In November 1999, on the corner of Madison Avenue and 42nd Street
in midtownManhattanan a man walked up to a pedestrian and, without
warning, smashed her skull with a six-and-one-half pound paving stone. In
March of the same year, in metropolitan Pittsburgh, another man walked
through a fast food restaurant and methodically shot and killed three
people and wounded two others. Both communities, and the nation as a
whole, were horrified by these instances of random violence, both
perpetrated by men who were mentally ill. The horror deepened when both
cities experienced strikingly similar incidents within months of the
earlier atrocities: In July of this year, less than fifteen blocks from
the first incident in Manhattan, a man known to be mentally ill dropped a
chunk of concrete on the head of a young woman passing by. In April, a
man who was not clinically ill but was clearly disturbed--went on a
shooting spree in suburban Pittsburgh, injuring six people and killing
five.
These terrifying acts of violence were merely the latest on a
growing list that has included the shootings at a brokerage office in
Atlanta and the shoving of a commuter in front of a Manhattan subway
train. They have prompted researchers and policymakers to take renewed
interest in old questions: Are the mentally ill more violent than the
rest of the population? And how can these tragedies can be
prevented?
Thanks to the recent headlines highlighting shocking crimes
committed by the mentally ill, the common public perception is that
random violence is on the rise and that people with mental disorders are
especially violence-prone. But most experts agree that such incidents are
a statistical rarity. Many also believe that these infractions are not
easily predicted or prevented; their relative infrequency makes it
difficult to create a profile of individuals prone to such behavior.
Individuals diagnosed with mental illness often engage in disturbing
behavior without ever coning violent acts. While there may, in many
cases, have been "warning signs" before actual violence erupted, they are
often clearer in hindsight.
Even when someone suspects that a family member, employee or
student may be violent, the mental health system often does not vide
sufficient and affordable avenues of treatment and monitoring that might
reduce the likelihood of violence. Few approaches target violence
reduction specifically; most operate on the assumption that treating the
obvious symptoms of mental illness will reduce the risk of violence. In
addition, because of concerns over the infringement of individual
liberty, the law requires substantial evidence that a person is
violence-prone before they can be required to submit to treatment.
In the wake of recent rampage killings and other acts of violence,
the public has demanded that mental health professionals and the judicial
system do more to protect them. A few recent court decisions have
reflected this sentiment, ruling that mental health professionals have a
duty to warn potential victims of the risk of harm from psychiatric
patients. Certain advocates also hope to relax legal roles that limit the
ability of clinicians and courts to require and monitor the treatment of
those suspected to have violent tendencies.
Fortunately, there is now a considerable body of research that
explores the relationship between mental illness and violence. The
results of this research can and should--provide real answers al)out the
link between violence and the mentally ill.
The Truth About Mental Illness and Violence
For many years, conventional wisdom in the mental health field held
that the mentally ill were no more prone to violence than those without
mental illness. It was also widely accepted that clinicians had no way of
identifying individuals likely to engage in violence. More recent),
however. researchers (including the co-author, Ed Mulvey) have concluded
that there is a statistically significant association between mental
illness and violence: Overall, the mentally ill are more likely to act
out violently than the general public. However, this association is nor
very strong. The overwhelming majority of people with diagnosed mental
disorders do not engage in violence. Also, the manner in which mental
illness contributes to violence, when it does, varies considerably and is
often far from clear.
Certain factors that appear to be associated with an increased
likelihood of violence are in line with common sense. Not surprisingly, a
prior history of violence has been found to be a significant risk factor
for the occurrence of future violence. So has the presence of substance
abuse. Location, too, is important: The kind of neighborhood in which a
mentally ill person lives appears to have a strong relationship to
violence--or its absence. Moreover, violence is most likely to take place
when an individual is experiencing active symptoms of a mental
disorder--the low of a depressive jag, the panic of an anxiety
attack--than it is while the disorder is lying dormant.
Tags:
acts of violence,
atrocities,
crime,
fast food restaurant,
infractions,
madison avenue,
mental disorder,
mental disorders,
mental illness,
public perception,
rarity,
substance abuse,
tragedies,
violence
