address this devastating disease?  This sounds somewhat unbelievable.  It is, however, the case with gun violence.   From San Bernardino to Sandy Hook, Columbine to Virginia Tech, we are facing again and again the effects of gun violence writ large.

While the nation polarizes around gun control, individuals are being struck down on a daily basis.  If we define mass shootings as four or more people being struck, there have been 353 this year.  Some days, there were as many as four mass shootings.  October 25, for example, was a bad day, with shootings in Washington, D.C.; Phoenix, Arizona;  Four Oaks, North Carolina, and Pageland, South Carolina — 16 shot, but, amazingly, only 3 killed.   While these make headlines, much gun violence happens in the home, in the form of suicides, homicides where the victim knows the perpetrator, or accidents.  Just last week, a young woman was brought to our ER, having been shot by a relative.  The cause?  An argument over a pair of Michael Jordan sneakers.  She did not survive.

We’ve all heard the phrase “Guns don’t kill people — people kill people.” The problem is that people with guns kill other people all too easily, and frequently unintentionally, or with little thought.  Perhaps nowhere is this more apparent than in the case of children.  Compared with their peers in developed countries, American children are 16 times more likely to die from accidental shootings, and some research indicates that this is actually an underestimate.  Guns rarely offer second chances; their use brings a high rate of fatality. 

As a psychiatrist, I regularly meet those who have attempted to take their own life with a gun.  Rarely is the suicide a long-thought-out, carefully planned act.  Rather, it is often a decision of the moment, sometimes fueled by alcohol.  The gun was there.  They used it.  End of story.  The lives of their friends and relatives will never be the same.  And, for each person that I meet, there are far more who never make it to the hospital.  Sadly, a gun owner is far more likely to die at the hands of his own gun than to use it in self-defense.   While these acts of suicide and accident are less likely to make the news than the mass shootings, they need to be part of this conversation about gun violence.

We need a better understanding of these violent acts of all scales , from suicides to mass casualties.  Some have put forth theories regarding this rising tide of violence.   In what now seems rather prescient, just a few weeks before the attacks in Paris, The American Journal of Medicine published an article by Arnold Eiser, MD, that posited an explanation for the rise in mass shootings. He termed the condition accounting for the violence Postmodern Stress Disorder (PMSD).  Eiser, Professor of Medicine at Drexel University College of Medicine and Chair of the Health and Public Policy Committee for the Pennsylvania Chapter of the American College of Physicians, suggests that PMSD is the product of today’s culture, in which news media, the Internet, and video games inundate us with violent images.  They may prime those who seek out these images for violence.

Eiser notes, “Common to all is repetitive digital input that violence (often gun violence) is the solution to a variety of diverse problems. In some sense, the violence is seen as purging or solving a problem in the game or video, when it clearly does not in actual life . . .”  While the healthy, normal response to violence includes various inhibitory processes in the brain to tamp down impulsive acts, studies have shown that youth who are exposed to violent video games become desensitized.  When those inhibitory, evolutionary advanced processes become less active, this could possibly “promote aggressive violent behavior.”

Studies have also shown that watching violence on television correlates with poor impulse control.  Men, it seems, are particularly vulnerable to the effect of violence; they show more pronounced effects of exposure than do women.  While Eiser draws on a number of examples to illustrate his proposition – from Eric Harris and Dylan Klebold, of Columbine, to Craig Stephen Hicks, who killed three students near the University of North Carolina campus — there remains the question of correlation versus causation.  It is conceivable that certain individuals have a predilection for violence — either from the way they were raised, their genetics, or, most likely, both — that draws them both to violent imagery in news and video games, as well as impelling them to commit terrible acts. Such a predilection might be the reason these individual commit the acts, rather than the fact that they watch violence.  The bottom line: We don’t know, and we need to figure this out.

This epidemic of violence has risen to the level of a public-health issue.  While the nation hunkers down into the pro- and anti-gun control camps, we need to remember that there are some things on which we can agree: What we are doing now isn’t working.  We need to start funding research on gun violence – whether that’s the act of a pair of shooters at a holiday party or the accidental death of a toddler. We need to better understand what is going on and how to stop it.  How many more deaths do we need before we make a change?


Eiser AR. Postmodern Stress Disorder (PMSD): A Possible New Disorder.  Am J Med. 2015 Nov;128(11):1178-81.

Innocents Lost: A Year of Unintentional Child Gun Deaths.  June 24, 2014.

Kim J. 14-year-old niece shot, killed by uncle during fight over Michael Jordan shoes, family says. Q13 Fox. December 7, 2015.

Mass Shooting Tracker. Accessed December 13, 2015.

Overberg P, Hoyer M, Hannan M, Upton J, Hansen B and Durkin E.  Behind the Bloodshed: The Untold Story of America’s Mass Killings. USA Today.  Updated December 13, 2015.


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  • Karen cox January 4, 2016 at 8:26 am

    Very informative. Thank you for writing it. I hope it’s a call to action. We have to try to stem this epidemic.