Violence and Serious Mental Illness: What’s to Hide?

My dad came to visit my mom and I for a couple of days this past week and I used some of the time for respite from care-taking duties. I went to go see Suicide Squad, a movie based on the DC comic book franchise. The squad is basically a team of super criminals. One of the super criminals is the character Harley Quinn, who in the movie is the girlfriend of a homicidal maniac, the Joker, the character of Batman comic book fame. Like the Joker, Quinn is also an immensely violent, psychotic killer. Her weapons of choice include a colorful, personalized baseball bat which she uses to bludgeon people to death.

quinnbat
Margot Robbie as Harley Quinn in the movie Suicide Squad.

As the movie demonstrates, there is little question that Hollywood, as with much of our pop culture, demonizes people with serious mental illness (SMI), particularly people with schizophrenia. In the movie, Quinn openly admits to hearing voices and experiencing other hallucinations. She exhibits some endearing qualities, like loyalty to her friends, but fully embraces and relishes in her homicidal and criminal urges.

As any mental health advocate would quickly point out, however, these portrayals are highly unfair and misleading. That fact is that most people with serious mental illness are much more likely to be victims of violence, vulnerable as they are to homelessness and compromised physical and psychological health. Theft and assault are the most common crimes committed against people with schizophrenia.  For women with schizophrenia, rape is a constant danger (1). This demonizing of people with serious mental illness undeniably contributes to the gross discrimination and victimization people with SMI experience in their daily lives, whether by other people or at the hands of the government.

To help combat this prejudice and stigma, mental health advocacy organizations, like the National Alliance on Mental Illness (NAMI), spend millions of dollars on educational programs and public relations campaigns. Indeed, I personally benefited from attending a NAMI family-to-family educational program when I first started trying to get help for my mom years ago. Learning about the different types and symptoms of mental illness and hearing the stories of other family members helped me develop immense insight and compassion for people with SMI and their families, including my own.

Not only does my mom have a SMI, but she has multiple brothers and sisters that lived or are living with SMI too. One of my few memories, as a child, of my schizophrenic aunt is of her having a violent outburst during a family gathering. She attacked my uncle and left a large, bloody scratch near his eye. My sister and I, terrified, huddled in the corner behind the living room couch, while the adults tried to restrain her until the police arrived.

Another time my aunt, without warning, hit her mom, my grandma, over the nose with a glass ashtray. Needless to say, I grew up afraid of my poor afflicted aunt. And for quite some time, I was also in denial of what kind of SMI my mom had. Initially, when trying to help my mom receive treatment and care, I thought she was perhaps bipolar. “She can’t be schizophrenic,” I’d say to myself.  “Schizophrenics are horribly deranged.” Slowly but surely, and through the course of dealing with much personal grief, I’ve come to accept that symptoms of schizophrenia were expressing themselves in my mom too. Hearing her talk to herself for the first time was absolutely heartbreaking. She mimicked the demon I came to think of my aunt as in my youth. She was the demented monster or “Psycho” in so much Hollywood movie lore. (My mom has been diagnosed with schizoaffective disorder.)

Fortunately for my family, my mom has never expressed the level of violence my aunt did. She yells and curses often times, but mainly to the voices tormenting her. She gets angry at me, of course, but manages to not swear at me or try and physically hurt me, to my surprise and relief. That’s not to say she hasn’t ever physically assaulted me, or sworn at me though, because she has.

Years ago when living with me in San Francisco, my mom punched me in the stomach one day when I stepped in front of her to prevent her from walking away from our apartment. A police officer was on the way to take her to General Hospital for a 51/50 hold. She was in an acute episode that morning and angry and hostile, claiming the people who were dropping off their children for school across the street were spying on her. As she turned around to go back into the apartment, she coldly said to me, “I’m going to fuck you up when I return [from the hospital].”

Fortunately, for us both, my mom is significantly less hostile and belligerent towards me than she used to be, even though her psychosis is more of a constant. Sometimes I wonder, though, if I should be more guarded. Maybe I should lock my bedroom door at night when she’s in an acute episode, like I sometimes used to. As a trained social scientist, I like to rely on evidence and research to inform my opinions. But the research on the connection between SMI and violence is woefully inadequate. Indeed, not much on it exists at all.

In a recent blog on the subject, well-known mental health advocate and journalist Pete Earley says, “Because of stigma, we always begin every conversation about violence by explaining that individuals with mental illnesses are no more violent than the general public and, in fact, are more likely to become victims than perpetrators” (2.) He’s talking about MH advocates and reformers, but the same can perhaps be said for researchers and/or academics. After all, they can be closely aligned with or dependent on advocacy organizations, like NAMI, that are reluctant to talk about violence committed by the mentally ill. Instead, they prefer to focus on positivity and recovery.

The fact of the matter is, however, that many people with SMI languish without successful treatment for years, if not for their whole lives. For many that suffer from persecutory paranoia and delusions (i.e. the belief that people or some kind of entities are out to get them), it’s likely they will violently lash out during a time of acute psychosis through physical force. (In their minds, they are defending themselves.)  When my mom punched me in my stomach and verbally threatened me, I know it was because she believed an evil spirit was controlling me or possessing me. My mom’s illness takes a very cultural and religious based form.

With respect to the sparse literature, much of it fails to illuminate the subject matter. One study published in an academic psychology journal in 2014 shows a relatively weak connection between violence and people with SMI. One thing of particular interest is the following, though; of the 429 crimes committed by 143 offenders with three major types of mental illness, researchers found that 3 percent of their crimes were directly related to symptoms of major depression, 4 percent to symptoms of schizophrenia disorders and 10 percent to symptoms of bipolar disorder. To me, this is interesting because it challenges my preconception that schizophrenics are among the most likely to commit crimes and/or violent acts. As the authors admit, though, there are some problems with the study’s methodology that need to be improved (3).

Just this past month, however, a recent study was published by the Treatment Advocacy Center that specifically focuses on family homicides committed by people with SMI. The study is persuasive and innovative, in that it uses national data provided by the Federal Bureau of Investigation (FBI), Center for Disease Control (CDC) and numerous media reports. In essence, it extrapolates media reports on family homicides committed by people to SMI onto national homicide data. It’s arguable that the data underreports the connection or numbers, since, for one, many homicides committed by people with SMI probably go unreported by the press. Nonetheless, the data shows that people with SMI do commit murders at higher rates than the general population.

According to the report, there were approximately 4000 family homicides committed in 2013. The number of family homicides associated with SMI was 1150. This was 29% of all family homicides and 7% of all homicides in 2013. People with SMI make up approximately 4% of the US population any given year. Thus, they obviously accounted for a disproportionate percentage of family homicides and total homicides nationwide. Other things of note in the study are the specific family relationships and comparison to changes in the national homicide figures (4).

The majority of homicides involving parents and their children were committed by people with SMI. In addition, around 67% of parents killed by children were killed by children with SMI. Around 50% of the children killed by parents were killed by parents with SMI.  And although homicide rates in the US have decreased in recent years, there has been virtually no decrease in the number of children with SMI killing parents or parents with SMI killing children (4).

As in the high profile cases that have rocked national attention recently, most of the people with SMI who commit murders are receiving inadequate or no psychiatric treatment. And in many instances, violent acts committed by people with SMI are preceded with warning signs such as obvious psychotic symptoms (e.g. severe hallucinations) and verbal threats. Key indicators also include abuse of drugs and/or alcohol and past acts of violence. While it can be difficult to distinguish which factor is more influential (Is it the abuse of drugs or not taking psychiatric medication that plays a bigger role?),  not taking effective medication no doubt increases the chance for violence, regardless of an individual’s personality traits and/or circumstances.

homeless-chicagoWe undoubtedly need more and better studies on the connection between violence and SMI, in order to better inform our policy and political decisions and change the way we as a society think about mental illness. Ignorance and fear leads to stigma, and the reality is that people with SMI and their families need more compassion and access to MH treatment and services than what is currently being provided. Violence, after all, takes various forms. Leaving people alone to suffer from their hallucinations and delusions is a form of violence. Leaving family members alone to deal with and try to help them is also violence, a psychological torture really. As long as this situation is allowed to continue, then nobody’s hands are truly clean.

Footnotes:

  1. Torrey, E. Fuller, Surviving Schizophrenia (New York: Collins, 2006), 287-289.
  2. http://www.peteearley.com/2016/06/23/violence-and-mental-illness-an-uncomfortable-subject-but-a-grim-reality-for-some-families/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+peteearley+%28The+Official+Blog+of+Author+Pete+Earley%29
  3. As the authors mention, the sample size is small and the number of violent crimes are probably underreported. http://www.apa.org/pubs/journals/releases/lhb-0000075.pdf
  4. Torrey, E. Fuller and others, Raising Cain: The Role of Serious Mental Illness in Family Homicides (Treatment Advocacy Center, June 2016) http://www.treatmentadvocacycenter.org/storage/documents/raising-cain.pdf

 

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