December 30, 2012

It's the sane, stupid

Be afraid of the sane, not the mentally ill. 

You already knew that, right?

Just to be sure:

... the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness. 

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.
 One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.
But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness. 

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.” 

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.” 

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”
Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people. 

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.
Ah, humans.  We love our delusions.

Deep down, we know it's the normal who are the problem, don't we?

Misguided focus on mental illness in gun control debate


  1. So, you don't believe that:

    “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”?

    You believe the guy who wrote an entire book demanding to know where Obama's "REAL" (yes, uppercase) birth certificate is?

    Where are all the articles stating that most were on meds?

    My recall of these things is that most were not under any sort of care, or if they were (or had been), no articles implicating any licit drugs, of which there are quite a few with poor reputations, although most often leading to strange behaviour and suicide, not mass shootings.

  2. What a befuddled article, Justin. Not one case presented stating that any school shooting linked to psychiatric medication, and not one example given of "gun person X was taking drug Y".

    The entire article is of the "you'd expect to see ...", but not what we actually see. The so called expert then goes onto say that medication isn't useful as what these young men invariably lack is social connectedness, so they need social support, not drugs - with no evidence that any were on meds anyway, all hypothetical.

  3. Ooops, sorry, did finally get to the list, but it's still not convincing, still doesn't support this arbitrary 90% figure. Lists a small number of shootings, not all of them school shootings, and some state that the person was withdrawing from Prozac - coming off it, not on it.

    Also states that one - only one - of the Columbine killers was on some medication. That means one half of the killing team wasn't on medication.

    And the Virginia Tech shootings state that medications were found, does not state that he was actually taking any - hardly a minor matter, since it's not difficult to establish drugs in the human system.

    And on it goes. Having stated at the outset that this was about school shootings, the examples given are not all school shootings, nor all mass shootings.

    What a dishonest mushed-up of a piece of writing.

  4. It ends with the most recent mass killing at a school, and is unable to offer any evidence that Lanza was on any medication.

    Reprehensible piece of writing!

    Case closed.

    (Oh, and the comments are intellectually tragic, including the conspiracy brigade claiming more than one shooter, or government involvement, in the most recent mass shootings. It's a sick, sick culture. Did they all leave school early, for safety reasons? Or just stopped taking their meds?)

  5. Anonymous4:37 PM

    THE NYT article states that mass killings are rare events, and that people with mental illness are in general no more violent than anybody else - no arguement with that.

    That said, are drugs connected with violent behaviour?

    The harm and high economic cost associated alcohol-related violence presents major challenges to all levels of government. In Australia around half of all homicides are alcohol-related. One in four Australians surveyed were found to be victims of alcohol-related verbal abuse. Today the impact of alcohol consumption, particularly among young people, is of growing concern. AIC research has identified key issues relating to alcohol-related violence and has advised on approaches to curb this behaviour. ABS

    That is just alcohol, but we know how alcohol works on the brain. The problem with SSRIs is that the mechanism of action is unknown, some people feel better having taken them, others don't - some do stuff totally out of character like murder their loved ones, or themselves - chemical roulette.

    Most people who drink piss and get into fights would not be considered mentally ill, the same as most people who take anti-depressants would not be considered mentally ill, but such drugs are connected with an increase in violent behaviour so it appears.

    Top Ten Legal Drugs Linked to Violence

    In summary, one proposition does not contradict the other: mental illness may not be significantly connected with violence, but it would appear that drugs are connected to violence more than we would like to address.

    “Violence and other potentially criminal behavior caused by prescription drugs are medicine’s best kept secret,” says Dr. David Healy, a world-renowned psychiatrist who has written extensively about the lack of data in evidence-based medicine, including in his latest book, Pharmageddon.


  6. So you're going to persist in ignoring the four percent figure then.

    Alcohol? Yep, no argument there, but don't see too many mentally ill drunk people gunning down school children.

    SSIRs are not even a little bit "medicine's best kept secret" - kind of well known, and especially a problem in medicating of teenagers, hence the warnings on the packets. There is no denial in the medical community that the mechanisms are unknown. You can read that any day of the week. No new. Not a secret. No one knows how an anesthetic works either, but would you really want to have open heart surgery or hip replacement without one?

    Given the number of Americans and British taking Prozac in the last decade (so much so that it's found in high concentrations in the sewage), the numbers breaking into violence are infinitesimally small. The cases that are attributed to medications are given very wide publicity, and remain, thankfully, few.

    Personally I don't think most psychiatric medications work, other than to the extent of numbing the patient sufficiently to keep them alive until a period of depression passes, or for the chronically ill, for the rest of their lives. They are used to render the mentally ill entirely passive, so that they may live in society without causing trouble to others or themselves. To that extent it's not a treatment, it's a tool to regulate those who are different or insufficiently perky.

  7. Anonymous7:00 PM

    Not at all Caz

    Only about 4 percent of violence in the United States can be attributed to people with mental illness.

    That would leave 96% of violent crime committed by people who are not mentally ill.

    Of that 96% of non-mentally ill perpetrators how many would have committed their crimes while under the influence of (or withdrawal from) drugs.

    I agree, (most) mental illness and violence are not connected, but drugs and violence are. iJustin simply posted that original link as a matter of interest re the violence thing, that's all.


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  9. Anonymous10:44 AM

    Prohibition does work Caz, sort of - follow the money - it makes interested parties (corporations) very rich indeed - but not the taxpayer, who pay the bills and suffer the consequences of the law.

    Of course if you happen to be an interested party then you are immune to the rule of law:

    Outrageous HSBC Settlement Proves the Drug War is a Joke

    The institutional bias in the crack sentencing guidelines was a racist outrage, but this HSBC settlement blows even that away. By eschewing criminal prosecutions of major drug launderers on the grounds (the patently absurd grounds, incidentally) that their prosecution might imperil the world financial system, the government has now formalized the double standard.

    It'd be interesting, for instance, to ask the residents of Tenaha, Texas what they think about the HSBC settlement. That's the town where local police routinely pulled over (mostly black) motorists and, whenever they found cash, offered motorists a choice: They could either allow police to seize the money, or face drug and money laundering charges.

    So there ya go - it's official. If you or me do big business with drug cartels and terrorists then we do very big gaol time - but not them bankers, they simply have to wait a bit longer to get their criminally earned very big bonuses.

    And our leaders expect us to take them and their bullshit seriously.

    Happy new year to you too Caz.

    And another erection, I'm so excited - it's a very hard choice when all on offer is total crap.



  10. Four corporate areas rule the US, and therefore the world:

    - the military
    - medicine (and medical insurance); let's not call it "health", since there's nothing healthy about it
    - the finance industry
    - oil and gas.

    Oh, and then there's illegal trade in drugs and firearms, which trumps the other four.

    Imagine the hundreds of billions of dollars that would be saved and spent of productive things if drugs were regulated and taxed.

    During the doomed prohibition period in the US, people died in the hundreds from drinking bad bootleg, and oddly, rates of drinking increased.

  11. "in order to more efficiently move as much illegal money as possible into the "legitimate" banking institution HSBC, drug dealers specifically designed boxes to fit through the bank's teller windows."


    Penalty: five weeks worth of their income.

    Nice work if you can get it.