The combination of mental disease and access to guns leaps out at almost everyone in connection with the Virginia Tech shootings. But from there ideas and advocacies tend to become amorphous and tinged with hopelessness. There is consensus that something should be done to intervene earlier in threatening forms of psychological disturbance, and as a psychiatrist I agree and also recognize some of the social obstacles to doing so. But while there will always be mentally ill people, a few of whom are violent, it is our gun-centered cultural disease that converts mental illness into massacre.

Indeed, I would claim that a gun is not just a lethal device but a psychological actor in this terrible drama. Guns and ammunition were at the heart of Seung-Hui Cho's elaborate orchestration of the event and of his Rambo-like self-presentation to the world. When you look at those pictures, you understand how a gun can merge so fully with a person that a man who makes regular use of it could (in the historical West and in Hollywood) become known as a "gun."

Some years ago, the distinguished historian Richard Hofstadter told me that, after a lifetime of studying American culture, what he found most deeply troubling was our country's inability to come to terms with the gun -- which in turn strongly affected our domestic and international attitudes. Emotions of extreme attachment to and even sacralization of the gun pervade American society, and commercial interests shamelessly manipulate those emotions to produce wildly self-destructive policies.