"The Vast Majority Of Violent People Are Not Mentally Ill And Most Mentally Ill People Are Not Violent"
Richard A. Friedman, professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, writes in The New York Times:
Indeed, only about 4 percent of overall violence in the United States can be attributed to those with mental illness. Most homicides in the United States are committed by people without mental illness who use guns.Mass killers are almost always young men who tend to be angry loners. They are often psychotic, seething with resentment and planning revenge for perceived slights and injuries. As a group, they tend to avoid contact with the mental health care system, so it's tough to identify and help them. Even when they have received psychiatric evaluation and treatment, as in the case of Mr. Rodger and Adam Lanza, who killed 20 children and seven adults, including his mother, in Connecticut in 2012, we have to acknowledge that our current ability to predict who is likely to be violent is no better than chance.
Large epidemiologic studies show that psychiatric illness is a risk factor for violent behavior, but the risk is small and linked only to a few serious mental disorders. People with schizophrenia, major depression or bipolar disorder were two to three times as likely as those without these disorders to be violent. The actual lifetime prevalence of violence among people with serious mental illness is about 16 percent compared with 7 percent among people who are not mentally ill.
What most people don't know is that drug and alcohol abuse are far more powerful risk factors for violence than other psychiatric illnesses. Individuals who abuse drugs or alcohol but have no other psychiatric disorder are almost seven times more likely than those without substance abuse to act violently.
I don't think the solution he offers -- keeping mentally ill people or people with a history of substance abuse -- is a real solution, because people who really compelled to kill will get guns. If you want one in my neighborhood, you don't have to go to a gun store. You go to Sixth Street or so, in the hood.
Here's what Friedman writes:
The current guideline for psychiatric treatment over the objection of the patient is, in most states, imminent risk of harm to self or others. Short of issuing a direct threat of violence or appearing grossly disturbed, you will not receive involuntary treatment. When Mr. Rodger was interviewed by the police after his mother expressed alarm about videos he had posted, several weeks ago, he appeared calm and in control and was thus not apprehended. In other words, a normal-appearing killer who is quietly planning a massacre can easily evade detection.In the wake of these horrific killings, it would be understandable if the public wanted to make it easier to force treatment on patients before a threat is issued. But that might simply discourage other mentally ill people from being candid and drive some of the sickest patients away from the mental health care system.
We have always had -- and always will have -- Adam Lanzas and Elliot Rodgers. The sobering fact is that there is little we can do to predict or change human behavior, particularly violence; it is a lot easier to control its expression, and to limit deadly means of self-expression. In every state, we should prevent individuals with a known history of serious psychiatric illness or substance abuse, both of which predict increased risk of violence, from owning or purchasing guns.
The reality is, there may not always be answers -- solutions, that is -- that allow us to prevent mass murders like this.
Maybe it's a tiny minority — but it only takes one to ruin your whole day.
dee nile at May 28, 2014 6:32 AM
It's unfortunate that Freidman winds up discrediting his whole argument by turning it into a roundabout plea for gun control. Judging by the wishful thinking of the gun-control enthusiasts, you'd think that nobody in the human race ever killed anything or anyone before guns were invented. I also think he blew it with the statement, "Individuals who abuse drugs or alcohol but have no other psychiatric disorder..." By definition, someone who abuses alcohol or drugs has a psychiatric disorder.
He does sort of have a point when he talks about people not seeking help because of the threat of institutionalization. Who do we institutionalize these days? We don't have any mental institutions any more; they've all been closed and abandoned. However, it has been my observation, and I've seen other people talk about it over the past day, that for young men in particular obtaining help is a problem, in part because the authorities tend to handle young men with mental issues strictly as a law enforcement problem. So the young men learn not to ask for help, because of the fear that they will simply be locked up in a cell if they do.
All that said, of all of the population of people with mental disorders, there are three categories: (1) people who have problems but control their behavior; (2) people who are incapable of controlling their behavir due to their condition, and (3) people who can control their behavior but usually choose not to. I haven't decided if Roger is a (2) or a (3).
Cousin Dave at May 28, 2014 6:56 AM
"So the young men learn not to ask for help, because of the fear that they will simply be locked up in a cell if they do."
I think it is a bit more complicated than that.
For young criminals, being bad, gives you street cred. Being mentally Ill does not.
A large percentage of inmates in our penal institution are mentally ill, but they are socially accepted for being 'bad'. They would not be, if they were labeled crazy.
This was explained to me by a very smart criminal law professor, who had been a DA in New Mexico.
I have a lot of sympathy for many caught up in the criminal justice system.
Isab at May 28, 2014 7:14 AM
Let's compare:
#NotAllMen
#NotAllMentallyIll
It's okay to stigmatize all men with the feminist Not All Men argument, but it's clear that feminists and social justice warriors would complain and have complained if anyone tries to stigmatize the entire population of the mentally ill.
And they'd be right to because as Friedman says, only 4% of the violence is committed by the mentally ill.
And yet, when it's pointed out the majority of men do not commit homicides or assaults either, what we get is cries men are DERAILING and #YesAllWomen
jerry at May 28, 2014 7:30 AM
I read a book about training pets once and the author made the point that we are, by keeping dogs and cats as pets, forcing them to be perpetual puppies and kittens. Mature animals do not depend upon others for food. They hunt. Or they starve. Immature animals are provided food by parents who hunt for them. With perpetual puppy/kitten-dom comes the frustration of having to live under another's thumb and by a set of arbitrary rules devised by others even though one is by then capable of making one's own way. So, our pets sometimes act out on that frustration by biting, digging, scratching, etc.
Freud made the same point in Civilization and Its Discontents - that religion and civilization have done much the same thing to human beings, tamping down their more animal inclinations and forcing them to live in relative peace with strangers; to live by an arbitrary set of rules devised and administered by others. This internal disharmony causes some people to react very badly.
Conan the Grammarian at May 28, 2014 9:00 AM
It's unfortunate that Freidman winds up discrediting his whole argument by turning it into a roundabout plea for gun control.
...
He does sort of have a point when he talks about people not seeking help because of the threat of institutionalization.
I know people who will not touch the mental health system for any reason BECAUSE of that politicization. Despite needing help - and knowing they do.
Because they're (correctly afraid) that they might get their gun rights yanked by the -grabbers. (Like we're seeing now with PTSD cases and the military.)
Unix-Jedi at May 28, 2014 9:26 AM
I know people who will not touch the mental health system for any reason BECAUSE of that politicization. Despite needing help - and knowing they do.
Because they're (correctly afraid) that they might get their gun rights yanked by the -grabbers. (Like we're seeing now with PTSD cases and the military.)
Posted by: Unix-Jedi at May 28, 2014 9:26 AM
That has been true for a long time. I was an Army officer, in the 80's and knew a lot of people who could be helped by meds or a psychiatrist, but visiting one would be the kiss of death for your career,
The recent gun grabbing has just made the problems worse.
Considering that courts now use any excuse to take your guns, I know of competitive shooters who have abandoned all their property, and their children to an irate spouse they thought was capable of filing a false domestic violence complaint with the police.
And people wonder why men don't want to get married any more.
Isab at May 28, 2014 9:45 AM
"We have always had -- and always will have -- Adam Lanzas and Elliot Rodgers."
Actually, this sort of massacre was much less common prior to 1966 than since.
--
Dr. Keith Ablow has a column out where he takes exception to this doctors thesis. One does get the impression, though, that KA is seeking to construct or reconstruct an elaborate system of social control for what is a contextually small problem. Fewer than 1% of the homicide victims in this country are killed in incidents where more than 3 lives are lost.
--
Re one of the comments above: the state asylum census has declined by about 90% since 1955. The thing is, the advent of Medicaid allows for more specialized long term care and allows for the use of private facilities. The census of the state asylum was bound to decline as much of its clientele were dispatched to nursing homes and group homes and some of the remainder were dispatched to private asylums. Also, tertiary syphilis has disappeared and much of the schizophrenic population can be managed without inpatient care.
Art Deco at May 28, 2014 2:42 PM
"Freud made the same point in Civilization and Its Discontents - that religion and civilization have done much the same thing to human beings, "
No, it's called social co-operation and division of labor, which allows people to subsist without hunting and foraging. You want to live like the Yanomano in order to not be a kitten, be everyone's guest.
Art Deco at May 28, 2014 2:46 PM
Art,
Freud wasn't talking about the division of labor in civilization. Nor was he suggesting we go back to living like primitive man (or kittens).
Nor am I.
Freud was discussing the psychological costs of civilization as a basis for understanding modern day psychological disorders.
He was suggesting that the human psyche has not yet evolved to live in large groups under an arbitrary set of rules.
I believe Amy has made similar observations in terms of understanding rudeness and incivility.
Conan the Grammarian at May 28, 2014 3:23 PM
He was suggesting that the human psyche has not yet evolved to live in large groups under an arbitrary set of rules.
He was trying to drum up business.
Art Deco at May 28, 2014 4:43 PM
"We have always had -- and always will have -- Adam Lanzas and Elliot Rodgers."
Actually, this sort of massacre was much less common prior to 1966 than since."
Citation? And what do you think changed, assuming anything has?
Define what sort of massacre meets your definition of "this sort of massacre"
Violent crime has been steadily declining in the US for the last thirty years.
However fifty years ago, crimes like this, were mostly reported locally and not nationally or internationally, leading to a lot of confirmation bias for anyone doing research.
Something so rare is hard to quantify, so saying "less common before 1966". Is extremely arbitrary.
Isab at May 28, 2014 5:00 PM
Rodgers and the Aurora shooter were asking for help--both were seeing mental health professionals. Maybe those mental health professionals need to wise up and worry less about privacy laws and more about the safety of the public.
KateC at May 28, 2014 8:13 PM
I couldn't disagree more KateC.
Those privacy laws are in place because it makes it easier for us that are mentally ill to seek help and trust those providing it.
Most of us that are mentally ill internalize our aggression. I am very happy for those strict privacy laws because I need to be as honest as possible to get the right meds.
Privacy has never been the problem, neither are guns, or bullying. This is just a random act, and everything that could have been done was done by those outside his family circle.
This responsibility falls on the parents. There is no way I would buy my son a 40,000 car even if he wasn't mentally ill.
Ppen at May 28, 2014 8:39 PM
More here.
I wish Amy had invested in better comment software 10 years ago.
Crid [CridComment at Gmail] at May 29, 2014 1:16 AM
One of the worst mass murders in U.S. history occurred in 1927.
Cousin Dave at May 29, 2014 6:52 AM
Crid:
Having seen the Haloscan/JS-Kit fiasco and evaporation (and Discus seems to have most of it's problems worked out, as long as you like BIG transfers and footprints... and transient problems).... I'll say Amy's commenting SW is just fine.
Unix-Jedi at May 29, 2014 9:50 AM
Amy Alkon
http://www.advicegoddess.com/archives/2014/05/28/the_vast_majori.html#comment-4696952">comment from Unix-JediThank you, Unix-Jedi.
Amy Alkon
at May 29, 2014 10:00 AM
Maybe those mental health professionals need to wise up and worry less about privacy laws and more about the safety of the public.
Luckily, nothing bad could happen with THAT!
http://24.media.tumblr.com/1b53a80e51e3b8f0db9c69319ff5edaa/tumblr_mx4wkbV8YI1qf4h75o1_500.gif
It's a crappy line in context, but pulled, it'll do.
Unix-Jedi at May 29, 2014 10:02 AM
At work, I can't comment, or even see the comments, from any site that uses Discus. Something about their scripts sets off our net-nanny software. Sometimes simpler is better.
Cousin Dave at May 29, 2014 10:48 AM
I have no idea what the market for comment software is like... But I know that the text-based BBS systems I was using twenty-five years ago were better than anything on blogs today. (Not kidding; not a metaphor; literal truth.) You could load a page and see exactly which topics had fresh comments, and when they were added, no matter how old the original posting was.
The browser people can't write software like that, because they're too distracted by mouse buttons and obtuse graphics.
Crid [CridComment at Gmail] at May 29, 2014 11:31 AM
"On our advanced blog comment system, every user will have their own little icon, next to their date of birth and favorite foods and blood sugar listing! Some people will want a picture of a pony, and some of the boys will want to be fearsome dragons, and some peo--"
BUT WHAT DO THEY THINK ABOUT THE FUCKING VETERANS ADMINISTRATION HEARINGS?!!??!
"...And some people will be little houses overlooking the ocean, and some people will have unicorns, and they'll be able to use pink for their own personal comment text color! So our new blog comment software will be EASY TO USE...."
Crid [CridComment at Gmail] at May 29, 2014 11:37 AM
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