COMMENTARY

Mass Distraction: Equating Mental Illness With 'Evil'

James L. Knoll IV, MD

Disclosures

February 14, 2013

In This Article

Distractor 2: "Cracking Down" on People With Mental Illness With Strict Regulations Will Effectively Prevent Mass Shootings

As discussed above, in the wake of a frightening tragedy, a reactionary focus on mental illness is a way of scapegoating and represents an intervention for which there is no supporting evidence. The phenomenon of mass murder is quite rare, and of all of these rare events, few perpetrators had histories of SMI, such as schizophrenia or bipolar disorder. Rather, most mass murderers are emotionally disturbed, angry, nihilistic individuals who have long nurtured their fantasies of violent revenge. Such individuals are unlikely to be adequately engaged in the mental health system because they function (perhaps marginally) in society and do not typically seek out mental health treatment.

Whether they suffer from SMI or not, the individuals who commit these acts do have an ill-defined trouble of the mind for which psychiatry has no immediate, quick-acting treatment. That is to say, if someone wanted to overcome deep, pervasive feelings of anger, persecution, revenge, and selfishness, they would need to want to step out of this living hell in a nonviolent way. They would need to find within themselves a hint of a yearning for even a small crack of light in their dark, isolated cell. Psychiatry can assist individuals who are determined enough to have more light enter, but we do not hold the only torch of enlightenment. It can be done by any means necessary, including healthy social connections, spirituality, and creativity. The point is that the individual must find within himself the inspiration to escape a bottomless pit of suffering. He must then make himself accessible to outside positive forces. It is unfortunately the case that some disturbed individuals will remain inaccessible. It is these individuals who are unlikely to be dissuaded, even by a top-notch mental health system, as much more is required.

In the past, we have seen programs involving "the war on drugs," or "get tough on crime" policies. Yet, it is often the case that by the time the declaration of war is issued, the war has either already been lost or is surely doomed to failure. It has been noted that "Problems are best solved when they are approached from the most effective vantage point."[23] Otherwise, one runs the risk of grasping the problem, as Epictetus said, "by the wrong handle."[24] This was the case with inadequate care for psychiatric inpatients before the 1970s (ineffective solution: Shut down state hospitals), involuntary commitment (ineffective solution: Raise the legal threshold for commitment), and risk in society (ineffective solution: Create a legal duty to protect).

The rally to crack down with stricter regulations on those suffering from mental illness is not only an ineffective way of solving the problem; it is also quite misguided. Only a small fraction of persons with SMI are violent, and of those who are, it is rarely SMI alone the leads to violence. Even if we were to assume a causal association between SMI and violent crime, the overall contribution of this population to violent crimes in society is only about 3%-5%.[25] Thus, focusing on persons with mental illness as a "risky" population is similar to what we observed after 9-11, when anyone of Middle Eastern ancestry was viewed with heightened suspicion. Indeed, since most of the violence in society may be attributable to young males, should we not enact laws that more tightly regulate this population? Of course, most would consider this a colossal waste of time and resources. Not so with mental illness, because it is easier to scapegoat this population, as opposed to all males between the ages of 15 and 25 years. Instead, we have chosen, as a society, to shift large numbers of persons with SMI from state hospitals to jails and prisons.

This transinstitutionalization was the result of many complex causal factors.[26] If fiscal and civil libertarian reasons were the germinal seeds of deinstitutionalization, subsequent neglect of mental illness as a major public health issue has been the fertilizer which facilitated its progression. This was the garden we tended. It has now born fruit, which we must now choke down while lamenting the fact that we should have planted a different seed.[27] We are now creeping up on the half-century mark to find that corrections is the de facto mental health system. As seen in politicians' comments, and as suggested by the research on public beliefs, society's primary motivation is to achieve social distance from individuals with mental illness.

And so the inescapable question we must confront is this: How much does society value mental health, and by extension, the pursuit of understanding the mind? I believe we shall discover the answer to this question in the coming decades. Regardless of how we develop our views, it seems painfully clear that we need to cultivate a much more enlightened understanding of mental illness. At present, we give short shrift to the mind and its vicissitudes. "Cracking down" on persons who live with mental illness is simply another way of demonstrating a regressive, fearful mentality that provides no substantive answers to the problem of violence in society.

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