Each time we have a mass shooting in the United States, a predictable conversation emerges. Like clockwork, media outlets immediately question the “cause” of the incident and speculate on the factors that may have led up to the latest mass shooting tragedy. Inevitably, the mental health history of the perpetrator is questioned: Was he mentally ill? Had he ever been treated by a mental health professional? Could this unspeakable tragedy have been prevented by appropriate mental health treatment? These questions are frequently followed by a debate about gun control and someone, without fail, states that people with a mental illness are dangerous and should not be permitted to possess firearms. At the same time, the state of mental health treatment availability (or lack thereof) is thrust into the spotlight. The underlying message of both debates is always the same: If we had better mental health resources, treatment, and care in this country, we could significantly decrease violence, because those in poor mental health are responsible for all of the senseless violence we repeatedly see before us.
Sounds simple enough. But how accurate is that assumption? Are people with mental illness dangerous?
Although certain mental illnesses and symptoms are associated with a higher likelihood of engaging in violent behavior, contrary to popular belief, most individuals with a mental illness are not dangerous. Most violence is perpetrated by those without having been diagnosed with a major mental disorder. As a matter of empirical fact, people who suffer from a mental illness are more likely to be victims, not perpetrators, of violent crimes. Below are some other interesting research findings about the relationship between mental illness and violence:
- As mentioned above, specific illnesses and symptoms have been correlated with a higher likelihood of committing a violent act. A paranoid delusion is one such symptom. The emotional distortions and psychotic beliefs about how evil is looming can override self-control and common sense judgment about reality. A paranoid person with command hallucinations that exhort him or her to act aggressively is particularly dangerous. The more severe and enduring the individual’s paranoid symptoms, the greater the risk of violence.
- A complex relationship exists psychotic symptoms and violence. It’s worth noting, however, that close friends and family of the affected person are most likely to be victims of that violence. Individuals who are unfamiliar to the perpetrator are less likely to become victims.
- Acts of violence perpetrated by people with a mental illness are likelier to occur during periods of medication noncompliance or periods when they are not receiving any mental health treatment.
- A combination of substance use and mental illness increases the likelihood of violence. When individuals with a mental illness use substances, they are likelier to act out violently. Drug and alcohol use can exacerbate symptoms of mental illness, especially those related to psychosis.
Psychosis per se, or the diagnosis of schizophrenia or bipolar disorder alone does not predict that a person with mental illness will commit an act of violence. As I said, most are not violent. An arguably greater danger is the lack of adequate information on those in the community who are “psychosis-prone,” that is, with a tendency to distort reality and towards flights of paranoid fantasy. With subtle, sub-clinical symptoms that are “under the radar,” they’re not diagnosed with anything and don’t seek treatment of any kind (likely too distrustful of professionals.) It’s only when, for one reason or another, the paranoia intensifies and the threat, however imagined, reaches a point that it overrides self-control. That’s a danger point, as violent behavior may become a self-protective reaction. It’s why, after so many of these deadly national tragedies, those who knew are acquainted with the assailant are shocked at his deadly violence
Fanning, J. R., Berman, M. E., Mohn, R. S., & McCloskey, M. S. (2011). Perceived threat mediates the relationship between psychosis proneness and aggressive behavior. Psychiatry research, 186(2-3), 210-218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041859/