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By Jonathan Bauman, MD, LFAPA ABAP Newsletter Editor Undoubtedly most of you recall the response by presidential candidate Obama when asked about working-class voters in old industrial towns decimated by job losses: "They get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.” While this comment was a broad generalization and ill-advised, I find the kernel of truth in it to be compelling in our day and age. It’s no secret that guns have become the leading cause of death among our youth, now outpacing automobile accidents. A recent editorial in the Washington Post, America’s teens are in crisis. States are racing to respond (April 1, 2023), describes how government leaders at the state level are rushing to respond to parental demands to address the epidemic of youth suicide, depression, anxiety, despair and acting-out. Leaders across the ideological spectrum are proposing budgets expanding access to treatment through various means. While awareness and access are important, I found the publication of this article on April Fools Day ironic. We know all too well how political leaders jump on the bandwagon of the fashionable crisis of the moment but fail to, or are unable to, provide the persistent leadership over fractious governing bodies or a distractible public to enact enduring change. The article also reminded me of something I wrote about a few blogs back: reification. If you recall, this is the substitution, i.e. elevation, of an apparently easy solution over the root cause of a problem. For example reification occurs when mental health services and “red flag” warnings, which are easy to agree upon, are promoted, or reified, over the root causes of increasing teenage and societal angst, namely guns and religion. Okay, that may sound simplistic and harsh, but hear me out. Despite the notion that “guns don’t kill people, people kill people”, it is clear that the only factor that differentiates the U.S. from other civilized nations in terms of mass murders and gun deaths is the availability of guns. Summarizing a new analysis of the Columbia Mass Murder Database, published in the Journal of Forensic Sciences, Megan Brooks writes (Medscape, 5/24/2023), “The findings show that most perpetrators of mass school shootings are young, White men without serious mental illness.” Mental health is often a “straw man” (see reification, above) in debates about mass shootings, according to lead investigator Ragy Girgis, MD. Tragically, a fervent gun culture and politicians who support it makes it impossible to enact sensible gun laws. This culture is fueled by and largely composed of White evangelical Protestants. Gun culture and its siblings, rugged individualism and the cowboy mentality, have a long history in the story of America, a history that is beyond the scope of this essay. Suffice it to say that White evangelical Protestants as a group view the individual, in particular the strong White male, as the protector from societal overreach by the collective, namely the government. In his article “God & Guns: Examining Religious Influences on Gun Control in the United States” (Religions 2018, 9, 189), Steven Merino writes, “Recent research sheds light on the complex relationship between religion and guns, including higher rates of gun ownership and stronger opposition to gun control among white evangelical Protestants.” White evangelical protestants favor individualistic solutions to gun violence and put more emphasis on religious values in their social surroundings. Wary of government laws that restrict or limit access to firearms, they are of the belief that we have school shootings because God and prayer has been eliminated from public schools and college campuses, rather than the plethora and availability of firearms. In addition to opposing gun control, White evangelical Protestants are more likely to own a gun than the general population. Also adolescents in this group have easy access to guns at home compared to adolescents in other religious groups. Furthermore, Merino points out that while mainline Protestants’ gun ownership is higher than non-Protestant groups, compared to evangelical Protestants they are more likely to support stricter gun laws as well as social reforms to address social problems. He adds that African American Protestants are less likely to own a gun and more likely to support stricter gun laws than their White counterparts, stemming from their direct experience with gun violence. Catholics are generally more likely to support gun control, perhaps related to institutional support from the Catholic Church. Jack Jenkins, in his article “Does God want Christians to be a ‘good guy with a gun’?” (Religious News Service/AP News, 9/16/2020), reminds us how God and guns made headlines when a Christian crowdfunding site raised almost half a million dollars for the the defense of Kyle Rittenhouse, the teenage vigilante who killed two demonstrators at a racial injustice protest with an AR-15 style rifle. He goes on to quote Kristin Kobes Du Mez, author of Jesus & John Wayne: How Evangelicals Corrupted a Faith and Fractured a Nation, “the idea that a Christian can be a ‘good guy with a gun’ is well-established in many white evangelical communities.” Jenkins describes a toxic mix of faith, guns, and politics espoused by evangelical leaders such a Jerry Falwell Jr., former Liberty University president, who encouraged students to arm themselves and obtain concealed carry permits. Additionally he reports that public polling has shown that White evangelicals are the least supportive of gun control measures compared to other major religious groups, and also that White evangelicals and Mormons are the only groups that express majority opinions in support of making concealed carry gun permits easier to obtain. In an article, “Shall not be infringed: how the NRA used religious language to transform the meaning of the Second Amendment” (Palgrave Communications, 2019), Jessica Dawson argues that “the NRA has capitalized on the religious nationalism that arose in the late 1970’s alongside the Moral Majority and has increasingly used religious language to shape the discourse surrounding the Second Amendment.” Around that time NRA leadership changed the organization from a shooting club to a gun rights advocacy organization in reaction to the violence and assassinations of the 1960’s. In the 1980’s, the New Christian Right rose to power, focusing on absolute obedience to God’s law as a solution to what it perceived as moral decay in America. An extension of the Moral Majority, the NCR forged an alliance with the NRA, both organizations viewing the Second Amendment as a God-given right that would serve as a bulwark against depredation by the unholy. Second Amendment absolutism was personified by Charlton Heston’s election to president of the NRA in 1997. A godly figure from his portrayal of Moses in “The Ten Commandments” and Judah Ben-Hur in “Ben-Hur” (adapted from the book Ben-Hur: A Tale of the Christ), Heston proclaimed, while waving a flintlock at the 2000 NRA Convention, “As we set out this year to defeat the forces that would take freedom away, I want to say... those fighting words to hear and heed, and especially for you, Mr. Gore: from my cold, dead hands!” Dawson points out research showing that gun ownership is negatively associated with religiosity, but that for White males who have lost or fear losing economic and social status, owning a gun provides moral purpose and a sense of identity that is both religious and patriotic (but is really neither, in my opinion). Hence religious nationalism and gun ownership combats deep insecurity among White evangelical Christians. In her study, Dawson goes on to catalogue the voluminous ways the NRA’s print bullhorn, The American Rifleman, has conflated references to God or God- given with the Second Amendment and unregulated gun ownership. As noted by ABC news on May 8th, the number of mass shootings, mostly with AR-15 style weapons, have exceeded the days of the year. As I previously mentioned, the leading cause of death in 2022 among children and adolescents — including suicides, homicides, mass murders and accidents — are guns, surpassing automobile accidents for the first time. Active shooter response training is now ubiquitous, and as adolescent and young adult psychiatrists, not to mention as parents, we are well aware of the persistent stress and fear this engenders. And, if matters can be worse, recently we’ve had several incidents where kids who made honest mistakes of being in the wrong place at the wrong time were gunned down by citizens who mistakenly (or delusionally) perceived threat. My goodness...don’t go to the wrong address! In her May 15th edition of Letters from an American, Heather Cox Richardson describes a Public Religion Research Institute poll showing that nearly 20% of Christian nationalism sympathizers are willing to take up arms to make the U.S. a White Christian nation. In her May 21st letter Richardson references an article by Madison Pauly (Mother Jones, March 8th) exposing how “the wave of anti-trans legislation passing through Republican-dominated state legislatures is written and pushed by well- funded Christian activists and organizations who argue...that they are protecting children.” She adds, ironically, that “86% of trans or nonbinary young people have reported the attacks on them are affecting their mental health, and nearly half have seriously considered suicide.” The religious right has culpability for contributing to stress, fear, pain and despair among our patients and their families. Specifically, laws prohibiting women and LBGTQ+ people, along with their healthcare providers, from making decisions about how to live their lives — prohibitions that defy science or reason in the name of God — are having a demonstrable impact on mental health. And let’s not forget the Republican politicians who pander to the religious right, encouraging hate, and violence by commission or omission. How many people will die because of bigotry and hate inspired by White evangelical “Christian Soldiers” and their GOP consorts. How many will commit suicide under the stress and despair of being forced to live a life that isn’t theirs? My only solution to this miserable state of affairs is not easy and will take time, but is essential if we are to make America a place in which we want to live. Namely, we have to elect Democrats at the local, state, and national level, even if for some it may mean holding your nose. So when your patients of voting age come to you with their anxiety, depression, and suicidal thoughts, of course you can’t tell them who they should vote for or even that they should vote. You can, however, help them tease out the threads of the stresses and threats they face, and help them think through the ways they can empower themselves to effect change.