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Mental illness and misconceptions

Understand the weak link between mental illness and violent behavior

Saturday, March 18, 2000

By Rohan Ganguli, M.D.

A poll by a Columbia University researcher found that 80 percent of Americans believe that severely mentally ill individuals are more likely to commit violent crimes, that it is natural and appropriate to be afraid of someone who is mentally ill, or that former mental patients are dangerous.


Rohan Ganguli, M.D. is professor of psychiatry, pathology and health & community systems, and vice chairman & chief of clinical services, at Western Psychiatric Institute & Clinic, UPMC. He is also president of the Allegheny County Mental Health and Mental Retardation Board.


In fact, a large amount of carefully collected research data indicates a weak link between mental illness (even serious psychotic illnesses like schizophrenia) and violent behavior. These studies actually show that gender (male) and age (younger) are more strongly predictive of an individual's likelihood of becoming violent, than the presence of mental illness.

It was heartening to read Sally Kalson's March 7 Post-Gazette story in the aftermath of the tragic Wilkinsburg shootings ("Health Experts: Mental Illness Not a Valid Predictor of Violence"). The story pointed out that the constant mention of the alleged mental illness of the assailant, in the extensive news coverage of this tragedy, would only serve to fuel the public's exaggerated fears of the mentally ill.

Unfortunately, the public perception of the mentally ill as dangerous leads to stigmatization of those with these illnesses and contributes to increasing their disability and deprives them of participation in the life of the community.

Ostracism, stigmatization and persecution of the mentally ill, including severe physical abuse and even extermination, unfortunately have a long history. Today, while there are few examples of physical abuse and neglect, the severely mentally ill still continue to live marginal socially isolated lives.

A number of research studies found that the majority of the public still have difficulty accepting mentally ill people as employees, tenants, spouses or neighbors. The misconception that most mentally ill people are dangerous is clearly one of the sources of these attitudes. Other factors which influence these common stereotypes include the belief that serious disorders like schizophrenia are untreatable and that mentally illness make an individual less intelligent and less capable of reasoning like an adult.

At least one research study found that knowledge of the treatability of schizophrenia positively changed participants' attitudes toward the mentally ill and even reduced the perception of the dangerousness. Unfortunately, insurance companies are still allowed to discriminate against the mentally ill by placing strict limits and exclusions on what treatments they pay for, reinforcing the notion that mental illnesses are not the same as other medical disorders, and are less treatable.

Research also shows that media depictions of mentally ill people as violent homicidal characters has a marked influence on public attitudes and contributes to stereotyping. This can be in the context of news reports of violent acts committed by mentally ill persons, as well as fictional accounts of psychotic criminals. Since the media do not emphasize the absence of mental illness in the perpetrators of 95 percent or more of violent acts, it is hardly surprising that the public has such an exaggerated impression of the risk of violence from the mentally ill.

Stigma places obstructions to social success for patients. In addition, the attitudes of the public toward them is often internalized and results in lowered self-esteem, hopelessness and despair for sufferers. Families also suffer from stigma, and the National Alliance for the Mentally Ill has made eradication of stigma a major part of its national campaign.

A recent survey of the Pennsylvania's County Behavioral Health Directors also identified stigma as one of the biggest obstacles preventing the severely mentally ill from achieving the best quality of life possible for them. In 1989 the American Psychiatric Association dedicated their annual meeting to "Overcoming Stigma." Unfortunately all of these efforts suffer a setback when there is a media story which, rather than highlighting the rarity of violence by mentally ill people, suggests that the connection is common.

Discrimination against those with mental illness in health insurance also contributes to gaps between public perceptions and reality. A national coalition of mental health professionals, patients and families has recently come together to address alternatives to the present health insurance system to make it fairer, more compassionate and inclusive for all Americans.

The Pittsburgh Psychiatric Society has forged a coalition of professionals and consumers and will hold a public education and consciousness-raising event two weeks from today (April 1) at Pitt's Graduate School of Public Health.

A civilized society must reject old stereotypes and biases and dismantle the discrimination and stigmatization that accompany them. The media also have a responsibility to report accurately and fairly, correcting misconceptions when necessary.

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