Violence & Untreated Mental Illness – There is a Connection

The most feared stigma: violence & mental illness

Posted Jul 31, 2012

    I’ve had an exceptionally difficult time deciding what and how to write the mass shooting. It is heart wrenching on so many levels: the loss of lives, the critically injured, the sustained emotional trauma for the community as well as society at large. No words can adequately convey my shock and sadness. It feels trite to write ‘I send thoughts of strength and peace to all who are suffering’, but I do.

What simultaneously arose for me as I heard about it, as embarrassed as I am to admit, was a dread and fear that I and others like me with mental illness will be associated with the actions of James Holmes. Jessica Lynn Gimeno, online communications associate for the Balanced Mind Foundation writes eloquently about the same fear in a blog post. And with my selfish perspective is from where I write.

We don’t know definitively Mr. Holmes has a mental illness. But the media’s speculation that he does, brings into question the connection of mental illness and violence and of course the resulting damaging stigma.

Maia Szalavitz writes in her TIME Healthland article entitled After Aurora, Questions About Mass Murder and Mental Illness: ‘Advocates for the mentally ill are faced with a deep dilemma each time extreme and deadly crimes are perpetrated by those with a mental illness’. She asks the excellent question: “How can we understand who is at risk for becoming violent without increasing the stigma associated with mental illness, especially when that stigma may account for a large part of the association between the two?” She posits that data could help.

If we don’t accurately present the facts about mental illness and violence, stigma and discrimination against those of us with psychiatric disorders will continue. Too many articles and websites cite only that those of us with mental illness are no more likely to be violent than anyone else. While this true, it is not the whole truth and the public knows it. If we gloss over some disturbing facts we also will miss potential solutions for preventing calamities like the Colorado shooting.

Ms. Szalavitz writes “people with schizophrenia...are roughly twice as likely to be violent as those who do not have the disorder, according to a 2009 review of research. People who have schizophrenia and a substance-use disorder are at even greater risk: they have a nine times higher risk of violence than people with neither disorder. The association is especially marked for homicide: those with schizophrenia are nearly 20 times as likely to kill another person as people unaffected by the disease.” These are not comforting facts.

But what is also true and what Ms. Szalavitz didn’t write is that these statistics are for untreated schizophrenia and psychosis. Only near the end of her article does she mention that “(For people with schizophrenia) appropriate medical treatment in the West has been shown to essentially eliminate patients’ risk of violence”.

The 2009 study ‘Schizophrenia and Violence: Systematic Review and Meta-Analysis’ which she cites (though she didn’t highlight this in her article) found that “increased risk of violence in schizophrenia and the psychoses comorbid with substance abuse was not different than the risk of violence in individuals with diagnoses of substance use disorders. In other words, schizophrenia and other psychoses did not appear to add any additional risk to that conferred by the substance abuse alone.” (pgs 7 & 8) It’s important to see that substance abuse is more of a lynch pin in violence than mental illness.

Acknowledging that violence may occur if schizophrenia and psychosis is left untreated can lead us to better solutions for treatment and solutions to better access to treatment.

Lack of access to treatment is one of the major problems. It’s easier to buy a gun than it is to get appropriate and timely care. This applies to people with mental illness who want help, but even more so for families whose loved one don’t have the insight to understand they are unwell.

In response to NAMI’s post 'The Colorado Tragedy: What Families Are Asking', an anonymous commenter wrote: “obtaining help for a mental disorder is much, much, much more difficult than obtaining a weapon. ‘Help them get help’ is so easy to write but almost impossible to put into practice. As a parent, I spent 6 months trying to get help for my son. It was a nightmare.”

Forced treatment has become a debate about civil liberties, but what about the right to be healthy? I know from personal experience that when in psychosis, I wasn’t able to see I needed help. Forced commitment was thrust upon and thank god it was. Traumatic yes, but also life saving. Pete Early, author and father of a son with schizophrenia, writes in his commentary 'Shootings tragic, but don't stigmatize mental illness': “The suspect’s parents will be blamed, though our civil rights laws make it extremely difficult for family members to force anyone to see a doctor or seek medical treatment if he or she has a mental disorder and is acting oddly. By law, we protect the right of an individual to be 'crazy'.” Yet, we become outraged when a Cho or a Loughner kill and maim.”

We don’t know if Mr. Holmes had a mental illness or if he did what it was. We do know he saw psychiatrist Dr. Lynn Fenton, who is now under attack along with the University for potentially being negligent in improperly assessing Holmes as a danger. Two related articles about the responsibility of Dr. Fenton: article 1 and article 2.

If we are wise enough and brave enough, we may be able to mine something valuable from the Aurora shooting. It could be a catalyst for important discussions and solutions about access to care, the reality of violence and mental illness and the opportunity to re-examine the benefit (in some cases) of forced treatment. Ideally our actions that result will save a life, or perhaps many.

 © Victoria Maxwell 2012 ( )