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.

The Sandy Hook School Shooting, Mass Murder And Mental Health Reform: Parts 1 and 2

istock_000005543513smallWhen I was in undergrad, I took a class called Mass Murder in the United States.

I picked up that book today and perused through it. It was published in 2000 and due to the number of mass murders that have taken place over the last

12 years, it felt severely outdated (although much of the psychological information in it remains relevant).

Unfortunately our country has a long history of mass murder with the number of incidents and victims increasing over the years, especially in the last 10.

After tragedies like the one that happened Friday at Sandy Hook Elementary School, it’s common that many people start wanting gun reforms and bands on assault refiles. Something that often gets overlooked, but now is finally getting some attention, is mental health reform.

According to research done by Mother Jones in November, no less than 80 percent of mass shooters obtained their guns legally.

In the 61 cases they looked at in the United States over the last 30 years, at least 38 of the shooters displayed signs of mental problems before the shootings.

This happens way too often. While assault rifle bands get the attention during terrible mass shootings, the mental health component often goes largely ignored, despite the fact that it often plays a crucial role.

Many of these perpetrators in the study done by Mother Jones had acute paranoia, delusions, hallucinations and/or depression.

At least 35 of the 61 perpetrators killed themselves at or near the scene with 7 others appearing to have committed suicide by cop.

Seung-Hui Cho, who killed 32 and injured 23 during the Virgina Tech shootings in 2007, was found mentally ill and in need of hospitalization during a psychiatric evaluation in 2005.

Jared Loughner, who shot 19 people including former congresswoman Gabby Giffords, had displayed signs of mental illness many years before the shooting, including yelling out in class and complaining about hearing voices. Still, he was able to purchase a gun and ammunition without a problem.

One of the bystanders who helped subdue Loughner that day after he stopped to reload, Patricia Maisch stated, “That beautiful day, our mental-health system failed us.”

Could many of the mass shootings we’ve seen over the past few years (at least 26 in the past seven years alone) been prevented with better mental health reform?

That’s not an easy question to answer because it takes into account the issues of civil liberties, medical ethics, and gun laws.

In our country, we want to make sure that everyone has the same rights to bare arms, even those with mental problems, but we have to try to figure out a way of keeping guns out of the hands of those likely to use them to inflict horror on our society.

At the minimum we need to look at how we are treating those with severe mental problems.

Our mental health system is broken, plain and simple. I’ve worked in many facets of the mental health system to know that it’s the truth.

Look around you. I am sure you know someone who has fallen through the system, needs help and is walking around with a mental illness that isn’t being addressed properly if at all. If not, just take a look at our staggering homeless population, many of which suffer from mental illnesses that are not being treated.

Too many states are cutting funding for those with mental illnesses and many people that need to be hospitalized, simply aren’t because so many mental institutions have been closed down due to lack of funding.

In the United States you are allowed to be mentally ill, which means that you can be diagnosed with a severe mental illness and allowed to not take medication, not see a psychiatrist/therapist and pretty much be ignored unless you draw attention to yourself.

It’s your right.

As a licensed mental health counselor in the state of Florida, I have the right to involuntarily hospitalize someone that is an imminent danger to them self/others or is at risk of self harm (i.e., running through traffic in a manic rage), but not the right to involuntarily hospitalize someone who is actively hearing voices or hallucinating, as long as they are in touch with reality and aren’t a danger to themselves or others, even if I know that person needs treatment.

Of course not all mass murders are done by people who are mentally ill. Some do it to seek revenge or have other troubles, but I can’t ignore the role that mental illness, including depression in young men, plays in mass murders.

Part 2: Stima Associated With Mental Illness May Increase Chances For Violence. depressed-teen-istock

I hate when tragedies like this happen because it often puts a stigma on those with mental illnesses who already have enough stigma.

Most people with mental illnesses, including schizophrenia are not violent. However, having schizophrenia makes a person twice as likely to be violent than a person without schizophrenia.

A person who has schizophrenia and a substance problem is about 20 times more likely to kill a person than someone without schizophrenia, so we can’t ignore the statistics.

The stigmatization of mental illnesses such as schizophrenia, often make it worse for those with it, causing exacerbation of existing symptoms of delusions, disconnection from reality, social withdrawal and lack of emotions.

I’ve talked previously about how many men with depression don’t seek help because of the stigma that goes along with a man seeking help for his problems (check out my post on Javon Belcher) and how that can turn deadly in the form of suicide, murder or in rare cases, mass murder.

A patient with schizophrenia, a former academic wrote anonymously about her experience with social stigma from her disease (via writer David Dobbs at Wired):

“I was diagnosed with schizophrenia just a month after Steven Kazmierczak (quickly identified as “schizoaffective”) shot six people to death on the campus of [Northern Illinois University] … Undoubtedly primed by this shooting, wary, uncertain, without enough time to think, my doctoral adviser suspended my graduate assistantship, banned me from the university, and alerted all faculty, graduate students and staff to forward all emails [from me] to her and, under no circumstances, respond.”

Her adviser unfortunately thought that she was planning to plant a bomb on campus, and although the decision to suspend her was reversed in about a week, the damage was already done:

“Friends — my doctoral cohort, as is often the case, were a close and tight-knit group — abandoned me overnight. Students and faculty passed me in the halls, staring ahead blankly as if I were an undergraduate they had never seen and would never see again. Parties were announced, talked about, and I was never invited. Never again.”

The social rejection exacerbated her illness. She became afraid to be around people, stopped attending classes and functions on campus:

For a while I struggled through classes, overwhelmed, perhaps in equal measure, by delusions and this new and unprecedented isolation. Voices took the places of both professors and friends. Following a hospitalization (and consequent withdrawal from a semester’s worth of classes), I descended into a state of the most stunning dysfunction, unable (or simply unmotivated) even to walk from my bed to the bathroom.

Eventually she was dismissed from her program:

Everything I have ever been told was a lie. My one way out — of poverty, desperation, madness — was never more than an illusion. And then disbelief. And then, how will I ever explain this to anyone, to family, to old mentors? And then betrayal. No language this time, no thoughts; crying, crying for hours. Alcohol, unconsciousness, unbidden dreams. Even there: repeating their words, over and over and over again. Isolation so intense, there is no way I will ever bridge it. I am lost. Days go by, weeks.

Eventually her thoughts turned to violence and self-destruction:

I fixated on a single vision, me, sometimes hanging, sometimes with gun in hand and a pool of blood on the floor, outside [her former adviser’s] office. Suicide, yes, obviously, but also something more: revenge.

This person never went through with murder or violence, but she says that she understands how someone in her situation would want to commit mass murder. This is sometimes the spiraling down process of someone with a mental illness who commits mass murder.

We have to do something about our mental health system if we don’t want to see a continuation or rise in the amount of mass murder in our country.

Maybe we need stronger gun laws that don’t allow someone who has been involuntarily committed to a hospital because of a mental illness or found mentally incapacitated to purchase guns without a thorough psychiatric evaluation and extensive cooling off period, if at all.

It’s time for the leaders of our states, our country, to sit down and have a serious conversation for the well-being of our nation’s mental health.

For more information on the Mother Jones research, check out the site below: http://www.motherjones.com/politics/2012/07/mass-shootings-map

The Most Commonly Diagnosed Mental Disorders

We are bombarded all the time with the depressing number of people diagnosed with illnesses such as cancer and heart disease, but did you know that mental illness is even more prevalent?

Like cancer and heart disease, mental illness is a medical condition that does not discriminate by age, sex, race/ethnicity or socioeconomic status.

Mental disorders often strike people when they less expect it, when they are in the prime of their lives and are often associated with other high risk behaviors such as gambling and substance abuse.

Like any other illness, they also vary in degree from mild, moderate and severe. In developed countries, these are the top 10 diagnosed mental disorders:

10. Autism Spectrum Disorders (Pervasive Developmental Disorders)

I’ve written a previous post on pervasive developmental disorders. They start when children are very young and are often difficult to diagnose. As a matter of fact, I know a parent who has just acknowledged (after much denial) that  her 17 year old son has Asperger’s, something he should have been tested for and began treatment for years ago.

9. Schizophrenia

To me, schizophrenia is one of the most interesting mental illnesses. I used to enjoy working with schizophrenic patients when I worked in the mental hospital, although I did feel very bad for them.

Imagine being tormented by voices telling you bad things about yourself, thoughts that someone is trying to poison you, or seeing visions of dead bodies everywhere. That’s just some of the things people with schizophrenia I’ve worked with were tortured by.

To be diagnosed with schizophrenia, a person has to have two or more of the following:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Emotional flatness

Contrary to popular believes, most people with schizophrenia are harmless.

8. Bipolar Disorder

Most people with bipolar disorder are diagnosed by age 25, although different things can bring out underlying bipolar symptoms, such as pregnancy.

“Bipolar” is a term loosely used these days, usually to describe someone who seems to have mood swings, although in most cases, people with bipolar disorder don’t change their moods from moment to moment, and if you ever get to meet someone with severe bipolar disorder and they are not on their medication, you will know it and probably never forget it.

I’ve seen grown men swinging from trees and women drop from exhaustion after running ragged for four days straight, partying, sleeping with half a dozen men and charging thousands of dollars on credit cards they can’t afford.

7. Panic Disorder

Sweating, rapid heart beat, nausea, shortness of breath, dizziness, fear, loss of control, chest pains, tingling, smothering sensation, these are all symptoms of panic disorder.

Panic disorder and panic attacks are common, and can be triggered by certain events such as riding in an elevator, being in a crowd, having to give a speech or being in a place where there is no easy escape (agoraphobia).

1 out of 3 people with agoraphobia become housebound and are basically held hostage in their own homes by their illness.

6. Anxiety Disorders

Anxiety disorders include obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD).

OCD is a combination of reoccurring thoughts (obsessions) and actions (compulsions) that a person performs because they believe it gives them control. For instance, a person may believe they have to take 50 baths a day or they aren’t clean and they may lose their job, friends and family to this behavior.

PTSD occurs after a person experiences a terrifying even in which they face great bodily harm, death, fear or helplessness. They may then have reoccurring thoughts, nightmares, heighten fear and avoidance behaviors. Many rape victims and soldiers coming back from war experience PTSD, but so do people who have been robbed, beaten or in a car accident.

GAD is basically when someone has anxiety, stress and worry for at least 6 months period for no specific reason. Some of these people are considered “worry worts” in layman terms, but their anxiety can cause them to have a host of physical systems and a decreased quality of life.

5. Phobias

Phobias are related to anxiety disorders and there is almost a phobia for everything although social phobia is one of the more common phobias.

In social phobia, everyday situations causes the person to become self-conscious and nervous, often leading to physical responses such as sweating which then causes the person to become even more self-conscious and nervous.

Children with social phobia often go through great lengths to avoid going to school and once at school may either be super anti-social or go to extremes to avoid other students by skipping, or staying in the clinic and feigning and illness.

A person can pretty much have a phobia of anything. Check out http://www.phobalist.com

4. Attention Deficit/Hyper Activity Disorder

This is another one I’ve written about previously. ADHD is very common and most children learn to manage their illness or outgrow it altogether, but some will have ADHD throughout their adult life.

3. Eating Disorders

Anorexia nervosa,  bulimia nervosa and binge-eating are common illnesses, usually affecting females.

People suffering from anorexia, when a person looks in the mirror, no matter how thin they are, all they see is a fat person. They then go through great lengths to restrict their food and burn calories until often they are on the verge of starving themselves to death, and sadly many do just that.

People suffering from bulimia are often of normal body weight, but binge on large quantities of food, then feel guilty about it and then may try to vomit it back up, exercise obsessively, or use laxatives to try to get rid of the food and calories.

People who suffer from binge-eating are caught in a vicious cycle of over-eating, feeling guilty about the over-eating, and then over-eating to try to self-soothe themselves, which all of course leads to weight gain and shame.

2. Personality Disorders

All humans have personality traits, most which are relatively fluid, based on our culture, upbringing and experiences. Many of us even have some traits of personality disorders, but people with true personality disorders have traits that are so rigid that they impair their ability to function and get along with people in their everyday life.

Some of the most common personality disorders diagnosed include:

  • Antisocial personality disorder– these people don’t follow rules of society, often care little about other people unless they can use them for their own gain, they can’t empathize or feel sorry for people, they generally show no remorse. They often have criminal behavior.
  • Avoidant personality disorder– these people are anxious, usually over-controlled and fear criticism, making them hesitant to become involved with other people. There for, they tend to avoid people as much as possible.
  • Borderline personality disorder– these people are generally impulsive, unstable, suicidal at times, fear abandonment while at the same time they tend to push people away from them, resulting in tense, unstable relationships.

1. Mood Disorders

Mood disorders are the number one most diagnosed mental illness in developing countries and something that nearly everyone can relate to in one form or another.

Mood disorders are sustained emotions that go beyond the usual, normal feelings of sadness, to deeper feelings such as dysthymic disorder and major depression.