Tucson Shooting Renews Gun Control Debate

Harold Bursztajn, M.D. co-founder, Massachusetts Mental Health Center's Program in Psychiatry and the Law
Stephen Hunter, author, Dead Zero

The January shooting of Rep. Gabrielle Giffords (D-AZ) and 18 others in Tucson has reignited two issues in the debate over guns in America: the legality of extended magazine clips like the one used by the suspected shooter, and access to firearms by the mentally ill.

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NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

We've begun to get a little distance from last month's shooting of Congresswoman Gabrielle Giffords and 18 others in Tucson. It's likely to be some time yet before we know how well she will recover, and any trial of Jared Loughner is months away.

From this perspective, the incident raises two issues that are part of the long-running debate on guns and gun control. Neither is new. Both, though, arise in a new light.

For starters, the high-capacity magazine that let the shooter fire off more than 30 bullets in a few seconds without reloading. Some legislators want to reinstate a federal ban on these devices. There are also questions about gun sales to people with mental illness. By all accounts, Jared Loughner's gun purchase was entirely legal.

Mental illness by itself does not disqualify firearm sales under Arizona or federal law. But should we now revisit those laws? Should we ask about the responsibilities of mental health professionals?

Later in the program, after CBS reports than an attack on correspondent Lara Logan in Cairo included sexual assault, we'll talk with NPR's Jamie Tarabay, who's worked in some of the same places.

But first, we want to hear from mental health professionals about your responsibilities regarding your patients and guns. Our phone number, 800-989-8255. Email talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Just a note: We're going to switch topics to talk about high-capacity magazines at 20 minutes after the hour. So if you're calling about that, hang on.

Joining us now is Dr. Harold Bursztajn. He co-founded the program in psychiatry and the law at the Massachusetts Mental Health Center. He's now with Harvard University's medical school and joins us from a studio on the campus there. Good to have you with us today.

Dr. HAROLD BURSZTAJN (Harvard Medical School): Thank you for inviting me to be with you.

CONAN: And in a sense, this is not really about Jared Loughner. So far as we know, he never saw a mental health professional. Administrators at his community college took note of his erratic behavior, had concerns about his mental capacity - not mental capacity but mental illness, told him he'd have to be cleared by a mental health professional in order to return to the school.

Should their responsibilities have extended past that?

Dr. BURSZTAJN: That's an excellent question. Now, again, I haven't examined Jared Loughner. I haven't examined the facts of the case. So I can't speak about the specific case.

But the question that you raise is a question which any mental health professional needs to ask, but beyond that, any university administrator needs to ask when someone is asking - is acting in a bizarre fashion.

The problem isn't that people come up with the wrong answer. The problem isn't that - is much more, that they don't ask the excellent question that you've just asked.

CONAN: Well, Dr. Bursztajn, the question goes - these were administrators, and they had questions. You can't make somebody go to the doctor, can you?

Dr. BURSZTAJN: You cannot make anyone go to see a physician. Moreover, we do attempt to do our best to respect the autonomy of any individual suffering from whatever illness they may be suffering from. The question which needs to be asked, though, is with - especially with certain forms of severe mental illness - is whether the person's autonomy is sufficiently diminished by the mental illness itself that some proactive steps need to be taken.

Generally, in my 30 years of experience in psychiatry, clinical psychiatry, forensic psychiatry, most people who are mentally ill will respond to honest encouragement and support, but some will not, and then the question becomes: What do you do with people who will not respond to encouragement or support because their mental illness impairs them from being able to recognize the fact that they are mentally ill and that they do need help, or their sense of hopelessness frightens them to the extent that the only solution to hopelessness is denial?

CONAN: There is - there are any number of different thresholds at which mental health professionals cope with such questions about their clients, about their patients. But should there be questions asked, that if you have concerns about this, you may want to institute - the profession may want to institute a series of - a capacity for a mental health professional to call up and say: My patient, Mr. Jones, ought to be placed on the list that if somebody conducts a background check to see if he can buy a weapon, the answer is no or at least not for the next six months.

Dr. BURSZTAJN: There's always the balancing between very legitimate public safety concerns on the one hand and avoiding undue stigmatization and breaches of confidentiality on the other hand. The problem with having a too-low threshold for breaching confidentiality is that that would tend to scare away from seeking help precisely those people who may benefit the most from being helped.

So for example, some people who are paranoid, if they have a sense that there's a place where they can talk freely and honestly, may eventually be open to treatment. On the other hand, if there's a sense that the very act of seeking help will expose them to public scrutiny and, from their perspective, an invasion of property, an invasion of their privacy, then they will avoid seeking help.

And as your initial question points out, and this is very important, so I'm glad that you began there, the person in question that we're speaking of is not someone who ever saw - as far as we know. I mean, that may change.

But at least as far as we know he never saw a mental health professional. So it's important that we don't lose the opportunity for being able to proceed with a therapeutic model by proceeding to have a paper-thin threshold for violating clinician-patient confidentiality in the mental health area.

CONAN: Well, we're talking about issues of responsibility and consideration of when to report, when not to. Here's another email that asks the question about resources, this from Ted(ph) in Sepulveda, California, I think. No, it's Sepula(ph), Oklahoma. That's quite different. In any case, he writes: Mental health professionals are thinly spread. They don't see their patients long enough or often enough to detect instability. I only see my doctor for 15 to 30 minutes once every few months. People who are in acute psychosis who manage to get to a hospital are only held for 72 hours with minimal care, perhaps meds review, perhaps not.

And he raises a good point.

Dr. BURSZTAJN: Ted does raise a very good and very important point, which is that there is a scarcity of resources and that as a society we have not made mental health be a major priority.

Moreover, whereas people who have other kinds of illnesses, such as, for example, cancer, usually have intact families that are able to advocate for them. Very often people with mental illness have so alienated their family support systems that there is no one to advocate for them.

And thus when it comes to priorities both as far as public funding is concerned and as far as private insurance funding is concerned, there just isn't the kind of funding which would allow people who are seriously mentally ill to get, at times, as comprehensive a treatment as would be beneficial.

CONAN: Let's go to a caller. This is Tom, Tom with us from Portland, Oregon.

TOM (Caller): Hello, thank you for taking my call.

CONAN: Sure.

TOM: Well, my comment was twofold, and as I was telling the screener, I work in an emergency department as part of a consultation service to ER physicians. And one thing that I notice in that role is we're often asked to serve in a forensic role around safety that relates to a patient's care.

And the key thing that came up for me in this discussion was that there's such a limited view of a person's safety in relation to firearms or in general that you have a brief snapshot to evaluate them, and it relates little to the gun laws. You're essentially charged with evaluating someone's safety at that point in time.

So there isn't much instruction that comes from the laws regulating that, beyond if someone has been mentally - has been committed by a court, and those are relatively rare, certainly in this state, probably nationally as well.

CONAN: And Dr. Bursztajn, I wonder if you could address that, but also in the context of the shootings of Virginia Tech, when gaping holes were found in the amount of state records on file for people with mental illness.

Dr. BURSZTAJN: One of the fundamental problems that we face is at what point should privacy be breached. And that involves being able to proceed with a clinical evaluation which takes into account who the individual is, what their values are, and what are some of the risk factors for violence.

Now, again, in an emergency setting it's - at times there's a tremendous amount of pressure to proceed, and as your caller from Portland pointed out, proceed to limit one's evaluation time-wise.

There are problems of triage. There are other sick people to be seen. As far as databases are concerned and gaps in the system, ideally there would be - you would have a more integrated system. The question is how to have such a more integrated system while protecting the privacy of the individuals who are suffering from major mental illness.

CONAN: Tom, thanks very much for the call, and Dr. Bursztajn, thank you very much for your time today. We appreciate it.

Dr. BURSZTAJN: Oh, thank you, and thank you for your excellent questions.

CONAN: Dr. Harold Bursztajn co-founded the program in psychiatry and the law at Massachusetts Mental Health Center. He's now with Harvard University's medical school and joined us from a studio on campus.

When we come back, we're going to tackle another of the issues raised by the Tucson shootings, and that is high-capacity magazines. Stay with us. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION from NPR News. Im Neal Conan in Washington.

The shooter in Tucson last month was tackled when he stopped to reload. That came after he'd already gotten off some 30 rounds, killed six, and injured another 13.

In response, there are now efforts - in Arizona, in New York State, in Florida, among other places, including Washington, D.C. at the federal Capitol - to ban or restrict those kinds of high-capacity ammunition clips.

Stephen Hunter argues that would not stop most criminals but could harm people who buy guns for self-defense. Gun owners, do you need 33-round clips? Why or why not? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation at our website. That's at npr.org. Just click on TALK OF THE NATION.

Stephen Hunter's op-ed, "Why 33 Rounds Makes Sense in a Defensive Weapon," appeared in the Washington Post earlier this month. You might also remember him as the former chief film critic for the Post. He earned the Pulitzer Prize in that role. He's also a well-known novelist and joins us from a studio at member station WYPR in Baltimore. Nice to have you back on the program.

Mr. STEPHEN HUNTER (Writer): Thank you so much, Neal. It's good to be here.

CONAN: And why - most police officers carry semi-automatic weapons with 10 or 11 rounds in a magazine. Why do you need 33?

Mr. HUNTER: Well, most police officers have several reloaded magazines on their bodies. They have - they're almost all wearing body armor. They have tasers. They have batons. And most important of all, they have a button by which they can call 50 men with sub-machine guns to get there in about three minutes. So their fight is going to be a lot different than my fight or your fight or Joe Smith's fight.

He'll be alone, in the dark, in his house. He'll be on the street. Well, he probably won't be on the street. He'll be in his house. He'll be scared to death. He'll be in a very weird, twisted, crazed world of the gunfight, where his fingers aren't working, and his mind isn't working clearly, and he can hardly breathe, and he can hardly think, and people in the dark are shooting at him.

The one thing he does not want to do is try and get through a reload. If you look at the literature of gunfights, you see that if you run out of ammo halfway through the fight, you're in very serious trouble, and the best thing about the 33-round magazine, or any extended magazine, is that in those circumstances you're not going to be betrayed by your technology. You're going to be spared that ordeal.

CONAN: We know that the shooter in Tucson - you pointed out the difficulties of reloads. Well, he was trying to reload and had difficulty. That's when he was tackled and stopped. And a lot of people had said: Wait a minute, if he'd only had 11 rounds, that might have meant a lot more people lived.

Mr. HUNTER: Possibly. But again, we're assuming that the extended magazine had some play in the number of deaths. My hunch - and no one knows, this has not yet been released, this information has not yet been released - my hunch is that he did the killing in the first five or six seconds, and he did it with the first 15 rounds.

And at that point panic set in, people started running crazily. He was being assaulted by other people in the area, and whether or not he was -he certainly wasn't able to shoot to kill.

And so we can't really say with certainty that, yes, indeed, it was that magazine that caused all those deaths. Was it a factor? Possibly. But it's just as large a possibility that it wasn't.

That's not to defend him or to suggest that, you know, these things should be widely available and that everyone should get one with their free lunch, but if a gun owner who thinks seriously about the scenario that he might face, it seems to me, has a very good need to have such a thing.

CONAN: Are you aware of any circumstances where a gun owner has needed that kind of ammunition load to defend themselves in a house?

Mr. HUNTER: Absolutely. Not a week ago, in Sterling, Virginia, three men assaulted a house, and the homeowner defended himself. He wounded two of them and drove the third away, and that guy is now an all-points-bulletin fugitive.

And I don't know if he had an extended magazine, I don't know exactly how that particular fight went down, but I'm betting that at a certain point he wished he had an extended magazine.

Now, the point here isn't - here's something I would like to get to, which is that nobody can predict the fight. There's a very good firearms trainer named Clint Smith(ph), whose mantra is: The fight will be what the fight will be.

That is, the fight is not going to obey your rules and your preferences. It's not going to obey percentages. It's not going to obey tendencies. It's going to be its own spontaneous, hysterical explosion of violence and mayhem at close range.

If you're facing that, you're far better off to prepare, as we do in all stages of our life, for what would be called the worst-case scenario, and it doesn't matter what - you know, if you're - what the numbers say. You can always end up fighting multiple antagonists in the dark. That happens more often than you would think it does.

And under those circumstances an extended magazine would be a superb defensive tool, and it's a very cheap investment for the gun owner. Many people put together self-defense packages. They'll have a vault under their bed, and it'll contain a pistol, it'll contain a cell phone, it'll contain a flashlight, and it's - and many, many times it'll contain an extended-round magazine because, you know, as I've been trying to make clear, nobody wants to reload a gun in the middle of a fight.

CONAN: We're talking with Stephen Hunter, who wrote an op-ed piece called "Why 33 Rounds Makes Sense in a Defensive Weapon." That appeared in the Washington Post. He's, of course, the well-known film critic, formerly with that paper, and a novelist as well. Most recent book is "Dead Zero." Joins us from Baltimore, 800-989-8255. We want to hear from gun owners. Why or why not do you need 33 rounds? Email us, talk@npr.org. And Nick(ph) is on the line calling from Jacksonville in North Carolina.

NICK (Caller): Thank you for taking my call.

CONAN: Sure, go ahead, please.

NICK: Much to the dislike of most weapons owners - I must admit I am a weapons owner, and I don't like the idea of any part of a weapon being limited in any way by anybody.

But I must disagree with the speaker on the requirement or even the advice that you should have an extended magazine. In my line of work, anything more than whatever the magazine's typical carrying load is, i.e., whatever is in the handle, would be anything for an assault.

If I'm sitting in my house and you're suggesting that I prepare for the worst, then I should clearly have (unintelligible) machine gun. That's illegal by law and for good reason. If I require any more ammunition than that, then I would assume it's for an attacking purpose, an offensive capability, not just defensive. I was wondering what your idea is on where to draw the line. I can take my call, or I can take my answer off the air.

CONAN: All right, Nick, thank you.

Mr. HUNTER: My answer to that would be that this fellow sounds like a young dynamic man who shoots a lot, who is very familiar with his guns, and he is capable of running a defense with a 15-round magazine. When he runs out of 15-round magazines, I'll bet you anything he's practiced, over and over again, the reloading drill, just as he's practiced the clearance drill, just as he's gone through his house in the dark and gotten himself acclimated to the various angles that he'll have to shoot from and the - what items of furniture are concealment, as opposed to what items of furniture are cover - that is, are capable of stopping an incoming bullet.

In other words, he's probably very serious about self-defense as a mission. More power to him. I think - I wish him luck, and I'm certain he will prevail.

However, imagine someone who's not so adept, who's not so interested in self-defense, who's not a part of the gun culture. He or she or whomever it may be, perhaps it's an elderly person, the last thing they want is the fight that they're in the middle of.

And in the middle of the fight, the last thing they want is to be changing magazines, which involves a certain skill. I mean, it's a complex physical movement, and it's very difficult to make it under high-pressure circumstances. For that person, for someone who is not a gifted and a practiced shooter, the high-capacity magazine gives them an additional level of survival in, as I said before, worst-case scenarios.

CONAN: Let's go next to John(ph), John with us from San Leandro, California.

JOHN (Caller): Good day. Yes, the reason I called in today is essentially all of these arguments always degenerate down to whatever the latest high-profile shooter has done.

I work in law enforcement. I own multiple extended-capacity magazines. I don't carry them in my duty weapon on a daily basis because they're awkward and impractical.

However, I would be lying if I told you that I didn't have two of them in the - what we'd call war bag that I carry in the trunk of my car in the event that I should find myself in some sort of massive urban shootout, I can make those available to myself if I'm able to crawl back to my car.

But really what this whole debate boils down to is that because this deranged individual in Tucson used an extended capacity magazine, this is what the anti-gun forces have gravitated on in this instance. Had he not use an extended capacity magazine, the anti-gun forces would've latched on to the fact that he used a semi-automatic. If this individual had used hollow points in a revolver, they would've latched on to hollow points.

And these magazines were outlawed, federally, from 1994 to 2004. So here we are six, seven years after they were made available to the general public, before the first high profile incident involving them occurred. I would argue that the fact that, you know, there wasn't just massive carnage in the streets that started a week after they were available to the general public again. It's fairly good, at least, anecdotal evidence that extended capacity magazines are not any significant problem facing our society.

CONAN: I have to ask, John. Have you ever felt the need to go to that war bag that you keep in the back of your car?

JOHN: Not in my law enforcement job. However, I'm also a military reservist and I brought - I can't even tell you how many extended capacity nine-millimeter Beretta magazines that I brought to Iraq with me. And I was doling those out to everybody that asked, because - the military for a while, was having a problem with the magazines they were buying for their handguns. They were going with the lowest bidder and there were lot of issues. And a lot of this is in 2004, a lot of the soldiers who were trying to buy the 15-round magazines for their weapon couldn't order them. And there were guys running around Iraq with a limited omnibus crime bill 10 round magazines. And I was handing out these extended capacity magazines like candy on Halloween to every soldier that I met in Iraq.

CONAN: I think you'd accept Iraq is different from Tucson.

JOHN: (Unintelligible)

Mr. HUNTER: Could I make a comment?

CONAN: Stephen Hunter, go ahead.

Mr. HUNTER: The point I wanted to make is that people who aren't knowledgeable of gun culture fear the extended magazine for reasons, as this gentlemen suggested, might be political in nature. But I'd like to just briefly describe the fate of the typical, high capacity magazine. A lot of people buy guns and gun equipment on - out of fashion. That is, they read the gun magazines, they find out that something new is in the marketplace, and it kind of tantalizes their imagination and they wonder about it. And it eventually reaches their retail outlet or perhaps they buy via the mail. And they acquire their one and only 33-round glock magazine. And they only just think this is neat. This turns the glock into a real, true blaster. It gives them so much more power, et cetera, et cetera. Then they go to the gun range and they load it.

Well, I want you to think about loading a magazine. You're forcing cartridges in against a spring. And the more cartridges you put in, the more the spring fights you. So the last 15 rounds, and particularly the last five rounds, it's very difficult and it's unpleasant. So they finally have got their 33 magazine - round magazine loaded. They put it in the gun. They turn and they face the silhouette or the bull's-eye, and they fire their 33 rounds. And they have a jolly good time doing it, because, as many people don't understand, shooting a firearm is a sensual pleasure that's rewarding in and of itself.

But at that point, they take the magazine out of the gun and they think, you know, that was a waste of time. What did it get out of it? Nothing that I wouldn't have gotten out of it anyway. And they throw it in their gun bag. The gun bag leaves the range. The gun bag goes home in the trunk of a car. The 33-round magazine comes out of the gun bag, and it goes into the drawer. And that is where I would bet 98 percent of the extended round magazines in this country are right now. They're sitting in a drawer, unused, because they're very difficult to use without a good reason to use them. They're difficult to load. They certainly vitiate the meaning of the pistol, which is a secondary self-defense arm or a concealed self-defense round.

And except in the narrow circumstances that I've illustrated for you, the stable self-defense situation confronting someone who is not a gun athlete, except for that one particular niche in the spectrum, they are generally useless and they generally play no part in - they're sitting in drawers. They're gathering dust right now.

CONAN: Stephen Hunter, you're listening to TALK OF THE NATION from NPR News.

And I wanted to get to this letter that was written to The Post after your piece appeared in - this was in the Free For All section by Katherine Protil or Protil, I don't know how she pronounces it.

Hunter's thesis was that extended magazines, such as the one used in the Arizona, are rarely used in crimes. However, there was this gem at the end of the column: People can use semiautomatic rifles and shotguns, but women generally don't care to put in the training needed to master them. And further: When the question arises of who needs an extended magazine, the answer is, the most defenseless of the defenseless. No statistic was given to support this unnecessary claim, leading me to conclude that the statement was Hunter's personal opinion when it came to women and guns.

And I was wondering if you had a response.

Mr. HUNTER: Well, it's funny because that line I had really written because women can't use that heavier weapon, or less likely to use the heavier weapon. And I realized that I will get my self - you know, that was my subconscious bias. I'm sorry. I am not a perfect man. However hard I try to be one, I fell well short. But I didn't go through. And I did change that to make it a training issue rather than an issue of taboo physical strength.

And, you know, I think I pretty much have to stand by my issue. I understand there are many women in gun culture. Many of them shoot far better than I ever will. And there does seem to be, I think, gun attractiveness or attraction is somewhat genetic. And it can show up in people despite their sex. However, that being said...

CONAN: Very quickly, if you could.

Mr. HUNTER: That being said, not many, some, but not many women are willing to acquire the training and the strength to use something like a semi-automatic rifle or (unintelligible).

CONAN: Stephen Hunter's op-ed ran in The Washington Post. There's a link to it at npr.org. Stay with us. We're talking about - well, this TALK OF THE NATION from NPR News.

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