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Perceptions of Violence

Perceptions of ViolenceTufts clinical psychiatrist Dr. Ronald Pies debunks the perceived link between mental illness and violence.

Boston [03.04.08] While many people wouldn't be surprised to hear that a murder suspect has a known or suspected mental illness, Tufts' Dr. Ronald Pies suggests in his recent guest column for The Boston Globe that the link between violence and mental illness is an overplayed stereotype that studies have discredited.

Pies, a clinical professor of psychiatry at Tufts School of Medicine, wrote that in his 25 years as a practicing psychiatrist, he experienced only one incident where a patient was physically violent to him. Despite this fact, he notes that newspaper headlines are flooded with cases, including the most recent shooting at Northern Illinois University, where the assailant has been identified as having a history of mental illness.

"What do these attacks say about mental illness?" Pies wrote. "Surely they create the impression that individuals with mental illness are a dangerous and violent lot... Yet the impression that we are awash in a sea of psychotic violence is clearly unfounded."

Citing work in the New England Journal of Medicine by Dr. Richard Friedman, Pies said that the percentage of violent acts in the general population tied to those with "serious mental illness," such as schizophrenia, major depression or bipolar disorder is only between 3 percent and 5 percent, while an estimated 19 percent of the general population suffers from such illnesses.

Acknowledging that a National Institute of Mental Health (NIMH) study showed the mentally ill with specific conditions were two to three times more likely to commit an act of violence, Pies also points out that substance abusers' rate of violence is twice that of the mentally ill.

He cited a 1998 MacArthur Violence Risk Assessment Study which, unlike the NIMH study, evaluated patients discharged from the hospital with self-reports collateral informants and police and hospital records to perform its study. Pies wrote in The Globe that "the prevalence of violence among discharged psychiatric patients without a substance abuse disorder was similar to that among community-dwellers who didn't abuse substances." Importantly, violence by discharged patients only rarely involved attacks on strangers or clinicians.

Pies notes, however, that "mental disorders to increase susceptibility to substance abuse, and thus indirectly increase risk of violence." Citing an email from a colleague at University of North Carolina Chapel Hill School of Medicine, which noted that some subgroup of people with metal illness may use alcohol or drugs to "self-medicate" their symptoms, Pies added that this behavior "may reflect the inadequate, fragmented care often provided to those with mental illness who also abuse drugs or alcohol..."

Mentioning research that say the mentally ill are more often victims then perpetrators, Pies said that the even the low rate of crime caused by the mentally ill can be reduced further with their adherence to treatment and the support of family.

"Finally, all of us can support increased funding for comprehensive, compassionate treatment of those with mental illness, substance abuse, or both..." he wrote. "The patient who assaulted me more than 25 years ago was 1 in 1,000. Nearly all those I have treated since have been nonviolent. Most have coped heroically with unspeakable sorrow and pain. In truth, I would trust many of them with my life."


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