COMMENTARY

Mass Distraction: Equating Mental Illness With 'Evil'

James L. Knoll IV, MD

Disclosures

February 14, 2013

In This Article

Distractor 1: Mental Illness Is Synonymous With Violence, Criminality, and "Evil"

The seasoned test-taker knows that it is often best to rule out the most obvious distractor first. This distractor is age-old and powerfully regressive. It beckons us with myths stretching back to ancient times, when magic was concocted and volatile gods roamed the earth. No, I'm not lapsing into a D&D flashback. I'm talking about the ancient tradition of equating mental illness with "evil," sin, and criminality.

A few days after the Sandy Hook tragedy, a spokesman for Senator Marco Rubio released to the press a statement that Rubio supported measures to keep guns "out of the hands of criminals and the mentally ill."[4] Not long after that, National Rifle Association (NRA) executive vice president Wayne LaPierre stated in a national press conference that "our society is populated by an unknown number of genuine monsters. People that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can even possibly comprehend them.... How can we possibly even guess how many, given our nation's refusal to create an active national database of the mentally ill?"[5]

Did you catch that, lurking there among the impassioned, outraged statements? Look carefully, and you will clearly see it: the presumed association among "criminals," "evil," and "the mentally ill." It is a sobering fact that in the present day and age, over 40% of Americans believe in demons, devils, and other superstitious concepts.[6] Belief in "evil" as an objective force can be observed among ordinary citizens. The more ominous the evil, the more influential the beliefs: Individuals are quite ready to believe that Hitler's aura of "evil" had spread into his sweater, causing them to refuse to wear it.[7,8]

This archaic tale -- the myth of evil -- is invariably "a false image that is imposed or projected on the opponent."[9] In contrast, what is not imaginary is our history of justifying mistreatment against individuals labeled as "evil." I have written elsewhere that although the problem of evil may be a philosophical or religious one, evil does not exist in nature or physical reality.[10] Rather, what most of us label as evil is, in the final analysis, extreme selfishness.

When we lack a clear understanding of something that frightens us, we call it "evil," which temporarily allays our anxiety. Our nerves settled, we believe we have become clear about the nature of the problem, and then we may go about defending ourselves against the "other" we have just created. But this defensive posture may all too easily transition into a preemptive strike -- the result of projecting onto the "other" the aspects of our own psyches that we hate or fear the most.

That a killer considers his self-centered interests more important than your life is not due to some supernatural evil force; it is simply supremely egoistic. Similarly, a distraught, angry, nihilistic individual who seeks to vent his rage and feel a moment's power by gunning down others before he takes his own life is yet another example of gratifying one's own impulses at the horrific expense of others. A final example was put succinctly by my colleague and esteemed forensic psychiatrist Robert Simon, MD, who asked:, "What could be more selfish than your life for my orgasm?" as in the case of a serial sexual murderer.[11] Disgusting, cruel, and sadistic? Of course. Supernatural malevolent force? Not in the realm of physical reality. But notions about evil as an objective, reality-based force persist in the 21st century and continue to be imputed broadly to those suffering from mental illness.

In 2013, almost 50 years after deinstitutionalization, there is still a deeply ingrained societal prejudice that persons with mental illness are "ticking time bombs, ready to explode into violence."[12] It is difficult to escape the conclusion that a significant portion of the lay public requires little persuasion to associate mental illness with criminality and evil.[13] Certainly, the association has been strengthened by Hollywood movie portrayals of mental illness (eg, The Exorcist), which perpetuate the myth that evil and mental illness are overlapping, related phenomena.[14,15]The ancient beliefs that depravity is somehow involved in the origin of mental disease lingers in the shadows and awaits resurrection in the wake of bizarre, horrific tragedies.

Research on the public's beliefs about mental illness shows that a majority identify schizophrenia (88%) and major depression (69%) as mental illnesses, and that most understand that complex biological and genetic factors are involved. This gain in a scientific understanding is overshadowed by a startling deficiency in rational understanding: There remains a strong stereotype of dangerousness and desire for social distance from those suffering from mental illness.[16] And somehow, this irrationality has increased over time. Comparing the research from 1950 with that of 1996 shows that perceptions of mentally ill people as violent or frightening have substantially increased, rather than decreased. In short, persons with serious mental illness (SMI) are more feared today than they were half a century ago.[17]

There is now a wealth of research data indicating that erroneous and negative attitudes towards persons with mental illness are widespread in society.[18] In addition to the dangerousness myth, common inaccurate beliefs about persons with mental illness include that they are personally to blame for their illness, they have no self-control, and they should "just pull themselves out of their problems."[16] Thus, although increasing public understanding of the biological influence on mental illness has improved, social acceptance of mental illness has not. This has facilitated "the acceptance of a medical solution," and that "mental illness requires professional help."[19]

The flip side of this development is that "attitudes towards persons with mental illness have not changed for the better."[19] It would seem that the side effects of the zealous promotion of the biological model may be to "enhance notions of 'otherness,' reduce treatment optimism and aggravate anticipations of unexpected and dangerous behavior."[19] This is not a surprising notion to forensic psychiatrists, who have witnessed defense attorneys carefully deliberate about whether to show a jury a defendant's neuroimaging at the sentencing phase of a capital trial. Their fear is that the jury might conclude, "Well, here's irrefutable proof that the defendant is permanently damaged and can't live safely in prison for the rest of his life."

Yet, as my colleague Dr. Ron Pies has noted, it is likely that the problem is not so much with acceptance of the biological or medical model as it is with "either/or," dichotomous thinking.[20] This can be observed frequently in correctional and forensic psychiatry, as well as in the media after a mass shooting: Was the killer "mad" or "bad"? This type of thinking is invariably far too simplistic.

Returning to the subject of "otherness" and the suffering endured by those branded as different, I feel obliged to reference one of the greatest and most influential writers of the 20th century: Franz Kafka. There can be little argument that Kafka's work explored (with an exceptional depth and style) themes of alienation and the psychological brutality we inflict upon each other. One of the main themes of Kafka's famous The Metamorphosis is alienation, and there are distinct "parallels between the experience of Gregor Samsa and those of people with severe mental illness."[21] After Gregor's transformation into a "monstrous vermin," his world becomes more constricted, and he finds himself unwanted. We see the horror of "the alienating effect of being different from others," and consequently, "how easy it is to be unintentionally cruel" to those who suffer from mental illness.[21]

At present, reeling from horrific violent tragedy, some seek a quick solution via the ancient way of scapegoating. In 2013, this means scapegoating a vulnerable population: those who suffer from mental illness. But of course, this is an ineffective way of solving the problem. It is grasping the issue by the wrong handle, while projecting negative stereotypes onto a convenient and vulnerable population. Regressive notions of evil as the adversary of good work well for increasing hostilities between disconnected groups,[22] setting the stage for rash and aggressive "solutions." The "other" is easily transformed into an enemy who is depicted as evil. Once declared evil, the matter is resolved and requires no further understanding, let alone concerns about health or welfare. All of this can be done free of guilt, for those who are evil bring about their own just desserts. We are reassured of our own "goodness," and there is now a comforting bright line between us and the evil others.

The comforting line was astutely drawn for us by Mr. LaPierre: There are "genuine monsters" lurking out there who are "evil" and "possessed" by "voices" and "demons." And is it true "that no sane person can even possibly comprehend them"? If hidden under the rubric of "evil," I believe LaPierre is correct. Examined under the light of reason, and in the absence of distraction, I believe we can comprehend them quite well. Perhaps the greatest flaw of legitimizing the "mental illness is synonymous with violence/criminality/evil" distractor is that it shuts down rational thought and does absolutely nothing appreciable to stop people, mentally ill or not, from committing terrible violence against others in the first place.

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