For many of us in the mental health field, the January 8 shooting in Tucson, Arizona was like a darker version of the movie, “Groundhog Day.” Surely we had seen this all before: the “senseless, horrific attack” on innocent persons; the “mentally disturbed young man” charged with murder; the ever-recurring polemical arguments between supporters and opponents of gun control.
While the facts are still unfolding, and the accused shooter’s motivations — Jared Lee Loughner — still unclear, the murders in Arizona have once again raised a number of troubling questions: what if any link is there between violence and mental illness? Which problems in our health care system may contribute to untreated or inadequately treated mental illness? How should we balance civil liberties — including legitimate second amendment rights — against society’s very real safety concerns, when deciding whether guns should be sold to those with a history of severe mental illness? And would the answers to these questions have made any substantial difference in the case of the Arizona shootings?
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Re: AZ shooting tragedy…We could all benefit from a little more civility when debating politics in the US. But we are missing the point if we don’t see that the real tragedy here is our society’s problems in treating the mentally ill people, who have little to no resources out there when it comes to Brain Disorders such as Schizophrenia & Psychosis. You wouldn’t wait until a person with heart disease has a heart attack to get treatment. Why do we have to wait for someone to get hurt before we treat the person with mental illness?
It is my understanding, (from news reports), that the accused killer, Jared Lee Loughner, was dismissed from the community college for bringing a gun to class. For the life of me, I cannot understand why he was only dismissed from school!
I do not disagree with any of your research or conclusions. And I am, (for the sake of full disclosure),as a history teacher, a proponent of the Second Amendment, even as I personally do not own one nor do I want one. However, this accused killer had already shown violent tendencies by bringing this gun to a place of learning — clearly an inappropriate setting and a threatening act. Statements from fellow students noted his changed behavior that was now bazaar and frightening.
So, I ask, what exactly does it take to commit a person? This person was dangerous! And responsible people were aware of his dangerous tendencies!
I personally assume that college professors and administration personal are responsible. Yet, they dropped the ball on this case by simply removing Jared Lee Loughner from school.
I cannot understand why police were not contacted. Why he was not brought to a hospital for a complete evaluation; for at least a hold to determine his state of mind. Why others were not interviewed to assess the entirety of the situation.
If these simple measures had been taken, it is *possible* that this tragedy in the making could have been prevented.
You are correct that all violence will never be prevented. But, there are times that the writing on the wall is there for all to see. All we need to do is read it.
I honestly believe this was one of those times.
Peace!
Thank you for a clear and comprehensive article about this difficult, complex subject. One thing that seems clear is that addressing the needs of the Dual Diagnosis population matters in the prevention of that portion of violent crime.
It would be interesting to be able to compare rates of violent crimes in communities that do/don’t legalize drugs and do/don’t provide good resources to this population.
How about mentioning the distinction between a mentally ill person versus a psychopath?
As the data you reviewed suggests, mentally ill people are not on the whole violent, and we are much more likely to be a danger to ourselves than to anyone else.
The ongoing claim that violent psychopaths who commit mass murders are “mentally ill” only serves to further stigmatize mental illness. Most of us would never be capable of such violence even in our very darkest moments. This distinction really needs to be brought to light in mainstream media so the public can be better informed on the topic and stop lumping us in with people who truly need to be locked away (as psychopaths, unlike people suffering mental illness, are on the whole incapable of rehabilitation).
Good article – thank you. Although I am all for gun control in general, I have one caveat about your suggestion that perhaps those who are suspended from school for reasons of mental illness should not be allowed guns: I have read that in recent times, especially after events such as lawsuits after student suicides and the Virginia Tech shooting, more schools are unjustly suspending students for any slight sign of a mental illness. For example, I read about one bipolar student who was suspended simply after exhibiting some disoriented night-time behavior after reacting badly to Ambien. Let’s not further perpetrate these injustices by saying that when universities wrongfully discriminate against students with mental illness, these should lose their second amendment rights, too.
I’m not saying that this caveat should apply in the Jared Loughner case – IMO, any mentally ill person who exhibits violent tendencies and any person, mentally ill or not, who brings a gun to class should be banned from having a gun from then onward.
I am missing one important word in this article. And in other reports on the incident. Terrorism. This guy had a background of political “activism”, he met the senator in past… attacking a political representative is definitelly a politically motivated crime.
When a white guy commits act of terrorism, we all go wondering about his mental health and his life and about our society… this is hardly ever done with Islamic terrorism… although it has also deeper causes and cannot be swept off by “well, they are evil”.
Before all the mental health debate, we need to examine our political atmosphere. Debates like these only shift the focus from uncomfortable issue (homegrown terrorism and political violence) to blame a vulnerable group. It reinforces stigma and makes it easier to abuse people who have mental illness label but never would hurt anybody.
Sunflower
I suggest you re-read the reports…according to the reports, Jared did not bring a gun to the classroom and according to reports did not purchase rthe gun until the end of November 2010. Allegedly he bought the bullets at walmart only days before the atttack.
All the “facts” are not known, or been made public.
Thank you for this article, Ron.
I understand very little about mental illness.
I do have a problem with people who want to help the situation by removing the weapon.
Anyone who wishes to do physical harm bad enough, will do physical harm.
We have all heard about countries with biological weapons, atomic weapons, and glocks. What I don’t understand about this is , if we remove the biological, atomic, or automatic weapons, the person wishing to do harm will revert to automobiles, knives,baseball bats, and eventually back to the original weapon, the rock.
We will have trouble removing all of the rocks.
More gun restrictions will only affect those who intend to abide by the laws. This man did not have intentions of abiding by the laws.
This is a result of our problems in our society.
Please do not read me as one not wishing more and better health care.
But look at the problems that caused this man to do this act and do not dwell on his choice of weapon.
Investigating the mentally ill for violence by using the DSM disorders is problematic. These “disorders” are not diseases but names given to behaviors. The authors of the DSM do not know what causes any of them thus cannot know how or if violence relates to them.
One thing that appears in cases of mass violence is Subliminal Distraction exposure. Although explained in first semester psychology most who read this don’t have a clue as to what SD exposure is. A design phenomenon since the original discovery forty years ago there is no paper or investigation of it in mental health services.
The believed to be harmless temporary episode it can cause cannot be distinguished from mental illness. Paranoia from the subliminal appreciation of threat is a common feature. That shapes how the victim perceives normal everyday occurrences.
These mass murder events seem to be sociopath meets Subliminal Distraction.
Thanks to all who have written in. We are dealing with the blizzard here in Mass., so it will be a while before I can respond substantively to the many excellent points and questions raised above. I respond directly only to signed (full name) email, as per my usual policy, but I will try to provide general information in response to all reasonable queries. Thanks for your interest and observations, all!–Best regards, Ron Pies MD
Dear Ron,
You have made so many valid, powerful and crucial points in this post, particularly regarding the mythological relationship between acts of violence and people with psychiatric diagnoses or mental illnesses.
The media, to which I belong, is perhaps more responsible for this erroneous connection than other group of people. Particularly headline-writers and editors who recognize the potential power in terms of readership/sensationalization of a “good” or grabby story.
Quite frankly, education and thoughtful discussion, like your essay here and all you write (quite frankly) is a paramount in beginning the public discourse to dispel this dangerous myth and help engender the compassion that people, like me, deserve.
There are so many people who live productive and meaningful lives with diagnoses of serious mental disorders like bipolar disorders, psychotic disorders and other emotional and psychiatric health challenges. These people are often and can be treated with a variety of medical, community health, peer support and a vast number of other therapeutic approaches.
Everyone is different and everyone needs a different and unique approach beginning with a person who will listen actively, intelligently and empathetically.
Like you.
We do not have loud, strong and credible voices that people want to hear or listen to… sadly.
So it’s so easy to blame us. To put us down. To scape goat us. History has proven this time and again. We cannot defend our positions. In particular the one which you rightly assert often has little to do with what has, indeed, been scientifically proven time and again.
More often, we (with mental, emotional and psychiatric diagnoses) are more the victims of violence than the perpetrators of it.
At the same time, I ask you, is it right, fair and accurate, for the Diagnostic and Statistical Manual of Mental Disorders to include people like Jared Lee Loughner who may have an Axis II or personality disorder, perhaps sociopathic or psychopathic personality disturbance (I do not know) that are not as treatable, not treatable at all or cannot be rehabilitated like the majority of other people, like me ~ all the rest of us ~ with our Axis 1 diagnosable mental illnesses or conditions?
This isn’t exactly what you were addressing, but it’s a question I’ve wanted to ask. Do you have a stand on this?
Every time someone says of a Jared Lee Loughner or another person who has committed a dreadful crime, an unspeakable crime, “he’s mentally ill,” or “he’s crazy” ~ to be honest, my blood begins to boil.
Why am I lumped in with him? Or them?
I cannot kill a mosquito without feeling guilty.
Just a question. Provoked by your absolutely fascinating, intriguing essay.
I thank you for writing it and stirring up these critical questions. They must be asked again and again, so people will begin to consider them and their impact on the lives of people, like me.
It’s time to change our thinking and our language.
With profound gratitude for your wisdom,
sln
This will be a common experience in the USA, that allows people to bear arms a crazy idea promoted by the gun lobby.
Hi,
Here I am again. Often my comments are one tracked sometimes, but until I see a change in policy I guess society will have to put up with my dedication.
As a guy who watched as the police carted away his wife in handcuffs after she assaulted me and stood there in utter confusion and disbelief. A woman who I had known and lived with for more then a decade and never once had a raised voice argument with. From the moment of her first week on SSRI’s she grew more and more agitated. Her behavior became more and more irrational. A switch from Zoloft to Prozac only made matters worse. I no longer knew the mind that inhabited her body.
These drugs that warn of possible episodes of mania. Symptoms of mania include: “Sudden changes from being joyful to being irritable, angry, and hostile Restlessness, increased energy, and less need for sleep, Racing thoughts, Tendency to make grand and unattainable plans, Tendency to show poor judgment, such as deciding to quit a job,
Inflated self-esteem or grandiosity — unrealistic beliefs in one’s ability, intelligence, and powers; may be delusional, Increased reckless behaviors (Some people with bipolar disorder become psychotic, hearing things that aren’t there. They may hold onto false beliefs, and cannot be swayed from them. In some instances, they see themselves as having superhuman skills and powers — even consider themselves to be god-like.”
How many of these incident such as Andrea Yates, Choe, Nidal Malik Hasan, Seung-Hui Cho, Susan Smith, OJ, Eric Harris, Chris Benoit, and so many other lesser known all seem to have “antidepressants” in their systems. So many times the family members saying, “I don’t know what happened, this is not them.” When are we going to stop creating these monsters then sit around and wonder where they came from?
Sage,
Please note, I did not state that he brought the same gun to the classroom that he used to perpetrate the mass murders. However, I did hear on *multiple* television reports that he did bring a gun to his community college. And that this incident was the “straw that broke the camels back,” for the college. It was this incident that caused the college to suspend him. I’m sorry if I did not make that clear in my statement above.
I will say that now, when I listen to the news reports, I am not hearing that same thing. All I am hearing today is “many disturbing incidences” by Jared Lee Loughner caused the college to suspend him. The same news networks are now no longer mentioning the gun incident. (And I do not listen to Fox! LOL!)
So, was there a problem with the original reports? Or is there someone protecting the college now? Or, is there some other explanation that I cannot think of now? I cannot say. I only wrote what I heard on the news…
Peace!
Peace!
I’d like to thank everybody who took the time to comment on my article, and particularly
Sandy Naiman and Therese Borchard, whose helpful blogs and opinions I consult periodically. Also
thanks to all who provided their complete names when writing in–something I am encouraging for
all online postings. Given the numerous issues raised in these comments, I will need to be brief
in my responses, and I appreciate your understanding.
Re: “what exactly does it take to commit a person…why he was not brought to a hospital…”
Laws regarding involuntary commitment vary considerably from state to state.Generally speaking, they require a person to be a “danger to self or others” by reason of a psychiatric condition. Arizona has such a commitment law, but Mr. Loughner was never seen (so far as we know) by
anyone with the authority to make this determination, as Dr. Grohol pointed out in his ownarticle on this website. According to recent reporting on CNN,
“Interviews with friends and former teachers and classmates provide a glimpse of how [Loughner] appeared in public – a little off, but not necessarily threatening. Background checks reveal brushes with the law that alone did not set off any alarm bells, a law enforcement official told CNN…On their own, the incidents prompted
as much action as school officials or law enforcement felt necessary, given the
circumstances.”
Re: “needs of the Dual Diagnosis population matters”
Yes, indeed. I think that the issue of substance abuse is probably the most important in this
entire area of violence and mental illness. Basically, if the substance abuse factor is elim-
inated, the risk of violence almost fades away, even in the presence of a major psychiatric
disorder. See, in this regard, the recent study by Fazel et al (http://www.ncbi.nlm.nih.gov/
pubmed/19668362)
Re: “distinction between a mentally ill person versus a psychopath” “claim that violent
psychopaths who commit mass murders are “mentally ill” only serves to further stigmatize
mental illness”
I agree that the general public lacks any substantial understanding of the difference
between a “psychopath” and someone with, for example, schizophrenia or bipolar disorder;
and that (as Sandy Naiman notes), the public tends to lump together everybody with a
“mental illness”. There is, however, controversy as to whether “psychopaths” should be
considered “mentally ill”. This comes up all the time in discussions of genocidal killers,
like Hitler or Pol Pot. It is generally agreed that psychopaths are not delusional or
“insane” in the usual sense of that term (being out of touch with reality). Essentially,
psychopaths lack what moral theorists would call a “conscience”. This is entirely different
from individuals with major depression, schizophrenia, bipolar disorder, anxiety disorders, and even most of the personality disorders. In fact, many persons with these conditions are are burdened by, if anything, an excessive amount of “conscience”, often blaming themselves for things that are not their fault at all. The general public really doesn’t “get” these
distinctions, and we in the mental health field have not done nearly enough to educate the
public in such matters.
Re: “suspending students for any slight sign of a mental illness”
I agree that students should not be denied the ordinary rights of any citizen, under the
second amendment, simply because they were suspended from school or college for “mental health issues” or problems. I do think that students suspended for violent or aggressive behavior, or for making threats to others, ought to be referred for mental health treatment, and in some severe cases, compelled to receive outpatient or inpatient treatment. I would also provide the names of such students to the NICS (National Instant Check System)to prevent them from acquiring guns.
Re: “Terrorism. This guy had a background of political “activism”…
It is very hard to define “terrorism”, but certainly, the presence of a serious mental illness does not preclude a political motive that involves the wish to induce fear or terror in
others. On the other hand, the evidence regarding most persons identified as terrorists (e.g., members of Al-Qaeda) suggests that they are not psychiatrically “ill” or psychotic.
Re:
“Anyone who wishes to do physical harm bad enough, will do physical harm…More gun restrictions will only affect those who intend to abide by the laws…”
I agree that someone who is pathologically or psychotically intent on doing harm is
likely, eventually, to do so (if they don’t
get treatment), using whatever means is available. But that does not make it
senseless or useless to have laws governing the production and sale of lethal weapons, any more than restricting speed on the highway is senseless because “only those who intend to abide by the law” will obey. For example, limiting the size of “clips” for handguns may not prevent a disturbed person from shooting someone, but it may make it more difficult for that person to fire off 30 shots in a few seconds. For more on rational gun control laws, I would strongly recommend reading the Op-Ed by Nicholas Kristoff in the NY Times from January 13
(see http://www.nytimes.com/2011/01/13/opinion/13kristof.html?_r=1&ref=todayspaper)
LK Tucker: Investigating the mentally ill for violence by using the DSM disorders is
problematic. These “disorders” are not diseases but names given to behaviors. The
authors of the DSM do not know what causes any of them thus cannot know how or if
violence relates to them. …One thing that appears in cases of mass violence is Subliminal
Distraction exposure…Paranoia from the subliminal appreciation of threat.”
I agree that the DSM categories are not “diseases” in the sense that, say, tuberculosis is
a disease. But they are more than just “names given to behaviors”. The major psychiatric
disorders(schizophrenia, bipolar disorder, major depression) are syndromes (constellations of
signs and symptoms) that–to varying degrees–have familial, genetic, and sometimes associated biochemical “markers”, as well as typical courses of illness and response to treatment. We do know how conditions called “psychoses” relate to violence: psychosis is clearly linked with acts of violence, but most of this effect is accounted for by the presence of concomitant substance abuse, as well as non-diagnostic factors, such as a history of physical abuse [see the Elbogen paper I cite in my article]. Rates of violence among those with psychosis and substance abuse are higher than rates in the general population, but not markedly higher than rates seen in substance abuse alone.
I am not familiar with “subliminal distraction”, but my search in the medical and scientific literature turned up no well-designed studies demonstrating the role of this supposed phenomenon in any psychiatric disorder.
from Sandy Naiman:
“…so many people who live productive and meaningful lives with diagnoses of serious mental
disorders…These people are often and can be treated with a variety of medical, community health, peer support and a vast number of other therapeutic approaches..is it right,
fair and accurate, for the Diagnostic and Statistical Manual of Mental Disorders to include
people like Jared Lee Loughner who may have an Axis II or personality disorder, perhaps
sociopathic or psychopathic personality disturbance (I do not know) that are not as treatable, not treatable at all or cannot be rehabilitated like the majority of other people, like me…”
I agree wholeheartedly, Sandy! Most individuals with serious psychiatric disorders are “solid
citizens” just trying to do their best, and are not violent or predatory in the way that
psychopaths often are. It is unfortunate, as I indicated above, that my profession has not
made these distinctions clearer to the general public.
Re: “possible episodes of mania. Symptoms of mania include: “Sudden changes from being joyful to being irritable, angry, and hostile…” “antidepressants” in their systems…”
I agree that in certain susceptible persons, antidepressants may (very rarely) lead to erratic
behavior, and that antidepressants may sometimes trigger manic episodes in a subset of persons
with bipolar disorder. However, I do not believe that a causal link between antidepressant use and
extreme violence has been demonstrated with any degree of confidence. Merely finding that a violent person was using antidepressants is not sufficient to establish the medication as causal. In any case, there is no evidence whatsoever (that I am aware of)that Loughlin was taking
an antidepressant or any psychiatric medications–or that he even had any contact with
the mental health system.
Sincerely, Ronald Pies MD
Corrections: make that “Loughner”, not Loughlin. Also, my statement should have said,
“Most individuals with serious psychiatric disorders are “solid citizens” just trying to do their best, and are not violent or predatory in any way.”
–Ron Pies MD
I am just beginning to learn about psychology. Im attending college and although I still have lots to learn, I like to ponder on things and find the root of the problems. Not sure if I’m correct on doing this or not but it helps me to understand things.
…My question/comment is:
Can mental illnesses be “prevented” with better parenting skills?
I mean, it is my theory that people who grew up with no good role models/parents, grow up to be violent because of fear and distrust of others.?
I have seen this in my own family. …or maybe I’m missing something. But my parents are uneducated and have personal issues. Because of that they weren’t able to be the good role models we needed. As I have learned in my first course of psychology, behavior is learned. My brothers learned to disrespect the law…to break it. …out of obedience to my dad. One of my brothers learned to reject other racist because he saw that from my dad. My brothers hit their wifes because my mother would violently “disciplined” us. And so on and so on… My brothers and I have grown up to have mental illnesses because of my parents unreadiness to be positive role models because their parents were unready and their parents and so on and so on.
And all that stops when one take responsibility of their own actions and desires to better them self’s…maybe because somewhere along their lives, they were inspired by someone or something to do so.
I grew up to hurt my first child the same way and my brothers hurt their kids…unconsciously but we hurt them because that is what we learned…how we were mentally affected.
Same goes for this guy or any other person who leads to killing or hurting anyone else in any other way. …At least this is my theory. I still have lots to learn and discover. But my point is that maybe it isn’t a health care problem or a college problem or whoever else at least indirectly that is. Maybe we need to target better education in parenting skills. Instill in people …in kids (our future generations) to be kind hearted positive citizen.
I’m not sure how to better explain this but what I’m saying is that maybe we wouldn’t have to deal with this kinds of situations if we would raise mentally and emotionally healthy kids to grow up and help others and not hurt them self’s or others.???
Estela, we need more like you in the field who are willing to look at the environments some of these children are living in. One of the things that stood out to me rather quickly in the child psych ward was that most of the homes (there were rare exceptions) these children came from were very dysfunctional, yet nobody seemed to be acknowledging that. Much easier to blame bipolar disorder than it is to address family problems.
If the fear of being sued is truly a reason for no one being more assertive in getting help for this young man, I’d like to offer a low cost solution:
Lets amend our “Good Samaritan” laws (which were put in place to protect those who stop and help accident victims), to also cover well-intentioned citizens who intervene in such cases.
The article stated:
The study revealed 6 homicides committed by 3 of the 951 discharged patients — thus, approximately 0.3% (3 in 951) of the released population were homicidal or committed acts of lethal violence.
3 of the 951 is 3% NOT 0.3%. 3% is a lot.
Thanks to those who just wrote in on this critical issue. I certainly agree that examining the home and family environment is very important in understanding how violent behavior may occur. For example, when children are physically abused, they often “learn” that behavior and repeat it with their own children. At the same time, we need to be careful not to blame parents for “bad parenting” when serious illnesses, such as schizophrenia, develop in a child. These disorders probably arise through a very complicated interaction of genetic, biochemical,
environmental, and socio-cultural factors. When effectively treated–and when not complicated by substance abuse–psychiatric disorders themselves are rarely associated with extreme violence. By the way, I think those of you who check my math will find that, indeed, the rate of homicide in the MacArthur study was approximately 0.3%–that’s roughly three-tenths cases per 100 discharged patients, or about 3 in 1000. –Best regards, Ron Pies MD
The MacArthur study dealt with people who had been discharged, meaning they got treatment. Have there been any studies of violence rates in those who are mentally ill and had no treatment?
A very good question: I am researching this and will respond ASAP. From a clinical standpoint, most of us in the profession would probably assert that violence rates rise in the absence of adequate treatment of severe psychiatric disorders, but I’ll look into the hard data.
–Best, Ron Pies MD
Re: the effects of treatment:
Controlling for age, gender, race, education, marital status, substance use, diagnosis,
and prior violence: the MacArthur study found that, within the 2nd 10 weeks after discharge,
violence of any kind occurred in 14% of discharged psychiatric patients who did not attend outpatient therapy; in 9.5% of those who went to treatment once per month; and in 2.9% of those who went once per week. The comparison rate of violence for the community was 4.6%. Thus, the
“no treatment” discharged patients had a “violence” rate of about 3 times that of the
comparison group in the general community; whereas those who had at least one
treatment session per week actually had a lower rate of violence than that of the general community.
The take-home message from my perspective: left untreated, severe mental illness (requiring
hospitalization) is associated with increased risk
of violence; when treated weekly, the risk actually drops to below the average in the
surrounding community. The caveat here is that subjects were not randomized for study,
so we can’t be assured that those with equally severe pathology were being compared
from group to group. Also, violence in the surrounding community may differ from region
to region in the U.S. [Source: Dr. John Monahan, lead author of the MacArthur study; personal
communication, 1/21/11]
I don’t think the MacArthur study really answered Gardendmpls question, though. Even those who were discharged and did not have further treatment, had been in the hospital so they had previously received treatment. Maybe the higher rates of violence had to do with abrupt withdrawal off psych meds. Maybe the higher rates of violence had to do with the rage over being forcibly detained. I don’t think you can make the leap that treatment improves outcomes without looking at some of those other issues.
The question that Gardendmpls raised makes me wonder what the rates of violence are in those who have never received ANY treatment. That would be an interesting comparison.
The question raised above is a good one, and not one easily answered with the existing data, according to Dr. John Monahan. The ultimate test required to answer the question might be deemed “unethical” by many research review boards,
nowadays; i.e., do a randomized, controlled comparison between two groups of severely ill psychiatric patients: one with treatment, one with no treatment, and measure rates of violence over X months. One could look at subgroups treated with pharmacotherapy, psychotherapy, both, and no treatment. This will probably
never be done, I would guess, since depriving subjects of treatment for severe psychiatric disorders is ethically questionable.
Nonetheless, some data regarding adherence to pharmacotherapy is provided by an NIMH-sponsored study by Swanson et al (The British Journal of Psychiatry (2008) 193, 37–43.). This study compared antipsychotic medications in reducing violence among patients with schizophrenia over 6 months. Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications.There was no placebo group, for reasons given. The estimated rate of violence at the end of 6 months decline from 19% to 14% in the intention-to-treat sample (subjects who didn’t stick with the treatment), whereas the observed rate declined from 16% to 9% in the retained sample. The proportional magnitude of decline in violence was substantially greater in the retained sample than in the intention-to-treat sample (43% v. 27% decline). However, adherence to medications reduced violence only in patients without a history of childhood conduct problems.
Several significant prospective predictors of violence emerged: economic deprivation, living with family or unrelated others v. living alone,
history of childhood conduct problems, substance use or misuse/ dependence and history of violent victimisation.
The authors concluded that, “…for patients with many developmental, social and environmental risk factors, even optimal pharmacotherapy might not reduce violent behavior; pharmacotherapy alone cannot be expected to mitigate essentially
non-clinical causes of violence.”
In short, we have some data suggesting that outpatient treatment and pharmacotherapy can help
reduce violence in a subset of patients with
serious psychiatric illness; but the jury is still out in terms of rigorous, controlled studies. For those of us who have spent our careers treating patients with such serious
illnesses, however, there is little question that
treatment can be critical in maintaining the person’s health, well-being, and non-violent
behavior. Finally, I would repeat the point that the vast majority of patients with psychiatric disorders do not engage in violence.–R. Pies MD