Facts on Violence/Psychiatric Diagnosis

By Sera Davidow

When something terrifying and tragic happens, people want answers. When they want answers, they naturally turn to those seen as being ‘in charge’. Inevitably, those seen as being ‘in charge’ (understandably) feel pressed to ‘do something’. Unfortunately, that pressure can lead those people to ‘do something’ more for the sake of the doing and to settle the public’s nerves, than because it will actually alleviate the problem at hand. In fact, all too often, those actions make the problem worse.

The Helping Families in Crisis Act (H.R. 2646 – also known as the Murphy Bill) is one such action that threatens to send us tumbling down a rabbit hole of extremely costly and regressive policies and protocols. While problematic on many levels, one clear issue is its contribution to the conflation of gun violence and psychiatric diagnosis.

There are several problems with the practice of linking gun violence to psychiatric diagnosis, the most obvious of which include:

There is no actual link between gun violence and psychiatric diagnosis: Most of us have now heard the phrase, “People with psychiatric diagnoses are more likely to be victims of violence than perpetrators.” It’s hard to hang on to that fact with the media (both news and entertainment outlets) consistently painting such a different picture, but it’s nonetheless true.

In fact, every significant research study since Macarthur (1998) has suggested that people who have been given psychiatric diagnoses are no more likely than their matched controls (individuals with no psychiatric diagnosis) to commit violence in the community. (See also the National Coalition on Mental Health Recovery’s fact sheet on mental health and violence: http://www.ncmhr.org/downloads/Research-on%20people-with-mental-health-diagnoses-and-violence%204-16-2014.pdf)

Co-existence of gun violence and psychiatric diagnosis is not proof of a causal link: In other words, the presence of a psychiatric diagnosis in someone who has committed gun violence may be completely and utterly unrelated (or, at least, not a primary motivating factor) to their actions in a given situation.

In theory, one could do a study of any two characteristics or qualities and measure them up against violent acts. For example, how many people who commit gun violence have brown hair, or have worked at a fast food restaurant at some point in their life? Any trend identified could mean there’s a real relationship between the two. Or, it could be that those qualities are actually linked to yet another factor that is the real predictor, or merely evidence of the prevalence of brown hair or the likelihood of holding a fast food job at some point in one’s life.

Given the growing frequency by which psychiatric diagnoses are doled out, it should be none too surprising that some people who commit violent acts also fit this category. However, a growing body of research indicates that causal links have been identified between violence and substance abuse, but not particularly with mental health. (Fazel, et al, 2009.)

There is no evidence that the ‘go to’ interventions proposed by legislation like the Murphy Bill would have stopped most of the recent gun violence: Proponents of restrictive and regressive mental health legislation are quick to capitalize on tragedy, and even to bus in distraught family members and victims of violence to testify about the horrors they’ve been through, pulling on the heartstrings of all in hearing range. Their stories are valid and they have every right to be sharing them. But what aren’t we being told?

Rarely is anyone asked to clearly explain how regressive mental health laws would have changed what happened. At best, broad and sweeping statements are made with little or no supporting evidence.

There is a reason for this: In so many cases, it wouldn’t have changed a thing. Why? Most such mental health policies focus on getting (or forcing) people into services, but in many instances held up as example, the person in question was already in treatment.

At least one individual in question (Cho, 2007) was already ordered into forced outpatient treatment (a particularly controversial and force-laden measure that Representative Tim Murphy emphasizes in all of his proposed legislation) before he engaged in a mass shooting.

There is evidence that the ‘go to’ interventions proposed by legislation like the Murphy Bill will have no impact on gun violence, or could even make it worse: There is currently no well-founded research to suggest that measures like outpatient commitment laws are effective at reducing hospitalization or violence, especially when separated out from the impact of an influx of quality services that are voluntary. Meanwhile, there are a growing number of studies suggesting that conventional interventions like psychiatric medication can make manifestations associated with psychiatric diagnosis worse over time, and can even increase the risk of violence.

For example, one long-term study (Harrow, 2011) of people diagnosed as psychotic found that medicated individuals had significantly worse outcomes in every area observed including anxiety, cognitive function, and what were seen as psychotic symptoms.

Few would disagree that the mental health system is broken, but why would we want to invest more dollars in blindly emphasizing (and even forcing) treatments that at least appear to be counter-productive for so many people and could potentially even raise the risk of violent outcomes?

The ‘go to’ interventions proposed by legislation like the Murphy Bill violate people’s civil rights in a way that would be seen as flatly unacceptable were any other group to be targeted in that manner: In reviewing literature on risk for gun violence, several predictive factors are listed including age (Farrington, 1986), gender (Brennan and Moore, 2009), race (Nielsen et al, 2005), and location (Ousey and Augustine, 2001). Yet, imagine the public outcry if legislation were introduced to restrict people’s civil liberties (such as the Murphy bill seeks to do around the right to privacy, to be in community, to make personal choices about interventions, etc.) based on being a young black man from a particular neighborhood?

And, the outcry would be justified – even in a situation where (unlike with psychiatric diagnosis) the research appears to actually point in a particular direction – because these results fail to consider so many other societal factors (racism, poverty, trauma, environmental violence, etc.), because they cannot be translated into ‘treatment plans’ at the individual level without doing far more harm than good, and because these are many of the freedoms upon which our very country was founded.

Focus on psychiatric diagnosis is often a manipulation to steer us away from a focus on gun control:

Every day, a reported 297 people (187,476 per year) in the United States are shot. Just under a third of them die as a result. Among those who die of a gunshot, over 11,000 are declared to have been murdered. (Brady Campaign, 2015.) Only an estimated 440 (4%) of those murders will have been committed by someone who also has a psychiatric diagnosis, and for how many people that psychiatric diagnosis played a factor in their actions is entirely unknown.

Given all that, it makes complete sense that the Consortium for Risk-based Firearm Policy (2013) asserts the following: ”Strategies that aim to reduce gun violence by focusing…on restricting access to guns by those diagnosed with a mental illness are unlikely to reduce the overall rate of gun violence in the US.”

It seems undeniable that, where gun violence is concerned, a focus on mental health legislation is little more than a distraction from the much deeper societal issues at hand, and is keeping us from taking a hard look at some of the changes that may be needed to actually save lives moving forward.

People with psychiatric diagnoses are the most obvious scapegoats when a scapegoat needs to be found. They have an already well-established ‘bad reputation’ in the media and so the public readily accepts them as the ones to blame. Their experiences are often misunderstood and typically seen as ‘other’ or separate from the rest of the population, so pointing the finger in their direction requires no real change or effort on the part of the average citizen. They also lack the major lobbying forces of the gun and pharmaceutical industries. It’s the easy choice. But not the right one.

Our society is fractured, and many of us are hurting and scared. Doing nothing is not an answer, but further fracturing through scapegoating, discrimination, and force is likely to breed violence all on its own. We need change that is thoughtful, not reactionary. We need willingness to be bold and courageous in response to the real ills of society. We need truth, and we need to acknowledge once and for all that focusing on psychiatric diagnosis in the face of so much gun violence is not the answer we seek.

Sera Davidow is a mother, an advocate, an activist and a filmmaker who devotes much of her time to the Western Massachusetts Recovery Learning Community (http://www.westernmassrlc.org). She entered the mental health system as a teenager and cites “non-compliance” as part of what saved her from a very different path that surely would not have included the freedom she now enjoys from all psychiatric labels and medications.

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