Taming the criminal myths
By Peggy Thompson


Schizophrenia is quite possibly the most misunderstood mental illness known to mankind. The medical condition of schizophrenia―more often than not―is mistakenly associated with many prejudicial notions, including the belief that those inflicted with the illness have a split personality and are dangerous. It’s a tough stereotype for consumers to shake; they certainly did not aspire to suffer from a mental illness, let alone be stigmatized as violent predators.

Schizophrenia affects men and women equally, and occurs at similar rates in all ethnic groups around the world, according to the US National Institute of Mental Health (NIMH). Symptoms such as hallucinations and delusions are usually first experienced between the ages of 16 and 30 by men, and sometimes later by women. In most cases, schizophrenia does not appear after age 45, and it is rarely diagnosed in children, although awareness surrounding childhood-onset schizophrenia is increasing.

As of yet, the analysis of mental illness is not offered in undergraduate schools, and so the majority of the population takes its cue from the media. All too often, bad press prevails over good when it comes to the mentally ill.

Time to Change
The Time to Change campaign, a British program to end discrimination faced by people with mental health issues, claims that Hollywood movies erroneously portray people with schizophrenia and other mental illnesses as either stupid or evil.

Peter Byrne, MD, a film expert and consultant psychiatrist at London's Newham University Hospital, criticizes the latest Batman film, The Dark Knight, and Heath LedgerÅfs portrayal of The Joker, for pandering to a false stereotype that people with schizophrenia have split personalities and are criminal. Byrne says that the humor and violence of the film is based almost entirely on this misinformation.

The incorrect stereotype in both cases, to a lesser and greater extent, is that schizophrenics have multiple personality disorder and that the second personality is always evil,” Byrne says. “This is omnipresent in cinema misrepresentations: The psycho killer is immortal and sadistic, motivated by madness. And in almost all psychosis films, that character will kill.”

Time to Change also found, through a 2009 study, that the 1975 film One Flew Over The Cuckoo's Nest, in which Jack Nicholson portrays a convict who pretends to be mad to avoid going to prison (and is instead sent to an insane asylum), is still the film most remembered by the public for characters with mental illness acting violently or strangely.

For the study, researchers surveyed 1,989 people and found that 49 percent had seen people with mental illness acting violently on screen. Overall, 44 percent of those asked said they believe that people with mental illness are more prone to violence.

“This report highlights that movies are the main source of information that reinforces negative stereotypes of mental illness above and beyond any other form of media,Åh says Time to Change director Sue Baker. ÅgWe need to make it clear to directors and producers that they can still break box office records without wrecking lives.

And then there's the press. The headlines are exceptionally graphic in England: Father who ate son's eyeball may be schizophrenic,Åh screamed the May 23, 2009 headline of The Morningstarr. Not to be outdone, the Thaindian News reported on Oct. 12, 2009 that Schizophrenics stab a person a week to death in England. Buried further in the story, it was stated that Ågmost schizophrenics are not violent.

On September 3, 2009, US online news source NYDailyNews.com ran the headline “Series of blunders frees schizophrenic cannibal who kills two more people.” And in Canada on October 7, 2009, TheEdmontonSun.com warned that a “schizophrenic murderer” was loose in British Columbia, and described him simply as a 46-year-old man, “six-foot-two, 265 pounds, with dark brown hair and brown eyes.”

Is it any surprise a large percentage of people are fearful of people with mental illness and do not wish to be associated with them?
Renowned psychiatrist and author, E. Fuller Torrey, MD, the founder of the Treatment Advocacy Center in Arlington, Virginia, who penned
The Insanity Offense, believes the media gives crimes committed by people with schizophrenia homicides in particularÅ\more ink because these crimes are more bizarre and not easily understandable to most people. Thus, most people immediately understand when a drug dealer is killed by another dealer trying to take over his territory, but nobody understands when a young mother with schizophrenia drowns her two small children, he says.

Treatment is paramount
Are all people with schizophrenia to be feared? The only way to answer that question is with fact. Your conclusions, in light of the evidence, are your own.

A study conducted in 2002 by the Windsor (Ontario) Star estimated that by 2020, more than 60 percent of people with schizophrenia will have a criminal record. Moreover, a recent study conducted by the University of Pennsylvania found that individuals with serious mental illnesses are responsible for 10 percent of all homicides in Indiana statistics that Torrey finds alarming.

Since we specialize in homicides in the U.S.―about 16,000 a year―even a low percentage translates into a lot of lives lost: 800 to 1,600 each year. Most important, these are mostly preventable homicides if the mentally ill perpetrators had been treated.”

That is the key: Treatment that includes medication along with combinations of cognitive behavioral therapy, interpersonal therapy (talk therapy), peer support groups, community services, diet, exercise, sleep, and social support can stop the violence.

“We all want to reduce stigma, but until we reduce the high-profile homicides, it will be impossible to do, Torrey says. They are the main cause of continuing stigma. Individuals with schizophrenia who are being treated are no more dangerous than the general population. However, if they are not being treated, a small percentage are definitely more dangerous than the general population, especially if they are also a substance abuser. So if an individual with schizophrenia who is not being treated and is abusing drugs moves in next door, then yes, people have a legitimate reason to fear that person.

Barry Jones, MD, a Canadian psychiatrist who specializes in schizophrenia, says fearing someone simply because he or she has schizophrenia is foolish. I don't think people should be afraid of someone with schizophrenia, he says. I think people should be cautious when they are around someone who is actively psychotic or demonstrating bizarre behavior, which will commonly be someone with schizophrenia. Caution suggests a rational response to someone who is irrational; fear can be an irrational fear, and I believe that someone with schizophrenia who is taking medication will generally be someone we do not have to fear.

Jones adds: I have worked almost exclusively with patients who have schizophrenia for a 25-year period, during which time I never was attacked or even threatened with physical violence. However, we have to realize that bizarre acts of violence do occur with this disease and it points out the importance of providing good care to someone who has this illness and picking up such cases early.

The real deal
British journalist Sathnam SangheraÅfs father and sister both have schizophrenia, so Sanghera knows from experience that as long as they take their medication, the mentally ill pose little risk to society.

Sanghera credits Torrey for not playing down the link between violence and severe mental illness, but highlighting it instead. Collecting newspaper clippings of stories about violent acts committed by people with mental illnesses since 1980, Torrey reproduced them in agonizing detail in The Insanity Offense. His argument for citing such evidence is that while it is true that most individuals with schizophrenia are no more dangerous than the general population, there are some who are but they are only dangerous if they are not being treated with antipsychotics.

By making this evidence public, it encourages those with the illness to get the treatment they need, and government bodies will hopefully see the urgent need to treat the mentally ill. Furthermore, the book aims to quell discrimination by providing a clearer understanding that people with schizophrenia are not violent per se, but have the potential to act violently when they are not treated.

Sanghera says Torrey's critics pronounce his data dubious, and they criticize him for ignoring studies that suggest the proportion of violent acts committed by people who are mentally ill account for just 5 percent or less. They charge that his argument risks setting off an unnecessary panic about anyone with schizophrenia.

“To say that some people with schizophrenia can sometimes be dangerous is not to say that they all are,Åh Sanghera says. I think Torrey's argument is more intelligent and realistic than the ones now broadcast by the mental health establishment that often diminishes the likelihood of violent mentally ill predators.

Sanghera, who calls schizophrenia the modern equivalent of leprosy, did not personally confront the reality of his father and sister's schizophrenia until his mid-20s. I have counseled friends through depression, and as shattering as the effects have been on them, they do not compare to what schizophrenia has done to my family, he says. In my reading on the subject, I have been struck by how commonly friends and family members abandon sufferers because the symptoms which can include hearing voices, feeling that your thoughts are being broadcast to the outside world, feeling that things are crawling beneath [your] skin, and believing an alien force is directing you are so terrifying that people donÅft know what to do and [they] end up running away.

Sanghera calls his now stable father a kind and gentle man, “but he had to live through decades of violent breakdowns, suicidal episodes, a period of imprisonment, endless firings from jobs due to erratic behavior, and unexplained domestic violence before he got there. And this is what family lives blighted by schizophrenia are like: the painful narrative keeps lurching forward bleakly until the medication starts working or someone―usually the sufferer―dies.”

Seeking the ‘enemy’
Torrey’s research shows that most severely mentally ill individuals who become violent do not select their victims at random: “Multiple studies have confirmed that between 50 and 60 percent of the victims are family members; by contrast, among homicides committed by non-mentally ill individuals, only 16 percent of the victims were family members,” he writes in The Insanity Offense.

Family peril was the key finding of the Windsor Star’s investigation into mental illness in Canada, particularly when it comes to schizophrenia and its close cousin, bipolar disorder. James Young, MD, Ontario’s chief coroner, was interviewed for the study and said “it’s a very common story to hear that the victims have been parents or someone close to the mentally ill person. Family members are seen as the enemy: the people who call the police, take them to hospital, or seek a court-ordered admission.”

People with schizophrenia often perceive their caregivers as enemies because they enforce difficult rules. Under a new Ontario law, designated decision-makers―typically parents―can obtain the legal authority to hospitalize their children or force them to take medication that often carries unpleasant side effects such as weight gain.

Torrey and Jones agree that most suicides and homicides committed by the mentally ill are preventable if the individuals responsible are treated.

“The most common reason for non-adherence is lack of insight, commonly due to the symptoms of the illness itself,” Jones explains. “Therefore, it becomes difficult for many patients to act responsibly.”

Many of those who committed homicide, according to the Windsor Star’s investigation, were defying court orders to take their medications, often under the belief that because their symptoms had subsided, they were cured. Typically, the assailant experienced a quick snap into psychoses, striking out as if in a trance. Many heard voices which cast their victims as NASA spies, satanic agents, or seven-foot monsters.

Ron Malone, of Fort Erie, Ontario, regrets that his 27-year-old son Jason was not given the opportunity to embark on an effective drug regime before he was charged with second-degree murder.

“He’s gone undiagnosed for most of his life,” Malone says. “Chances are he wouldn’t be accused of this crime if he was properly treated. In the end, it was his lawyer that got him diagnosed and treated―in jail. He pushed for it.”

Malone says his son, taunted by internal voices, paranoia, and suicidal tendencies, was turned away from hospitals more often than he can count. “He would actually go to the hospital himself and tell the doctors that he felt suicidal and homicidal, only to be told that since he had the presence of mind to recognize his feelings, he was ‘okay.’”

Incarcerated numerous times for his unlawful activities, Malone says his son was tormented, lost in the system, and even stigmatized by those who are mandated to help him. “We were in court one day along with some other individuals who were mentally ill. The judge asked in a joking manner if anyone had seen One Flew Over The Cuckoo’s Nest. It was shameful.”

As a parent, Malone says he was as off course as his son because he was often considered Jason’s enemy. Even today, he is still worn down by the fight for a proper diagnosis and treatment. “Even on medication Jason had problems. He needs to be on the right medication.”

Educating the public
Falling through cracks is something that, unfortunately, happens all too often. Cho Seung-Hui, a 23-year-old senior at Virginia Tech, killed 32 students and teachers on campus in a carefully planned attack in April 2007. Following the killing spree, Cho was identified as suffering from a mental illness.

In The Insanity Offense, Torrey details some of what went wrong: “Cho was court-mandated to be psychiatrically evaluated; he was held overnight in a local hospital, but apparently not treated. He was ordered to get treatment as an outpatient, but did not do so. The counseling center at Virginia Tech received a copy of his court order mandating treatment, but it apparently did nothing. According to an official investigation, the center did not accept ‘involuntary or ordered referrals from any source,’ and even students with schizophrenia were treated only if they requested it. The Virginia state law for involuntary psychiatric commitment and treatment requires that the person be an ‘imminent danger’ to himself or others, or be ‘substantially unable to care for himself.’

“This is one of the most stringent state commitment statutes in the United Sates, and another example of how changes in mental illness laws in the 1970s and ’80s continue to have consequences,” Torrey writes.

It would appear that the systems created to protect those with mental illness are broken. And with the issue of morality on both sides, in an imperfect world, how do we proceed safely and reverently when it comes to violence and the mentally ill?

“The solution lies in the area of public education,” Jones says. “I have seen media reports of violent acts carried out by someone with mental illness constantly miss the point; they focus instead on gun control issues or school violence instead of the lack of services for the severely mentally ill. There should be more education about mental illness in schools and early detection. The legal system needs to find a way to deal more effectively with treatment orders for the mentally ill before the potential for violence has emerged. Stigma will always be present, but rational management of this illness can exist even in the presence of stigma.” 

Peggy Thompson, a freelance writer based in Fort Erie, Ontario, is also the associate editor for Magpie Publishing/Media, Inc.