In the wake of events in Charleston, South Carolina this week, the nation is once again abuzz about mass shootings. An article written in Slate magazine that's been getting around makes the point that mental illness is often inappropriately blamed at the expense of talking about real issues like hate, racism, and terrorism.



Hopefully a few readers of Psych Unseen will have noticed that I've made this same point in a couple different pieces, including an article for Aeon magazine called "Running Amok: The Crisis and Opportunity of Mass Shootings in America," and a previous blogpost here at Psychology Today: "Mass Shootings in America: Crisis and Opportunity." And soon I will be talking about how — a classic example of the "Psychiatry of Everyday Life" — might be linked to mass shootings... Watch this space Monday morning.



But this Saturday morning, I want to briefly comment on allegations that medications might be yet another "real cause" of the Charleston shooting. This isn't a new claim by any means — on the contrary, it has been made for "every" mass shooting event in history. Predictably, that claim has resurfaced with the news that the Charleston shooting suspect was arrested in possession of Suboxone, a used to treat opiate dependence. Just today, Presidential candidate and former Texas governor Rick Perry jumped on this bandwagon:

“I think there’s a real issue to be talked about: It seems to me — again, without having all the details about this one — that these individuals have been medicated. And there may be a real issue in this country, from the standpoint of these drugs, and how they’re used... So, I mean, there are a lot of issues here underlying this that I think we as a country need to have a conversation about,” Perry concluded, “rather than just the knee-jerk reaction of saying, you know, if we can just take all the guns away this won’t happen.”

Here's my take:

1. First, the medication allegedly found in the possession of the Charleston suspect was Suboxone, a combination of the mixed opiate agonist-antagonist (used to treat opiate as a "substitution" agent like methadone, but without any substantial risk of overdose or any associated "high") along with naloxone (an opiate antagonist that is poorly absorbed by mouth and is included to prevent abuse of Suboxone by injection).



Available information suggests that the Charleston suspect did NOT have a prescription for this medication, such that we has getting it through illegal "diversion." We also do NOT know if he has actually taking Suboxone (it is, for example, possible that he was selling it).



2. Contrary to what sources like Infowars would have us believe, Subxone has NOT been "linked to violence," at least not through any legitimate reporting mechanism like the FDA Medwatch system or the academic literature. While Infowars does cite online web sources that collect anecdotal reports of people's experiences taking medications, any purported "side effects" could just as likely be due to other factors, such as the extremely unpleasant experience of opiate withdrawal (the condition for which Suboxone is typically prescribed). Readers of Psych Unseen will hopefully remember the importance of randomized, blinded, controlled experiments to judge true effects of medications.

Looking at data from placebo-controlled studies, patients taking Suboxone have reported psychiatric complaints like , nervousness, , and , but NOT at a rate greater than those taking . And there are NO reports of violent behavior from those clinical trials.

3. Looking more broadly at the claim that "every" or even "most" mass murderers were on psychiatric medications, where's the actual evidence that this is true? In the vast majority of cases, we don't have access to their medical records and we certainly don't know if the medications, even if prescribed or otherwise obtained, were actually being taken.



If psychiatric medications were being taken, it might be more accurate to say that they weren't working very well rather than assuming causality in terms of violence. But given my own claims that most mass shooters don't have full-blown mental illnesses (as opposed to symptoms or mental illness or other mental health issues), this should come as no surprise. With , the much publicized work of psychologist Irving Kirsch has demonstrated that these antidepressants are often no better than placebo, for people who have only mild forms of depression (or don't have depression at all).

And then, of course, there's the issue of correlation vs. causality. After all, I'm fairly certain all known mass murderers were drinkers of tap water, which has also been linked to violent outbursts.



4. With regard to Rick Perry's claim that Suboxone might be a more appropriate culprit than guns, excuse me for stealing a page from the Jon Stewart playbook by highlighting this story that claims that Perry was taking "painkillers" during his 2012 presidential campaign:



http://www.huffingtonpost.com/2012/04/03/rick-perry-painkillers-debates-...



Apologies in advance for the snark and stooping to a source that relies on unverified claims from an e-book — I wouldn't presume to know if Perry's use of such medications as reported is accurate. But if so, his statements today at the very least seem hypocritical given the similarity of buprenorphine to convential opioid painkillers (though I suppose you could argue that he's speaking from a position of personal experience).



And, more to the message, it's just the kind of typical finger pointing at external causes (it's not guns, look here, it's medications!) that led me to call for a look within ourselves to explain mass shootings in the first place.



To read more about the psychology of the gun control debate and about mass shooters, see:



The Psychology of Guns

Guns in America: What's Freud and Sex Got to Do With It?

Worshipping the AR-15: Cult, Church, or the American Way?

Mass Shootings in America: Crisis and Opportunity

Active Shooters: Not Mentally Healthy, But Not Mentally Ill

When Racism Motivates Violence

