Recent shootings in the news bring up the recurring question of what leads people to commit these dramatic acts of violence. Surveys show that about 75% of the public believe that mental illness causes violence. A national study of the relationship between mental illness and violence has been done to examine whether this is true. The study tried to separate out the factors of mental illness alone, mental illness with drug or alcohol abuse, and mental illness with a prior history of violent acts. There was no elevated level of violence in people suffering with major depression, bipolar disorder or schizophrenia alone. The risk was elevated if they were also abusing drugs and alcohol and/or if they had a pre-existing history of violence. If all three of these elements were present the risk of dangerousness was elevated by a factor of ten! What are other factors that contribute to risk of violence? Childhood physical abuse, humiliation, losses such as divorce and unemployment, and parents with criminal behavior are some examples.
As a psychiatrist, one of the most difficult things I have to do is to attempt to determine whether someone is dangerous to others. Outside of my professional role, like other members of society, I have to struggle with the media reports of these horrific shootings and to wonder what leads people to these desperate and destructive acts. It is seems simple to attribute violence to mental illness but the reality is far from simple. The vast majority of people who have been my patients over the years have not been violent. My patients have suffered from stigma because they are depressed or anxious or just in need of some therapy to talk through difficult times. They have felt that society sees them as “crazy” and maybe dangerous. What is really dangerous in my opinion is if stigma prevents people who need therapy or medication from coming in for treatment.
