Claiming a Second Chance After Psychosis Triggers Violence

The first time I met Cohen Miles-Rath, I struggled not to interrupt him—not out of rudeness, but because we had so much in common.

We’re both nearly 30, drummers, punk enthusiasts, and mental health advocates who speak and write about our lived experiences of schizoaffective disorder, bipolar type (a mix of schizophrenia and bipolar disorder). With schizoaffective disorder affecting only 0.3 percent of the population, it’s rare to meet someone with your type. Even our delusions overlapped: When Cohen said he believed he was Jesus and destined to marry an ex, I blurted, “No way, me too!”

But our stories diverge in one crucial way: Though I was never violent during psychosis, Cohen tried to kill his dad in 2016.

Dispelling the Myth of Violence and Mental Illness

As someone with a serious mental illness, I’ve long been frustrated by the false stereotype that people like me are all violent despite research consistently proving the vast majority of us aren’t. The exact rates of violence remain unclear due to varied definitions of violence and mental illness.

Some studies suggest a small link between violence and mental illness, while others show none at all. What’s clear is that the link is overblown. A 2022 study found that 55 percent of Americans believe mental illness is the leading cause of mass shootings—when it’s not even among the top five risk factors.

Cohen’s Story: When Psychosis Results in Violence

Still, I can’t ignore how psychosis can distort perceptions, making others seem like threats. I’ve experienced this, but my socialization as a woman likely influenced my instinct to flee rather than fight. Others, like Cohen, aren’t as fortunate. When delusions led him to believe that a demon had possessed his dad, he grabbed a kitchen knife.

Thankfully, Cohen’s father’s thumb stopped the knife from piercing his throat, and police arrived shortly after. When Cohen stabilized, he found himself in jail with two felony charges.

“I wanted to die,” the former collegiate track star later wrote on Instagram.

The Stigma of Sensational Headlines

Though such stories are exceedingly rare, they draw disproportionate attention from a public eager to consume headlines linking violence to mental illness. Cohen’s incident resulted in eight articles with headlines such as “Man Bites off Father’s Ear in Knife Attack.”

These articles “tormented” Cohen, a painful reality given that, as he pointed out, they could have easily been written differently—or not at all. In grad school, he managed to get a few taken down, but the rest remain online.

“They still impact me all the time,” Cohen shared. “Anytime I meet someone, anytime I go on a first date or start a new job, they're always there.”

Becoming a Voice for Change

Cohen may never escape his past, but he’s found purpose and healing in mental health advocacy. In fact, he’s unique. Neither of us knows of another advocate who became one after being violent. Cohen was fortunate he couldn’t follow through with his attempt—it’s hard to imagine those who aren’t so lucky developing a platform, let alone receiving a book deal.

Most schizophrenia advocates emphasize how rare violence is in our community, often overlooking or ostracizing those who’ve experienced it. I’m guilty of this myself: When many, including Governor Kathy Hochul, blamed recent subway violence in New York City on mental illness without evidence, I posted a graphic that echoed a rallying cry popular among schizophrenia advocates: “I’m mentally ill, and I don’t kill.”

Confronting Stigma Within Advocacy

“My stomach knotted up,” Cohen told me of the first time he saw a t-shirt with this phrase, elaborating that he felt “stigmatized.” He’d hoped to be welcomed into our community with open arms. Instead, when he reached out to fellow advocates, he got few replies.

“I’m not a part of the mission,” he explained.

When Cohen contacted me after my post, his story made me reevaluate my advocacy. Deep down, I’d assumed people like Cohen might be violent regardless of illness. If my illness didn’t lead to violence, surely theirs wasn’t the cause either.

A Path Toward Understanding and Healing

But now, I’m certain Cohen’s incident wouldn’t have happened without months of worsening psychosis. He’s just as frustrated by violent stereotypes as I am.

“When I hear those [narratives], I still feel like, ‘Oh my god, that's not representative of me. That's not who I am,’” he said.

When I asked why he shares his violent act in his memoir and talks, he replied he wants to be a voice for those who’ve experienced violence during psychosis. He also wants to show that recovery is not only possible—it’s probable with the right circumstances.

“They’re just suffering with [their actions],” he told me. “I know intimately it wasn’t their fault. I believe they’re very worthy of empathy and care.”

Empathy: A Catalyst for Care

I can’t help but wonder if empathy could reduce the rate of violence in psychosis. Cohen points to the lack of trained mental health professionals as one reason many struggle without support. Stigma likely discourages professionals from specializing in psychosis, and a 2020 research review found that schizophrenia is one of the most stigmatized diagnoses among this group.

A cultural shift toward empathy for those like Cohen would likely inspire more to choose this specialty. More and better-trained providers could help reduce episodes of psychosis, in turn preventing stories like Cohen’s.

It might also curb the mortality rate for people like Cohen and me, who live, on average, 15 to 20 years shorter. Part of this stems from our increased vulnerability to violence in psychosis—in fact, we’re 14 times more likely to be victims of it than perpetrators. I know from personal experience that I’m at a higher risk of death if I slip into psychosis; my recurring persecutory delusions once became so severe that I jumped in front of a car.

Rewriting the Narrative

For Cohen, it’s too late to rewrite the past. His actions will likely follow him forever. But his advocacy is slowly reshaping his narrative. When you Google his name, articles about his work are starting to eclipse those about the incident. And now, search results include his memoir—Mending Reality: An Advocate’s Existential Journey with Mental Health.

“I’m taking it back,” he said. “I’m owning it.”

About Cohen Miles-Rath

Cohen Miles-Rath, MSW, is a mental health professional, advocate, and author of the upcoming memoir Mending Reality: An Advocate’s Existential Journey with Mental Health, scheduled to be published in July 2025 through Simon & Schuster.