Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Violence in Human History
- A.A.W. Amarasinghe , M.D.,, 30253-4005 USA (7 September 2002)
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Can we eliminate voilence?
- Rajesh Moholkar, Luton LU4 0FB (8 September 2002)
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Re: Violence in Human History
- David N. Gonzalez (9 September 2002)
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Public deserves a more sophisticated debate
- Tom Clark (9 September 2002)
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Odd conclusions
- Stephen Harper (11 September 2002)
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Violence in society also against mentally ill.
- Sir Nil (13 September 2002)
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Violence and Mental Illness
- Mental Health Recipient (15 September 2002)
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Violence and Mental Illness- Keep the Myth Alive!!
- Sameer P. Sarkar, MD (15 October 2002)
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Re: Violence in Human History
- Michael D Innis (20 October 2002)
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A.A.W. Amarasinghe , M.D.,, Consultant in Correctional Psychiatry 102 Bay Berry Hills, McDonough, Georgia, 30253-4005 USA
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Although there is no clear cut definition of ' violence ', the history of mankind repeatedly illustrates that violence towards members of its own kind is a human phenomenon almost exclusively perpetrated by the male. Clues to factors attributing to violence lie uncovered in human history. |
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Rajesh Moholkar, SHO Psychiatry Orchard unit, Calnwood road, Luton LU4 0FB
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Dear sir, Elizabeth Walsh and Thomas Fahy have concluded that mental disorder makes a small contribution to the voilence in the society(1). The highest proportion appears to be attributable to drug abuse and alcohol abuse. This article is quite relevant to the new proposed mental health act draft paper published by department of health. The emphasis of the draft bill is to protect the society from voilence by detaining the people deemed to be suffering from a mental disorder; defined as any dysfunction of mind.This will no doubt include those in whom the voilence is related to drug and alcohol abuse. The point to ponder is whether locking these individuals will reduce the voilence in the society? The predominant risk factors; i.e. substance misuse, voilent upbringing etc will continue to exist in the society. It does appear to me that voilence is more of a social phenomenon than a medical one. It reflects the state the society is in.Hence, trying to enforce a medical solution to a social problem appears to be inadequate. Voilence has always existed in the society.Attempts to pair voilence with mental disorder will lead to increased stigmatization of patients and will add to the society's bias against them. References 1.Violence in society Elizabeth Walsh and Thomas Fahy BMJ 2002; 325: 507-508 |
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David N. Gonzalez, freelance Mental Health
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I feel compelled to respond to what I perceive to be a biased comment submitted by an obviously highly educated individual who wrote that: "the history of mankind repeatedly illustrates that violence towards members of its own kind is a human phenomenon almost exclusively perpetrated by the male". Is this a sexist statement? Or merely ignorance of human nature? Violence, in particular domestic violence, is not just the man's fault - nor the woman's fault. They are both equally responsible in their mutual dance of violence and ferocity and in their inability to compromise with one another's differences. Your father and your mother, your sister and your brother, you and I, all carry the seeds of violence within us, sanctioned by centuries of pre-conditioned aggression. We are bombarded daily by images of violence and aggression on television, in newspapers and in the movies, and people whose threshold for aggression is low, can lash out over the most trivial incidents. According to a 1985 study on domestic violence published in "The Journal of Marriage and Family", while 1.8 million women annually suffered one or more assaults from a husband or boyfriend, more than two million men annually were assaulted by a wife or a girlfriend. The same study also found that 54% of all domestic violence termed "severe" was perpetrated by women (Los Angeles Times 6/21/94). None of this, of course, is meant to excuse male perpetrators of domestic violence, however we do ourselves a grave injustice by slipping into a gender-biased frenzy and branding only men as violent. Why are we as a society predisposed to overlooking the conduct of women aggressors in cases of domestic violence? Have our sociologists been blinded by the myth of "the weaker sex"? Perhaps the most well-known case of female aggression is the Lizzie Borden case, which saturated the tabloids at the turn of the century. Although Lizzie Borden was not convicted of hacking her father and stepmother to death with an axe in their Massachusetts mansion, the majority of the courtroom spectators believed that her respected status in the community - plus the fact that she was a woman - influenced the jury's final decision. Another less-known, yet equally horrific case, which took place in Oregon over 35 years ago, involved a 33 year-old mother and her 21 year-old lover Jeannace Freeman, who was labeled "the devil woman." The details which slowly unraveled in the mid-western courtroom left the local citizens gasping at the sheer brutality of the two women. Jeannace Freeman, who found her lover's two children an obstacle in her love affair with their mother, convinced the 33 year-old mother that her son and daughter would have to be killed. So they took the children to the top of a cliff where Jeannace strangled the six-year-old boy, hacked off his genitals, and tossed him over the cliff. Then together, they mutilated the four-year-old girl with the same knife, and threw her, still alive, after her brother. And probably one of the most heart-wrenching cases to scandalize the nation, was the case of Susan Smith, who strapped her two baby boys into the back seat of her Mazda and rolled it into the John D. Long Lake, drowning her two children alive. Law enforcement officers who commented about Smith's "strange and callous behavior" during the nine-day search for her children, testified that Smith had said that she was "looking forward to going to the beach and learning how to dance." And of course, I would be remiss if I did not point out the recent of Andrea Yates who killed her five defenseless children in their own home. As a male I am offended by the suggestion that she was depressed or "mentally-ill." She was "too ill" to realize that what she was doing was wrong... yet she was sane enough to methodically drown her five children one by one (the irony in such reasoning defies belief). Had this crime been committed by the father such a defense would have never been an option, because of the myth that "violence is exclusively a male trait." Might I suggest that what men and women have in common is much more revealing then their differences and that they should both acknowledge their role in this epidemic of violence. David Gonzalez |
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Tom Clark, Clinical research fellow in forensic psychiatry University of Birmingham
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The central message of Walsh and Fahy’s editorial, that the contribution to societal violence of mentally disordered persons is too small to justify the apparent preoccupation of politicans and the print and broadcast media is correct, though becoming hackneyed after endless repetition. Despite this, there is an established association between mental disorder and violence that cannot be explained by cofactors (Monahan 1992). Even if there were no statistical association, psychiatry would still have a role to play when they do co-exist. The failure of forensic psychiatry to demonstrate simple associations between specific symptoms (of psychosis) and violence has been followed in recent years by repeated assertions that the relationship between mental illness and violence is minor. At the same time medium secure psychiatric facilities continue to proliferate and forensic psychiatry continues to expand and super-specialise. Some might say that “less than 10% of serious violence” is a significant proportion to be attributable to psychosis – the most severe and least common form of mental illness. It is not surprising if the public, the politicians and the media are confused. We are left with this perpetual conflict between on the one hand their understandable insistence that we engage in public protection and on the other, psychiatry’s endless repetitions of the same tired statistics, which pointedly fail to address the public’s concerns. Psychiatry cannot expect the public to understand the vicissitudes of psychiatric diagnosis so long as it continues to insist that there is one group of patients with “real mental illness” (usually psychosis or schizophrenia) who pose little risk, and another group of people with “pseudo-mental illness” (personality disorder and substance misuse) who cause all the problems. Everyone knows this is over simplistic and irrelevant to the real world, where personality disorder, substance misuse, severe mental illness and less severe mental illness commonly co- exist. Attempts to divine exactly what proportion of violence may be specifically attributable to psychosis, or to other psychiatric syndromes, is futile. The public deserves a more sophisticated debate than this. Rather than avoiding responsibility on the basis of what will appear to be spurious diagnostic conveniences, psychiatry must accept its occasional role in public protection and the importance of risk of violence assessment in clinical practice, while openly and clearly explaining the limits and difficulties of clinical risk assessment and debating the appropriate boundaries of psychiatric care. References Monahan J. (1992) Mental Disorder and Violent Behaviour: Perceptions and Evidence. American Psychologist 47 511-521 Walsh, E.; Fahy,T. (2002) Violence in Society. British Medical Journal 325: 507-508 |
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Stephen Harper, Lecturer, Media Studies Crichton University Campus, Dumfries
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As Tom Clark comments (Rapid Response 9 Sep), the public does indeed deserve a more sophisticated debate about this issue. The major problem with Walsh and Fahy's piece is that its conclusion that mental illness contributes only minimally to violence is unsupported by the body of the argument, where it is clearly stated that those with a diagnosis of schizophrenia are four times more likely than controls to self-report violence. The article shows a clear correlation between mental illness and violence, but seems unable to acknowledge this. What is needed, I feel, is a more wide-ranging definition of violence. By replacing the purely individual definition of violence used in liberal/medical discourse with a more radical conception of violence as a societal phenomenon, the stigmatisation of the mentally ill may be alleviated. However well-intentioned they may be, arguments such as Walsh and Fahy's can never, in my view, achieve this. |
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Sir Nil, Patient activist http://hem.passagen.se/sir.nil/
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Sirs -- I wish to thank this journal for articles like this that decreases the stigma of schizophrenia and thus facilitates integration in society. Reuters have written a summary of this editorial so many newspaper will spread this information to the public. Schizophrenia is known as a very variable disease between different individuals and also within the identical individual over time. Less known is that the course and outcome varies very much between different countries. "In the WHO 10-country study at two-year follow-up, the percentage of cases with full remission after a single episode ranged between 3% in the USA and 54% in India, while the cases with continuous psychotic illness varied between 2% in Nigeria and 33% in Japan." (1). Thus the American study reporting a 4 fold increased risk of violence for schizophrenia might be valid for US, but maybe not for Europe, with less hardship, better care and social benefits. In US 47 % of people with schizophrenia also seems to have alcohol and/or drug abuse problems (2). As a sufferer of schizophrenia, I find it strange that the discrimination and scorn that people with schizophrenia faces in society is not discussed as a cause of violence. Many ordinary people find it natural to treat people with schizophrenia as second class citizens. I am sure that many normal people would become violent, if subjected to that. A part of the violence in schizophrenia can thus be a quite natural reaction against social injustices and not an act of violence in it's true sense. Victimization is very high in schizophrenia with theft, assault and rape in women reported as high as 20-50 % (2). Sufferers of schizophrenia are probably more often victims of violence than the opposite. The drug treatment of schizophrenia gives minimal or no effect in approx 30 % (2). This might affect violence as non-compliance to medication have been said to be a risk factor. According to WHO 10 % of schizophrenia patients causes 80 % of society's costs for the disease (1). Obviously, more effective drugs could decrease the cost for society dramatically and also improve the quality of life. Today, at least 10 different antipsychotics with a novel mechanism of action are being clinically tested. The authorities should force the pharmaceutical companies with such antipsychotics to already in clinical trials phase III test the drug on non-responders to antipsychotics - this to ensure that those in greatest need of improved drug therapy rapidly gets it. References: 1. Barbato,A (1998) Schizophrenia and public health WHO/MSA/NAM/97.6, 40 pages http://www5.who.int/mental_health/download.cfm?id=0000000055 available free as pdf-file 2. Fuller Torrey, E (2001) Surviving schizophrenia - A Manual for Families, Consumers, and Providers, 4th ed, 512 pages Quill |
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Mental Health Recipient, Anti-stigma website http://www.seecinemania.com/
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While I wholeheartedly agree that people diagnosed as "mentally-ill" engage in acts of violence, I totally disagree that such people are any more likely to engage in acts of violence than so-called "normal" people. Mental illness is no more a valid indicator of violence than sanity is. In fact, history will attest to the fact that the most heinous acts of violence ever committed have been committed by our most cultured and educated people. Violence is committed by people who are morally corrupt and ethically bankrupt, regardless of whether they are mentally-ill or mentally-well. That’s not to say that some people who are morally corrupt may not legitimately have a mental illness, that’s to say that violence is not a result of mental illness, but a result of moral corruption. In our "no-fault" era, we have been hoodwinked by convenient "terms of absolution" like "untreated mental illness", "behavioral disorder", or "chemical imbalance". Unfortunately, because of the mounting violence in our society, sociologists have a vested interest in identifying the source of that violence, with the unspoken need to exonerate themselves and the rest of society from any culpability. This desire to rationalize unjustified acts of violence as "symptoms of a mental illness" is modern man's need to exculpate himself from his own capacity to be violent. Consider the possibility that psychiatry is merely a secular form of theology which seeks to explain the behaviors of man without using such words as, good and evil, or God and the Devil, and is therefore compelled to equate unjustified acts of violence with mental illness. These acts cannot be identified as wicked because to do so would imply a belief in God and the Devil. In the award-winning film "Silence of the Lambs" Officer Starling is admonished by the murderous psychiatrist Dr. Lecter who insists: "Nothing happened to me, Officer Starling. I happened! You can't reduce me to a set of influences. You've given up good and evil for behaviorism, Officer Starling. You've got everybody in moral dignity pants, nothing is ever anybody's fault. Look at me Officer Starling. Can you stand to say I'm evil?" David@seecinemania.com |
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Sameer P. Sarkar, MD, Consultant Forensic Psychiatrist Broadmorr Hospital, Berks, RG45 7EG
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Sirs: Let me congratulate Prof Fahy and Dr Walsh first for having the courage to state what seems counterintuitive. Like many other myths, this one has survived some scientific analysis and I suspect will outlive some more studies. Recently a rather famous Professor of Forensic Psychiatry spoke at the Institute of Psychiatry quite at length stating his disquiet that recent American Reserachers have found that Schizophrenia can actually be a protective factor in violence. The main points of his disquiet seemed to be visceral rather than reasoned. I say this because he himself pointed out that American researchers, notably the MacArthur Foundation have demonstrated after a painstakingly detailed study that Schizophrenia uncomplicated by Personality Disorder or Substance abuse does indeed appear to be correlated negatively with violence, either on self report or police record. Apparently his own research (although not matching in Dollar amount in grant, he told us with great irritation) found pretty much the same thing, except that he found the concept of schizophrenia being 'protective', laughable. What is worrying is that psychiatrists themselves have a great investment in perpetuating the myth that mental illness causes violence. No one doubts that it may cause violence, but perhaps not with the alarming degree that is projected. Moreover, in studies which consider self report of violence records violence of every severity and not just serious violence. Perhaps the Forensic Psychiatrist should also tell people more vocally that the chances of getting killed by a mentally disordered (Personality disorder included) is no more than winning the national lottery(Taylor and Gunn 1998). If I was to tell you that more people with a history of Influneza killed another than those without, would you look at your spouse or elderly parent differently from now on? Surely it is possible that People kill or hurt other people with some other autonomous motive than raving psychosis or deep depression. Society did not have public protection in mind when they created Doctors. I think the same applies for Psychiatrists. Some of us will be worse off if violence is correctly delinked from mental illness, in terms of research grants and special units to run for example. But I wonder if that is a price worth paying to protect our medical identity. A physician's sworn motive still remains to "protect the interest of his patient first". Of course, one may argue that not being violent to others is a 'good thing' in itself, but I remain unconvinced how and when that became a medical discourse. As I read through the responses posted here, I can not help but feel even more despondent about the possibility that in my lifetime the Society will give us a clear mandate through parliament to wear uniforms, and patrol the streets looking for disorder. We will have power of arrest and power to enter every household where violence is being perpetrated and intervene. One American psychotherapist has written a book calling violence our deadliest epidemic(Gilligan 1997). If we sell violence as an epidemic of a disease waiting to be treated, no wonder the public will want us to do the needful. Just make sure that our uniform in this dystopian future has the Motif of a Red Cross somewhere prominent, if only to remind ourselves of our medical background. REFERENCES: Taylor PJ, Gunn J. Homicides by people with mental illness: myth and reality. Br J Psychiatry 1999; 174: 9-14 Gilligan, J. Violence: Reflections on a National Epidemic. Vintage Books;NY 1997 |
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Michael D Innis, Director Medisets International
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Editor, The loss of innocent lives in New York, Bali, Palestine, Israel and other places around the world is a tragic reflection of the gulf between the ideologies of the East and West and stems principally from the grandiose ideas of Bush and his desire to make a world of Nations subservient to the will of America. Bush, Blair and Howard seem incapable of understanding that terrorizing the people of Iraq by imposing sanctions and threatening the populace with missile and air attacks is alienating millions around the world and is not the best way of protecting their own citizens from retaliatory measures. Their arrogance in demanding a Nation change its elected Leader to suit them is reminiscent of 19th Century colonialism which by now they should have learned died in Saigon – while the world looked on approvingly. Saddam Hussain and Mr Arafat are the choice of their people – it is not for Bush or anyone else to interfere in the people’s choice. Deliberate bombing of civilians in Iraq to make them conform is just as heinous a crime as any perpetrated by the al-Quida group and brings back memories of Hitler. If world harmony is to be restored neo- colonialism must give way to mutual respect among nations – or Bush, Blair and Howard will make citizens of their respective countries targets everywhere. Even though they will claim no responsibility for such attacks. Where once Christians and Moslems could exist peacefully celebrating each other’s festivals and mourning each other’s tragedies the actions of these men have driven a wedge between those societies. These “leaders” appear not to have been taught the Golden Rule - “ Do unto others as ye would they should do unto you”. It is time for the people to teach them and campaign against the negative policies of egocentric political adolescents before they sacrifice the lives of our children and grandchildren in their personal vendettas and prejudices. Michael Innis |
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