Mental Health, Mental Illness, and Trauma: On the Distinction of Terms in the Gun Debate

In the aftermath of the Uvalde shooting, there's a lot of talk in the media and among some politicians about the mental state of the shooter. Mostly, these comments and sidebars work as a distraction tactic to divert conversation from the main issue––the access to assault weapons and lack of common sense gun regulation in this country. Politicians don't want to take a stand on gun legislation, so they say this is a mental health problem. They say a troubled, violent young man committed this act because he was troubled, and not because he was able to walk into a store and purchase two assault rifles just days after his eighteenth birthday. They say this is a "mental health" problem; then they say we need better resources for the "mentally ill." More moderate sources say the shooter had a "traumatic" past, so his actions were those of a deranged individual. That's what this post is about, the conflation of the terms "mental health," "mental illness," and "trauma," both as they pertain to this conversation about gun violence and more broadly. That conflation, I argue, serves as an obvious scapegoat for the failure to legislate these weapons, and it also causes confusion and further stigma regarding mental health and mental illness in general. Let's get started.

When we talk about argumentation––stating a thesis or hypothesis and then attempting to prove or support that hypothesis with evidence––one of, if not the most crucial components is the defining of key terms. If we are going to debate, we need to first agree on the terms we are mobilizing for that debate. If I'm arguing that soccer is a more complex sport than baseball, for example, but the whole time I was saying soccer I meant football, that would change the scope of my argument. In forming my argument, I need to declare what I mean when I say soccer before I advance my argument. So before we even get to the problem of conflating the terms above, we need to reflect on how little we, as a culture, pause to ask for definition and clarification. Most often we just run straight into battle, and arguments get muddled and logical fallacies run rampant. Holding someone accountable for what they mean when they use a term, forcing them to commit to a definition of that term, is step one in engaging in critical conversation. What do you mean when you say soccer?

Okay, so let's outline some terms. Mental health is a term that refers to our overall state of mental and emotional well-being. Everyone has mental health, just like everyone has physical health. If I ask, how is your mental health, I'm asking about your general state of being. I am not asking you if you have a diagnosed mental illness. Mental illness is medical diagnosis that speaks to a pathological process regarding how you think, feel, behave, or engage with other people. Clinical depression, generalized anxiety disorder, post-traumatic stress disorder––these are diagnosed medical conditions with very specific criteria. Someone can have a controlled mental illness and have excellent mental health. Likewise, someone can have no diagnosed mental condition and extremely poor mental health (I actually think this is pretty common). Last, trauma refers to an emotional response to a severely disturbing or life-threatening event that has lasting or ongoing health adverse effects to the individual. Trauma can certainly cause changes to one's mental health, and in some cases, trauma can lead to a medical diagnosis of a mental illness like clinical depression, high functioning anxiety, or post-traumatic stress disorder. Not everyone who experiences a traumatic event will develop a mental illness, but most people will have an alteration (at least temporarily) to their mental health. See the difference?

The conflation of the terms mental illness and mental health are highly problematic for multiple reasons, but let's just look at three. First, we lose the diagnostic criteria necessary for treatment and lifestyle modifications for mental illness when we just start referring to it as mental health, because again, everyone has mental health. Not everyone has a mental illness. A patient with diabetes has a diagnosed medical condition, a physical illness. A patient with a poor diet and sedentary lifestyle may be in poor health, but they are not necessarily ill. They need self-regulation, maybe a dietician, but they don't need insulin. They don't need frequent lab work. The distinction between health and illness may be on a spectrum, but it is still a distinction.

Second, when we conflate mental health with mental illness, we blur the lines of accountably. A patient with a diagnosed mental illness may not, in a court of law, be responsible for their actions depending on their diagnosis and state of treatment. A mental illness is a pathological process that may compromise an individual's ability to determine right from wrong action. With regards to the Uvalde shooter, if we're going to argue he was mentally ill, we may be making the case that he was not responsible for his actions (to be clear, I am not making that argument. I'm just playing out the thought process. Also, there is no indication that this shooter had any mental diagnosis so far).

Third, and I think this is the one that angers me most, is that, especially in these gun conversations when it's a clear attempt to detract from the main argument, the conflation of mental health and mental illness capitalizes on the stigma of mental illness as an appeal to emotion. To say this is a mental health issue, to say the problem is these "deranged" individuals running around with guns and not the military-grade weapons in the hands of untrained civilians, is to harken back to a time not so long ago, when the social stigma surrounding mental illness was so grave, people would rather literally die than seek help. Because to be mentally ill meant you were crazy. Dangerous. A threat to society that needed to be locked away. And while, as a culture, we've done a lot of work on the stigma of mental illness, the conflation of poor mental health with a diagnosed medical condition is to call upon the biases of one to justify the other. And then make an argument using the terms as if they are the same because their meaning and cultural association has been merged. That's detrimental to those with a diagnosis and to those who need mental health support more broadly.

The overlay of trauma onto all of this only serves to further muddy the conversation. Trauma may predispose someone to mental illness, but most survivors of trauma do not go on to receive a medical diagnosis. A survivor of trauma needs mental health care, of course, but in no way does that mean they are mentally ill as a result of the trauma. And I get, as someone with diagnosed complex-post-traumatic stress disorder, no one wants to have to say they have a mental illness. It feel much more palatable to say mental health, but that's only because of the stigma surrounding mental illness I wrote about in the preceding paragraph.

Did the Uvalde shooter have a traumatic past? Yes, it sounds like he did. Might he have been struggling with his mental health? Yes, of course. Could he have had a mental illness if he had ever received a proper assessment? Maybe. But the statistics are very solid that people with a mental illness are far more likely to be the victim of a violent crime than the perpetrator. We can talk about the fact that he came from a troubled home, but lots of us come from troubled homes. We don't shoot up elementary schools. To conflate trauma with mental health and then mental health to mental illness only serves to collapse the conversation into one based on fear of the other. In this case, the other being the mentally ill. And again, even if we wanted to go there (and we don't), decades of research has shown us that the mentally ill are no more violent than any other community, and in most cases, they are less violent and more vulnerable.

It serves all of us to be clear about what terms we are using when we engage in discourse, and what terms we are signing onto when we agree with someone else's discourse. Invoke the pause. Ask for clarification. "Senator xxxx, what do you mean when you say this is a mental health issue? Can you define what you mean when you say mental health?" Because saying someone who murders school children in their classroom has poor mental health feels like a "no shit" statement. That person is probably also struggling with their spiritual health, their emotional health, maybe even their physical health. So are a lot of us. Most of us will get through this day, however, without taking a life. My point is that to talk about mental health provides no scapegoat to the gun argument unless we conflate mental health with mental illness and all its associated stigmas. And even then, it's a straw man argument (a straw man argument is when one person makes a claims, and then another person creates a distorted version of that claim and proceeds to attack that distorted version in order to win an argument). And it commits great violence to those of us who do live with a mental illness and who are working to counter the social stigmas of such everyday.