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Mentally ill no more likely to be violent than anyone else

Sunday, May 07, 2000

By Anita Srikameswaran, Post-Gazette Staff Writer

Correction/Clarification: (Published May 9, 2000) Experts estimate that 0.7 percent of the population will suffer from schizophrenia over a lifetime. A story about mental illness and violence in Sunday’s editions incorrectly cited a figure 10 times higher.

Only rarely are violent acts committed by people who are mentally ill.

It's a message that has been emphasized for years -- but each time there is a deadly shooting spree, such as the recent ones for which Ronald Taylor of Wilkinsburg and Richard Baumhammers of Mt. Lebanon have been charged, many people are inherently skeptical of that assertion.

Still, experts insist that large studies support the idea that mentally ill people are no more likely to commit violent acts than anyone else, and in fact may not commit them as often as would be expected from their proportion of the population.

One of the key studies that supports that idea was done partly in Pittsburgh.

The MacArthur Violence Risk Assessment Study compared more than 1,000 people with mental disorders to 500 well people who lived in the same neighborhoods. Participants were enrolled in Kansas City, Mo.; Worcester, Mass.; and Pittsburgh.

In a May 1998 report published in the Archives of General Psychiatry, researchers examined data gathered in Pittsburgh and found that violence rates were indistinguishable between mental patients and their well neighbors.

Other studies have estimated that about 3 percent of all the violence that occurs around the country can be attributed to mental illness, said Dr. Paul Appelbaum, a forensic psychiatrist at the University of Massachusetts at Worcester who is also an investigator in the MacArthur project.

"Even then, it's not clear that it's the mental disorder that makes them violent, as opposed to environmental circumstances or personality traits of the individual," he added.

If that figure is accurate, it means that mentally ill people are less likely to commit violence than would be predicted by their general proportion of the population.

Major surveys have estimated that about 0.7 percent of the people in the United States will suffer from schizophrenia at some point during their lifetimes, and that 20 percent of the population will experience an identifiable mental disorder of some type within any 12-month period.

Appelbaum said the MacArthur data also has been used to examine the relationship between delusions and risk for violence.

Delusions are false beliefs that remain unchanged despite proof to the contrary, such as a conviction that anyone wearing a baseball cap is trying to kill you. Hallucinations are false perceptions, such as hearing voices or seeing things that aren't there. Both are key features of psychosis, which can be defined as a disconnection from reality.

One might surmise that a person who has delusions is more likely to be violent than a well person.

But regardless of their content, "delusions did not predict a higher rate of violent behavior," Appelbaum said. "Violence was more likely to be associated with high levels of anger and high degrees of impulsiveness than it was with delusions."

There is one factor that does seem to increase the risk of violence by a mentally ill person -- drug or alcohol abuse, said Edward Mulvey, one of the study investigators and a psychiatry professor at the University of Pittsburgh.

One man who can attest to that is Philadelphia resident Jay Centifanti, a Harvard University business and law school graduate who is now an advocate for the mentally ill.

Centifanti became infamous in his hometown in August 1975, when he followed his estranged wife and her male friend onto a Philadelphia commuter train. In front of many witnesses, Centifanti fired five .38-caliber bullets into his wife and then forced the couple to jump from the moving train. He jumped from the train, then hid from police for a month before finally turning himself in.

All that time, he said, he saw in his mind's eye a display board with scrolling neon messages: "Kill," "Let her live," and then finally, "Surrender."

"I had command hallucinations telling me to do my crime," Centifanti said. "I remember all of them. There were 16."

His wife survived, and he pleaded guilty but mentally ill to two counts of aggravated assault. During his 21/2-year stay at Norristown State Hospital, Centifanti was diagnosed with bipolar disorder, also known as manic-depressive illness.

Since he has been freed, he has fought to get his law license reinstated.

And while he is open in talking about his hallucinations and mental disorder at the time he shot his wife, he believes that the real culprit for his actions was his drinking problem, which he said began partly as a way to "medicate" himself to deal with his manic-depressive symptoms.

"In my case, I had lost my wife. She had had enough of my alcoholism," he said. "I lost my kids, I lost my house, the law firm fired me. There were all kinds of pressures that fed into my bipolar illness."

In the two recent killing sprees, Taylor, who is black, is accused of killing white males, and Baumhammers, who is white, is accused of killing a Jewish woman and four men, an Indian, a Chinese, a Vietnamese and an African American.

That raises the related question of whether the two men's purported hatred of certain types of people was a product of their mental disorders.

Even if some mentally ill people hate certain ethnic or racial groups, that prejudice is not in and of itself a sign of mental illness, said Dr. Rohan Ganguli, chief of clinical services at Western Psychiatric Institute and Clinic.

"There's lots of people out there who have delusions about various things, but they don't have hate toward other specific groups."

A recent analysis in the New York Times examined the relationship of mental illness to homicide in "rampage" killings, which the newspaper defined as a crime having multiple victims and at least one fatality that occurred in a short span of time and in a place where people gather.

The reporters found 102 such killers in their search of newspaper clippings and scientific articles from all 50 states, and counted 435 people killed and 510 injured by those attackers.

Of the cases examined, 47 killers -- about half -- had a history of mental health problems, 42 had been seen by a mental health professional, 24 had been prescribed psychiatric drugs, 14 were not taking the prescribed drugs, 20 had undergone a previous psychiatric hospitalization, 26 had tried or thought of suicide and 49 had exhibited paranoid talk.

The trouble with the findings, said Ganguli, is, "there are literally thousands of people who meet that profile but who will never commit any violent act. What are you going to do? Because one in a thousand is going to do it, will you essentially deprive the other 999 people of their liberty or freedom?"

And Pitt's Mulvey doesn't accept at face value that nearly half of the rampage killers had mental health problems. "I don't know what standard they used to determine that. I don't know what they mean by that."

The real challenge, Mulvey said, is finding out, "What is it that moves somebody beyond that level of just thinking about it or fixating on it and actually taking an action?"

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