| Recovery to Practice Special
Feature |
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One
Response to One Reaction to the Newtown Tragedy
by Larry
Davidson, Ph.D. |
While
the country argues over stricter gun control
legislation proposed by the president, mental
health providers, along with persons with mental
health conditions and their loved ones, continue
to be in the position of having to respond to how
some people in broader society have reacted to the
tragedy in Newtown, Connecticut. Although much of
the country has been compassionate and thoughtful,
there have also been media reports, talk shows,
op-eds, blogs, and other media outlets replete
with highly offensive and stigmatizing references
to persons with mental illnesses—in which the mass
shootings that unfortunately seem to be becoming a
not-so-rare part of American culture are blamed
(inexplicably) on "the mentally ill." The use of
terms such as "monsters," "mental defects," and
"madmen" is not only based on grave
misunderstanding of mental illness and extremely
hurtful to tens of millions of Americans who are
working hard at their recovery; it also does
nothing to explain the loss of 28 lives in Newtown
on December 14. More important, perhaps, it does
nothing to prevent such horrors from occurring
again in the future.
Many of us would like
to simply dismiss such false and destructive myths
and sever the erroneous connections made between
mental illness and violence completely. But for
those practitioners, persons in recovery, and
family members who feel they are in a position of
having to respond to these damaging attitudes and
beliefs, we offer the following facts and
considerations.
Let's start with the
facts. According to the Institute of Medicine
(IOM), "Although studies suggest a link between
mental illnesses and violence, the contribution of
people with mental illnesses to overall rates of
violence is small, and further, the magnitude of
the relationship is greatly exaggerated in the
minds of the general population" (IOM, 2006). In
fact, according to the MacArthur Study of Mental
Disorder and Violence—the most rigorous scientific
study conducted to date by the country's leading
experts on mental illness and violence—the
contribution to violence made by persons with
mental illness is no larger than the contribution
made by persons who do not have a mental illness
(Monahan et al., 2001), with other demographic and
socioeconomic factors contributing much more than
mental illness. The subgroup most at risk for
committing violent acts is actually young and
single working-class white males. Within
behavioral health, broadly, active substance use
does contribute to violence. But within mental
health, schizophrenia (the condition most alluded
to by people who characterize "the mentally ill"
as violent) contributes least to violence among
the major illnesses. As summarized by Stuart
(2003):
"The prevalence of violence among
those with a major mental disorder who did not
abuse substances was indistinguishable from
their non-substance abusing neighborhood
controls … those with schizophrenia had the
lowest occurrence of violence over the course of
the year (14.8 percent), compared to those with
a bipolar disorder (22.0 percent) or major
depression (28.5 percent)."
Not
only does mental illness contribute little to
violence (estimated to be around 4 percent);
persons with mental illnesses are generally much
more at risk for being victims of
violence than being perpetrators (Appleby,
Mortensen, Dunn, & Hiroeh, 2001). Here the
data are quite striking. Studies have consistently
found that "people with severe mental illnesses …
are 2 ½ times more likely to be attacked, raped,
or mugged than the general population" (Hiday,
1999). In addition, "individuals with
schizophrenia living in the community are at least
14 times more likely to be victims of a violent
crime than to be arrested for one" (Brekke,
Prindle, Bae, & Long, 2001). Despite the
highly consistent findings that persons with
mental illnesses are much likelier to be
victimized by others than to hurt them, there have
been 13 times as many articles on the
violence presumably perpetrated by persons with
mental illnesses as there have been on crime
victimization among persons with mental illnesses.
In the face of the atrocity committed in
Newtown, these facts unfortunately do little to
persuade many people that mental illness is not
the culprit. They want somebody and something to
blame, and have a hard time believing a person
could act in such a heinous way without being out
of touch with reality. Confronted with so many
deaths, especially of children, appealing to
science may be seen as cold and heartless. What,
then, should we do? Below are a few
considerations—some based on research, others on
experience—that may be useful in moving the
discussion in a more constructive direction.
- Point out that mental illnesses are much
more common than stereotypes suggest, with one
in five Americans experiencing a mental health
disorder during his or her lifetime. Were
Congress to pass new laws that affect persons
with mental illnesses, these would apply to one
fifth of the American population, or roughly
60,000,000 Americans. These laws would affect at
least one in two American families.
- Personalize the issue by disclosing you have
a mental illness (if you do) or know and care
about people who have mental illnesses—whether
they are loved ones, friends, coworkers, or the
people you serve. Point out visible examples of
people who have, or have had, mental illnesses
who have made important contributions to our
society—from Abraham Lincoln to Beethoven and
Mozart to Paul Wellstone, William Styron, Kate
Jamison, Robin Williams, Billy Joel, and Alma
Powell, to more recent figures such as teen idol
Demi Lovato, rapper DMX, and soccer legend David
Beckham. Although most people with mental
illnesses will not become such public figures,
they are more likely to succeed in politics,
write stirring music or fluid prose, or become
an accomplished actor or athlete than they are
to hurt anyone.
- Educate people about the "real problem"
associated with mental illness today—that so few
people can or choose to access effective care
for their condition, leading to unnecessary
suffering on the part of the person and his or
her loved ones (rarely on the part of the
community) as well as lost productivity. Because
mental health care has yet to be adequately
funded in this country (the money never followed
patients out of state hospitals, and our society
has not viewed mental illnesses as illnesses for
which effective treatments exist), very few
people can access care. This travesty will
hopefully be redressed through the combination
of parity legislation passed in 2008 and
provisions of the Affordable Care Act passed in
2010 (i.e., by mandating states include adequate
coverage for behavioral health conditions in all
benefits packages). At the present time,
high-quality, effective mental health care
remains difficult to access in most parts of the
country, and impossible to access in some.
Additionally, even when care is
available, many people choose not to access that
care, precisely because of the pervasive
societal attitudes and beliefs about mental
illness we criticized above. Many people choose
not to access mental health care or follow
through with outpatient care once discharged
from a hospital because they do not see
themselves as "mental defects" or "madmen"—nor
do they want to. Rather than being a justified
approach based on accurate information, societal
responses that view persons with mental
illnesses as dangerous and unpredictable
accomplish exactly the opposite of what they
intend. They drive people in need away from the
care that would be effective in addressing their
concerns.
No one would willingly choose
to adopt the label and identity of a "mental
patient" or "crazy person." This is why it
requires considerable courage for people to seek
mental health care in the first place. One
recent consequence of these attitudes is the
startling statistic mentioned in our Jan. 10 RTP Highlight:
more American soldiers died from suicide in the
previous year than from combat in Afghanistan.
Painting misguided and offensive pictures of
mental illness only fortifies the barriers that
already exist and keep people from getting the
care that is available. If we want to decrease
the actual burden that mental illnesses impose
on our country, we should disseminate accurate
information to the public and offer fact-based
education to our youths on as broad a scale as
possible. We should make role models of recovery
as visible and accessible to as many people as
possible, infusing the mental health
workforce—and general workforce—with persons who
embody the reality of recovery. And we should
invite, rather than coerce, people into care
that is respectful and responsive to their
needs, so they need not suffer in silence and
alone, and so using mental health care need no
longer be something to be ashamed of.
A
final consideration has to do with the issue of
"insight." We addressed this issue at length in
the Feb. 6 Special Feature.
In the context of current debates about mental
health policy, we would like to point out that
there are many reasons why some people with mental
illnesses choose not to participate in care or
take psychiatric medications. The stigma and
stereotypes that surround mental health care are
at least as prominent a reason for not accessing
care or taking medications as the reason for
lacking "insight" into having such an illness. No
one is born knowing what mental illnesses are or
how to know or recognize when one begins to
experience symptoms associated with having one.
How, then, can a person develop such "insight"? If
the only things people are taught about mental
illnesses are the negative and insulting
stereotypes described above, we can assume many
people will continue not to have "insight" when
they begin to experience the symptoms of a mental
illness. From their perspective, they are not
"crazy" or "insane" … they are not "mental
defects" or "madmen"—so they could not possibly
have a mental illness. They are, after all, just
like you and me (because they are,
after all, you and me).
If we truly want
people to recognize and gain insight into having a
mental illness when they begin to experience the
symptoms of one, we need to dispel these
fallacious and off-putting myths. We need to
educate the public and youths in particular about
what mental illnesses are, including how common
they are (e.g., one in five Americans will have
one), that effective treatments are available,
and, importantly, how possible it is to recover.
Then we can turn our attention to the isolation,
rejection, alienation, silent suffering, and
culture of violence that truly underlie such
atrocities.
Dr. Davidson is the RTP
Project Director.
References
Appleby, L., Mortensen, P.B., Dunn, G., &
Hiroeh, U. (2001). Death by homicide, suicide, and
other unnatural causes in people with mental
illness: A population-based study. The Lancet,
358, 2110–12.
Brekke, J.S., Prindle,
C., Bae, S.W., & Long, J.D. (2001). Risks for
individuals with schizophrenia who are living in
the community. Psychiatric Services, 52,
1358–66.
Hiday, V.A. (2006). Putting
community risk in perspective: A look at
correlations, causes and controls.
International Journal of Law and Psychiatry,
29, 316–31.
Institute of Medicine.
(2006). Improving the quality of health care
for mental and substance-use conditions.
Washington, D.C.: Institute of Medicine.
Monahan, J., Steadman, H., Silver, E.,
Appelbaum, P., Robbins, P., Mulvey, E., Roth, L.,
Grisso, T., & Banks, S. (2001). Risk
assessment: The MacArthur Study of Mental Disorder
and Violence. Oxford: Oxford University Press.
Stuart, H. (2003). Violence and mental
illness: An overview. World Psychiatry,
2(2), 121–24. |
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| We
welcome your views, comments, suggestions, and
inquiries. For more information on this topic or
any other recovery topic, please contact RTP at
877.584.8535 or email recoveryt...@dsgonline.com.
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| The
views, opinions, and content of this Special
Feature are those of the author, and do not
necessarily reflect the views, opinions, or
policies of SAMHSA or the U.S. Department of
Health and Human Services. |
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