(Author’s note: This article has been a year in the making. Each time another mass shooting makes headlines, I think, this is the moment to speak, and then life intervenes. The opportunity to contribute meaningfully feels missed. But the cruelest irony is this: Wait ten more days, and there will be another tragedy to make the conversation relevant again. That, in itself, is the most heartbreaking fact of all.)

“Study my brain please. I’m sorry.” That was the final written plea of Shane Devon Tamura, a 27-year-old man who opened fire at the NFL’s Midtown Manhattan office in July 2025, killing four people before turning the gun on himself. In a three-page note, he blamed football for giving him CTE and wrote, “You cannot go against the NFL, they will squash you.” Take a moment to sit with that. Imagine being ravaged by an illness that hijacks thought, impulse, and identity, yet some fragment of your humanity remains, intact enough to leave behind a final act of clarity: Study my brain. A cry not for exoneration, but for understanding. This is not a Second Amendment defense article, nor is it an anti-gun one. It is an invitation to pause the shouting match and consider something deeper: What happens when a country built on the sanctity of individual autonomy is forced to confront the reality that the mind itself can break?

Let me get my personal view out of the way right up front. Personally, I find it absurd that in the richest country in the world, brimming with resources, research, and regulation, it is still easier to buy a gun than to access competent mental health care. I say this not as a pundit, but as a psychiatrist; I have over 25 years of clinical experience, including decades spent practicing in a liberal East Coast university town. So I want to be clear: I am not here to carry water for either side of the gun debate. My goal is to move us beyond that stalemate. So let me offer something different, not a new idea, but one that deserves more serious attention: What if we reframe gun violence, at least in part, as a mental health issue? Not to deflect from regulation, but to create shared ground. And if you are not ready to accept that premise outright, then consider this more modest proposition: Maybe we have a better shot at finding national consensus around mental health laws than around gun laws. What if that became the operating framework, the starting point for intervention? Not a retreat from the problem, but a different way into it.

Sometimes, a society’s greatest strength is also its deepest weakness. In America, that strength is the belief in radical individualism, the idea that each of us is self-made, self-governing, and self-reliant. The self is not just central; it is sacred. It overrides community, tradition, and even reality itself. But what happens when the very organ that constructs the self begins to fracture? When thought betrays thought, when memory, logic, or emotional coherence no longer hold? What happens when the self becomes unreliable? This is why I often say that the American psyche and mental illness are inherently at odds. The belief in autonomy is so absolute that a patient saying, “I need to leave the hospital to resume drinking,” and another insisting, “I need to leave because aliens are implanting chips in my brain,” are often weighed through the same lens. In a culture where the self is sacrosanct, the content of one’s beliefs matters less than the right to hold them.

Mental illness in its severe forms (schizophrenia, bipolar disorder, and major depression with psychotic features) shatters the myth of the sovereign self. It dismantles our ability to hold coherent beliefs, to act with intention, and to live self-sufficiently. And yet, our policies continue to treat the mentally ill as if that myth still holds. The paradox is brutal: We cling to the sanctity of selfhood, yet refuse to reckon with what it means when the self disintegrates. And so we punish those whose minds unravel, not always out of cruelty but out of denial.

Stephen Hawking did his greatest work while paralyzed from the neck down, because the organ that defined his identity still functioned: his mind. Now imagine the reverse: a man in perfect physical health, but lost in psychosis, unable to tether thought to truth. Whom do we honor? Whom do we save? The body without the mind is embraced. The mind without the body is mourned. But the mind without itself? That, we exile. Mental illness is not just clinical; it is existential. It forces us to confront a failure baked into the American promise: that each person is always rational, always autonomous, and always in control. But severe psychiatric illness collapses that promise. And when it does, we have no framework for care, only the fiction of choice and the consequences of abandonment.

We deinstitutionalized in the name of freedom. But what we really did was abandon. As Dr. E. Fuller Torrey lays out in American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System, “The freedom to be insane is a cruel hoax, perpetrated on those who cannot think clearly by those who will not think clearly.” The discovery of Thorazine was misinterpreted as a cure, not a tool. It was as if we had discovered a cough suppressant and declared pneumonia solved. The psychiatric hospitals were emptied with no plan for long-term care. Policymakers mistook quiet for cure. It was a catastrophic misreading. Today, the largest providers of mental health services in America are jails and prisons. Facilities like Rikers Island, Twin Towers, and Cook County Jail have become de facto psychiatric institutions.

But let me be clear: This is not an article about the structure of the mental health system or what needs to change, though change it must, and radically. That is a conversation for another time. What I want to focus on here is something more elemental: the idea of mental illness itself. How we understand it. How we frame it. And how that framing reveals something deep (perhaps even broken) about the way we think about freedom, responsibility, and the self. So now that we have unpacked how mental illness challenges the very idea of autonomy, and how our systems, myths, and laws often fail to reckon with that, let us return to the question at hand: How does this tie into the gun debate?

Because when we talk about mass shootings, we are not just talking about access to firearms. We are talking about untreated minds in crisis. That may sound provocative, but ask any seasoned psychiatrist to walk you through the history of a mass shooter, and a familiar rhythm emerges: the slow unraveling of a mind. When the sirens fade and the headlines recede, what remains is almost always a haunting profile: the loner. The withdrawn. The paranoid. The volatile. A young man, often, who has fallen through every crack in the system.

These are not universal features, but they recur with chilling consistency. The signs were there. The suffering was real. What was missing was timely care. And as a professional, I find it deeply ironic that each time this happens, the debate cycles back to familiar scripts: gun control, political blame, video games, and online radicalization. I am not denying those factors; they matter. But they have been around for decades. What is striking is how quickly we reach for explanations that are familiar, external, and narratively tidy, because they feel easier to grasp. That is human nature: We search for what makes emotional and political sense in the moment.

But what if the most consistent thread is the one we least want to confront? What if, beneath all the noise, this violence is more often rooted in untreated mental illness? It reminds me of another statistical truth: Most murder and abuse victims are harmed by someone they know. But mass shootings do not follow that pattern. They are often random, targeting symbolic spaces or arbitrary victims, driven not by revenge but by the distorted logic of a fractured mind. That is what makes them so hard to process, why the most common refrain after these tragedies is: “I never thought he would do something like this.” Or worse: “I just cannot imagine why.” That search for a “why,” that insistence on a motive, is central to how the American mind processes tragedy. We believe every act has a rationale, something we can argue about. But when mental illness drives the act, the rationale is often illogical, opaque, or unknowable. And perhaps that is why we turn away. It defies the very kind of meaning-making our culture is built around.

We now live in a country where you can buy an AR-15 at a gun show in ten minutes, but a severely psychotic patient might wait days or weeks for a psychiatric bed. That absurdity is not just bureaucratic. It reveals the deeper cost of elevating personal liberty above public safety. Autonomy only works when the mind is intact.

It is a strange but telling irony that two of America’s most iconic liberal cities (New York and San Francisco) have enacted some of the nation’s most assertive policies around involuntary psychiatric intervention. In 2022 and 2023, both expanded the authority of police and outreach teams to initiate treatment in public spaces without consent. These measures mark a cultural reckoning: We can no longer pretend that doing nothing is humane. But that reckoning cannot end with coercion. The question is not whether we should intervene; it is how we intervene, and whether we are willing to build systems that offer care, not just containment.

For years, public debate around homelessness has focused on rent inflation, zoning laws, or immigration. But the truth (one that cities are now being forced to confront) is simpler and more sobering: Chronic homelessness is most often the visible expression of untreated mental illness and addiction. In a country with food programs, shelters, Medicaid, and housing vouchers, it is exceedingly difficult to end up sleeping on the street unless something deeper has broken: the mind, the will, or both.

Now imagine this: In my home state of Connecticut, a state with some of the most restrictive gun laws in the country, you can voluntarily check yourself into a psychiatric facility, and if you happen to own firearms, those must be reported to the state. But if you are involuntarily committed (a scenario far more common in those with severe illness and impaired insight), that same reporting requirement does not apply. Yes, you read that correctly. And no, it is not a typo. This policy, born out of well-meaning legislation passed after the Sandy Hook tragedy, reflects a deeper truth: Even laws crafted with the best intentions can be built on misunderstandings of clinical reality. Instead of focusing on severity of illness, the statute hinges on voluntariness of care, a standard that often excludes those at the highest risk. It is a perfect example of how our laws around mental health and guns can get things backward, not out of malice, but out of a failure to fully grasp what it means for the mind to break.

In Connecticut, where I practice, a person can be held for up to 15 days under what is called a Physician’s Emergency Certificate (essentially, involuntary psychiatric hospitalization without a court order). After that, it is up to the probate courts. I have participated in dozens of those hearings over the years, and a painful pattern emerges. A patient is hospitalized in crisis: psychotic, manic, and sometimes catatonic. Treatment begins, medications start to work, and by the time the court date arrives, they seem calmer. More coherent. Cooperative. And so, the judge says what I have heard many times before: “If he is taking the medication now and he is not dangerous at this moment, there is no basis to continue holding him.” The history, the multiple prior hospitalizations, the cycle of stopping meds and unraveling, does not carry much legal weight. What matters is how the patient presents in that moment. The law demands a snapshot, not a trajectory. And then it happens again: The patient is discharged, stops taking medications, decompensates, and returns in crisis. The revolving door keeps turning.

Some might point to Assertive Community Treatment (ACT) teams as a solution: mobile, interdisciplinary teams designed to support patients in the community. And yes, ACT can be life-changing for some. But here is the catch: ACT teams have no legal authority. They can recommend, support, offer medication, and even show up at your doorstep, but they cannot compel you to take your meds, cannot mandate continued care, and cannot stop the cycle if you choose to walk away. And when someone has lost insight, when psychosis convinces them they are not ill, recommendation is rarely enough.

In other parts of the world, the laws reflect a different understanding of how psychiatric illness unfolds. In the U.K., for example, mental health law allows for continued treatment oversight even after discharge through mechanisms like Community Treatment Orders. Other Western countries permit longer involuntary care under regular review and place greater emphasis on clinical history, not just how a patient looks on a single day in court. That difference matters. Because the truth is, mental illness, especially in its most severe forms, is rarely linear and almost never cured in 15 days. Recovery takes time. Insight is slow to return. And yet, our legal structures often expect clarity, consent, and stability from people whose illness has stripped them of all three.

I get it; some of our hesitation around psychiatric authority is rooted in history. Psychiatry has not always earned the public’s trust. From lobotomies to the misuse of diagnoses for political suppression, there are chapters of deep harm and abuse. But that is not modern psychiatry. That is not the work we do today. In the 21st century, psychiatry is more collaborative, more evidence-based, and more ethically accountable than it has ever been. The ghosts of the past should inform caution, yes, but they should not paralyze us into inaction. The laws and attitudes we build today should reflect what psychiatry has become, not what it once was.

There is something more subtle, but critical, that often gets overlooked in these conversations. At the heart of it, the way severe mental illness manifests is often shaped by the culture in which it unfolds. Let me explain. I was born and raised in Pakistan, and one of the hallmark symptoms of schizophrenia, no matter where you are, is thought broadcasting: the belief that one’s thoughts are being projected out loud for others to hear. In the U.S., those thoughts might be “broadcast” through the internet, television, or smartphones. Patients may fear the FBI, the CIA, or alien surveillance. But in rural Pakistan, where electricity may still be scarce, the same symptom appears; only now, the broadcasting happens through the mosque loudspeaker. And the paranoia? It does not revolve around federal agents. It centers on cousins, neighbors, or the village shopkeeper. The biology of illness is universal. But its language is borrowed from the world around it. Culture does not create the disorder, but it shapes its expression.

This brings me to this country’s unique and tragic epidemic: mass shootings. No other developed nation experiences this pattern with such frequency or brutality. And yes, gun laws matter. Access matters. But I would argue that what we are also witnessing is the American cultural expression of untreated mental illness. In a society built on radical individualism, celebrity spectacle, and the mythology of righteous violence, this is how psychosis often speaks here. Mass shootings are not just about policy failure. They are about cultural vulnerability, the way our collective imagination creates the script for how a troubled mind might collapse. In another place, it may be the mosque loudspeaker. Here, it is the school, the shopping mall, the assault rifle, and the final broadcast: violence made visible.

Let me be clear: This is not a policy paper by any stretch. I am not here to present a legislative blueprint, nor to rank competing reforms. What I am offering is something simpler, but perhaps more radical: a shift in perspective. What if we went back and looked at these tragedies, not just through the lens of gun access or political failure, but through the lens of mental illness and mental health? What if we treated mass shootings not only as crises of security, but as symptoms of a deeper diagnostic picture, one that points us, again and again, toward the same underlying pathology? I assure you: If you look closely, you will find the patterns. You will see the fractured minds, the missed interventions, and the unraveling long before the gun was ever raised. And once you see those patterns, it becomes harder to unsee them.

Let that be what shapes the path forward. Let our policies grow out of what the evidence actually shows: that we need earlier access to care, stronger safety nets, more assertive outreach, and yes, in some cases, the moral courage to intervene when someone cannot recognize their own collapse. That means not just talking about involuntary treatment, but reimagining it, not as punishment, but as protection. Not as loss of freedom, but as the temporary stewardship of a life until it can be safely handed back. If freedom is the cornerstone of the American experiment, then mental health is the architecture that holds it up. And we ignore it at our peril. As I said earlier, maybe consider this: We are far more likely, as a nation, to find consensus around changing our approach to mental illness, how we fund it, legislate it, and yes, how we enforce accountability within it, than we are to change gun laws anytime soon. That may not be a compromise, but it could be a beginning.

Sabooh S. Mubbashar is a psychiatrist.