Violence And The Mentally Ill

Violence And The Mentally Ill

Many people believe that all violent, sadistic and dangerous people in our society are mentally ill, thus coming to the conclusion that mentally ill people are dangerous.

The truth is, people with mental illnesses are no more likely to be violent than anyone else. Only about 3% to 5% of violent acts can be attributed to individuals with a serious mental illness.

Many movies depict violent characters as being mentally ill and often the news continuously replays stories of the rare occurrences when someone with a mental illness acted out in violence. We start to associate mental illness with violence.

One of society’s biggest fears are acts of violence that are senseless, random, unprovoked and unpredictable and thanks to the media, we often associate this with mental illness. We somehow take more comfort in knowing a man was stabbed to death walking down the street during a robbery than if he was stabbed to death walking down the street for no apparent reason.

This stigmatization is just one of many things people with a mental illness face. I have often heard people say they were afraid of a suicidal individual or someone who self-injured themselves: “If they would do that to themselves, what do you think they would do to me?” The fact is, most suicidal and self-harming individuals would rather hurt themselves before they would hurt anyone else.

While it is rare, people with mental illnesses, just like anyone else in the general population, can act out in violence. Individuals who have a substance abuse disorder alone are much more likely to become violent than the general public, including those individuals who have a mental illness alone or an associated substance abuse disorder.

However, when it comes to dealing with mental illness, individuals who abuse substances, have a co-occurring mental disorder and are non-compliant with their medication are at higher risk of committing violence.

Even with the combination of substance abuse and non-medication compliance, the general public are not at high risk of being attacked by someone with a mental illness. People who are in close relationship with these individuals such as family and friends, especially if they have troubled relationships and/or are financial dependence are more likely to become victims of violence.

Some of the most predictive variables for violence untreated psychotic symptoms to include suspicion/paranoia, hostility, severe hallucinations and poor insight into their delusions and the overall mental illness.

A Tragic Example

I recently spoke to a young man who appears to have had his first psychotic episode, at-least as far as he knows. He’s in his early twenties and at the prime age for the onset of many psychiatric disorders including schizophrenia.

One day last week he was home watching YouTube videos and became paranoid that someone was going to come and rape his mother. Alarmed and frightened, he armed himself, first with a shotgun, but discovering the shot gun was not operational, he armed himself with a handgun. He proceeded to guard the house from what he thought were real threats to his mother, some mysterious intruder/rapist. What happened next rocked the whole community.

At some point, his mother came downstairs and he shot her twice in the head. He then shot their dog twice in the head as well before setting the house on fire and rowing a boat across a lake. According to the people who were at that house, he came out of the boat shirtless, walking slowly and looking like Jason from Friday the 13th.  He was chased away by the homeowner and ran off into the woods. Soon after he turned himself into authorities and the totality of his behavior was brought to light. When the authorities went to his burned down home they found the charred body of his mother and their dog.

I have worked with a lot of individuals who were experiencing their first psychotic episodes, but I have never spoken to someone so young that went from apparently “normal” to acting out so violently in response to paranoid delusions and hallucinations.

Most individuals, who develop a psychotic disorder or any mental illness for the most part, start off with small signs and symptoms that if left untreated, can lead to worsening symptoms and rarely horrible things like suicide or violence. Usually this takes several months to years to decompensate to this level. It’s very rare for someone’s first psychotic episode to turn out so violent, causing death and destruction.

Thankfully, situations like that are extremely rare.

Warning Signs

Some warning signs to look out for when dealing with anyone, not just someone with a mental illness include:

  • Pacing
  • Psychomotor Agitation (i.e., leg bouncing rapidly)
  • Combative posturing (i.e., fist balled up)
  • Paranoid or threatening remarks
  • Irritability
  • Talking to self in language that includes violence or paranoia

If you see these behaviors, it may or may not mean that the person has a mental illness, but these are signs that someone is possibly in a volatile state. Stay calm, give them space, avoid intimidating eye contact.

If you have to deal with the person because they are a friend, family member or even a customer in your place of business, use a calm/soothing voice, helpful attitude, avoid loud noises, remove potentially dangerous objects and attempt to give positive reinforcement until you can either get help or get out of the situation.

We all probably know someone with a mental health problem and many of us don’t even know it because most individuals with mental health problems are productive members of our community.

When we destigmatize the violence associated with being mentally ill, we make it easier for those individuals to seek treatment and to talk about it with their family and friends instead of hiding it out of fear or shame.