Welcome to From Insults to Respect.

Whenever we learn of a mass shootings, we hear people unfairly connecting the horrendous murderous acts to people who have been classified as having a mental illness. For example, at one point immediately after one such tragic event, Paul Ryan, the former speaker of the House, announced, “People with mental illness are getting guns and committing these mass shootings.” Such statements connect in the minds of the public the notion that people who have been labelled mentally ill are dangerous, thereby promoting the stigmatizing of a group of people, the vast majority of whom are no more violent than average citizens.

For those who are interested in a scientific analysis of possible connections between mental illness and violence, I recommend “Mental illness and Reduction of Gun Violence and Suicide: Bringing Epidemiologic Research to policy” (see HERE). Its major conclusion is that the large majority of people viewed by mental health professionals as having a mental disorder do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.

Now, to be sure, some studies have reported a statistically significant but fairly modest positive association between violence and mental illness. However, this apparent connection, when we look carefully at the data, suggests that this association is likely to be misleading.

Clarifying the Relationship Between the Statistical Findings

The first thing to keep in mind is that the notion of mental illness is a lot more vague than many mental health professionals would like you to believe. People facing the complexity of their existence will often become concerned about how they are feeling or acting for an incredible variety of reasons. When they seek some support from a mental health professional, in order to access this support their concerns must be converted into mental illness terminology. Without being labelled, no services. It just so happens that because the descriptors needed to classify someone as mentally ill are so vague, pretty much anyone seeking mental health services won’t be turned away as long as they can either afford the cost for the services or that they have some insurance policy that covers mental health services.

Keeping in mind how vague the notion of mental illness is and the incredible variety of concerns that people seek mental health services, note that there is a whole additional group of people who get labelled as mentally ill. This group of people are adolescents who are acting out violently and therefore are referred to mental health services by teachers and parents. Once these adolescents are referred, they too, in order to access services, are labelled as having one mental illness or another.

In one series of studies we find that violence involvement during adolescence is also a potent risk factor for ongoing violence involvement well into young adulthood (Borowsky, Widome, & Resnick, 2008; Dahlberg & Potter, 2001; Herrenkohl et al., 2000). So, when violent acting adolescents get labelled as having a mental illness, it is not because they clearly meet any of the vaguely worded criteria for a mental illness classification, but rather because it is a requirement of the bureaucracy to access services. This violence prone group is then added in statistical analyses to the larger group of people who make up all those who are labelled mentally ill. When analyses combine those who are labelled as mentally ill for all reasons with the subgroup of those who are already displaying violent behavior, it leads to a statistically significant finding between mental illness and violence. There are a host of reasons why someone is violent, such as having parents who display violent behavior, living in communities where violence is all around, etc. Rather than attributing the vague notion of “mental illness” as the reason of such violent conduct, we would be better off identifying its specific causes.

Here’s another reason for the misleading statistical correlation between those who are labelled mentally ill and violence. People who have been labelled mentally ill come from a full range of social and economic conditions. At the same time, such labelled people are somewhat more likely to be exposed to social and economic risk factors such as poverty, crime victimization, involvement with illegal drugs and drug markets, early life trauma exposure, and ambient neighborhood crime. Perhaps it is this exposure, rather than the vague notion of mental illness, that leads to the statistical increased risk of violence among mentally ill labelled people. Examining this possibility, Swanson et al. (see HERE) published a study on the prevalence and correlates of interpersonal violent behavior in a five-state pooled sample of 802 adult psychiatric outpatients with serious mental illness who were receiving services in the states’ public behavioral health care systems. The study compared 3 groups of individuals.

Group 1: Individuals in this group had been labelled mentally ill and also came from a very low social capital situation—mostly unemployed, economically impoverished, typically residing in disadvantaged neighborhoods, often misusing alcohol and illicit drugs, and reporting alarmingly high rates of trauma and violent victimization over their life course.

Group 2: This group’s members were participants in the study who merely had a diagnosis of serious mental illness but did not have a history of violent victimization, were not exposed to neighborhood violence, and were not abusing drugs or alcohol.

Group 3: This group’s members were individuals who were representative of the general population.

The results indicate that those in Group 1 (mentally ill plus low social capital situations) had a higher rate of violence than those in Group 3 (those individuals typical of the general population). Meanwhile, Group 2 members (mentally ill but no history of low social capital situations had annual rates of violent behavior that were no different from those in Group 3 (the general population group).

Thus, these findings suggest that it is not the vague “thing” we call mental illness that is the cause of the increased rates of violent behavior, but rather being exposed to low social capital situations. Said another way, more people who have been exposed to low social capital situations tend to get a mental illness label than people in general. When this low social capital situation group is combined in statistical analyses with everyone who has a mental illness label, it gives the appearance that it is the mental illness condition causing the increase in rates of violence. In actuality, it really is the exposure to low social capital situations that is the cause for the increased rates of violence.

Here’s a third argument that it is not “mental illness” that is the cause for the statistical increase in violence. Perhaps the statistical finding is due to the psychiatric drugs that people labelled mentally ill often take. To be sure, most people who take psychiatric drugs do not become violent. However, a number of writers have pointed to the evidence that one of the recognized side effects of taking these drugs is an increased risk of violent behavior (as examples see HERE and HERE). Moreover, it has been reported that many of those who shot up schools were on psychiatric drugs, including this most recent case (see HERE).

Conclusion

The mental illness explanation for the school atrocities is far too simplistic, unfairly stigmatizes an enormous number of nonviolent individuals, and diverts our attention from coming to understand the real factors that are involved.

———————————
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.