Mental illness and violence

March 24, 2000|By Fred Osher

THE TRAGIC episode involving Joseph Palczynski, which started in Bowleys Quarters and ended in Dundalk, has created a host of victims.

Five people are dead and their families' grief palpable and immeasurable. The trauma to three hostages and a community held hostage for four days will be re-experienced by these victims for years to come. We struggle to make sense of the senseless and seek explanations that emotionally protect us from the ever-present dangers associated with our culture of violence.

This event affects another group of victims who wince every time violence and mental illness are linked by circumstance and the media's glare -- those millions of non-violent Americans who struggle day-to-day with their own mental illnesses.

The anxiety engendered by the events of the past two weeks force a search for people, programs and policies to blame. One of the simplest arguments is to lay the blame at the feet of those with mental illnesses. Here we have another high-profile crime, with only a possible relationship to the perpetrator's mental disorder, and the flames of stereotyping persons with mental illness are fanned once again.

cf03 The Sun

cf01 deserves credit for reporting, while not overplaying, Mr. Palczynski's history of mental illness. Yet no sooner had this association been made than calls for forced medication and hospitalization rang out. By police report, Mr. Palczynski was a mean, vicious and violent individual. Without knowing his clinical history, it is purely speculative to assume his having a bipolar disorder was causally related to his killing spree.

It is fair to raise the question and examine the facts about violence and mental illness. Certainly there are times when brain-disordered individuals, typically not receiving treatment, commit heinous violent acts as a result of their diminished capacity. But this is rare.

The link between disorders of addiction and violence is much stronger. When persons with mental illness also have substance use disorders, the risk of violence increases. The truth is that the vast majority of violent acts are committed by persons without brain disorders, and the vast majority of persons with brain disorders do not commit crimes.

Earlier this year, the first Surgeon General's Report on Mental Health was published. This seminal report documents the high prevalence of mental disorders throughout the world, as well as the fantastic advances ineffective treatment for these disorders. The report also documents that despite scientific advances in treatment and rehabilitation, public attitudes toward persons with mental illnesses have become increasingly judgmental. This can be attributed to a growing fear of violence.

In fact, the report states that 13 percent of the general public associated violence with mental illness in the 1950s, and that association rose to 31 percent in the 1990s. And this shift occurred while the amount of violence attributable to persons with mental disorders decreased.

The surgeon general's report documents that two-thirds of all people with mental disorders do not seek treatment. This is despite the fact that mental health interventions are as effective as medical interventions for other chronic illnesses such as heart disease. Health insurers typically fund mental health care at rates far below those of general health. These facts are the direct result of the stigma of mental illness in our society.

The explicit and implicit coupling of mental illness with violence reinforces this discrimination. Without knowing the facts of this incident, advocates for re-institutionalizing persons with mental illness and forcing medication are free to exploit tragedy for their own agenda.

Let us not use the bare outlines of this tragedy to amplify society's discriminatory attitudes toward persons with mental illnesses. Increasing access to care, motivating people to seek care and improving our understanding of the needs of persons with mental illnesses have a far greater chance of improving the quality of all of our lives.

Dr. Fred Osher is director of the University of Maryland Center for Behavioral Health, Justice and Public Policy and an associate professor at the University of Maryland School of Medicine.

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