NYAPRS Note: Larry Davidson, Ph.D., is a Professor of Psychology and Director of the Program for Recovery and Community Health at Yale University’s Department of Psychiatry and School of Medicine. Dr. Davidson is also the Director of the Recovery to Practice Project Director and regularly offers compelling perspectives through the RTP Highlight articles. Dr. Davidson offers yet another impressively insightful response to the broader societal reaction to the Newtown Tragedy. The Recovery to Practice Initiative welcomes your views, comments, suggestions, and inquiries. For more information on this topic or any other recovery topic, please contact RTP at 877.584.8535 or email email@example.com.
One Response to One Reaction to the Newtown Tragedy
By Larry Davidson, Ph.D., Recovery to Practice Special Feature February 1, 2013
While the country argues over stricter gun control legislation proposed by the president, mental health providers, along with persons with mental health conditions and their loved ones, continue to be in the position of having to respond to how some people in broader society have reacted to the tragedy in Newtown, Connecticut. Although much of the country has been compassionate and thoughtful, there have also been media reports, talk shows, op-eds, blogs, and other media outlets replete with highly offensive and stigmatizing references to persons with mental illnesses-in which the mass shootings that unfortunately seem to be becoming a not-so-rare part of American culture are blamed (inexplicably) on "the mentally ill." The use of terms such as "monsters," "mental defects," and "madmen" is not only based on grave misunderstanding of mental illness and extremely hurtful to tens of millions of Americans who are working hard at their recovery; it also does nothing to explain the loss of 28 lives in Newtown on December 14. More important, perhaps, it does nothing to prevent such horrors from occurring again in the future.
Many of us would like to simply dismiss such false and destructive myths and sever the erroneous connections made between mental illness and violence completely. But for those practitioners, persons in recovery, and family members who feel they are in a position of having to respond to these damaging attitudes and beliefs, we offer the following facts and considerations.
Let's start with the facts. According to the Institute of Medicine (IOM), "Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population" (IOM, 2006). In fact, according to the MacArthur Study of Mental Disorder and Violence-the most rigorous scientific study conducted to date by the country's leading experts on mental illness and violence-the contribution to violence made by persons with mental illness is no larger than the contribution made by persons who do not have a mental illness (Monahan et al., 2001), with other demographic and socioeconomic factors contributing much more than mental illness. The subgroup most at risk for committing violent acts is actually young and single working-class white males. Within behavioral health, broadly, active substance use does contribute to violence. But within mental health, schizophrenia (the condition most alluded to by people who characterize "the mentally ill" as violent) contributes least to violence among the major illnesses. As summarized by Stuart (2003):
"The prevalence of violence among those with a major mental disorder who did not abuse substances was indistinguishable from their non-substance abusing neighborhood controls … those with schizophrenia had the lowest occurrence of violence over the course of the year (14.8 percent), compared to those with a bipolar disorder (22.0 percent) or major depression (28.5 percent)."
Not only does mental illness contribute little to violence (estimated to be around 4 percent); persons with mental illnesses are generally much more at risk for being victims of violence than being perpetrators (Appleby, Mortensen, Dunn, & Hiroeh, 2001). Here the data are quite striking. Studies have consistently found that "people with severe mental illnesses... are 2 ½ times more likely to be attacked, raped, or mugged than the general population" (Hiday, 1999). In addition, "individuals with schizophrenia living in the community are at least 14 times more likely to be victims of a violent crime than to be arrested for one" (Brekke, Prindle, Bae, & Long, 2001). Despite the highly consistent findings that persons with mental illnesses are much likelier to be victimized by others than to hurt them, there have been 13 times as many articles on the violence presumably perpetrated by persons with mental illnesses as there have been on crime victimization among persons with mental illnesses.
In the face of the atrocity committed in Newtown, these facts unfortunately do little to persuade many people that mental illness is not the culprit. They want somebody and something to blame, and have a hard time believing a person could act in such a heinous way without being out of touch with reality. Confronted with so many deaths, especially of children, appealing to science may be seen as cold and heartless. What, then, should we do? Below are a few considerations-some based on research, others on experience-that may be useful in moving the discussion in a more constructive direction.
A final consideration has to do with the issue of "insight." We addressed this issue at length in the Feb. 6 Special Feature. In the context of current debates about mental health policy, we would like to point out that there are many reasons why some people with mental illnesses choose not to participate in care or take psychiatric medications. The stigma and stereotypes that surround mental health care are at least as prominent a reason for not accessing care or taking medications as the reason for lacking "insight" into having such an illness. No one is born knowing what mental illnesses are or how to know or recognize when one begins to experience symptoms associated with having one. How, then, can a person develop such "insight"? If the only things people are taught about mental illnesses are the negative and insulting stereotypes described above, we can assume many people will continue not to have "insight" when they begin to experience the symptoms of a mental illness. From their perspective, they are not "crazy" or "insane"... they are not "mental defects" or "madmen"-so they could not possibly have a mental illness. They are, after all, just like you and me (because they are, after all, you and me).
If we truly want people to recognize and gain insight into having a mental illness when they begin to experience the symptoms of one, we need to dispel these fallacious and off-putting myths. We need to educate the public and youths in particular about what mental illnesses are, including how common they are (e.g., one in five Americans will have one), that effective treatments are available, and, importantly, how possible it is to recover. Then we can turn our attention to the isolation, rejection, alienation, silent suffering, and culture of violence that truly underlie such atrocities.
Appleby, L., Mortensen, P.B., Dunn, G., & Hiroeh, U. (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: A population-based study. The Lancet, 358, 2110–12.
Brekke, J.S., Prindle, C., Bae, S.W., & Long, J.D. (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services, 52, 1358–66.
Hiday, V.A. (2006). Putting community risk in perspective: A look at correlations, causes and controls. International Journal of Law and Psychiatry, 29, 316–31.
Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, D.C.: Institute of Medicine.
Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Risk assessment: The MacArthur Study of Mental Disorder and Violence. Oxford: Oxford University Press.
Stuart, H. (2003). Violence and mental illness: An overview. World Psychiatry, 2(2), 121–24.