For the Last Time, Stop Conflating Violence and Mental Illness

By all means, let’s improve mental health services in the US. Please. We desperately need it. But if you want to talk about how to prevent rampage violence, I’m afraid you’re going to need to move on to other subjects.

Dec 17, 2012 at 9:01am | Leave a comment

A lot of conversations are being had in the wake of the horrific shooting that occurred in Connecticut last Friday, when a gunman took the lives of 20 innocent children and seven adults. The United States is having some hard discussions right now, in a year of awful mass shootings and a period of particular tension.

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As always in cases of rampage violence, mental illness has been dragged into the mix, and I’ve been watching the Internet for the last three days with a growing sense of both deja vu and horror. None of the things being said are new -- all of them are in fact very bone-achingly familiar -- and all of them are extremely unhelpful, dangerous and counterproductive.

There are a lot of things I want to say about the artificial linkage between mental illness and violence; it’s a huge subject. But more than that, I want to drill into some of the specific things that have been circulating this weekend, and why they are wrong.

ON VIOLENCE AND MENTAL ILLNESS

Let’s talk about violence and mental illness for a moment, though, because everyone seems to believe that mentally ill people are inherently violent and dangerous, and that only “crazy” people can commit crimes like this. Gunmen in rampage killings like these do indeed tend to fit a profile -- one of loner white men who feel disaffected. Some have indeed been in treatment for mental illness at some point, but being mentally ill -- even severely mentally ill -- doesn’t predispose you to violence.

A lot of anecdotes have been circulating about mental illness -- something that affects an estimated 25% of the adult population at any given time -- this weekend. The plural of anecdotes, however, is not data. So here’s some hard data on the facts behind mental illness and violence, courtesy of a large number of scientific studies conducted in rigorous conditions and peer-reviewed to determine their applicability, validity, and usefulness.

“The vast majority of people who are violent do not suffer from mental illnesses,” says the American Psychiatric Association. Substance abuse is a much bigger risk factor for violent behavior; in people with untreated mental illness (a shockingly large number due to the difficulty involved in accessing services), drug abuse is a confounding factor in acts of violence in many cases, not the underlying mental illness. Socioeconomic status, age, gender and history of violence are also more significant indicators of the risk of violence. In fact, mentally ill people are far more likely to be victims of violence:

Despite widespread public fears of dangerous psychotic patients, individuals suffering from severe mental illness are far more likely to be victims of violence than perpetrators of violence. One study revealed that they experienced violent victimization at four times the rate of the general population. In another study, 25% of those with severe mental illness were victims of violence as compared to only 3% of the general population. (Source.)

Your likelihood of being hit by lightning is more probable than that of being killed by someone with schizophrenia, a commonly demonized mental illness. In fact, “violence in the community could be reduced by less than five percent if major mental disorders could be eliminated.”

Each time an incident like this occurs and distancing language blaming it on mental illness and refusing to engage with other social factors is used, society pulls further away from mentally ill people. A study in Germany showed that levels of social acceptance for mentally ill people don’t go back to normal after such events. In other words, the stigma faced by mentally ill people increases every single time there’s a horrific event blamed on mental illness circulating in the public consciousness.

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"When you think of mental illness, is this what you see?" asks artist Jennifer Mathis.

AUTISM AND VIOLENCE

There’s also been a great deal of misinformation circulating about autism spectrum disorders and violence in the wake of speculation about whether the suspected killer might have been on the spectrum. It’s important to note that, one, autism and mental illness are two very different things although comorbidities certainly do occur, and, two, autistic people are not any more inherently violent than mentally ill people. Or anyone else, for that matter. 

The Autistic Self Advocacy Network notes in a response to the speculation that:

Autistic Americans and individuals with other disabilities are no more likely to commit violent crime than non-disabled people. In fact, people with disabilities of all kinds, including autism, are vastly more likely to be the victims of violent crime than the perpetrators. Should the shooter in today’s shooting prove to in fact be diagnosed on the autism spectrum or with another disability, the millions of Americans with disabilities should be no more implicated in his actions than the non-disabled population is responsible for those of non-disabled shooters.

While some autistic people can experience reactive outbursts, these are very different from methodically planned and executed violence. An autistic meltdown is nowhere near the rampage violence exhibited by the killer in this case, and the false linkage between autism and violence perpetuates dangerous stereotypes about autistic people.

RAMPAGE KILLINGS AND MENTAL ILLNESS

Most people want to assert that “no sane person” would commit a crime like this; that’s simply not true. Even the much-touted story from “Mother Jones” (which I’ll be getting to in a moment) about mental illness and rampage violence could only come up with “signs of mental health problems” in 38 of 61 killers. As Kate Harding put it on Twitter, “That’s 23 perfectly sane killers U.S. needs to own.”

And what about that “Mother Jones” piece? With such unclear methodology and no information about how the data were gathered, what kind of criteria were used, and who evaluated the information, that 38/61 number is largely useless. This is the kind of misinformation that’s being circulated about mental illness -- and people accept it because it affirms what they already believe about mental illness, which is that it’s inherently dangerous and evil.

And what about that very widely circulated “I am Adam Lanza’s mother” piece, in which a woman compares her son to a cold-blooded murderer in a horrifically objectifying and deeply disturbing piece dangerously conflating mental illness and violence? This is not, as some people are trying to claim, a standalone narrative about one woman’s experiences; it is a statement piece being made at a very charged time, and one which suggests that mentally ill people like her son are dangerous and scary.

Ordinary people have the capacity to do awful things. And that is awful and terrible. And we should talk about why that is. We should talk about why it is that most rampage killers come from a very specific background, and about the culture of masculinity in the United States. We should also talk about the fact that all of the adult victims in this awful crime were women, and that women are disproportionately victims of violent crime, including rampage shootings like this one. It is not a coincidence that disaffected white men are targeting women.

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Image credit: Quinn Dombrowski.

WE NEED TO TALK ABOUT MENTAL HEALTH SERVICES ALL THE TIME

Here’s the thing. We need better mental health services in the United States. Mental health advocates, patients, and professionals have been speaking out about this issue nonstop for years. Yet, society collectively doesn’t pay attention until something awful happens, at which point the focus is usually purely about how to stop mentally ill people from doing awful things, even though the vast majority of mentally ill people aren’t likely to ever do awful things.

There’s no thought to the benefits comprehensive mental health services would offer to society in general, not just mentally ill people -- nor is there thought to what those services might look like. We live in a country where law enforcement are often tasked with providing mental health services and parents of severely mentally ill children are told there are no resources for them and they should call the police for help. Yet calling the police is extremely dangerous for mentally ill people.

We live in a country where it is extremely difficult to access services and to maintain continuity of care, two things that are critical for mentally ill people.

If your tooth really hurts, you’re going to be extremely persistent about finding a dentist, because your tooth hurts, you understand why it is hurting, and you want it to stop. You’ll make the calls you need to make, sit at the walk-in clinic, do what you have to do. If you’re having a mental health crisis, you don’t have the capacity to fight for treatment. You’re likely to end up homeless, using drugs, and struggling to survive. You will likely be victimized, and you’ll fall into the justice system, which won’t provide you with adequate mental health services.

Mentally ill people need stigma reduction. And comprehensive services including early intervention and preventative care, diversion programs, cooperative programs integrating experienced personnel at every level, from schools to colleges to workplaces. And social support throughout treatment. And a recognition that mental illness isn’t the end of your life, but treatment is a lifelong commitment, and treatment needs may be complex. They can also change over time, requiring constant check-ins and adjustment.

Mentally ill people need more than a band-aid solution thought up in a hurry in a reactive response to a horrible act committed by someone who may or may not have had a mental illness. Don’t get me wrong, I’m glad to see people taking an interest in mental health policy, but I am disappointed in how misplaced it is at the moment. If we want genuine mental health reform, we need to be covering it all the time, not just when we’re looking for a convenient scapegoat. News coverage of mental health issues is virtually nonexistent, and what coverage there is tends to be very poor.

By all means, let’s improve mental health services in the US. Please. We desperately need it.

But if you want to talk about how to prevent rampage violence, I’m afraid you’re going to need to move on to other subjects. Subjects like gun control. Like sexism and misogyny. Like how we talk about masculinity. Like how we model social behaviors. Like how we interact with each other as human beings.