Hardly a day goes by that I do not encounter some reference to a mental illness. Television dramas abound that use the thesis of mental illness to characterize the criminal behavior of an actor. Newspaper stories abound about budget shortfalls in government programs or mistreatment at state mental hospitals. Stories of police shootings and horrific crimes fill television news broadcasts. If one were to judge the state of society by what we view from media content it would be relatively easy to see all of society as crazy.
As much coverage as the subject gets, there is little that reflects the larger measure of the state of mental illness in our communities. I live in a state that in 2006 the United States Census calculated to have 3,700,758 people. If general statistics hold true and nearly one percent of those people suffer from schizophrenia, then there should be nearly 37,000 people in the state have or have been considered to have schizophrenia.
The Partnership for Safety and Justice reports that in 2004 there were 2700 people incarcerated in Oregon with a diagnosis of mental illness. If you add another 800 estimated citizens confined to the State Hospital, that would equate to approximately 3,500 mentally ill persons or roughly one percent of those who suffer a diagnosis. All of the homicides in the state for the year 2004 accounted for 112 deaths. Even if all of those were committed by a person with mental illness, the rate of incidence would be more like .003%. This exercise is intended not to minimize the horrific crime of taking another's life, but to show the relative frequency of its occurrence. In contrast to the 112 homicides there were 555 suicides which means that any given person would be 5 times more likely to kill themselves as they would be to harm another person.
When compared to traffic deaths, suicides are nearly even with automobile accidents, 531 deaths versus 555 suicides. Statistically this means you are 5 times more likely to die in an automobile accident that be killed by any homicidal means.
The point here is to shed some light on a more realistic assessment of the danger to someone as the result of a mental disease. That is not to make light of the serious nature of the issue, but provide some perspective.
If you were to ask the average person about the relative danger of a person with mental illness, I doubt that few people would be able to provide a realistic assessment of the risk involved to a citizen that they would suffer harm from a person with mental illness. Having said that, a personal acquaintance of mine who work at a business that is one of my customers is a victim of just such a circumstance.
Harvey is a very nice person, affable and friendly, Harvey works at a water well drilling supply company. Harvey and his wife offered a place to stay in a trailer located in the back yard of their property to a man who suffers from a mental illness. The man had been staying at the location for several years. Harvey and his wife could sense the deterioration of the man's condition and sought to get him treatment through the county. What they were told was that since nothing had happened to cause a crisis, there were no services available through community mental health. Harvey's boss related to me that he overheard Harvey at work begging on the phone for access to some services, but was denied.
The man attacked Harvey's wife and punched her in the temple with a sharpened screwdriver blade and put her into a hospital in critical condition. The news reports described a police standoff with a crazed person who critically injured an innocent Grandmother. While true, it does not capture the essence of the story. For lack of an entry point into a treatment system, several lives are forever altered. None of them for the better. Harvey and his wife face massive medical bills and long term therapy. Their promise of a peaceful retirement shattered. Their children and grandchildren will never again view their grandmother as she was before the event. The State will incarcerate the mentally ill man at the cost of thousands and thousands of dollars per year. No one will escape unscathed. Worst of all, the lesson will not be that we need to provide treatment that will keep these events from happening. Stigma resulting from public perception and society's addiction to spectacular news coverage will clamor for "tougher" stances against criminals without reasonable discussion of why the events unfolded the way that they did.
Another factor in way that stigma is promoted in society has to do with the very definition of diseases like schizophrenia. Because there are only theories of the chemical mechanisms behind schizophrenia, there is no medical test for the disease. Indeed, the theories proposed to date include a number of chemical and genetic components, but the disease is defined by behavior and behavior alone. This leads to massive problems with stigma and public perception probably most famously exemplified by Tom Cruise's interview on the Today Show. Mr. Cruise boldly denied the existence of virtually any mental illness suggesting that disorders had no basis at all. If one subscribes to the theory that individual behavior is fully controllable by a person and the disorders are defined by behaviors, that would make a nice tidy little analysis. The problem with that is behaviors are very clearly not in the direct control of a person's mental state, and that mental state is not always functioning correctly.
This can be demonstrated quite easily with hallucinogenic drugs or alcohol that can clearly show impaired brain function and decreases in reasoning that cannot be corrected by a person. It would then follow that if a brain can be made to function improperly, there is a reasonable expectation that it could suffer dysfunction just like any other organ in the body. Indeed, laboratory experiments have proven that fact beyond any scientific uncertainty.
The problem psychiatry has is bridging the analysis of behavior to the chemical function of the brain. Since the exact mechanism is unknown and the diagnosis is relatively broad, there could easily be thought to be a number of diseases or disorders that could cause similar behavior yet result from different causes.
All of this analysis leads us back to the relationship of the diagnosis and its roots in behavior of the person who suffers from the disease. This also leads us back to how society views the entire connection and its relationship to behavior. Since the vast majority (99%) of people do not experience psychosis and the vast majority have relative ease at defining reality, what are they to think of the tiny minority (1%) that experience delusions?
The answer lies in how media and art portray psychosis in contemporary society. Unfortunately, this is the greatest challenge to those who work on behalf of those with mental illness. Behavior is viewed by the vast majority that is something within the control of the individual. Indeed, to an extremely large measure it is. Go back to the .003% rate of homicides in the general population and how that compares to a fraction of one percent of those who have experienced psychosis. Clearly, if psychosis resulted in homicidal tendencies regularly, there would be a far greater number of homicides. Even the worst case scenario would lead one to conclude that psychosis would result in five times more suicides than homicides. The numbers are small, but the spectacular nature of the events grab attention. When compared to automobiles, the benefit of personal mobility is rationalization for continued use of automobiles, but one death at the hands of a psychotic is viewed as intolerable, as though it could have somehow easily been prevented. Society's answer has become one of oversimplification. Lock the mentally ill in jails and keep them there. This helps nothing. Prisons absorb budget money from treatment programs, resulting in more crisis and greater expense and less community preventive services. Harvey and his wife are paying the price for those policies. Oregon is one of five states in America that spends more on corrections than higher education. It also is among the highest ranking states that incarcerate the greatest percentage of its citizens.
Finally, we look at society's way of poking fun at itself. The Onion, a popular Internet site that lampoons nearly topic, produces video sketches of phony news items. One recent satiric news cast "reported" on whether the Government was doing enough to "spy" on people with schizophrenia. Instead of focusing on a related aspect of the disease, the video directly addressed the behavior of people with schizophrenia as the basis for the joke itself. They suggested additional cameras be place on busses to observe schizophrenics and many other similar topics. Imagine, if you will, them doing a piece on the diagnostic characteristics of people with heart disease or AIDS. There would be outrage. Unfortunately, there will be some private letters and a grass roots effort to quietly remove the video as attracting attention could cause more harm and attention to stigma surrounding mental illness.
Meanwhile the effort goes on quietly, engaging one heart and mind at a time like this web site proposes to do.
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