With all the talk and counter-talk this year about gun violence, I’m not sure that we have actually looked at the real issue at all.  And the real issue goes like this.

Last year there were roughly 11,000 homicides, of which approximately 80% involved the use of guns. There’s endless talk about how the US is much more violent, and really much more gun violent than any other advanced country, and we need to do something about it.  The NRA says that we need more armed citizens.  The other side says we need less guns.  Neither side can point to any definitive data to prove their point, but when did facts ever get in the way of opinions anyhow?

I want to talk about another kind of gun violence, the kind we don’t talk about at all.  For every person who was shot with a gun in a criminal affair, more than two people (roughly 18,000) shot themselves with guns.  That’s right. Gun suicide is more than twice as common as gun homicide, and I don’t notice anything in all the proposed bills floating through Congress that mentions this issue.

The one thing that everyone in Washington seems to agree on is that we need to add mental health records to NICS.  Now maybe that would prevent some crazy person from buying a gun and walking onto a college campus to shoot at a whole bunch of people, but it would likely have little impact on gun suicides.  In the majority of suicides, the victim actually saw a health professional within the last two weeks of their life.  That’s the real problem with suicide; it’s a very impulsive, very private kind of behavior.

The private nature of suicide and mental health in general makes it even more difficult to understand the extent of the problem.  Coroners and medical examiners are very careful when it comes to dealing with homicides, but suicides are usually family affairs, so even the cause of death is frequently stated as something else.  For a country that is obsessed with health, we draw a line when it comes to mental health and we prefer at best to discuss it rarely, or at worst to ignore it completely.

Precisely because it’s private and impulsive, a gun is the perfect tool to use if someone decides to end their life.  You don’t have to find a rooftop that you can get to, you don’t have to figure out how to tie a good knot around your neck, you don’t have to cram a fistful of pills down your throat.  No wonder that guns are successful in 95% of the times they are used as a life-ending device, whereas hangings work only 50% of the time and more than 90% of pill overdoses result in a quick trip to the local hospital to have your stomach pumped out.

The NRA has gone off the deep end with this bizarre attempt to criminalize discussions between physicians and patients about the ownership of guns.  When a patient tells a physician that he is feeling depressed, the doctor always asks whether the depression has provoked life-ending thoughts.  And if the patient responds in the affirmative, how can the physician or other medical professional then not ask if the patient has access to a gun?  If anyone reads this last paragraph and feels obliged to respond with the obligatory defense of the 2nd Amendment, do me and the other readers a favor and don’t waste our time.

I agree with the NRA that people who use guns to commit crimes need to be held fully accountable for their behavior and for the damages caused by the gun.  But people who use guns to kill themselves can’t be held responsible because if they were able to think rationally, they wouldn‘t try to kill themselves in the first place.  If we need a national strategy to deal with gun violence, it’s a strategy to deal with suicide, and that’s a discussion that hasn’t yet occurred.