MELBOURNE – James Holmes, accused of opening fire in a crowded movie theater in Aurora, Colorado, last summer, had no criminal history, but was seeing a psychiatrist prior to the incident. Adam Lanza, suspected of murdering his mother and gunning down 20 children and six adult staff members at a Connecticut elementary school before taking his own life, had never been in legal trouble, but had been diagnosed with a “personality disorder,” as well as the developmental disorder Asperger syndrome. Anders Behring Breivik in Norway, Jared Lee Loughner in Arizona, Seung-Hui Cho in Virginia – the list of mass murderers defined according to their mental illnesses goes on.
The fact is that deciding to murder, at random, a large number of innocent people reflects deeply disturbed thinking, which might reflect a mental illness. But, contrary to popular belief, this does not mean that people with mental illnesses are likely to be dangerous or violent. The belief that they are – and the reporting that feeds it – is reinforcing widespread stigmatization of those with mental illness, increasing their suffering and preventing them from participating fully in society.
Public perceptions of the risk of violence associated with mental illness are at odds with the facts. In the United States, for example, roughly 42% of adults believe that a depressed child is likely to be dangerous. And 70% of Americans believe that patients hospitalized for a mental illness may be dangerous. But, according to the American Psychiatric Association, people with mental disorders, who account for roughly one-quarter of the population in a given year, commit only 4-5% of violent crimes. Indeed, while mentally ill people may be more likely to commit violent acts if they are not treated, or are misusing alcohol or drugs, the risk is small.
Personal experience usually refutes the link between mental illness and violence. A survey of the American public found that, while 68% of adults knew at least one person who had been hospitalized with a mental illness and 10% knew five or more people, only 9% had ever been threatened or physically harmed by such a person. People in close contact with the mentally ill, such as mental-health professionals and family members of people affected, are the least likely to believe that they are dangerous.
The discrepancy between experience and perception is largely caused by the media, which frequently link mental illness with acts of violence. One study of American newspaper reports found that 39% of reports concerning mental illness were focused on violence or danger. In Germany, extensive reports on violent attacks against prominent politicians by two people suffering from schizophrenia in 1990 bolstered the German public’s belief that mentally ill people are dangerous.
Coverage of violent acts that result in multiple deaths is particularly extensive. The public inevitably seeks some explanation, and the media will explore any potential link to mental illness to provide one – for example, acquaintances’ reports of “odd” behavior and social withdrawal or accounts of previous interactions with mental-health professionals.
Meanwhile, defense attorneys may try to lessen their client’s culpability by claiming insanity, as Breivik’s lawyers attempted to do after he killed 77 people to protest the multiculturalism that he claims threatens Norway. Although this approach is rarely successful – Breivik received a 21-year sentence – it is widely reported, linking crime to mental illness in the minds of the public.
The perception that mentally ill people are dangerous is global. But it is more prevalent in developing countries than in the developed world. The major exception is the US, where the ready availability of firearms contributes to one of the highest homicide rates – and the highest gun homicide rate – among developed countries.
Given that multiple homicides in the US draw international interest, media reports highlighting a perpetrator’s mental illness or describing insanity pleas inform perceptions of mental illness worldwide. Loughner’s shooting of 19 people in 2011, including Congresswoman Gabrielle Giffords, attracted global attention, as did the court-ordered evaluation of his mental competency.
Indeed, on the other side of the world, the newspaper The Australian mentioned Giffords 160 times in the six months following the shooting, compared to just one mention in the previous 12 months. Though mass shootings are extremely rare even in the US, the media’s coverage continually reinforces negative perceptions at home and abroad. In this manner, the US may well be exporting the mental-illness stigma to the rest of the world.
Similarly, Cho’s history of mental illness was widely discussed. Moreover, his mental-health records were released to the public two years later, reviving the link between his crime – killing 32 people and wounding 17 others before committing suicide – and his mental illness.
In this context, US President Barack Obama’s gun-control efforts – which include intensifying background-check requirements and increasing financing for mental-health programs for young people – hold global significance. While expanding the scope of mental-health services is a positive step, with the potential to contribute to the physical safety of US citizens, it is crucial that this link not be allowed to feed the perception that people with mental illnesses are dangerous. Rather, American legislators and media outlets must use their international influence to reduce the stigma experienced by people suffering from mental illnesses worldwide.
Anthony Jorm, a former president of the Australasian Society for Psychiatric Research, leads the Population Mental Health Group at the Melbourne School of Population Health, and is Chair of the Research Committee of Australian Rotary Health.
Copyright: Project Syndicate, 2013.