The shootings in Tucson once again have stirred debate over whether mental illness is linked to violence.
A landmark study less than two years ago by the U.S.-based National Institute on Alcohol Abuse and Alcoholism – among 34,000 American adults – found that “the vast majority of murders in the United States have absolutely nothing to do with mental illness.”
Major depression and other forms of mental illness – such as bipolar disorder, anxiety disorders or schizophrenia – do not predict violence of the kind that unfolded in the shopping mall in Arizona.
Each of these conditions has psychological and physical effects. For example, depression is an independent risk factor for heart attack.
“People with serious mental illness, without other big risk factors, are no more violent than most other people,” lead author of the U.S. study, Dr. Eric Elbogen of the University of North Carolina School of Medicine, says. “Mental illness is not a strong predictor of violence by itself.”
So what is? The study team produced a Top 10 list:
- Younger age
- Personal history of violence
- Male gender
- History of juvenile detention
- Divorce or separation in the past year
- History of physical abuse
- Parental criminal history
- Unemployment
- Severe mental illness with substance abuse
- Being a crime victim in the past year
Mass murderers and serial killers are often found to have anti-social personalities – the fabled psychopath. But an anti-social personality, hatred, social alienation, narcissism or a lack of empathy are not mental illness. Aberrant and dangerous, sure. But not a clinically treatable illness.
Psychiatrists struggle to understand what makes a psychopath tick. The struggle goes on. These people seem to exist in an state beyond the reach of science. Some experts believe that anti-social behaviour has genetic factors.
An article published recently by the Centre for Addiction and Mental Health suggests psychopaths are born “to follow life strategies emphasizing deception, aggression, and indifference to the welfare of others.”
With that, the authors draw this critical distinction: Psychopaths do not display the “clinical deficits” associated with mental illness. These people are not mentally ill, they just are.
Violence and the word “psychotic” are often linked. Here again, fact and fiction collide. Psychosis is a mind state that can be triggered by schizophrenia but also by alcohol or drug use, brain tumours or prolonged isolation.
In a psychotic episode, the brain tricks itself into hearing voices when it is really thinking thoughts, or seeing things when it is only imagining them. Psychosis rarely triggers violence of the nature we saw in Tucson.
So here’s the point: People living with mental illness are more likely to be victims of violence than its perpetrator.
Except for one kind of violence – the inward kind.
Suicide.
The high prevalence rates of depression have made suicide a major public health problem that is present in many of the 32,000 suicides a year in the United States, and 4,000 in Canada. As a result of the depression epidemic, suicide, not homicide, is now the leading cause of violent death, according to the National Institute of Mental Health in the United States.
As the story of violence in the Arizona sunshine plays out, we shouldn’t be surprised to find out that mental illness did not pull the trigger of that gun, the kid did.
Bill Wilkerson is co-founder of the Global Business and Economic Roundtable on Addiction and Mental Health, and is mental health adviser to the RCMP.
