This is an archived article that was published on sltrib.com in 2016, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
If something is good, more is better, right? Not for those of us who have been trained in medicine. So much of medicine is based on having just enough — not too much and not too little. When we have just enough, we apply the term "normal" or "healthy."
Thus we have heart rate, blood pressure, temperature, electrolyte balance of the blood, white cells, red cells, cholesterol — the list is extensive.
We have growth. There is a healthy rate for children to grow. Too fast, or too slow, they are in trouble. Too much, or too little, they are in trouble.
We have cell division. Too little and worn out tissues won't be replaced. Too much, and we call it "cancer."
We have physical exercise. Too little, and the body falls apart. Too much, and the body falls apart!
We have weight. Too little and the body gets sick and dies. Too much, and the body gets sick and dies!
We prescribe medications for disease. We urgently encourage just the right dosage. Too little, and there is no therapeutic effect. Too much, and the body can be dangerously poisoned.
In fact there is almost nothing in medicine that does not involve normal ranges for healthy functioning, healthy limits, healthy boundaries. We in medicine are so used to it, that it makes tragedies like Orlando even more puzzling.
In trying to understand Orlando, people look at four possible factors: easy access to guns, Islamic religion, fear/hatred of gays and bipolar disorder. From a medical standpoint, all of these factors are coincidental, not causative. The vast majority of people who own guns, who are Muslims, who suffer from bipolar disorder, are not violent, much less mass murderers! Even people who fear/hate gays (I don't believe hatred is possible without fear) are not violent.
No, there is a fifth factor and that is a dosage problem. Not guns, but assault weapons with very high rates of fire. That is what makes mass murder possible.
The solution should be common sense: Control the dosage. Limit the rate of fire available to the non-soldier. And yet it doesn't happen. Why not? Because too many people say, "First they want to limit how many bullets our weapons can fire. Before you know it, we won't have any guns at all!"
This is as logical as saying, "They're putting speed limits on roads. Pretty soon, we're not going to be able to move at all!"
But no rational person says the latter. There is no NRA (National Roadway Association) that clamors for "no speed control!"
So why the former? Because of a phenomenon that we in psychiatry call the "dirtiest four-letter word in the English language — fear." Fear — the great crippler, the wreaker of destruction, the destroyer of rationality.
Because of fear, this problem cannot be dealt with by only logical solutions. We must have a way of appealing to people's emotional security.
Perhaps if we can help people see that the problem is not guns, but a dosage problem, high rate of fire, and the rate needs to be limited the same way that speed is limited on highways, the same way that therapeutic dosages of medications are limited. Perhaps then, people can see the limit, not as a loss of freedom, but one of many common sense limits in life that allow us to function in a safe, normal and healthy range.
Michael A. Kalm, M.D., has been in the private practice of psychiatry in Salt Lake City since 1977. He is a clinical assistant professor at the University of Utah.